Peer-reviewed article
Inequalities in child immunization coverage in Ghana: evidence from a decomposition analysis
Derek Asuman, Charles Ackah, Ulrika Enemark ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines differences in child immunization coverage between rural and urban areas in Ghana using data from two waves of the Demographic and Health Survey. The researchers found that the patterns of inequality shifted between 2008 and 2014, with rural children more likely to complete vaccinations in 2014 after a pro-urban advantage in 2008. The analysis shows that health system improvements and campaign efforts targeting rural areas have been effective, but gaps remain for vulnerable populations in urban settings.
Key points
- Rural-urban inequalities in child immunization coverage exist but have reversed direction between 2008 and 2014
- In 2008, urban children had an advantage due to differences in family characteristics; by 2014, rural children had an advantage due to differences in effectiveness factors
- Child-specific, maternal, and household characteristics significantly influence immunization status
- Health system development and campaign efforts have specifically benefited rural areas
- Vulnerable children in urban areas and high socio-economic households require targeted attention
Limitations
The analysis is observational and cannot establish causal relationships. The study does not identify specific health system interventions or campaigns responsible for the changes observed between the two survey periods.
Abstract
Childhood vaccination has been promoted as a global intervention aimed at improving child survival and health, through the reduction of vaccine preventable deaths. However, there exist significant inequalities in achieving universal coverage of child vaccination among and within countries. In this paper, we examine rural-urban inequalities in child immunizations in Ghana. Using data from the recent two waves of the Ghana Demographic and Health Survey, we examine the probability that a child between 12 and 59 months receives the required vaccinations and proceed to decompose the sources of inequalities in the probability of full immunization between rural and urban areas. We find significant child-specific, maternal and household characteristics on a child's immunization status. The results show that children in rural areas are more likely to complete the required vaccinations. The direction and sources of inequalities in child immunizations have changed between the two survey waves. We find a pro-urban advantage in 2008 arising from differences in observed characteristics whilst a pro-rural advantage emerges in 2014 dominated by the differences in coefficients. Health system development and campaign efforts have focused on rural areas. There is a need to also specifically target vulnerable children in urban areas, to maintain focus on women empowerment and pay attention to children from high socio-economic households in less favourable economic times.