State of inequality in diphtheria-tetanus-pertussis immunisation coverage in low-income and middle-income countries: a multicountry study of household health surveys
State of inequality in diphtheria-tetanus-pertussis immunisation coverage in low-income and middle-income countries: a multicountry study of household health surveys
复制标题
DOI：
10.1016/s2214-109x(16)30141-3
复制
发表时间：
2016-09-01
影响因子：
34.3
通讯作者：
Barros, Aluisio J. D.
中科院分区：
文献类型：
--
作者：
Hosseinpoor, Ahmad Reza;Bergen, Nicole;Barros, Aluisio J. D.
背景免疫接种计划为降低儿童疾病负担做出了巨大贡献，但越来越需要确保计划以公平为导向。我们的目的是提供关于国家间不平等和国家内经济相关不平等的详细最新情况，包括三剂白喉、破伤风类毒素和百日咳联合疫苗（DTP 3），方法我们使用的数据来自最新的人口与健康调查和多指标聚类调查，在51个低优先级国家进行，收入和中等收入国家。第三代牙科治疗方案覆盖率的数据按财富五分位数分列，不平等是根据最富有（五分位数5）和最贫穷（五分位数1）家庭财富五分位数的覆盖率计算的差异和比率。计算了21个国家在10年期间两个时间点的超额变化数据。对六个高度优先的国家进行了进一步的分析，即那些国家免疫覆盖率低和/或未接种疫苗儿童绝对数量高的国家。显着性确定使用95%CIs.Findings全国DTP 3免疫接种覆盖率在51个研究国家范围从32%在中非共和国到98%在约旦。在各国内部，DTP 3免疫覆盖率的差距表明存在有利于富人的不平等，51个国家中有20个国家的第一和第五五分位数之间存在20个百分点或更多的差异。在尼日利亚、巴基斯坦、老挝、喀麦隆和中非共和国，五分之一和五分之一之间的差距超过40个百分点。在21个研究国家中的15个国家，随着时间的推移，DTP 3免疫接种的全国覆盖率有所增加，同时最贫穷的五分之一人口的改善速度比最富有的五分之一人口快。例如，在布基纳法索、柬埔寨、加蓬、马里和尼泊尔，覆盖率的绝对增长至少为2。最贫穷的五分之一人口的改善速度更快。在五个高优先级研究国家（DR刚果、埃塞俄比亚、印度尼西亚、尼日利亚和巴基斯坦）报告了大量与经济相关的DTP 3免疫接种覆盖率不平等，但乌干达除外。有必要监测免疫覆盖率方面与经济有关的不平等，以揭示存在的差距，并为接触弱势群体的适当方法提供信息。版权所有（C）世界卫生组织。这是一篇在CC BY 3.0 IGO许可下发布的开放获取文章。
Background Immunisation programmes have made substantial contributions to lowering the burden of disease in children, but there is a growing need to ensure that programmes are equity-oriented. We aimed to provide a detailed update about the state of between-country inequality and within-country economic-related inequality in the delivery of three doses of the combined diphtheria, tetanus toxoid, and pertussis-containing vaccine (DTP3), with a special focus on inequalities in high-priority countries.Methods We used data from the latest available Demographic and Health Surveys and Multiple Indicator Cluster Surveys done in 51 low-income and middle-income countries. Data for DTP3 coverage were disaggregated by wealth quintile, and inequality was calculated as difference and ratio measures based on coverage in richest (quintile 5) and poorest (quintile 1) household wealth quintiles. Excess change was calculated for 21 countries with data available at two timepoints spanning a 10 year period. Further analyses were done for six high-priority countries-ie, those with low national immunisation coverage and/or high absolute numbers of unvaccinated children. Significance was determined using 95% CIs.Findings National DTP3 immunisation coverage across the 51 study countries ranged from 32% in Central African Republic to 98% in Jordan. Within countries, the gap in DTP3 immunisation coverage suggested pro-rich inequality, with a difference of 20 percentage points or more between quintiles 1 and 5 for 20 of 51 countries. In Nigeria, Pakistan, Laos, Cameroon, and Central African Republic, the difference between quintiles 1 and 5 exceeded 40 percentage points. In 15 of 21 study countries, an increase over time in national coverage of DTP3 immunisation was realised alongside faster improvements in the poorest quintile than the richest. For example, in Burkina Faso, Cambodia, Gabon, Mali, and Nepal, the absolute increase in coverage was at least 2 . 0 percentage points per year, with faster improvement in the poorest quintile. Substantial economic-related inequality in DTP3 immunisation coverage was reported in five high-priority study countries (DR Congo, Ethiopia, Indonesia, Nigeria, and Pakistan), but not Uganda.Interpretation Overall, within-country inequalities in DTP3 immunisation persist, but seem to have narrowed over the past 10 years. Monitoring economic-related inequalities in immunisation coverage is warranted to reveal where gaps exist and inform appropriate approaches to reach disadvantaged populations. Copyright (C) World Health Organization. This is an Open Access article published under the CC BY 3.0 IGO license.