scholarly journals Monitoring inequality changes in full immunization coverage in infants in Latin America and the Caribbean

2020 ◽  
Vol 44 ◽  
pp. 1
Author(s):  
Manuel Colomé-Hidalgo ◽  
Juan Donado Campos ◽  
Ángel Gil de Miguel
Keyword(s):  
Income Inequality ◽  
Latin American ◽  
Health Surveys ◽  
Immunization Coverage ◽  
Wealth Quintile ◽  
Income Quintile ◽  
Demographic And Health Surveys ◽  
Time Points ◽  
Absolute And Relative Inequalities ◽  
Full Immunization

Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12–23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.

scholarly journals Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

2014 ◽  
Vol 17 (11) ◽  
pp. 2407-2418 ◽  
Author(s):  
Helga Bjørnøy Urke ◽  
Maurice B Mittelmark ◽  
Martín Valdivia
Keyword(s):  
Urban Areas ◽  
Health Surveys ◽  
Maternal Education ◽  
Wealth Quintile ◽  
Household Wealth ◽  
Demographic And Health Surveys ◽  
Sampling Weights ◽  
Cross Sectional ◽  
Growth Standards ◽  
Low Educated

AbstractObjectiveTo examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.DesignTrend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991–2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban–rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).SettingPeru.SubjectsChildren aged 0–59 months surveyed in 1991–92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007–08 (n 8232) and 2011 (n 8186).ResultsChild stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991–2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).ConclusionsThe 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

scholarly journals The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: Analysis from four recent Demographic and Health Surveys in Nepal

2019 ◽  
Author(s):  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Dinesh Dharel
Keyword(s):  
Vaccination Coverage ◽  
Maternal Education ◽  
Immunization Coverage ◽  
Wealth Quintile ◽  
Educational Status ◽  
Household Wealth ◽  
Demographic And Health Surveys ◽  
Relative Index ◽  
Index Of Inequality ◽  
Over Time

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in child health care use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens:Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.Results Full immunization coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from -32.3 [-45.5,-19.1] in 2001 to an SII of-8.4 [-18.6,-1.7] in 2016. Similarly, the SII for education decreased from -61.8 [-73.5,-50.1] in 2001 to an SII of -30.5 [-40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full immunization coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (-0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

scholarly journals Rising trends and persisting inequalities in cesarean section rates in Nepal: evidence from demographic and health surveys 2006-2016

2020 ◽  
Author(s):  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Chandra Mani Dhungana
Keyword(s):  
Higher Education ◽  
Cesarean Section ◽  
Maternal Mortality ◽  
Health Surveys ◽  
Universal Access ◽  
Maternal Mortality Ratio ◽  
Mountain Region ◽  
Income Quintile ◽  
Demographic And Health Surveys ◽  
Mortality Ratio

Abstract Background Sustainable development goals require member countries to reduce maternal mortality ratio below 70 per 100,000 live births by 2030. Addressing inequalities in accessing emergency obstetric care is crucial for reducing the maternal mortality ratio. This study was undertaken to examine the time trends and socio-demographic inequalities in the utilization of cesarean section (CS) in Nepal during the period of 2006 and 2016.Methods Data from the Nepal Demographic and Health Surveys (NDHS) 2006, 2011 and2016 were sourced for this study. Women who had a live birth in the last five years of the survey (most recent birth if there were two or more childbirths) were the unit of analysis for this study. Absolute and relative inequalities in CS rates were expressed in-terms of rate difference and rate ratios, respectively. We used binary logistic regression models to assess the rate of cesarean sections by background socio-demographic characteristics of women. Results Age and parity adjusted CS rates were found to have increased almost three-fold (from 3.2%,95% CI:2.1-4.3 in 2006 to 10.5%;95% CI:8.9-11.9 in 2016) over the decade. In 2016, women from Mountain region (3.0%;95% CI:1.1-4.9), those from poorest wealth quintile (2.4%,95% CI:(1.2-3.7) and those living in province 6(2.4%,95% CI:1.3-3.5) had CS rate below 5%. Whereas, women from the richest income quintile (25.1%,95% CI :20.2-30.1), with higher education (21.2%,95% CI:14.7-27.8) and those delivering in private facilities (37.1%,95% CI:30.5-43.7) had CS rate above 15%. Women from the richest income quintile (OR-3.3,95% CI: 1.6-7.0) and those delivered in private/NGO-run facilities (OR-3.6;95% CI:2.7-4.9) were more than three times more likely to deliver by CS compared to women from the poorest income quintile and those delivering in public facilities, respectively. Conclusion To improve maternal and newborn health, strategies need to be revised to address the underuse of C-section in poor, mountain region and province 2, province 5, province 6 and province 7 so that universal access to comprehensive sexual and reproductive health care services is ensured. Simultaneously, there is a pressing need for policies, guidelines and continuous monitoring of CS rates to reduce overuse in rich women, women with higher education and those delivered in private facilities.

