ArticleInternational journal for equity in health2018
Differential achievements in childhood immunization across geographical regions of Pakistan: analysis of wealth-related inequality.
Article in International journal for equity in health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Vaccine equity in low and middle income countries: a systematic review and meta-analysis.International journal for equity in health · 2022Pooled it
- Decomposition Analysis of Socioeconomic Inequalities in Vaccination Dropout in Remote and Underserved Settings in Ethiopia.The American journal of tropical medicine and hygiene · 2024Article
- A non-linear decomposition analysis of children's dietary diversity scores: explaining rural-urban inequality.Quality & quantity · 2022Article
- Causal relationship between health insurance and overall health status of children: Insights from Pakistan.Frontiers in public health · 2022Article
- A data-driven framework for introducing predictive analytics into expanded program on immunization in Pakistan.Wiener klinische Wochenschrift · 2021Article
- Vaccination assessments using the Demographic and Health Survey, 2005-2018: a scoping review.BMJ open · 2020Article
- Article
- Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: a cross-sectional study of 8,722 women in Sierra Leone.BMC public health · 2020Article
- Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia.International journal for equity in health · 2019Article
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4 authors.
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Abstract
backgroundChildhood immunization is one of the most cost-effective interventions for child health. Still, many children are not able to receive completed immunization status. Wealth - related inequality in immunization is considered a major reason for equitable coverage of immunization in Pakistan. Therefore, we examine wealth-related inequality in completed childhood immunization and to assess achievement indices across geographical regions in Pakistan.
methodsThe analysis was based on a nationally representative demographic and health survey (DHS) of Pakistan, conducted in 2012-13. We examined completed childhood (12-23 months) immunization in the various regions of the country and we used concentration, extended concentration and achievement indices to demonstrate inequality across geographical regions in Pakistan.
resultsInequality in completed childhood immunization was seen in Pakistan with concentration index (CI) of 0.181 (95% CI: 0.164-0.209). Regions with high average of complete immunization showed lower inequality except for Sindh. Despite having better average immunization coverage in Kyber Pakhtunkhwa, the relative change of 128% in concentration index (CI) from C2 (standard CI) to C5 (when poorer quantile received highest weights) shows this to be also the most inequitable regions. Four parameters of inequality aversion (v = 2, 3, 4 & 5) demonstrated that 'dis - achievement' in completed immunization is densely concentrated among the poorer regions. Balochistan, Sindh and Gilgit Baltistan exhibited broader inequality gaps (93.75%, 83.35%, and 54.93%, respectively) at higher aversion parameter.
conclusionsAs hypothesized, achievement index uncovers 'penalized' immunization coverage amongst the poorest population. Thus any policy that stringently focuses on improving average immunization rate without any strategy to deal with inequality will only improve immunization rate within wealthier groups. Based on these results, it is advisable to public health policy makers to use both aspect of information: average and degree of inequality in immunization coverage.
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