Health Nutrition Education and Agriculture Research Development, Saptari, Nepal.
School of Public Health, University of Queensland, Brisbane, Australia.
BMC Public Health. 2024 Jul 25;24(1):1990. doi: 10.1186/s12889-024-19456-z.
Over the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn't been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality.
Data for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12-23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination.
The coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers' awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake.
There was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.
在过去的二十年中，尼泊尔全国儿童健康指标有了显著改善。然而，这种进步在不同的人口群体中并不均衡。本研究旨在确定与儿童全面接种相关的决定因素，评估与财富相关的不平等现象，并深入探讨导致这种不平等的关键因素。
本研究的数据来自于 2022 年最新的尼泊尔全国代表性人口与健康调查。共纳入了 959 名 12-23 月龄接受国家免疫规划常规儿童基础抗原接种的儿童进行分析。采用二元逻辑回归模型确定与结局变量（全面接种率）相关的因素。使用集中曲线和 Erreygers 标准化集中指数评估全面接种率的不平等程度。采用家庭财富五分位指数评分衡量与财富相关的不平等程度，并进行分解分析以确定解释儿童疫苗接种与财富相关不平等的决定因素。
全国儿童全面接种率为 79.8%。一些因素与儿童全面接种率有关，包括孕产妇卫生服务利用变量（如产前保健、机构分娩）、与访问卫生设施相关的经济挑战，以及母亲对所在病房卫生母亲小组会议的认识。集中曲线低于平等线，相对 Erreygers 标准化集中指数为 0.090，表明来自富裕群体的儿童全面接种率不成比例较高。分解分析确定了机构分娩（20.21%）、访问卫生设施所需的资金（14.25%）、母亲教育（16.79%）、母亲年龄（8.53%）和种姓（3.03%）是造成儿童全面接种率与财富相关不平等的重要因素。
尼泊尔儿童全面接种疫苗存在显著的与财富相关的不平等。涉及利益相关者的多部门行动对于减少不平等至关重要，包括促进获得孕产妇保健服务和提高社会经济弱势群体母亲的教育程度。
