VoICE Immunization Evidence: Geographic inequity

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Geographic Inequity

Many vaccine-preventable diseases are inequitably distributed geographically. For example, children living in urban communities may be at increased or decreased risk of a given disease due to specific disease risk factors, access to primary health care services and treatment, etc. Geographic inequity may also refer to the geographic distribution of vaccines. Some distant or rural communities are harder to reach, both with preventive and treatment services. Geographic inequity may also overlap with factors associated with wealth inequity or educational inequity. For example, some rural populations may have lower wealth and educational attainment than an urban population in the same region.
6 Key Ideas, 7 Sources
Key Idea

A study in a population of urban poor in Delhi, India, which examined household and neighborhood-level determinants of childhood immunization, found that less than half of children between 1 and 3.5 years of age received complete immunization as recommended. This was significantly lower than the overall state-level average of 70% immunization coverage.

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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.

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Key Idea

Children in Tanzania living 5 km or greater distance from the nearest healthcare facility were less likely to be immunized than children living less than 5 km from facilities. Compared to children living close a health facility, children far from a health facility had almost three times the risk of missing out on BCG, 84% higher risk of missing the third dose of DTP, and 48% higher for missing the first dose of measles-containing vaccine. Of children who did receive BCG, those living more than 5 km from facilities had a 26% more likely to received BCG vaccine late than children close to the facility.

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Key Idea

In an analysis of of data from India’s National Family Health Survey showed that despite a decline in urban-rural and gender differences over time, girls and children residing in rural areas remained disadvantaged. Moreover regions that had the lowest gender inequality in 1992 observed an increase in gender difference over time. Similarly, urban-rural inequality increased in one region during the data collection period.

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Key Idea

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.

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Key Idea

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).

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Key Idea

Globally, coverage of the third dose of DTP is 8% higher among urban dwellers compared to children raised in a rural environment.

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A woman carrying vaccines

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The VoICE tool allows you to search for research studies and published evidence based on a topic, location, and disease or vaccine.

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