VoICE Immunization Evidence: Geographic inequity
Polio eradication investments in some of the countries with the most fragile health systems, provide an opportunity to leverage polio vaccination for other health priorities.
Polio eradication investments in health infrastructure have been concentrated in some of the lowest performing health systems in the world, challenged internally by geography, poverty, armed conflict, etc. These assets can be leveraged to improve the health system and immunization overall nationally.
Children living in slum conditions who are at greater risk of infectious diseases than those in urban areas, are less likely to be vaccinated.
Children in slum settings have higher burdens of vaccine-preventable disease (one study found children in slums in Manila, Philippines were 9 times more likely to have tuberculosis than other urban children) and lower rates of immunization (a study in Niger found 35% coverage in slums vs. 86% in non-slum urban areas).
A recent review of data in India found significant evidence of geographic inequity in vaccine coverage: between states, within states and in rural vs. urban comparisons.
Inequity in vaccination coverage in India was found between states, within states, 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.
Studies have shown that urban vs. rural dwelling is significantly associated with immunization coverage
Globally, coverage of the third dose of DTP is 8% higher among urban dwellers compared to children raised in a rural environment.