Peer-reviewed article
Trends and inequalities in full immunisation coverage among children aged 24 months in Rwanda: evidence from DHS and regional comparisons in Africa (2000–2021)
Albert NDAGIJIMANA, Michael Habtu, Theoneste Mutsindashyaka, Francesca Scott, Anaclet Ngabonzima et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at trends in full childhood immunisation coverage in Rwanda from 2000 to 2021, comparing it with other African countries using national survey data. Rwanda's coverage rose from 76% to 96% over this period. The study found that inequalities based on wealth, region, and residence in Rwanda shrank significantly, though gaps between different areas of the country remained the largest source of inequality. Other African countries studied still show much wider gaps in immunisation coverage linked to wealth, education, and location. The authors suggest Rwanda's strong local health system and equity-focused approach offer lessons for other countries.
Key points
- Rwanda's full immunisation coverage rose from 76% in 2000 to 96% in 2019.
- Subnational (regional) inequality was the most persistent gap, though it fell sharply (PAR from 15.40% to 3.10%).
- Wealth-based inequality remained low but present (PAR 1.53% in 2019).
- Residence-based inequality also remained low but present (PAR 1.43% in 2019).
- Compared to Rwanda, other sub-Saharan African countries showed much wider socioeconomic, educational, and geographic immunisation gaps.
Limitations
The study is based on survey data across countries with possibly different data quality and timing, and it does not identify which specific policies or programmes caused Rwanda's improvements.
Abstract
BackgroundDespite progress, sub-Saharan African countries (SSA) face immunisation disparities. Rwanda has high rates, but the drivers of success are unclear. There's a gap in understanding inequalities and a lack of comparative equity analyses with other SSA countries.MethodsThis study analysed population-based survey data from 17 SSA countries, including Rwanda, among two-year-old children. Full immunisation included all recommended vaccines, according to age and the national immunisation schedule. For Rwanda, the coverage was assessed across six inequality dimensions using frequencies, percentages, and 95% CIs. Absolute (Difference, SII) and relative (Ratio, RCI) measures of inequalities were plotted over time. Population Attributable Risk (PAR) and Fraction (PAF) were estimated for public health impact. Equiplots visualised inequalities across countries.ResultsBetween 2000 and 2019, Rwanda’s full immunisation coverage rose from 76% to 96%. Despite substantial reductions in inequalities in full immunisation coverage in Rwanda between 2000 and 2019, subnational disparities remained the most pronounced, with PAR decreasing from 15.40% to 3.10%, while wealth and place of residence inequalities persisted at low levels (wealth PAR 1.53%; residence PAR 1.43% in 2019). Equiplots highlight that, while Rwanda made significant progress in narrowing gaps across all the equity dimensions, other SSA countries showed wide socioeconomic, educational, and geographic gaps.ConclusionRwanda’s experience with full child immunisation highlights the importance of strong primary healthcare systems and equity-focused delivery strategies, offering transferable lessons for reducing immunisation inequalities across sub-Saharan Africa.