Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Area
2.2. Survey Design and Sampling
2.3. Field Survey Procedures
2.4. Data Collection
2.5. Definitions
2.6. Analytical Method
2.7. Ethical Considerations
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Bora, J.K.; Saikia, N. Neonatal and under-five mortality rate in Indian districts with reference to Sustainable Development Goal 3: An analysis of the National Family Health Survey of India (NFHS), 2015–2016. PLoS ONE 2018, 13, e0201125. [Google Scholar] [CrossRef] [PubMed]
- Chan, M. Beyond expectations: 40 years of EPI. Lancet 2014, 383, 1697–1698. [Google Scholar] [CrossRef]
- Hu, Y.; Li, Q.; Chen, Y. Timeliness of childhood primary immunization and risk factors related with delays: Evidence from the 2014 Zhejiang provincial vaccination coverage survey. Int. J. Environ. Res. Public Health 2017, 14, 1086. [Google Scholar] [CrossRef] [PubMed]
- Silva, I.; Restrepo-Mendez, M.C.; Costa, J.C.; Ewerling, F.; Hellwig, F.; Ferreira, L.Z.; Ruas, L.P.V.; Joseph, G.; Barros, A.J.D. Measurement of social inequalities in health: Concepts and methodological approaches in the Brazilian context. Epidemiol. Serv. Saúde 2018, 27, e000100017. [Google Scholar] [PubMed]
- Reading, R.; Jarvis, S.; Openshaw, S. Measurement of social inequalities in health and use of health services among children in Northumberland. Arch. Dis. Child. 1993, 68, 626–631. [Google Scholar] [CrossRef] [PubMed]
- Wagstaff, A.; Paci, P.; van Doorslaer, E. On the measurement of inequalities in health. Soc. Sci. Med. 1991, 33, 545–557. [Google Scholar] [CrossRef] [Green Version]
- Hajizadeh, M.; Hu, M.; Bombay, A.; Asada, Y. Socioeconomic inequalities in health among indigenous peoples living off-reserve in Canada: Trends and determinants. Health Policy 2018, 122, 854–865. [Google Scholar] [CrossRef] [PubMed]
- Yaya, S.; Uthman, O.A.; Amouzou, A.; Ekholuenetale, M.; Bishwajit, G. Inequalities in maternal health care utilization in Benin: A population based cross-sectional study. BMC Pregnancy Childbirth 2018, 18, 194. [Google Scholar] [CrossRef] [PubMed]
- Umuhoza, S.M.; Ataguba, J.E. Inequalities in health and health risk factors in the Southern African development community: Evidence from world health surveys. Int. J. Equity Health 2018, 17, 52. [Google Scholar] [CrossRef] [PubMed]
- Wypych-Slusarska, A.; Czech, E.; Kasznia-Kocot, J.; Slowinski, J.; Niewiadomska, E.; Skrzypek, M.; Malinowska-Borowska, J. Health inequalities among students of lower secondary schools in Bytom, Poland. Ann. Agric. Environ. Med. AAEM 2018, 25, 4–8. [Google Scholar] [CrossRef] [PubMed]
- Corsi, D.J.; Bassani, D.G.; Kumar, R.; Awasthi, S.; Jotkar, R.; Kaur, N.; Jha, P. Gender inequity and age-appropriate immunization coverage in India from 1992 to 2006. BMC Int. Health Hum. Rights 2009, 9 (Suppl. 1), S3. [Google Scholar] [CrossRef] [PubMed]
- Bugvi, A.S.; Rahat, R.; Zakar, R.; Zakar, M.Z.; Fischer, F.; Nasrullah, M.; Manawar, R. Factors associated with non-utilization of child immunization in Pakistan: Evidence from the demographic and health survey 2006–2007. BMC Public Health 2014, 14, 232. [Google Scholar] [CrossRef] [PubMed]
- Antai, D. Gender inequities, relationship power, and childhood immunization uptake in Nigeria: A population-based cross-sectional study. Int. J. Infect. Dis. IJID 2012, 16, e136–e145. [Google Scholar] [CrossRef] [PubMed]
- Wado, Y.D.; Afework, M.F.; Hindin, M.J. Childhood vaccination in rural southwestern Ethiopia: The nexus with demographic factors and women’s autonomy. Pan Afr. Med. J. 2014, 17 (Suppl. 1), 9. [Google Scholar] [CrossRef] [PubMed]
