Us Childhood Immunization Inequalities

Author : Catherine Arsenault
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (11 download)

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Download or read book Vaccination, Inequality, and Children's Learning Achievements in Low and Middle-income Countries written by Catherine Arsenault and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: "The decline in morbidity and mortality from infectious diseases through vaccination is regarded as one of the greatest public health achievements of the 20th century. However, nearly one fifth of the world's children remain unvaccinated. Across low- and middle-income countries (LMIC), inequalities in access to vaccines persist. Eliminating these inequalities first requires that they are effectively measured and monitored. Beyond the prevention of morbidity and mortality, vaccines may also provide a broader range of benefits that have been omitted from economic evaluations. It has been proposed that childhood vaccination may provide benefits in the form of improved physical and cognitive development and better educational outcomes. However, there is currently little evidence behind these propositions. The objectives of this thesis were: 1) to describe the magnitude of inequalities in vaccination coverage and discuss measurement approaches; 2) to investigate whether national factors are associated with inequalities in vaccination coverage; and 3) to estimate the effect of vaccination on children's learning achievements. In the first manuscript in this thesis, we described inequalities in coverage with three doses of diphtheria-tetanus-pertussis (DTP3) and measles-containing vaccines across 45 LMICs. Using the most recent Demographic and Health Surveys, we measured inequalities across seven social dimensions (e.g. wealth, education, multidimensional poverty) using risk differences and ratios and the slope and relative indices of inequality. This allowed us to empirically explore how different measurement approaches would affect conclusions about the magnitude of inequalities and the comparative ranking of countries. These findings led to the development of an equity dashboard, which is described in the second manuscript. In the third manuscript, we used meta-regressions to assess whether national factors were associated with DTP3 coverage and inequalities. We found that political stability, gender equality and smaller land surfaces were important predictors of higher and more equitable levels of DTP3 coverage. Inequalities were also lower in countries receiving more external resources for health and with lower rates of out-of-pocket health spending. In the fourth manuscript, we used cohort data from the India Human Development Survey to estimate the effect of vaccination on children's cognitive abilities, as measured by basic learning achievements (the ability to read, write and do math). We used inverse-probability of treatment weighting to account for potential confounding by 33 community, household, mother and child-level characteristics. Full vaccination against six diseases was associated with an 11% increase (95% CI 5%, 18%) in literacy. The findings in this thesis may help to inform actionable strategies for countries and development partners to redress inequalities in coverage and improve the performance of immunization systems. Our findings also support the hypothesis that vaccination has lasting effects on children's cognitive abilities and learning achievements. Immunization is recognized as a core component of the human right to health. Investments in immunization must be sustained and inequalities in access to vaccines should be eliminated. Quantifying the full benefits of vaccines, and determining where and why inequalities arise, is crucial for achieving these goals and improving the health and social conditions of vulnerable populations. This thesis represents my contribution to this effort." --