The Knowledge Hub

What is the Knowledge Hub?

Explore the VoICE Knowledge Hub—a searchable database featuring the latest peer-reviewed research on immunization benefits, especially in low- and middle-income countries. Browse the Knowledge Hub using a variety of different filters to find vaccine evidence based on country, region, topic, or disease. Click on a tag to find more evidence on a specific area, such as the return on investment of vaccines or impacts of infectious disease outbreaks.


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Children in female-headed households were less likely to be fully vaccinated compared to male-headed households

An equity impact analysis of the 2016 Ethiopia Demographic and Health Survey dataset for full vaccination coverage among children aged up to 36 months found that children living in female-headed households were 49% less likely to have full vaccination coverage compared to children living in male-headed households.

Geweniger A, Abbas KM. 2020. Childhood vaccination coverage and equity impact in Ethiopia by socioeconomic, geographic, maternal, and child characteristics. Vaccine. 38(20).

Immunization in India’s Universal Immunization Program improves schooling attainment and economic status for women

In an analysis of the impact of India’s Universal Immunization Program (UIP) on schooling attainment in adults, a subgroup analysis found a strong positive association between UIP implementation and increased school attainment for women. Women born after the UIP rollout attained 0.29 more schooling grades compared women from the same household born before UIP rollout. Among unmarried women, the UIP was associated with an increment of 1.2 schooling years, which corresponds to as much as an INR 35 (US $0.60) increase in daily wages. Thus, the researchers concluded that the UIP is also likely to improve the economic status of women in India.

Nandi A, Kumar S, Shet A et al.. 2020. Childhood vaccinations and adult schooling attainment: Long-term evidence from India’s Universal Immunization Programme. Social Science & Medicine. 250.

Children of mothers with no education or primary education are more likely to have delayed vaccinations

A study of delayed vaccination in India found that children whose mothers had no formal education were 37-81% more likely to have delayed vaccinations than children of mothers with 12 or more years of schooling [depending on the vaccine]. Children whose mothers had a primary school eduction fared only slightly better with 33-62% greater odds of getting their vaccination late, when compared to those with highly educated mothers.

Data in this analysis was from the National Family and Health Survey 4.

Choudhary TS, Reddy NS, Apte A et al.. 2019. Delayed vaccination and its predictors among children under 2 years in India: Insights from the national family survey-4. Vaccine. 37(17).

Children of divorced mothers and mothers who work part-time are less likely to be fully immunized

Children of divorced mothers in Ghana were three times less likely to be fully immunized than mothers cohabitating with a partner. In addition, it was found that children of mothers who work part time were approximately 2.3 times less likely to be fully immunized than mothers who work full time.

Anokye, R., Acheampong, E., Budu-Ainooson, A., et al.. 2018. Socio-demographic determinants of childhood immunization incompletion in Koforidua, Ghana. BMC Reserach Notes. 11(656).

Children whose mothers have secondary education or higher are more likely to be fully immunized

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.

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

Empowering women in a community improves children’s immunization rates and overall health

The level of women’s community-level autonomy is associated with an increased number of children immunized above and beyond that which is seen with individual-level women’s autonomy. These results indicate that empowering women within households not only improves the individual mother’s children’s health, but also serves to improve the lives of other children within the community.

This analysis is from the 2011 Ethiopian Demographic and Health Survey that investigated the relationship between individual- and community-levels of women’s autonomy and children’s immunization status.

Ebot, J.O.. 2014. Place Matters: Community Level Effects of Women’s Autonomy on Ethiopian Children’s Immunization Status. African Population Studies. 28(2).

Despite improvements, girls and rural children in India still face disadvantages in healthcare and education

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.

Singh, P.K.. 2013. Trends in Child Immunization across Geographical Regions in India: Focus on Urban-Rural and Gender Differences. PLoS ONE. 8(9).

Gender inequity in healthcare is most evident in lower income families

In an analysis of statewide survey data collected in Bihar, India, researchers reported that female newborns had significantly lower odds of receiving care if ill compared to male newborns (80.6% vs. 89.1%) and lower odds of having a postnatal check up visit within a month of birth (5.4% vs. 7.3%). This gender inequity is more pronounced among families at lower wealth levels and those with higher numbers of siblings.

Vilms, R.J., McDougal, L., Atmavilas, Y., et al.. 2017. Gender inequities in curative and preventative health care use among infants in Bihar, India.. Journal of Global Health. 7(2).

Gender gap in immunization coverage is affected by poverty, low mternal education, and birth order

A study that examined the gender gap in immunization coverage in a rural area of Bangladesh showed that poverty, low maternal education, and second or higher birth order had a stronger negative effect on the likelihood of full immunization coverage for girls compared to boys. In other words, girls from households in this area that were below the poverty line were 11% less likely to be fully immunized than boys from households below the poverty line. Girls were also 6% less likely than boys to be fully vaccinated if their mothers did not attend high school and 5% less likely than boys to be vaccinated if they were not the first born child in the family.

Hanifi, S.M., Ravn, H., Aaby, P., et al.. 2018. Where girls are less likely to be fully vaccinated than boys: Evidence from a rural area in Bangladesh. Vaccines. .

Globally, girls and boys were found to have the same likelihood of being vaccinated

A study looking at DHS data from 67 countries found that, globally, girls and boys had the same likelihood of being vaccinated. In some countries where there is known gender inequity and son preference, girls were more likely to not be vaccinated.

Hilber, A. M., Bosch-Capblanch, X., Schindler, C., et al.. 2010. Gender and immunisation. World Health Organization. .