2021
DOI: 10.2471/blt.20.279232
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Subnational inequalities in diphtheria–tetanus–pertussis immunization in 24 countries in the African Region

Abstract: Objective To analyse subnational inequality in diphtheria–tetanus–pertussis (DTP) immunization dropout in 24 African countries using administrative data on receipt of the first and third vaccine doses (DTP1 and DTP3, respectively) collected by the Joint Reporting Process of the World Health Organization and the United Nations Children’s Fund. Methods Districts in each country were grouped into quintiles according to the proportion of children who dropped out between DTP… Show more

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Cited by 10 publications
(8 citation statements)
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“…These studies consistently find that gender equality, and the related construct of women's empowerment, are associated with improved immunization coverage, decreased child mortality, and other positive child health outcomes. Existing work has also demonstrated substantial subnational inequality in immunization, highlighting the relevance of subnational policies and outreach efforts, as well as intra-country variations in immunization access and resources [31,32]. Our study builds on this existing literature to demonstrate that within-country variation in gender inequality is associated with immunization coverage at the subnational level, and suggests that gender inequality may be one of many drivers of subnational inequalities in coverage.…”
Section: Discussionmentioning
confidence: 55%
“…These studies consistently find that gender equality, and the related construct of women's empowerment, are associated with improved immunization coverage, decreased child mortality, and other positive child health outcomes. Existing work has also demonstrated substantial subnational inequality in immunization, highlighting the relevance of subnational policies and outreach efforts, as well as intra-country variations in immunization access and resources [31,32]. Our study builds on this existing literature to demonstrate that within-country variation in gender inequality is associated with immunization coverage at the subnational level, and suggests that gender inequality may be one of many drivers of subnational inequalities in coverage.…”
Section: Discussionmentioning
confidence: 55%
“…However, reaching zero-dose children requires context-specific interventions to overcome barriers to vaccination that are multifaceted and nuanced to each setting [ 30 ]. In addition, mechanisms need to be in place to reduce drop-out in an equitable manner so that children are not only reached once but receive all the vaccines they need [ 31 ]. The quest to ensure that no child is left behind requires a tailored approach that addresses multiple and intersecting economic vulnerabilities, sociocultural barrier, and health system challenges to deliver immunization services through the primary healthcare system [ 32 ].…”
Section: Discussionmentioning
confidence: 99%
“…It is worth noting that declines in no-DTP prevalence—and thus increased coverage of DTP1, a marker of program reach—do not inherently equate to gains in broader program retention or complete immunization. For instance, in much of Ethiopia, DTP3 coverage has not improved in parallel amid sizeable increases in DTP1 [ 7 , 54 , 55 ]. This means that while more children are being reached by vaccination services—an unequivocally crucial milestone—an increasing percentage of them remain under-vaccinated and thus may still be vulnerable to preventable disease.…”
Section: Discussionmentioning
confidence: 99%