Islamabad : Children who benefit from multiple forms of advantage are more likely to be vaccinated than children who experience a single type of advantage. For example, in Pakistan—as also in Afghanistan, Chad, and Nigeria—a child whose mother has secondary school education, is aged 20–34 years, and who is from the richest 20% of the population, had between 7 and 51 times higher chances of receiving the third dose of all DTP-containing vaccines, compared with a child whose mother has no formal education, is aged 15-19 years and who is from the poorest 20% of the population.
This is one of the many key findings of a WHO report launched in July 2018. The report, which describes how a child’s likelihood of being vaccinated is affected by socioeconomic, demographic and geographic factors, is based on international household health surveys conducted in 10 countries: Afghanistan, Chad, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan and Uganda between 2012 and 2016. These countries face the most severe immunisation challenges, and together account for more than 70% of children who do not get a full course of basic vaccines.
Across the 10 countries, some common findings prevailed. Inequality on the basis of household economic status was pervasive: children from poor households were less likely to receive vaccinations than those in rich households. The countries demonstrated various patterns of inequality across household wealth quintiles. In Nigeria, childhood immunisation coverage increased steadily, moving from the poorest to the richest. In Indonesia and Pakistan, the poorest quintile (20%) of households had substantially lower coverage than the rest. For children in Nigeria in 2013 and Pakistan in 2012, the chance of being vaccinated for Diphtheria-Tetanus-Pertussis (DPT3) was 7 times greater among those in the richest households, compared to those in the poorest households, other characteristics being equal.
Children whose mothers have higher levels of education uniformly have higher immunisation coverage, the report states. In Indonesia and Nigeria, maternal education differentials showed marked inequalities in childhood immunisation coverage.
A mother’s age at the time of birth is an important predictor of whether a child will be immunized. Generally, children fared worst when their mothers were younger than 20 years when they gave birth. In Ethiopia in 2016, the chance of being vaccinated for DTP3 was more than double among children whose mothers gave birth aged between 20 and 34 years, compared with children whose mothers gave birth at age 15-19 years, other characteristics being equal.
In countries home to large numbers of unvaccinated children, immunisation coverage varies by province, state or region. In some countries, children who are the first born tend to have higher levels of childhood immunisation coverage than later-born children. Pakistan (2012) reported birth order DTP3 immunisation coverage gaps that spanned more than 20 percentage points.
Childhood immunisation coverage was about the same for boys and girls with similar family characteristics and living conditions: in other words, there was no sex-related inequality in childhood immunisation.
