Department of Epidemiology and Biostatistics, School of Public Health, International campus, Tehran University of Medical Sciences, 5th Floor, Poursina Street, Keshavarz Boulevard, PO Box: 14155-6446, Tehran, Iran, Islamic Republic of.
Centre for Systems Studies, Hull University Business School, Hull University, Hull, HU6 7RX, UK.
Int J Equity Health. 2018 Aug 17;17(1):122. doi: 10.1186/s12939-018-0837-6.
Childhood immunization is one of the most cost-effective interventions for child health. Still, many children are not able to receive completed immunization status. Wealth - related inequality in immunization is considered a major reason for equitable coverage of immunization in Pakistan. Therefore, we examine wealth-related inequality in completed childhood immunization and to assess achievement indices across geographical regions in Pakistan.
The analysis was based on a nationally representative demographic and health survey (DHS) of Pakistan, conducted in 2012-13. We examined completed childhood (12-23 months) immunization in the various regions of the country and we used concentration, extended concentration and achievement indices to demonstrate inequality across geographical regions in Pakistan.
Inequality in completed childhood immunization was seen in Pakistan with concentration index (CI) of 0.181 (95% CI: 0.164-0.209). Regions with high average of complete immunization showed lower inequality except for Sindh. Despite having better average immunization coverage in Kyber Pakhtunkhwa, the relative change of 128% in concentration index (CI) from C2 (standard CI) to C5 (when poorer quantile received highest weights) shows this to be also the most inequitable regions. Four parameters of inequality aversion (v = 2, 3, 4 & 5) demonstrated that 'dis - achievement' in completed immunization is densely concentrated among the poorer regions. Balochistan, Sindh and Gilgit Baltistan exhibited broader inequality gaps (93.75%, 83.35%, and 54.93%, respectively) at higher aversion parameter.
As hypothesized, achievement index uncovers 'penalized' immunization coverage amongst the poorest population. Thus any policy that stringently focuses on improving average immunization rate without any strategy to deal with inequality will only improve immunization rate within wealthier groups. Based on these results, it is advisable to public health policy makers to use both aspect of information: average and degree of inequality in immunization coverage.
儿童免疫接种是儿童健康最具成本效益的干预措施之一。尽管如此，许多儿童仍无法完成免疫接种。在巴基斯坦，免疫接种方面的贫富不平等被认为是实现免疫接种公平覆盖的主要原因。因此，我们研究了儿童免疫接种完成情况方面的贫富不平等，并评估了巴基斯坦各地区的实现指数。
本分析基于巴基斯坦 2012-13 年进行的全国代表性人口与健康调查（DHS）。我们检查了该国各地区 12-23 个月儿童的免疫接种完成情况，并使用集中指数、扩展集中指数和实现指数来展示巴基斯坦各地区的地理区域差异。
在巴基斯坦，儿童免疫接种完成情况存在不平等，集中指数（CI）为 0.181（95%CI：0.164-0.209）。高平均完全免疫接种地区的不平等程度较低，但信德省除外。尽管开伯尔-普赫图赫瓦的平均免疫接种率较高，但从 C2（标准 CI）到 C5（较贫穷分位数获得最高权重）的集中指数（CI）的相对变化为 128%，表明这也是最不平等的地区。不平等厌恶的四个参数（v=2、3、4 和 5）表明，在较贫穷地区，完成免疫接种的“不良”表现高度集中。俾路支省、信德省和吉尔吉特-巴尔蒂斯坦的不平等差距较大（分别为 93.75%、83.35%和 54.93%），在较高的厌恶参数下。
正如假设的那样，实现指数揭示了最贫困人群中“受惩罚”的免疫接种率。因此，任何严格关注提高平均免疫接种率而不采取任何策略来解决不平等问题的政策，只会提高富裕群体的免疫接种率。基于这些结果，建议公共卫生政策制定者同时使用免疫接种覆盖率的平均和不平等程度这两个方面的信息。
