Department of Social Medicine, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
BMJ Glob Health. 2022 May;7(5). doi: 10.1136/bmjgh-2022-008833.
The Sustainable Development Goals (SDGs) recommend stratification of health indicators by ethnic group, yet there are few studies that have assessed if there are ethnic disparities in childhood immunisation in low-income and middle-income countries (LMICs).
We identified 64 LMICs with standardised national surveys carried out since 2010, which provided information on ethnicity or a proxy variable and on vaccine coverage; 339 ethnic groups were identified after excluding those with fewer than 50 children in the sample and countries with a single ethnic group. Lack of vaccination with diphtheria-pertussis-tetanus vaccine-a proxy for no access to routine vaccination or 'zero-dose' status-was the outcome of interest. Differences among ethnic groups were assessed using a χ test for heterogeneity. Additional analyses controlled for household wealth, maternal education and urban-rural residence.
The median gap between the highest and lowest zero-dose prevalence ethnic groups in all countries was equal to 10 percentage points (pp) (IQR 4-22), and the median ratio was 3.3 (IQR 1.8-6.7). In 35 of the 64 countries, there was significant heterogeneity in zero-dose prevalence among the ethnic groups. In most countries, adjustment for wealth, education and residence made little difference to the ethnic gaps, but in four countries (Angola, Benin, Nigeria and Philippines), the high-low ethnic gap decreased by over 15 pp after adjustment. Children belonging to a majority group had 29% lower prevalence of zero-dose compared with the rest of the sample.
Statistically significant ethnic disparities in child immunisation were present in over half of the countries studied. Such inequalities have been seldom described in the published literature. Regular analyses of ethnic disparities are essential for monitoring trends, targeting resources and assessing the impact of health interventions to ensure zero-dose children are not left behind in the SDG era.
可持续发展目标（SDGs）建议按族裔对卫生指标进行分层，但很少有研究评估在低收入和中等收入国家（LMICs）中儿童免疫接种是否存在族裔差异。
我们确定了自 2010 年以来进行了标准化国家调查的 64 个 LMICs，这些调查提供了有关族裔或替代变量以及疫苗接种覆盖率的信息；在排除了样本中儿童少于 50 人的国家和只有一个族裔的国家后，确定了 339 个族裔。未接种白喉-百日咳-破伤风疫苗（代表无法获得常规疫苗接种或“零剂量”状态）是感兴趣的结果。使用卡方检验异质性评估族裔之间的差异。额外的分析控制了家庭财富、母亲教育和城乡居住情况。
所有国家中，最高和最低零剂量流行率族裔之间的中位数差距等于 10 个百分点（IQR 4-22），中位数比率为 3.3（IQR 1.8-6.7）。在 64 个国家中的 35 个国家中，族裔之间的零剂量流行率存在显著异质性。在大多数国家，调整财富、教育和居住情况对族裔差距影响不大，但在四个国家（安哥拉、贝宁、尼日利亚和菲律宾），调整后高-低族裔差距减少了 15 个百分点以上。属于多数群体的儿童零剂量的流行率比样本中的其余部分低 29%。
在所研究的国家中，有超过一半的国家存在儿童免疫接种方面的统计学上显著的族裔差异。此类不平等现象在已发表的文献中很少有描述。定期分析族裔差异对于监测趋势、靶向资源和评估卫生干预措施的影响至关重要，以确保在可持续发展目标时代不会留下零剂量儿童。