- Pande, R.P. Selective gender differences in childhood nutrition and immunization in rural India: The role of siblings. Demography 2003, 40, 395–418. [Google Scholar] [CrossRef] [PubMed]
- Barata, R.B.; Ribeiro, M.C.; de Moraes, J.C.; Flannery, B.; Vaccine Coverage Survey 2007 Group. Socioeconomic inequalities and vaccination coverage: Results of an immunisation coverage survey in 27 Brazilian capitals, 2007–2008. J. Epidemiol. Community Health 2012, 66, 934–941. [Google Scholar] [CrossRef] [PubMed]
- Cutts, F.T. The use of the who cluster survey method for evaluating the impact of the expanded programme on immunization on target disease incidence. J. Trop. Med. Hyg. 1988, 91, 231–239. [Google Scholar] [PubMed]
- Li, Q.; Hu, Y.; Zhong, Y.; Chen, Y.; Tang, X.; Guo, J.; Shen, L. Using the immunization information system to determine vaccination coverage rates among children aged 1–7 years: A report from Zhejiang province, China. Int. J. Environ. Res. Public Health 2014, 11, 2713–2728. [Google Scholar] [CrossRef] [PubMed]
- Heckley, G.; Gerdtham, U.G.; Kjellsson, G. A general method for decomposing the causes of socioeconomic inequality in health. J. Health Econ. 2016, 48, 89–106. [Google Scholar] [CrossRef] [PubMed]
- Ataguba, J.E.; Ojo, K.O.; Ichoku, H.E. Explaining socio-economic inequalities in immunization coverage in Nigeria. Health Policy Plan. 2016, 31, 1212–1224. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hu, Y.; Luo, S.; Tang, X.; Lou, L.; Chen, Y.; Guo, J.; Zhang, B. Does introducing an immunization package of services for migrant children improve the coverage, service quality and understanding? An evidence from an intervention study among 1548 migrant children in Eastern China. BMC Public Health 2015, 15, 664. [Google Scholar] [CrossRef] [PubMed]
- Gessner, B.D.; Feikin, D.R. Vaccine preventable disease incidence as a complement to vaccine efficacy for setting vaccine policy. Vaccine 2014, 32, 3133–3138. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Antai, D. Inequitable childhood immunization uptake in Nigeria: A multilevel analysis of individual and contextual determinants. BMC Infect. Dis. 2009, 9, 181. [Google Scholar] [CrossRef] [PubMed]
- Abuya, B.A.; Onsomu, E.O.; Kimani, J.K.; Moore, D. Influence of maternal education on child immunization and stunting in Kenya. Matern. Child Health J. 2011, 15, 1389–1399. [Google Scholar] [CrossRef] [PubMed]
- Racine, A.D.; Joyce, T.J. Maternal education, child immunizations, and public policy: Evidence from the us national immunization survey. Soc. Sci. Med. 2007, 65, 1765–1772. [Google Scholar] [CrossRef] [PubMed]
- Balogun, S.A.; Yusuff, H.A.; Yusuf, K.Q.; Al-Shenqiti, A.M.; Balogun, M.T.; Tettey, P. Maternal education and child immunization: The mediating roles of maternal literacy and socioeconomic status. Pan Afr. Med. J. 2017, 26, 217. [Google Scholar] [CrossRef] [PubMed]
- Ozer, M.; Fidrmuc, J.; Eryurt, M.A. Maternal education and childhood immunization in Turkey. Health Econ. 2018, 27, 1218–1229. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Vikram, K.; Vanneman, R.; Desai, S. Linkages between maternal education and childhood immunization in India. Soc. Sci. Med. 2012, 75, 331–339. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Maharani, A.; Kuroda, Y. Determinants of immunization status among 12- to 23-month-old children in Indonesia (2008–2013): A multilevel analysis. BMC Public Health 2018, 18, 288. [Google Scholar]
