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Rural-urban disparities in missed opportunities for vaccination in sub-Saharan Africa : a multi-country decomposition analyses
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Adamu, Abdu, Uthman, Olalekan A., Sambala, Evanson Z., Ndwandwe, Duduzile, Wiyeh, Alison B., Olukade, Tawa, Bishwajit, Ghose, Yaya, Sanni, Okwo-Bele, Jean-Marie and Wiysonge, Charles S. (2019) Rural-urban disparities in missed opportunities for vaccination in sub-Saharan Africa : a multi-country decomposition analyses. Human Vaccines & Immunotherapeutics, 15 (5). 1191-1198 . doi:10.1080/21645515.2019.1575163
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WRAP-Rural-Urban-disparities-vaccination-sub-Saharan Africa-Uthman-2019.pdf - Accepted Version - Requires a PDF viewer. Download (2594Kb) | Preview |
Official URL: https://doi.org/10.1080/21645515.2019.1575163
Abstract
Background
In this study, we aimed to explore the rural-urban disparities in the magnitude and determinants of missed opportunities for vaccination (MOV) in sub-Saharan Africa.
Methods
This was a cross-sectional study using nationally representative household surveys conducted between 2007 and 2017 in 35 countries across sub-Saharan Africa. The risk difference in MOV between rural or urban dwellers were calculated. Logistic regression method was used to investigate the urban-rural disparities in multivariable analyses. Then Blinder-Oaxaca method was used to decompose differences in MOV between rural and urban dwellers.
Results
The median number of children aged 12 to 23 months was 2113 (Min: 370, Max: 5896). There was wide variation in the the magnitude of MOV among children in rural and urban areas across the 35 countries. The magnitude of MOV in rural areas varied from 18.0% (95% CI 14.7 to 21.4) in the Gambia to 85.2% (81.2 to 88.9) in Gabon. Out of the 35 countries included in this analysis, pro-rural inequality was observed in 16 countries (i.e. MOV is prevalent among children living in rural areas) and pro-urban inequality in five countries (i.e. MOV is prevalent among children living in urban areas). The contributions of the compositional ‘explained’ and structural ‘unexplained’ components varied across the countries. However, household wealth index was the most frequently identified factor.
Conclusions
Variation exists in the level of missed opportunities for vaccination between rural and urban areas, with widespread pro-rural inequalities across Africa. Although several factors account for these rural-urban disparities in various countries, household wealth was the most common.
| Item Type: | Journal Article | |||||||||
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| 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 |
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| SWORD Depositor: | Library Publications Router | |||||||||
| Library of Congress Subject Headings (LCSH): | Vaccination -- Africa, Rural health services -- Africa, Cities and towns -- Health aspects -- Africa | |||||||||
| Journal or Publication Title: | Human Vaccines & Immunotherapeutics | |||||||||
| Publisher: | Landes Bioscience | |||||||||
| ISSN: | 2164-5515 | |||||||||
| Official Date: | 19 February 2019 | |||||||||
| Dates: |
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| Volume: | 15 | |||||||||
| Number: | 5 | |||||||||
| Page Range: | 1191-1198 | |||||||||
| DOI: | 10.1080/21645515.2019.1575163 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Publisher Statement: | “This is an Accepted Manuscript of an article published by Taylor & Francis in Human Vaccines & Immunotherapeutics on 19/02/2019, available online: http://www.tandfonline.com/10.1080/21645515.2019.1575163 | |||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||
| RIOXX Funder/Project Grant: |
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