The role of public health programmes in reducing socioeconomic inequities in childhood immunization coverage.

OBJECTIVES This paper asks whether intensive outreach services can eliminate socioeconomic differentials in vaccine coverage. METHODS In 1990, the Matlab Maternal and Child Health/Family Planning Project (MCH-FP) surveyed 4238 respondents in an intervention area that received outreach and 3708 respondents in a comparison area in rural Bangladesh. Interacted multiple regression methods assessed the degree to which various socioeconomic indicators predicted the probability of vaccine receipt in each area. RESULTS Low parental schooling, small dwelling size and female gender were significantly associated with incomplete vaccination in the comparison area, where only the limited government services existed. Residence in the MCH-FP outreach area greatly reduced, and in some cases eliminated, the effects of these socioeconomic barriers to vaccine receipt. CONCLUSIONS Public health programmes utilizing outreach can reduce prevailing gender and socioeconomic differentials in vaccine receipt.

[1]  D. Bishai,et al.  Measles vaccination improves the equity of health outcomes: evidence from Bangladesh. , 2003, Health economics.

[2]  A. Bhuiya,et al.  Bangladesh : an intervention study of factors underlying increasing equity in child survival , 2001 .

[3]  S. Humiston,et al.  Impact of vaccine financing on vaccinations delivered by health department clinics. , 2000, American journal of public health.

[4]  M. Mahmud Khan,et al.  COsting of the integrated management of childhood illeness in Bangladesh : a study based on Matlab data [research paper] , 2000 .

[5]  B. Guyer,et al.  The effect of parental monetary sanctions on the vaccination status of young children: an evaluation of welfare reform in Maryland. , 1999, Archives of pediatrics & adolescent medicine.

[6]  T. Konrad,et al.  The role of state policies and programs in buffering the effects of poverty on children's immunization receipt. , 1999, American journal of public health.

[7]  A. Bhuiya,et al.  The immunization programme in Bangladesh: impressive gains in coverage, but gaps remain. , 1999, Health policy and planning.

[8]  T. Kenyon,et al.  Persistent Low Immunization Coverage Among Inner-city Preschool Children Despite Access to Free Vaccine , 1998, Pediatrics.

[9]  A. Sommerfelt,et al.  Childhood immunization: 1990-1994 , 1997 .

[10]  Bruce G. Link,et al.  Understanding sociodemographic differences in health--the role of fundamental social causes. , 1996, American journal of public health.

[11]  A. Bhuiya,et al.  Factors affecting acceptance of immunization among children in rural Bangladesh. , 1995, Health policy and planning.

[12]  M B Tucker,et al.  Factors related to immunization status among inner-city Latino and African-American preschoolers. , 1995, Pediatrics.

[13]  M. Koenig,et al.  Assessing the mortality impact of an integrated health programme: lessons from Matlab Bangladesh. , 1995 .

[14]  N. Adler,et al.  Risk factors for delayed immunization among children in an HMO. , 1994, American journal of public health.

[15]  H. Rashad.  Evaluation of the impact of health interventions , 1994 .

[16]  J. T. Boerma,et al.  Maternal education and child survival: a comparative study of survey data from 17 countries. , 1993, Social science & medicine.

[17]  P. Thapa,et al.  Risk factors for delayed immunization in a random sample of 1163 children from Oregon and Washington. , 1993, Pediatrics.

[18]  J. Chakraborty,et al.  Contraceptive use in Matlab, Bangladesh in 1990: levels, trends, and explanations. , 1992, Studies in family planning.

[19]  A. Culyer,et al.  Utilisation as a measure of equity by Mooney, Hall, Donaldson and Gerard. , 1992, Journal of health economics.

[20]  C. Donaldson,et al.  Utilisation as a measure of equity: weighing heat? , 1991, Journal of health economics.