Peer-reviewed article
Trends of inequalities in childhood immunization coverage among children aged 12-23 months in Kenya, Ghana, and Côte d’Ivoire
Hermann Pythagore Pierre Donfouet, Gaye Agesa, Martin Kavao Mutua ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines trends in inequality in childhood immunization coverage among children aged 12-23 months in Kenya, Ghana, and Côte d'Ivoire using data from demographic surveys. The researchers found that immunization inequality persists over time in most years, with coverage favouring more advantaged households, though Ghana showed a sharp decrease in inequality. The authors recommend that policymakers design health interventions through an equity lens to address these disparities and improve vaccination coverage in disadvantaged populations.
Key points
- Immunization inequality in the three countries persists over time and favours most-advantaged households
- Ghana showed a sharp decrease pattern in inequalities in childhood immunization coverage over time
- The three countries are transitioning from Gavi support to self-financing vaccine costs between 2025-2027
- Rate difference, rate ratio, and relative concentration index were used to measure inequality
- Policymakers should design health interventions through an equity lens, centring disadvantaged households
Limitations
The study describes trends in inequality but does not evaluate a specific intervention to reduce these inequalities. The document does not provide details on the causal factors driving pro-rich bias or the specific contextual reasons for Ghana's improvement.
Abstract
BACKGROUND: Immunization is one of the most cost-effective health intervention to halt the spread of childhood diseases, and improve child health. Yet, there is a substantial disparity in childhood immunization coverage. The overall objective of the study is to investigate the trends of within-country inequalities in childhood immunization coverage among children aged 12-23 months in Kenya, Ghana, and Côte d'Ivoire. The three countries included in this study are countries that are on the verge of entering the accelerated phase of the Gavi, the Vaccine Alliance's co-sharing of costs of vaccine and eventually assuming full costs of vaccines. Côte d'Ivoire is in the Gavi preparatory transition phase, entering the accelerated transition phase in 2020, with an expected transition to full self-financing in 2025. Ghana is expected to enter the accelerated transition phase in 2021 and to full self-financing in 2026 while Kenya will enter in 2022 and fully self-finance in 2027. We examine the pattern of inequality in childhood immunization coverage over time through an equity lens by mainly exploring the direction of inequality in coverage. METHODS: We use data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys. The rate difference, rate ratio, and relative concentration index are used as measures of inequality. RESULTS: Results of the study suggest that in most years inequality in immunization coverage in the three countries persist over time, and it favors the most-advantaged households. However, there is a sharp decrease pattern in inequalities in childhood immunization coverage in Ghana over time. CONCLUSION: Policymakers could be more strategic in addressing pro-rich inequality in immunization coverage by designing health interventions through an equity lens. Using inequality data and putting disadvantaged households at the center of health intervention designs could increase the efficiency of the primary health care system and reduce the incidence of mortality and morbidity as a result of vaccine-preventable disease.