Peer-reviewed article
Socioeconomic inequalities in child vaccination in low/middle-income countries: what accounts for the differences?
Mohammad Hajizadeh ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined socioeconomic inequalities in child vaccination across 46 low- and middle-income countries using data from 372,499 children. In most countries, vaccination coverage was higher among wealthier families, but Gambia, Namibia, and Kyrgyz Republic showed the opposite pattern with poorer children better vaccinated. The research found that when wealthier mothers received more antenatal care, their children were more likely to be vaccinated, suggesting that improving prenatal care access for poorer mothers could help reduce vaccination inequalities.
Key points
- Immunisation coverage was pro-rich (favouring wealthier children) in most of the 46 countries studied, with a median concentration index of 0.161
- Gambia, Namibia, and Kyrgyz Republic were the only countries where wealthier children were less likely to receive all four core vaccines than poorer children
- Meta-regression analysis found that concentration of antenatal care visits among wealthier mothers was positively associated with concentration of vaccination coverage among wealthier children (coefficient=0.606)
- The four core vaccines studied were bacille Calmette-Guérin, diphtheria-tetanus-pertussis (three doses), polio (three doses), and measles
- Policies targeting antenatal care access for lower socioeconomic groups may help reduce vaccination inequalities
Limitations
The study identifies correlations between antenatal care concentration and vaccination inequality but does not establish causation through intervention testing. The analysis is cross-sectional across countries rather than longitudinal, so causal mechanisms and temporal relationships cannot be definitively determined.
Abstract
BACKGROUND: Socioeconomic inequalities in child vaccination continue to be a global public health concern. This study aimed to measure and identify factors associated with socioeconomic inequalities in full immunisation coverage against the four core vaccine-preventable diseases (ie, bacille Calmette-Guérin, diphtheria-tetanus-pertussis (three doses), polio (three doses) and measles vaccines) in 46 low/middle-income countries. METHODS: The most recent nationally representative samples of children (aged 10-59 months, n=372 499) collected through the Demographic Health Surveys were used to measure vaccination rates. The concentration index (C) was used to quantify socioeconomic inequalities in vaccination coverage. Furthermore, meta-regression analyses were used to determine factors affecting socioeconomic inequalities in vaccination coverage across countries. RESULTS: Results suggested that immunisation coverage was pro-rich in most countries (median C=0.161, IQR 0.131). Gambia (C=-0.146, 95% CI -0.223 to -0.069), Namibia (C=-0.093, 95% CI -0.145 to -0.041) and Kyrgyz Republic (C=-0.227, 95% CI -0.304 to -0.15) were the only countries where children who belong to higher socioeconomic status group were less likely to receive all the four core vaccines than their lower socioeconomic status counterparts. Meta-regression analyses suggested that, across countries, the concentration of antenatal care visits among wealthier mothers was positively associated with the concentration of vaccination coverage among wealthier children (coefficient=0.606, 95% CI 0.301 to 0.911). CONCLUSIONS: Pro-rich distribution of child vaccination in most low/middle-income countries remains an important public health policy concern. Policies aimed to improve antenatal care visits among mothers in lower socioeconomic groups may mitigate socioeconomic inequalities in vaccination coverage in low/middle-income countries.