VoICE Immunization Evidence: Wealth inequity

Key Idea

A study conducted in the urban poor in Delhi, India examining household and neighborhood-level determinates of childhood immunization found that the odds of complete vaccination in children were higher if the mother was literate (1.6), if the child was born within the city limits (2.7), born in a health facility (1.5), and if they belonged to the wealthiest 20% of families sampled from this poor urban area (2.5).

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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In a systematic review of qualitative research from low- and middle-income countries, women’s low social status was shown to be a barrier to their children accessing vaccinations. Specific barriers included access to education, income, resource allocation and autonomous decision-making related to time. The author’s suggest that expanding the responsibility for children’s health to both parents (mothers and fathers) may be one important element in removing persistent barriers to immunization often faced by mothers.

Merten, S., Hilber, A.H., Biaggi, C., et al. 2015. Gender Determinants of Vaccination Status in Children: Evidence from a Meta-Ethnographic Systematic Review.. PloS ONE. 10(8).

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Globally, coverage of the third dose of DTP is 15% higher among children in the highest compared to lowest wealth quintile. However, this masks differences of up to 64% in the most inequitable countries (Nigeria).

Hinman, A.R., and McKinlay, M.A. 2015. Immunization equity. Vaccine. 33(2015):D72-D77.

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Inequity in vaccination coverage in India was found between states, within states, and in urban vs. rural. 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.

Mathew, J.L. 2012. Inequity in childhood immunization in India: a systematic review. Indian Pediatrics. 49:203-23.

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In a study designed to explore the association of maternal education and empowerment with childhood polio vaccination rates in Pakistani mothers, it was observed that the highest percentage of completely vaccinated children (72.6%) was seen among mothers of the richest quintile, followed by 63.4%, 58.0%, 49.8% and 39% for the richer, middle, poorer and poorest wealth quintiles, respectively.

Khan, M.T., Zaheer, S., Shafique, K. 2017. Maternal education, empowerment, economic status, and child polio vaccination uptake in Pakistan: a population based cross sectional study. BJM Open. 7(3).

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In Tanzania, poverty was found to have a negative effect on receiving vaccines on time (at the recommended age). Children in the wealthiest quintile experienced 19% fewer delays for BCG vaccination, 23% fewer delays for the third dose of DTP vaccination, and 31% fewer delays for the first dose of measles-containing vaccine, compared to children of the poorest quintile.

Le Polain de Waroux, O., Schellenberg, J.R., Manzi, F., et al. 2013. Timeliness and completeness of vaccination and risk factors for low and late vaccine uptake in young children living in rural southern Tanzania.. International Health. 5(2).

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