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      Explaining socioeconomic inequalities in immunisation coverage in India: new insights from the fourth National Family Health Survey (2015–16)

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          Abstract

          Background

          Childhood vaccinations are a vital preventive measure to reduce disease incidence and deaths among children. As a result, immunisation coverage against measles was a key indicator for monitoring the fourth Millennium Development Goal (MDG), aimed at reducing child mortality. India was among the list of countries that missed the target of this MDG. Immunisation targets continue to be included in the post-2015 Sustainable Development Goals (SDG), and are a monitoring tool for the Indian health care system. The SDGs also strongly emphasise reducing inequalities; even where immunisation coverage improves, there is a further imperative to safeguard against inequalities in immunisation outcomes. This study aims to document whether socioeconomic inequalities in immunisation coverage exist among children aged 12–59 months in India.

          Methods

          Data for this observational study came from the fourth round of the National Family Health Survey (2015–16). We used the concentration index to assess inequalities in whether children were fully, partially or never immunised. Where children were partially immunised, we also examined immunisation intensity. Decomposition analysis was applied to examine the underlying factors associated with inequality across these categories of childhood immunisation.

          Results

          We found that in India, only 37% of children are fully immunised, 56% are partially immunised, and 7% have never been immunised. There is a disproportionate concentration of immunised children in higher wealth quintiles, demonstrating a socioeconomic gradient in immunisation. The data also confirm this pattern of socioeconomic inequality across regions. Factors such as mother’s literacy, institutional delivery, place of residence, geographical location, and socioeconomic status explain the disparities in immunisation coverage.

          Conclusions

          In India, there are considerable inequalities in immunisation coverage among children. It is essential to ensure an improvement in immunisation coverage and to understand underlying factors that affect poor uptake and disparities in immunisation coverage in India in order to improve child health and survival and meet the SDGs.

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          Most cited references23

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          The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality.

          When the health sector variable whose inequality is being investigated is binary, the minimum and maximum possible values of the concentration index are equal to micro-1 and 1-micro, respectively, where micro is the mean of the variable in question. Thus as the mean increases, the range of the possible values of the concentration index shrinks, tending to zero as the mean tends to one and the concentration index tends to zero. Examples are presented on levels of and inequalities in immunization across 41 developing countries, and on changes in coverage and inequalities in selected countries. Copyright (c) 2004 John Wiley & Sons, Ltd.
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            Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys

            Background Inequalities in health have received considerable attention from health scientists and economists. In South Africa, inequalities exist in socio-economic status (SES) and in access to basic social services and are exacerbated by inequalities in health. While health systems, together with the wider social determinants of health, are relevant in seeking to improve health status and health inequalities, those that need good quality health care too seldom get it. Studies on the burden of ill-health in South Africa have shown consistently that, relative to the wealthy, the poor suffer more from more disease and violence. However, these studies are based on selected disease conditions and only consider a single point in time. Trend analyses have yet to be produced. This paper specifically investigates socio-economic related health inequality in South Africa and seeks to understand how the burden of self-reported illness and disability is distributed and whether this has changed since the early 2000s. Methods Several rounds (2002, 2004, 2006, and 2008) of the South African General Household Surveys (GHS) data were used, with standardized and normalized self-reported illness and disability concentration indices to assess the distribution of illness and disability across socio-economic groups. Composite indices of socio-economic status were created using a set of common assets and household characteristics. Results This study demonstrates the existence of socio-economic gradients in self-reported ill-health in South Africa. The burden of the major categories of ill-health and disability is greater among lower than higher socio-economic groups. Even non-communicable diseases, which are frequently seen as diseases of affluence, are increasingly being reported by lower socio-economic groups. For instance, the concentration index of flu (and diabetes) declined from about 0.17 (0.10) in 2002 to 0.05 (0.01) in 2008. These results have also been confirmed internationally. Conclusion The current burden and distribution of ill-health indicates how critical it is for the South African health system to strive for access to and use of health services that is in line with need for such care. Concerted government efforts, within both the health sector and other social and economic sectors are therefore needed to address the significant health inequalities in South Africa.
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              Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: a recipe for good practice.

              The tools to be used and other choices to be made when measuring socioeconomic inequalities with rank-dependent inequality indices have recently been debated in this journal. This paper adds to this debate by stressing the importance of the measurement scale, by providing formal proofs of several issues in the debate, and by lifting the curtain on the confusing debate between adherents of absolute versus relative health differences. We end this paper with a 'matrix' that provides guidelines on the usefulness of several rank-dependent inequality indices under varying circumstances. Copyright © 2011 Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                sswati146@gmail.com
                ashu100789@gmail.com
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                16 June 2020
                16 June 2020
                2020
                : 20
                : 295
                Affiliations
                [1 ]GRID grid.419349.2, ISNI 0000 0001 0613 2600, International Institute for Population Sciences, ; Mumbai, 400088 India
                [2 ]GRID grid.9835.7, ISNI 0000 0000 8190 6402, Department of Sociology, , Lancaster University, ; Lancaster, UK
                Article
                2196
                10.1186/s12887-020-02196-5
                7296926
                32546138
                68ea2c25-d210-4a9c-b00a-790f0e53ab38
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 20 September 2019
                : 9 June 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Pediatrics
                immunisation,india,national family health survey,concentration index,decomposition analysis,standardization,immunisation intensity,sustainable development goals

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