Firew Tekle Bobo1, Augustine Asante2, Mirkuzie Woldie3, Angela Dawson4, Andrew Hayen4. 1. School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia; Department of Public Health, Institute of Health Sciences, Wollega University, Nekmete, Ethiopia. Electronic address: firew.t.bobo@student.uts.edu.au. 2. School of Population Health, University of New South Wales, Sydney, Australia. 3. Department of Health Policy and Management, Jimma University, Jimma, Ethiopia; Fenot Project of Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia. 4. School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
Abstract
BACKGROUND: Vaccines have substantially contributed to reducing morbidity and mortality among children, but inequality in coverage continues to persist. In this study, we aimed to examine inequalities in child vaccination coverage in sub-Saharan Africa. METHODS: We analysed Demographic and Health Survey data in 25 sub-Saharan African countries. We defined full vaccination coverage as a child who received one dose of bacille Calmette-Guérin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DTP 3), three oral polio vaccine doses (OPV 3), and one dose of measles vaccine. We used the concentration index (CCI) to measure wealth-related inequality in full vaccination, incomplete vaccination, and zero-dose children within and between countries. We fitted a multilevel regression model to identify predictors of inequality in receipts of full vaccination. RESULTS: Overall, 56.5% (95% CI: 55.7% to 57.3%) of children received full vaccination, 35.1% (34.4% to 35.7%) had incomplete vaccination, while 8.4% (95% CI: 8.0% to 8.8%) of children remained unvaccinated. Full vaccination coverage across the 25 sub-Saharan African countries ranged from 24% in Guinea to 93% in Rwanda. We found pro-rich inequality in full vaccination coverage in 23 countries, except for Gambia and Namibia, where we found pro-poor vaccination coverage. Countries with lower vaccination coverage had higher inequalities suggesting pro-rich coverage, while inequality in unvaccinated children was disproportionately concentrated among disadvantaged subgroups. Four or more antenatal care contracts, childbirth at health facility, improved maternal education, higher household wealth, and frequently listening to the radio increased vaccine uptake. CONCLUSIONS: Continued efforts to improve access to vaccination services are required in sub-Saharan Africa. Improving vaccination coverage and reducing inequalities requires enhancing access to quality services that are accessible, affordable, and acceptable to all. Vaccination programs should target critical social determinants of health and address barriers to better maternal health-seeking behaviour.
BACKGROUND: Vaccines have substantially contributed to reducing morbidity and mortality among children, but inequality in coverage continues to persist. In this study, we aimed to examine inequalities in child vaccination coverage in sub-Saharan Africa. METHODS: We analysed Demographic and Health Survey data in 25 sub-Saharan African countries. We defined full vaccination coverage as a child who received one dose of bacille Calmette-Guérin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DTP 3), three oral polio vaccine doses (OPV 3), and one dose of measles vaccine. We used the concentration index (CCI) to measure wealth-related inequality in full vaccination, incomplete vaccination, and zero-dose children within and between countries. We fitted a multilevel regression model to identify predictors of inequality in receipts of full vaccination. RESULTS: Overall, 56.5% (95% CI: 55.7% to 57.3%) of children received full vaccination, 35.1% (34.4% to 35.7%) had incomplete vaccination, while 8.4% (95% CI: 8.0% to 8.8%) of children remained unvaccinated. Full vaccination coverage across the 25 sub-Saharan African countries ranged from 24% in Guinea to 93% in Rwanda. We found pro-rich inequality in full vaccination coverage in 23 countries, except for Gambia and Namibia, where we found pro-poor vaccination coverage. Countries with lower vaccination coverage had higher inequalities suggesting pro-rich coverage, while inequality in unvaccinated children was disproportionately concentrated among disadvantaged subgroups. Four or more antenatal care contracts, childbirth at health facility, improved maternal education, higher household wealth, and frequently listening to the radio increased vaccine uptake. CONCLUSIONS: Continued efforts to improve access to vaccination services are required in sub-Saharan Africa. Improving vaccination coverage and reducing inequalities requires enhancing access to quality services that are accessible, affordable, and acceptable to all. Vaccination programs should target critical social determinants of health and address barriers to better maternal health-seeking behaviour.
Authors: Sahr A Yendewa; Manal Ghazzawi; Peter B James; Mohamed Smith; Samuel P Massaquoi; Lawrence S Babawo; Gibrilla F Deen; James B W Russell; Mohamed Samai; Foday Sahr; Sulaiman Lakoh; Robert A Salata; George A Yendewa Journal: Vaccines (Basel) Date: 2022-05-11
Authors: Nicole Bergen; Bianca O Cata-Preta; Anne Schlotheuber; Thiago M Santos; M Carolina Danovaro-Holliday; Tewodaj Mengistu; Samir V Sodha; Daniel R Hogan; Aluisio J D Barros; Ahmad Reza Hosseinpoor Journal: Vaccines (Basel) Date: 2022-04-18