Regional inequality and vaccine uptake: a multilevel analysis of the 2007 Welfare Monitoring Survey in Malawi

BMC Public Health

Jon Erik Finnvold²  Vibeke Oestreich Nielsen¹  Dawit Shawel Abebe² 

[1] Statistics Norway, Kongensgate, Oslo, Norway;NOVA – Norwegian Social Research, Munthesgate, Oslo, Norway

关键词: Multilevel analysis;    Survey;    Malawi;    Social inequality;    Regional inequality;    Vaccination coverage;   

Others  :  1162733
DOI  :  10.1186/1471-2458-12-1075

 received in 2012-06-08, accepted in 2012-12-10,  发布年份 2012

【 摘 要 】

Background

A significant part of childhood mortality can be prevented given the existence of a well functioning health care system that can deliver vaccines to children during their first year of life. This study assesses immunization differentials between regions in Malawi, and attempts to relate regional disparities in immunization to factors on individual, household and village level.

Method

We used data from the 2007 Welfare Monitoring Survey which includes 18 251 children ages 10–60 months. Multilevel logistic regression models were applied for data analysis.

Results

Major differences in full vaccine coverage (children receiving all of the 9 recommended vaccines) were documented between the 27 official regions, called districts, of Malawi. The vaccine coverage among regions varied from 2% to 74% when all children 10 – 60 months old were included. Vaccine coverage was significantly higher for women that had their delivery attended by a midwife/nurse, or gave birth at a hospital or maternity clinic. Regions with a high percentage of deliveries attended by health personnel were also characterized by a higher coverage. Characteristics of health care utilization on the individual level could in part account for the observed regional variations in coverage.

Several factors related to socio-demographic characteristics of individuals and households were significantly correlated with coverage (child’s age, illiteracy, income, water and sanitary conditions), implying a lower coverage among the most vulnerable parts of the population. However, these factors could only to a minor extent account for the regional variation in coverage.

Conclusions

The persistent regional inequalities suggest that the low immunization coverage in Malawi is less likely to be a result of geographical clustering of social groups with difficult level-of living conditions. Although the mean vaccine coverage in Malawi is low, some regions have succeeded in reaching a relatively high proportion of their children. The relative success of some regions implies that there is a substantial potential for political intervention to improve vaccine coverage. One important negative implication of regional inequality is the presence of clusters with under-vaccinated children, leading to an increased vulnerability during outbreaks of vaccine-preventable diseases.

【 授权许可】

   
2012 Abebe et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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