Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities.

Bobo, FT; Asante, A; Woldie, M; Dawson, A; Hayen, A

Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities.

Bobo, FT Asante, A Woldie, M Dawson, A

Hayen, A

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Vaccine, 2021, 40, (1), pp. 141-150
Issue Date:: 2021-11-15

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Field	Value	Language
dc.contributor.author	Bobo, FT
dc.contributor.author	Asante, A
dc.contributor.author	Woldie, M
dc.contributor.author	Dawson, A https://orcid.org/0000-0003-0926-2202
dc.contributor.author	Hayen, A https://orcid.org/0000-0003-4046-8030
dc.date.accessioned	2021-12-29T21:01:47Z
dc.date.available	2021-11-02
dc.date.available	2021-12-29T21:01:47Z
dc.date.issued	2021-11-15
dc.identifier.citation	Vaccine, 2021, 40, (1), pp. 141-150
dc.identifier.issn	0264-410X
dc.identifier.issn	1873-2518
dc.identifier.uri	http://hdl.handle.net/10453/152561
dc.description.abstract	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Vaccine
dc.relation.isbasedon	10.1016/j.vaccine.2021.11.005
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	06 Biological Sciences, 07 Agricultural and Veterinary Sciences, 11 Medical and Health Sciences
dc.subject.classification	Virology
dc.title	Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities.
dc.type	Journal Article
utslib.citation.volume	40
utslib.location.activity	Netherlands
utslib.for	06 Biological Sciences
utslib.for	07 Agricultural and Veterinary Sciences
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - WHO CC
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	open_access	*
pubs.consider-herdc	true
dc.date.updated	2021-12-29T21:01:46Z
pubs.issue	1
pubs.publication-status	Published
pubs.volume	40
utslib.citation.issue	1

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.

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http://hdl.handle.net/10453/152561