- Babirye, J.N.; Engebretsen, I.M.; Rutebemberwa, E.; Kiguli, J.; Nuwaha, F. Urban settings do not ensure access to services: Findings from the immunisation programme in Kampala Uganda. BMC Health Serv. Res. 2014, 14, 111. [Google Scholar] [CrossRef] [PubMed]
- Abadura, S.A.; Lerebo, W.T.; Kulkarni, U.; Mekonnen, Z.A. Individual and community level determinants of childhood full immunization in Ethiopia: A multilevel analysis. BMC Public Health 2015, 15, 972. [Google Scholar] [CrossRef] [PubMed]
- Siddiqui, N.T.; Owais, A.; Agha, A.; Karim, M.S.; Zaidi, A.K. Ethnic disparities in routine immunization coverage: A reason for persistent poliovirus circulation in Karachi, Pakistan? Asia Pac. J. Public Health 2014, 26, 67–76. [Google Scholar] [CrossRef] [PubMed]
- Orr, N.; Elliott, M.N.; Burkhart, Q.; Haviland, A.; Weinick, R.M. Racial/Ethnic differences in medicare experiences and immunization: The role of disease burden. Med. Care 2013, 51, 823–831. [Google Scholar] [CrossRef] [PubMed]
- Hu, Y.; Li, Q.; Luo, S.; Lou, L.; Qi, X.; Xie, S. Timeliness vaccination of measles containing vaccine and barriers to vaccination among migrant children in East China. PLoS ONE 2013, 8, e73264. [Google Scholar] [CrossRef] [PubMed]
- Fosu, G.B. Childhood morbidity and health services utilization: Cross-national comparisons of user-related factors from DHS data. Soc. Sci. Med. 1994, 38, 1209–1220. [Google Scholar] [CrossRef]
- Huang, N.; Yip, W.; Chang, H.J.; Chou, Y.J. Trends in rural and urban differentials in incidence rates for ruptured appendicitis under the national health insurance in Taiwan. Public Health 2006, 120, 1055–1063. [Google Scholar] [CrossRef] [PubMed]
Variables | The 2014 Survey (N = 2772) | The 2017 Survey (N = 770) | ||||||
---|---|---|---|---|---|---|---|---|
No. of Children (%) | FPI Children | No. of Children (%) | FPI Children | |||||
n (%) | χ2 | p | n (%) | χ2 | p | |||
Sex of child | 0.3 | 0.58 | 0.93 | 0.93 | ||||
Male | 1395 (50.3) | 1119 (80.21) | 389 (50.5) | 331 (85.1) | ||||
Female | 1377 (49.7) | 1116 (81.05) | 381 (49.5) | 325 (85.3) | ||||
Birth order of child | 25.3 | <0.01 | 12.3 | <0.01 | ||||
1 | 1952 (70.4) | 1622 (83.07) | 502 (65.2) | 444 (88.4) | ||||
2 | 651 (23.5) | 490 (75.22) | 229 (29.7) | 182 (79.5) | ||||
≥3 | 169 (6.1) | 124 (73.37) | 39 (5.1) | 30 (76.9) | ||||
Ethnic group of child | 132.2 | <0.01 | 49.3 | <0.01 | ||||
Han | 2525 (91.1) | 2104 (83.34) | 708 (91.9) | 622 (87.9) | ||||
Others | 247 (8.9) | 131 (53.04) | 62 (8.1) | 34 (54.8) | ||||
Age of mother (years) | 0.6 | 0.43 | 10.1 | <0.01 | ||||
<30 | 1826 (65.9) | 1480 (81.04) | 682 (88.6) | 591 (96.7) | ||||
≥30 | 946 (34.1) | 755 (79.81) | 88 (11.4) | 65 (73.9) | ||||
Maternal education level | 127.3 | <0.01 | 19.3 | <0.01 | ||||
No/Primary | 183 (6.6) | 101 (55.08) | 29 (3.8) | 19 (65.5) | ||||
Second level | 1690 (61.0) | 1328 (78.60) | 449 (59.3) | 371 (82.6) | ||||
College level | 899 (32.4) | 806 (89.66) | 292 (37.9) | 266 (91.1) | ||||
Maternal employment status | 37.4 | <0.01 | 9.3 | <0.01 | ||||
Home full-time | 367 (13.2) | 339 (92.38) | 156 (20.3) | 145 (92.9) | ||||
Employed | 2405 (86.8) | 1896 (78.84) | 614 (79.7) | 511 (83.2) | ||||
Residence | 19.7 | <0.01 | 8.7 | <0.01 | ||||
Urban | 1362 (49.1) | 1052 (77.24) | 388 (50.4) | 316 (81.4) | ||||
Rural | 1410 (50.9) | 1183 (83.92) | 382 (49.6) | 340 (89.0) | ||||
Immigration status | 285.0 | <0.01 | 66.9 | <0.01 | ||||
Resident | 1661 (59.9) | 1484 (89.35) | 480 (62.3) | 448 (93.3) | ||||
