Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys

Hu, Yu; Liang, Hui; Wang, Ying; Chen, Yaping

doi:10.3390/ijerph15092000

Cited by 13 publications

(19 citation statements)

References 36 publications

(38 reference statements)

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“…Although Zhejiang province has an effective and efficient immunization program, some perplexing variations within the province still exist. Zhejiang province has attained and maintained high coverage (>90% for individual vaccine doses) for almost all the individual antigens in the national vaccination schedule as per administrative reports [6,7], but two rounds of provincially representative surveys (2011 and 2013) have found the surprising gaps in coverage between rural and urban areas to the advantage of rural areas [8]. In Zhejiang province, vaccination services are delivered through fixed clinic sessions conducted at community health centers and all vaccines included in EPI are provided free of charge.…”

Section: Introductionmentioning

confidence: 99%

Analyzing the Urban-Rural Vaccination Coverage Disparity through a Fair Decomposition in Zhejiang Province, China

Hu¹,

Wang²,

Chen³

et al. 2019

IJERPH

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Objectives: Exploring determinants underlying disparities in full vaccination coverage (FVC) can contribute to improved immunization interventions. FVC and its risk factors in Zhejiang province have been studied, yet the determinants explaining the rural–urban disparity in FVC have not been studied. This study aimed to disentangle the factors explaining rural–urban disparities in FVC of vaccine doses scheduled during the first year of life in Zhejiang province. Methods: We used data from a vaccination coverage survey among children aged 24–35 months conducted in 2016. The outcome measure was full vaccination status, and the grouping variable was the area of residence. Descriptive statistics were used to analyze the FVC and rural–urban residence across the exposure variables. The Fairlie decomposition technique was used to decompose factors contributing to explaining the FVC disparity. Results: There were 847 children included in this study, of which 49.6% lived in a rural area. FVC was 94% in rural areas and 85% in urban areas. A disparity of 9% to the advantage of the rural areas and the exposure variables explained 81.1% of the disparity. Maternal factors explained 49.7% of the explained disparity with education, occupation, and ethnicity being the significant contributors to the explained disparity. Children’s birth order and immigration status contributed somewhat to the explained inequality. Conclusion: There was a significant disparity in FVC in Zhejiang province, a disadvantage to the urban areas. Policy recommendations or health interventions to reduce the inequality should be focused on eliminating poverty and women’s illiteracy, targeted at migrant children or children from minority ethnicities.

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Section: Introductionmentioning

confidence: 99%

Analyzing the Urban-Rural Vaccination Coverage Disparity through a Fair Decomposition in Zhejiang Province, China

Hu¹,

Wang²,

Chen³

et al. 2019

IJERPH

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“…This is due to the substantial variation between countries. In China, the Gambia, Nigeria, and Zambia, for all years of data and included studies, there is a significant relative benefit to being vaccinated given living in a rural area compared to urban settings [49, 97, 46, 48, 50, 80, 92], whereas in Ethiopia, India, Kenya, Myanmar, Pakistan, and Vietnam, the opposite relationship is seen [55, 56, 62, 96, 76, 75, 94, 82, 93]. Similarly, Ameyaw et al and Muche Fenta et al, who examined multiple countries in Africa, found significant relative risks to being vaccinated given residing in rural settings compared to urban areas [19, 24].…”

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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“…For the poor and those who live in remote areas (or areas that are geographically difficult to access), the cost of getting immunized is higher (Hodge et al, 2014). Although basic immunization services are funded by the government (free), the cost of going to a health facility and the opportunity cost to bring a child to a health facility is borne by the household (Bhuiya et al, 1995;Herliana & Douiri, 2017;Hu et al, 2018;Maharani & Tampubolon, 2015). In areas where the number of health facilities is very limited and geographical conditions are difficult, higher costs, both time and actual transportation cost, to visit health facilities hinder many households get their children immunized.…”

Section: Discussionmentioning

confidence: 99%

Socio economic factors of child basic immunization: Case of West Java Province

Saraswati

Gani

2020

jmmr

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Indonesia has committed to eradicating infectious diseases by launching an Expanded Program on Immunization (EPI) in 1977 with a focus on 6 diseases: tuberculosis, diphtheria, tetanus, pertussis, measles, and polio. According to the Basic Health Survey (RISKESDAS) 2018, the rate of basic immunization coverage for children in Indonesia was still below 60% and coverage between provinces varies. West Java was among the province with low child basic immunization coverage. The current study is designed to examine the socio-economic factors that influence child basic immunization using logistic regression. Socioeconomic data were extracted from the National Socioeconomic Survey (Susenas) 2017 and Village Potential (Podes) Survey 2018. The study finds that income, maternal education, location of residence, insurance ownership, availability of health facilities and health workers increase the likelihood of children getting immunized. Indonesia telah memiliki komitmen untuk eradikasi penyakit menular dengan menjalankan Expanded Programme on Immunization (EPI) pada tahun 1977 dengan fokus pada 6 penyakit: TBC, difteri, tetanus, pertussis, campak dan polio. Menurut data Riset Kesehatan Dasar (RISKESDAS) 2018 angka cakupan imunisasi dasar anak diIndonesia masih dibawah 60% dan cakupan antar provinsi bervariasi. Jawa Barat adalah salah satu provinsi dengan cakupan imunisasi dasar anak yang rendah. Penelitian saat ini dirancang untuk memeriksa faktor-faktor sosial ekonomi yang mempengaruhi imunisasi dasar anak menggunakan regresi logistik. Data sosial ekonomi diambil dari Survei Sosial Ekonomi Nasional (Susenas) 2017 dan Survei Potensi Desa (Podes) 2018. Studi menemukan bahwa pendapatan, pendidikan ibu, lokasi tempat tinggal, kepemilikan asuransi, ketersediaan fasilitas kesehatan dan tenaga kesehatan meningkatkan kemungkinan anak-anak diimunisasi.

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Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys

Cited by 13 publications

References 36 publications

Analyzing the Urban-Rural Vaccination Coverage Disparity through a Fair Decomposition in Zhejiang Province, China

Analyzing the Urban-Rural Vaccination Coverage Disparity through a Fair Decomposition in Zhejiang Province, China

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

Socio economic factors of child basic immunization: Case of West Java Province

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