Caste-ethnic disparity in vaccine use among 0- to 5-year-old children in Nepal: a decomposition analysis

Devkota, Satis; Butler, Christopher K.

doi:10.1007/s00038-016-0789-9

Cited by 10 publications

(13 citation statements)

References 21 publications

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“…In Nepal, the majority of research on immunisation has emphasised evaluating factors that affect access to healthcare as well as the quality of service delivery, including the vaccination rates. 6 Previous research in Nepal has found that poverty, geographic location (difficult terrain), being from a low caste or indigenous population, traditional cultural attitudes, being woman and low levels of maternal education all reduce the likelihood that a child will be immunised. 2 6 7 10 Previous research 6 found that children from indigenous and previously untouchable caste (eg, Dalits) were less likely to be immunised than high caste children.…”

Section: Introductionmentioning

confidence: 99%

“…6 Previous research in Nepal has found that poverty, geographic location (difficult terrain), being from a low caste or indigenous population, traditional cultural attitudes, being woman and low levels of maternal education all reduce the likelihood that a child will be immunised. 2 6 7 10 Previous research 6 found that children from indigenous and previously untouchable caste (eg, Dalits) were less likely to be immunised than high caste children. Terai caste and Muslim children were not included in the study analysis.…”

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confidence: 99%

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Inequalities in complete childhood immunisation in Nepal: results from a population-based cross-sectional study

2020

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ObjectiveTo investigate the effect of different aspects of inequality on childhood immunisation rates in Nepal. The study hypothesised that social inequality factors (eg, gender of a child, age of mother, caste/ethnic affiliation, mother’s socioeconomic status, place of residence and other structural barrier factors such as living in extreme poverty and distance to health facility) affect the likelihood of children being immunised.DesignUsing gender of a child, age of mother, caste/ethnic affiliation, mother’s socioeconomic status, place of residence and other structural barrier factors such as living in extreme poverty and distance to health facility as independent variables, we performed bivariate and multivariate logistic regression analyses.SettingThis study used data from the most recent nationally representative cross-sectional Nepal Demographic and Health Survey in 2016.ParticipantsThe analysis reviewed data from 1025 children aged 12–23 months old.Outcome measuresThe main outcome variable was childhood immunisation.ResultsOnly 79.2% of children were fully immunised. The complete vaccination rate of ethnic/caste subpopulations ranged from 66.4% to 85.2%. Similarly, multivariate analysis revealed that children from the previously untouchable caste (OR 0.58; CI 0.33 to 0.99) and the Terai caste (OR 0.54; CI 0.29 to 0.99) were less likely to be fully immunised than children from the high Hindu caste.ConclusionGiven Nepal’s limited resources, we suggest that programmes that target the families of children who are least likely to be fully immunised, specifically those who are not only poor but also in financial crises and ‘underprivileged’ caste families, might be an effective strategy to improve Nepal’s childhood immunisation rates.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Inequalities in complete childhood immunisation in Nepal: results from a population-based cross-sectional study

2020

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“…Negligible or contrasting differences between urban and rural settings were noted in Cambodia, Indonesia, and South Africa with general geographic heterogeneity suggested in Afghanistan, Mozambique, Nepal, and Togo [77, 41, 78, 79, 80, 81, 38, 82, 83, 84, 85, 86, 87, 88, 89]. Dropout of vaccination driven by transport costs and access was highlighted in South Africa and Uganda, despite mitigation through outreach activities [90, 91].…”

Section: Resultsmentioning

confidence: 99%

“…Ethnicity or caste were found to be significant factors contributing to immunisation coverage in Bangladesh, Cambodia, China, Ethiopia, Gambia, India, Namibia, Nepal, Pakistan, and Vietnam with lower immunisation rates among ethnic minorities [71, 41, 97, 56, 51, 100, 93, 82, 99, 86, 85]. In India and Nepal, caste was found to be a highly significant contributor to immunisation coverage, with children from lower castes less likely to be immunised [99, 100, 86, 85]. Though the gap for oral polio vaccine (OPV) coverage in India declined as a result of caste over time, it remained significant at the bivariate level, when results were unadjusted for other potential confounding factors [100].…”

Section: Resultsmentioning

confidence: 99%

Vaccine Equity in Low and Middle Income Countries: A Systematic Review and Meta-analysis

Ali

Hartner

Echeverría-Londoño

et al. 2022

Preprint

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BackgroundEvidence to date has shown that inequality in health, and vaccine coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in vaccine coverage and impact. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies.MethodsA systematic review of two databases (PubMed and Web of Science) was undertaken using Medical Subject Headings (MeSH) and keywords to identify studies examining factors on vaccine inequality and heterogeneity in vaccine coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic.ResultsOne hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccine dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest.ConclusionsWe found a nuanced picture of inequality in vaccine coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic.RegistrationProspero CRD42021261927

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“…Ironically, the government's priority for full vaccination has pushed some clients out of the health service delivery chain for two primary reasons. First, various researchers have noted that clients who miss vaccinations are likely to be members of the most vulnerable and marginalized groups [27][28][29]. They face significant distance and travel challenges and often cannot allocate time for travel, mostly because of financial constraints and the need to be continuously engaged in income-generating tasks.…”

Section: Positive Service Biasmentioning

confidence: 99%

The last stretch: Barriers to and facilitators of full immunization among children in Nepal’s Makwanpur District, results from a qualitative study

Paul

Nepal²,

Upreti³

et al. 2022

PLoS ONE

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Background Approximately 35% of Nepal’s children have not received all recommended vaccines, and barriers to immunization exist on both the demand- (i.e., access, affordability, acceptance) and supply- (i.e., logistics, infrastructure) sides. Objective This article describes a formative study to understand the barriers to and facilitators of immunization in Makwanpur, Nepal from both the demand- and supply-sides. Methods Through in-depth interviews, key informant interviews, and focus group discussions (N = 76), we assessed knowledge, attitudes, and experiences with immunization; social norms related to immunization; perceptions of local health facilities; and descriptions of client-provider relationships. Data were analyzed using an iterative, grounded theory approach. Results Three major themes emerged, including positive demand of vaccines, lack of mutual trust between service seekers and service providers, and internal and external motivators of vaccine supply. On the demand-side, caregivers reported high levels of immunization-related awareness, knowledge, and acceptance, largely perceived to be due to a generational shift. On the supply-side, providers expressed passion for their work despite lack of support from local authorities and a desire for more training. Between caregivers and providers, lack of mutual trust emerged as a prominent barrier, revealing a cycle of positive service bias. Conclusions We identified mutual trust as a key pathway toward reaching full immunization coverage in Nepal and we recommend future interventions adopt an approach which focuses on removing social barriers (i.e., distrust) and structural barriers (i.e., opening hours, neglected infrastructure) to immunization.

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Caste-ethnic disparity in vaccine use among 0- to 5-year-old children in Nepal: a decomposition analysis

Abstract: Nepal's national vaccine programs should increase focus on reaching geographically distant populations, and continue to develop vaccination-related education efforts.

Cited by 10 publications

References 21 publications

Inequalities in complete childhood immunisation in Nepal: results from a population-based cross-sectional study

Inequalities in complete childhood immunisation in Nepal: results from a population-based cross-sectional study

Vaccine Equity in Low and Middle Income Countries: A Systematic Review and Meta-analysis

The last stretch: Barriers to and facilitators of full immunization among children in Nepal’s Makwanpur District, results from a qualitative study

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