Migrant | 1111 (40.1) | 751 (67.60) | 290 (37.7) | 208 (71.7) | ||||
Socio-economic status | 15.6 | <0.01 | 48.2 | <0.01 | ||||
Q1 (poorest) | 924(33.3) | 713 (77.12) | 257 (33.4) | 191 (74.3) | ||||
Q2 (middle) | 924 (33.3) | 742 (80.30) | 257 (33.4) | 219 (85.2) | ||||
Q3(least poor) | 924 (33.3) | 780 (84.42) | 256 (33.2) | 246 (96.1) |
Variables | Level | Concentration Index (95%CI a) | % of Contribution | ||
---|---|---|---|---|---|
FPI | - | 0.12028 (0.10852:0.13175) | |||
Birth order of child | ≥3 | Ref | |||
2 | −0.05242 (−0.06055:−0.043806) | 0.11526 | 0.2348 | −0.69 | |
1 | 0.16813 (0.15209:0.18122) | 0.20509 | 0.7042 | 11.75 | |
Ethnic group of child | Others | Ref | |||
Han | 0.22306 (0.21026:0.23149) | 0.11283 | 0.9109 | 11.09 | |
Maternal education level | No/primary | Ref | |||
Second level | 0.32109 (0.30258:0.34513) | 0.50153 | 0.6097 | 29.52 | |
College level | 0.58637 (0.55977:0.60238) | 0.61027 | 0.3243 | 38.68 | |
Maternal employment status | Home fulltime | Ref | |||
Employed | −0.08262 (−0.07271:−0.088608) | 0.08464 | 0.8676 | −0.29 | |
Residence | Urban | Ref | |||
Rural | 0.20651 (0.19615:0.21902) | 0.18514 | 0.5087 | 9.41 | |
Immigration status | Resident | Ref | |||
Migrant | −0.26233 (−0.24583:−0.27265) | 0.20227 | 0.4008 | −10.29 | |
GDP per-capita (CNY) | - | 0.00123 (0.00110:0.00184) | 0.00001 | 68804.68 | 0.41 |
the percentage of the total health spending allocated to public health | - | 0.12255 (0.11530:0.12974) | 0.01512 | 7.41 | 6.65 |
Variables | Level | Concentration Index (95%CI a) | % of Contribution | ||
---|---|---|---|---|---|
- | 0.10129 (0.095914:0.12068) | ||||
Birth order of child | ≥3 | Ref | |||
2 | 0.04031 (0.03532:0.06007) | 0.05771 | 0.2974 | 1.43 | |
1 | 0.15055 (0.14211:0.17005) | 0.11439 | 0.6519 | 9.28 | |
Ethnic group of child | Others | Ref | |||
Han | 0.17325 (0.16452:0.18995) | 0.08743 | 5.64 | ||
Age of mother (years) | ≥30 | Ref | |||
<30 | 0.154204 (0.14398:0.16703) | 0.07421 | 0.8857 | 5.09 | |
Maternal education level | No/primary | Ref | |||
Second level | 0.27025 (0.26101:0.28121) | 0.42557 | 0.5831 | 27.41 | |
College level | 0.60103 (0.58912:0.61005) | 0.62224 | 0.3792 | 39.72 | |
Maternal employment status | Home fulltime | Ref | |||
Employed | −0.09014 (−0.08336:−0.10065) | 0.06224 | 0.7974 | −2.73 | |
Residence | Urban | Ref | |||
Rural | 0.17187 (0.16228:0.18430) | 0.12426 | 0.4961 | 3.32 | |
Immigration status | Resident | Ref | |||
Migrant | −0.28303 (−0.27461:−0.29822) | 0.26122 | 0.3766 | −16.42 | |
GDP per-capita (CNY) | - | 0.00093 (0.00087:0.00119) | 0.00001 | 72065.8 | 0.36 |
the percentage of the total health spending allocated to public health | - | 0.19346 (0.18095:0.21047) | 0.10133 | 8.32 | 9.27 |
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Hu, Y.; Liang, H.; Wang, Y.; Chen, Y. Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys. Int. J. Environ. Res. Public Health 2018, 15, 2000. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15092000
Hu Y, Liang H, Wang Y, Chen Y. Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys. International Journal of Environmental Research and Public Health. 2018; 15(9):2000. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15092000
Chicago/Turabian StyleHu, Yu, Hui Liang, Ying Wang, and Yaping Chen. 2018. "Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys" International Journal of Environmental Research and Public Health 15, no. 9: 2000. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15092000