School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia; Department of Public Health, Institute of Health Sciences, Wollega University, Nekmete, Ethiopia.
School of Population Health, University of New South Wales, Sydney, Australia.
Vaccine. 2022 Jan 3;40(1):141-150. doi: 10.1016/j.vaccine.2021.11.005. Epub 2021 Nov 16.
Vaccines have substantially contributed to reducing morbidity and mortality among children, but inequality in coverage continues to persist. In this study, we aimed to examine inequalities in child vaccination coverage in sub-Saharan Africa.
We analysed Demographic and Health Survey data in 25 sub-Saharan African countries. We defined full vaccination coverage as a child who received one dose of bacille Calmette-Guérin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DTP 3), three oral polio vaccine doses (OPV 3), and one dose of measles vaccine. We used the concentration index (CCI) to measure wealth-related inequality in full vaccination, incomplete vaccination, and zero-dose children within and between countries. We fitted a multilevel regression model to identify predictors of inequality in receipts of full vaccination.
Overall, 56.5% (95% CI: 55.7% to 57.3%) of children received full vaccination, 35.1% (34.4% to 35.7%) had incomplete vaccination, while 8.4% (95% CI: 8.0% to 8.8%) of children remained unvaccinated. Full vaccination coverage across the 25 sub-Saharan African countries ranged from 24% in Guinea to 93% in Rwanda. We found pro-rich inequality in full vaccination coverage in 23 countries, except for Gambia and Namibia, where we found pro-poor vaccination coverage. Countries with lower vaccination coverage had higher inequalities suggesting pro-rich coverage, while inequality in unvaccinated children was disproportionately concentrated among disadvantaged subgroups. Four or more antenatal care contracts, childbirth at health facility, improved maternal education, higher household wealth, and frequently listening to the radio increased vaccine uptake.
Continued efforts to improve access to vaccination services are required in sub-Saharan Africa. Improving vaccination coverage and reducing inequalities requires enhancing access to quality services that are accessible, affordable, and acceptable to all. Vaccination programs should target critical social determinants of health and address barriers to better maternal health-seeking behaviour.
疫苗在降低儿童发病率和死亡率方面发挥了重要作用，但覆盖范围的不平等仍然存在。本研究旨在考察撒哈拉以南非洲儿童疫苗接种覆盖的不平等情况。
我们分析了 25 个撒哈拉以南非洲国家的人口与健康调查数据。我们将完全接种定义为儿童接受一剂卡介苗（BCG）、三剂白喉、百日咳和破伤风疫苗（DTP3）、三剂口服脊髓灰质炎疫苗（OPV3）和一剂麻疹疫苗。我们使用集中指数（CCI）衡量国家内部和国家之间完全接种、不完全接种和零剂量儿童的财富相关不平等。我们拟合了多水平回归模型，以确定完全接种不平等的预测因素。
总体而言，56.5%（95%CI：55.7%至 57.3%）的儿童接受了完全接种，35.1%（34.4%至 35.7%）的儿童接种不完全，8.4%（95%CI：8.0%至 8.8%）的儿童未接种疫苗。25 个撒哈拉以南非洲国家的完全接种覆盖率从几内亚的 24%到卢旺达的 93%不等。我们发现 23 个国家的完全接种覆盖率存在贫富不均等现象，冈比亚和纳米比亚除外，这两个国家的接种覆盖率偏向穷人。接种率较低的国家不平等程度更高，表明覆盖范围偏向富人，而未接种儿童的不平等程度不成比例地集中在弱势亚群中。有四个或更多产前保健合同、在卫生机构分娩、提高母亲教育水平、更高的家庭财富和经常听广播都增加了疫苗接种率。
撒哈拉以南非洲地区需要继续努力改善疫苗接种服务的可及性。提高接种覆盖率和减少不平等需要加强获得负担得起、可及且所有人都能接受的优质服务。疫苗接种计划应针对健康的关键社会决定因素，并解决改善孕产妇寻求保健行为的障碍。
