Vidal Fuertes Cecilia, Johns Nicole E, Goodman Tracey S, Heidari Shirin, Munro Jean, Hosseinpoor Ahmad Reza
Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland.
Department of Immunization, Vaccines, and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland.
Vaccines (Basel). 2022 Jun 27;10(7):1032. doi: 10.3390/vaccines10071032.
This study explores the association between childhood immunization and gender inequality at the national level. Data for the study include annual country-level estimates of immunization among children aged 12-23 months, indicators of gender inequality, and associated factors for up to 165 countries from 2010-2019. The study examined the association between gender inequality, as measured by the gender development index and the gender inequality index, and two key outcomes: prevalence of children who received no doses of the DTP vaccine (zero-dose children) and children who received the third dose of the DTP vaccine (DTP3 coverage). Unadjusted and adjusted fractional logit regression models were used to identify the association between immunization and gender inequality. Gender inequality, as measured by the Gender Development Index, was positively and significantly associated with the proportion of zero-dose children (high inequality AOR = 1.61, 95% CI: 1.13-2.30). Consistently, full DTP3 immunization was negatively and significantly associated with gender inequality (high inequality AOR = 0.63, 95% CI: 0.46-0.86). These associations were robust to the use of an alternative gender inequality measure (the Gender Inequality Index) and were consistent across a range of model specifications controlling for demographic, economic, education, and health-related factors. Gender inequality at the national level is predictive of childhood immunization coverage, highlighting that addressing gender barriers is imperative to achieve universal coverage in immunization and to ensure that no child is left behind in routine vaccination.
本研究探讨了国家层面儿童免疫接种与性别不平等之间的关联。该研究的数据包括2010 - 2019年165个国家12至23个月儿童的年度国家层面免疫接种估计数、性别不平等指标及相关因素。研究考察了以性别发展指数和性别不平等指数衡量的性别不平等与两个关键结果之间的关联：未接种任何剂量白喉、破伤风、百日咳联合疫苗（零剂次儿童）的儿童患病率以及接种了第三剂白喉、破伤风、百日咳联合疫苗（白喉、破伤风、百日咳联合疫苗3剂次接种覆盖率）的儿童。使用未调整和调整后的分数logit回归模型来确定免疫接种与性别不平等之间的关联。以性别发展指数衡量的性别不平等与零剂次儿童比例呈正相关且具有统计学意义（高不平等地区调整后比值比 = 1.61，95%置信区间：1.13 - 2.30）。同样，白喉、破伤风、百日咳联合疫苗3剂次全程免疫接种与性别不平等呈负相关且具有统计学意义（高不平等地区调整后比值比 = 0.63，95%置信区间：0.46 - 0.86）。这些关联在使用另一种性别不平等衡量指标（性别不平等指数）时依然稳健，并且在一系列控制人口、经济、教育和健康相关因素的模型设定中保持一致。国家层面的性别不平等可预测儿童免疫接种覆盖率，这突出表明消除性别障碍对于实现免疫接种的普遍覆盖以及确保没有儿童在常规疫苗接种中掉队至关重要。
