VoICE Immunization Evidence: Education Inequity

Key Concept

Key Evidence: Children in the U.S. whose mothers were not educated beyond high school have significantly lower vaccination rates for rotavirus than children of mothers with advanced degrees (68% vs. 84%).

Pindyck T, Tate JE, Parashar UD 2018. A decade of experience with rotavirus vaccination in the United States – vaccine uptake, effectiveness, and impact. Expert Review of Vaccines. 17(7).

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Key Evidence: In India, inequities in vaccination coverage exist between states, within states, and in urban vs. rural settings. Lower parental education resulted in lower coverage, girls had lower coverage than boys and infants born to families with a large number of children also had lower coverage than others. A direct relationship between household wealth and coverage was also found.

Devasenapathy, N., Ghosh Jerath, S., Sharma, S., et al. 2016. Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study. BMJ Open. 6:e013015.

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Key Evidence: Wealth and mother’s education are significant predictors of vaccination rates in both urban and rural settings. However, low paternal education, lack of antenatal care, and home births were significantly associated with low vaccination rates only in rural settings. This suggests the need for tailored vaccine programs.

From the VoICE Editors: This study compared the significance of risk factors for low vaccination rates in rural versus urban settings in Tanzania.

Nadella, P., Smith, E.R., Muhihi, A., et al. 2019. Determinants of delayed or incomplete diphtheria-tetanus-pertussis vaccination in parallel urban and rural birth cohorts of 30,956 infants in Tanzania.. BMC Infectious Diseases. 19(188).

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Key Evidence: In a large survey in Pakistan, children were about 30% more likely to receive all the national immunization program vaccinations on time if either their mother or father had a secondary school or higher level of education than those whose mothers or fathers had no formal education.

Noh J-W, Kim Y-M, Akram N et al. 2018. Factors affecting complete and timely childhood immunization coverage in Sindh, Pakistan: a secondary analysis of cross-sectional survey data. PLoS One. 13(10).

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Key Evidence: Nigerian Demographic Health Survey data suggests that community literacy influences immunization status. Children in communities with low levels of illiteracy were 82% less likely to be fully immunized than children in communities with medium levels of illiteracy.

Antai, D 2012. Gender inequities, relationship power, and childhood immunization uptake in Nigeria: a population-based cross-sectional study. Journal of Infectious Disease. 16(2).

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Key Evidence: Children of mothers with secondary education or higher were significantly more likely to be fully immunized than children of mothers with lower levels of educational attainment.

From the VoICE editors: Data was collected in the Democratic Republic of Congo from a cross-sectional survey (the Demographic and Health Survey) and analyzed in the aggregate. However, the authors note high variation in coverage across localities. 

Acharya P., Kismul H., Mapatano, M. A., Hatløy, A. 2018. Individual- and Community-level Determinants of Child Immunization in the Democratic Republic of Congo: A Multilevel Analysis. PLOS One. 13(8).

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Key Evidence: A study conducted in Eastern Uganda found that Ugandan children whose mothers had some secondary schooling were 50% more likely to have received scheduled vaccinations by 6 months of age than children whose mothers had attended school only through primary level. This effect became more pronounced with delivery of the later doses of each vaccine (OPV2, 3 & DPT-HB-Hib 2,3).

Nankabirwa, V, Tylleskar, T., Tumwine, J., et al 2010. Maternal education is associated with vaccination status of infants less than 6 months in Eastern Uganda: a cohort study. BMC Pediatrics. 10:92.

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Key Evidence: Children born to mothers in Southwest Nigeria who had no formal education were four times more likely to be unvaccinated or partially vaccinated than those born to mothers who completed primary school and were six times more likely to be partially vaccinated or unvaccinated than children whose mothers completed a post-secondary education.

Ijarotimi KT, Fatiregun AA, Adebiyi OA et al 2018. Urban-rural differences in immunization status and associated demographic factors among children 12-59 months in a southwestern state, Nigeria. PLoS One. 13(11).

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