Sambala, Evanson Z., Uthman, Olalekan A., Adamu, Abdu, Ndwandwe, Duduzile, Wiyeh, Alison B., Olukade, Tawa, Bishwajit, Ghose, Yaya, Sanni, Okwo-Bele, Jean-Marie and Wiysonge, Charles S. (2018) Mind the gap : what explains the education-related inequality in missed opportunities for vaccination in sub-Saharan Africa? Compositional and structural characteristics. Human Vaccines & Immunotherapeutics . pp. 1-22. doi:10.1080/21645515.2018.1460985 (In Press)

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Abstract

Missed opportunities for vaccination (MOV) is an important barrier hindering full immunisation coverage among eligible children. Though factors responsible for MOV are well documented in literature, little attention has been paid to the role of inequalities. The aim of this study is to examine the association between contextual or compositional factors and education inequalities in MOV. Blinder-Oaxaca decomposition technique was used to explain the factors contributing to the average gap in missed opportunities for vaccination between uneducated and educated mothers in sub-Saharan Africa using DHS survey data from 35 sub Saharan African countries collected between 2007 and 2016. The sample contained 69,657 children aged 12 to 23 months. We observed a wide variation and inter-country differences in the prevalence of missed opportunity for vaccination across populations and geographical locations. Our results show that the prevalence of MOV in Zimbabwe among uneducated and educated mothers was 9% and 21% respectively while in Gabon corresponding numbers were 85% and 89% respectively. In nine countries, MOV was significantly prevalent among children born to uneducated mothers (pro-illiterate inequality) while in two countries MOV was significantly prevalent among educated mothers (pro-educated inequality). Our results suggest that education-related inequalities in missed opportunities for vaccination are explained by compositional and structural characteristics; and that neighbourhood socio-economic status were the most important contributor to education-related inequalities across countries followed by either under-five children, media access or household wealth index. The results showed that the differential effects such as neighbourhood socio-economic status, under-five children, media access and household wealth index, primarily explained education-related inequality in MOV. Interventions to reduce gaps in education-related inequality MOV should focus on social determinant of health.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Vaccination of children -- Complications -- Africa, Sub-Saharan, Immunization of children -- Complications -- Africa, Sub-Saharan, Education -- Health aspects -- Africa, Sub-Saharan, Educational equalization -- Africa, Sub-Saharan
Journal or Publication Title:	Human Vaccines & Immunotherapeutics
Publisher:	Taylor & Francis Inc.
ISSN:	2164-5515
Official Date:	9 April 2018
Dates:	Date Event 9 April 2018 Available 16 March 2018 Accepted
Date of first compliant deposit:	10 April 2018
Page Range:	pp. 1-22
DOI:	10.1080/21645515.2018.1460985
Status:	Peer Reviewed
Publication Status:	In Press
Access rights to Published version:	Restricted or Subscription Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID Official Development Assistance Funding National Institute for Health Research http://dx.doi.org/10.13039/501100000272

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