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

Abstract

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.

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

“…This suggests that individuals in the poorest subpopulations are 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest. This result is consistent across the vast majority of included studies and datasets, only Nepal, the Gambia, China, and Brazil have studies suggesting a negative influence or no significant trend [86, 50, 46, 48, 52]. We do note some variation over time in Ethiopia and China.…”

“…Wuneh et al, however, found no differences by wealth in rural Ethiopia [116]. In Nepal, Pakistan, and Tanzania, associations in the disparity of vaccination coverage among wealth quintiles was found to change over time, with Nepal and Pakistan displaying a decreasing disparity and Tanzania showing increases [85, 86, 87, 82, 117, 118, 83, 104]. In Vietnam and Thailand, studies found conflicting associations with immunisation and wealth [93, 119, 25].…”

“…Other included studies found no significant effect or found contrasting effects to other studies in the same country. [92,93,24,19,88,82,80,86,94,95,69,75,76,62,96,50,55,49,97,46,48,53,70,73].…”

Age-appropriate vaccination coverage and its determinants in children aged 12-36 months in Nepal: a national and subnational assessment

“…Though, geographically Province 2 is easily accessible, the lower vaccination coverage could be due to low literacy rate, hesitancy towards vaccination, knowledge and attitude about the immunization program, lack of proper health care infrastructure in rural areas, and other cultural barriers. [39][40][41] In case of Province 6 the lower age appropriate coverage could be due to hard to reach terrain, lack of awareness about the immunization schedule, lack of su cient infrastructure such as transportation and storage facilities, and lack of human resource in health sector. 32,33 Province 3 had the highest coverage of almost all the vaccines as it is the central region with most of the areas urbanized and developed.…”

COVID-19 Social Science and Public Engagement Action Research in Vietnam, Indonesia and Nepal (SPEAR): Protocol for a mixed methods study exploring the experiences and impacts of COVID-19 for healthcare workers and vulnerable communities

“…Access to COVID-19 vaccines comes on the back of existing general vaccine access challenges, particularly for the most at-risk populations in LMICs. In Nepal, equity gaps in childhood immunisation coverage have narrowed over time, but there are still substantial inequalities, by household wealth, maternal education, ethnic group and region 18,19 . Indonesia is among 20 countries prioritised by the Global Vaccine Alliance (GAVI), facing severe challenges related to coverage, equity and sustainability of routine immunization 20 .…”