Catherine Arsenault1, Sam Harper2, Arijit Nandi2, José M Mendoza Rodríguez3, Peter M Hansen4, Mira Johri5. 1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada. Electronic address: catherine.arsenault@mail.mcgill.ca. 2. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada. 3. Statistics Canada, Ottawa, Canada. 4. Gavi, The Vaccine Alliance, Geneva, Switzerland. 5. Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada; Département de gestion, d'évaluation et de politique de santé, École de santé publique de l'Université de Montréal (ESPUM), Montreal, Canada.
Abstract
OBJECTIVES: (1) To conduct a systematic analysis of inequalities in childhood vaccination coverage in Gavi-supported countries; (2) to comparatively assess alternative measurement approaches and how they may affect cross-country comparisons of the level of inequalities. METHODS: Using the most recent Demographic and Health Surveys (2005-2014) in 45 Gavi-supported countries, we measured inequalities in vaccination coverage across seven dimensions of social stratification and of vulnerability to poor health outcomes. We quantified inequalities using pairwise comparisons (risk differences and ratios) and whole spectrum measures (slope and relative indices of inequality). To contrast measurement approaches, we pooled the estimates using random-effects meta-analyses, ranked countries by the magnitude of inequality and compared agreement in country ranks. RESULTS: At the aggregate level, maternal education, multidimensional poverty, and wealth index poverty were the dimensions associated with the largest inequalities. In 36 out of 45 countries, inequalities were substantial, with a difference in coverage of 10 percentage points or more between the top and bottom of at least one of these social dimensions. Important inequalities by child sex, child malnutrition and urban/rural residence were also found in a smaller set of countries. The magnitude of inequality and ranking of countries differed across dimension and depending on the measure used. Pairwise comparisons could not be estimated in certain countries. The slope and relative indices of inequality were estimated in all countries and produced more stable country rankings, and should thus facilitate more reliable international comparisons. CONCLUSIONS: Inequalities in vaccination coverage persist in a large majority of Gavi-supported countries. Inequalities should be monitored across multiple dimensions of vulnerability. Using whole spectrum measures to quantify inequality across multiple ordered social groups has important advantages. We illustrate these findings using an equity dashboard designed to support decision-making in the Sustainable Development Goals period.
OBJECTIVES: (1) To conduct a systematic analysis of inequalities in childhood vaccination coverage in Gavi-supported countries; (2) to comparatively assess alternative measurement approaches and how they may affect cross-country comparisons of the level of inequalities. METHODS: Using the most recent Demographic and Health Surveys (2005-2014) in 45 Gavi-supported countries, we measured inequalities in vaccination coverage across seven dimensions of social stratification and of vulnerability to poor health outcomes. We quantified inequalities using pairwise comparisons (risk differences and ratios) and whole spectrum measures (slope and relative indices of inequality). To contrast measurement approaches, we pooled the estimates using random-effects meta-analyses, ranked countries by the magnitude of inequality and compared agreement in country ranks. RESULTS: At the aggregate level, maternal education, multidimensional poverty, and wealth index poverty were the dimensions associated with the largest inequalities. In 36 out of 45 countries, inequalities were substantial, with a difference in coverage of 10 percentage points or more between the top and bottom of at least one of these social dimensions. Important inequalities by child sex, child malnutrition and urban/rural residence were also found in a smaller set of countries. The magnitude of inequality and ranking of countries differed across dimension and depending on the measure used. Pairwise comparisons could not be estimated in certain countries. The slope and relative indices of inequality were estimated in all countries and produced more stable country rankings, and should thus facilitate more reliable international comparisons. CONCLUSIONS: Inequalities in vaccination coverage persist in a large majority of Gavi-supported countries. Inequalities should be monitored across multiple dimensions of vulnerability. Using whole spectrum measures to quantify inequality across multiple ordered social groups has important advantages. We illustrate these findings using an equity dashboard designed to support decision-making in the Sustainable Development Goals period.
Authors: Margaret E Kruk; Anna D Gage; Catherine Arsenault; Keely Jordan; Hannah H Leslie; Sanam Roder-DeWan; Olusoji Adeyi; Pierre Barker; Bernadette Daelmans; Svetlana V Doubova; Mike English; Ezequiel García-Elorrio; Frederico Guanais; Oye Gureje; Lisa R Hirschhorn; Lixin Jiang; Edward Kelley; Ephrem Tekle Lemango; Jerker Liljestrand; Address Malata; Tanya Marchant; Malebona Precious Matsoso; John G Meara; Manoj Mohanan; Youssoupha Ndiaye; Ole F Norheim; K Srinath Reddy; Alexander K Rowe; Joshua A Salomon; Gagan Thapa; Nana A Y Twum-Danso; Muhammad Pate Journal: Lancet Glob Health Date: 2018-09-05 Impact factor: 26.763
Authors: Rebecca Mary Casey; Lee McCalla Hampton; Blanche-Philomene Melanga Anya; Marta Gacic-Dobo; Mamadou Saliou Diallo; Aaron Stuart Wallace Journal: Pan Afr Med J Date: 2017-06-21
Authors: Catherine Arsenault; Sam Harper; Arijit Nandi; José M Mendoza Rodríguez; Peter M Hansen; Mira Johri Journal: Bull World Health Organ Date: 2016-11-21 Impact factor: 9.408
Authors: Cheikh Mbacké Faye; Fernando C Wehrmeister; Dessalegn Y Melesse; Martin Kavao Kavao Mutua; Abdoulaye Maïga; Chelsea Maria Taylor; Agbessi Amouzou; Safia S Jiwani; Inácio Crochemore Mohnsam da Silva; Estelle Monique Sidze; Tyler Andrew Porth; Tome Ca; Leonardo Zanini Ferreira; Kathleen L Strong; Richard Kumapley; Liliana Carvajal-Aguirre; Ahmad Reza Hosseinpoor; Aluisio J D Barros; Ties Boerma Journal: BMJ Glob Health Date: 2020-01-26