Socioeconomic and residence‐based related inequality in childhood vaccination in Sub‐Saharan Africa: Evidence from Benin

Eugene Budu · Bright Opoku Ahinkorah · Wilfried Guets · Edward Kwabena Ameyaw · Mainprice Akuoko Essuman · Sanni Yaya

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Vaccine Coverage and Hesitancy Global Maternal and Child Health Public Health and Social Inequalities

Abstract

Abstract Background and Aims Childhood vaccination remains a cost‐effective strategy that has expedited the control and elimination of numerous diseases. Although coverage of new vaccines in low‐ and middle‐income countries increased exponentially in the last two decades, progress on expanding routine vaccination services to reach all children remains low, and coverage levels in many countries remains inadequate. This study aimed to examine the pattern of wealth and residence‐based related inequality in vaccination coverage through an equity lens. Methods We used data from the 2017−2018 Benin Demographic and Health Survey. Statistical and econometrics modeling were used to investigate factors associated with childhood vaccination. The Wagstaff decomposition analysis was used to disentangle the concentration index. Results A total of 1993 children were included, with 17% in the wealthiest quintile and 63% were living in rural areas. Findings showed that wealth is positively and significantly associated with vaccination coverage, particularly, for middle‐wealth households. A secondary or higher education level of women and partners increased the odds of vaccination compared to no education (p < 0.05). Women with more antenatal care visits, with multiple births, attending postnatal care and delivery in a health facility had increased vaccination coverage (p < 0.01). Inequalities in vaccination coverage are more prominent in rural areas; and are explained by wealth, education, and antenatal care visits. Conclusion Inequality in child vaccination varies according to socioeconomic and sociodemographic characteristics and is of interest to health policy. To mitigate inequalities in child vaccination coverage, policymakers should strengthen the availability and accessibility of vaccination and implement educational programs dedicated to vulnerable groups in rural areas.

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References

2008Closing the gap in a generation: health equity through action on the social determinants of health 2016World health statistics 2016 : monitoring health for the SDGs, sustainable development goals 2010Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health 2007Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States 2018Global Routine Vaccination Coverage — 2017 2015Vaccination: the cornerstone of an efficient healthcare system 2012Individual and Contextual Factors Associated with Low Childhood Immunisation Coverage in Sub-Saharan Africa: A Multilevel Analysis 2017The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis

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