scholarly journals Trend and inequity in infant vaccination coverage: Analysis from three recent Demographic Health Surveys in Nepal

2019 ◽  
Author(s):  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Dinesh Dharel
Keyword(s):  
Vaccination Coverage ◽  
Health Surveys ◽  
Formal Education ◽  
Maternal Education ◽  
Immunization Coverage ◽  
Sharp Decrease ◽  
Health Care Use ◽  
Income Quintile ◽  
Demographic Correlates ◽  
Using Data

Abstract Background Despite policy intention to reach disadvantaged populations, inequities in child health care use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between 2002 and 2016.Methods Using data from demographic health surveys conducted in 2006, 2011 and 2016, we investigated the trend of coverage of six antigens: Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles) between 2002 to 2016. Rich-poor difference, Rich: Poor ratio and concentration index were calculated to measure income inequity. Lorentz curve was drawn to show the change in income-related inequity over time. Bivariate and multivariate logistic regression analyses were conducted to investigate socio-demographic correlates of full vaccination coverage.Results Full immunization coverage was slightly increased from an average of 83% during 2002-2006 to 87% during 2007-2011, but it decreased to 78% during 2012-2016. There was a significant increase in full vaccination coverage among infants from the poorest income quintile and a simultaneous decrease among infants from richer income quintiles. Province 2 saw the largest drop, from 79.2% (95%CI 64.8-88.8) during 2002-2006 to 65.2% (95%CI 56.4-73.0) during 2012-2016. In Province 2, maternal education was the independent predictor of full vaccination coverage; the mother with secondary education was over three times more likely to fully immunize their children compared to mothers with no formal education (AOR 3.2; 95% CI:1.5-6.7).Conclusion Full vaccination coverage in Nepal saw significant decrement away from the national target after 2011. A sharp decrease in coverage of full vaccination among infants from wealthier income quintiles and an increase in coverage among infants from the poorest income quintile between 2002 and 2016 created a pro-poor equity gain. While a national effort to improve full vaccination coverage is overdue, children from province 2, specifically those born to mothers with no or primary education need particular programmatic focus. Further research is needed to understand the reasons behind decrement in full vaccination coverage, particularly among rich income quintiles.

scholarly journals Does Socioeconomic Environment Is A Risk Factor For Malaria In Senegal ? A DHS Data Analysis of Malaria Trends From 2010 To 2016 In Senegal

2021 ◽  
Author(s):  
Ndeye Mareme Sougou ◽  
Adama Faye ◽  
Mamadou Makhtar Mbacké Leye ◽  
Oumar Bassoum ◽  
Ibrahima Seck
Keyword(s):  
Health Surveys ◽  
Protective Factor ◽  
Wealth Quintile ◽  
Malaria Prevalence ◽  
Demographic And Health Surveys ◽  
Socioeconomic Environment ◽  
Factors Associated ◽  
Logistic Analysis ◽  
Malaria Trends ◽  
Multivariate Logistic Analysis

Abstract Introduction Analysis of the evolution of malaria will help address the determinants of malaria elimination in this country. The aim of this study is to analyze the evolution of malaria in Senegal from 2010 to 2016.MethodsThis article uses data from the Senegalese Demographic and Health Surveys (for 2010-2011, 2012-2013, 2014, 2015 and 2016. To assess the factors associated with the positivity of the RDT, a multivariate logistic analysis was conducted to account for the effect of confounding factors. Adjusted odds ratios were calculated with their 95% confidence intervals. The dependent variable was the result of the Malaria rapid diagnostic test. ResultsThe malaria prevalence rate varies from 3.01% in 2010 to 0.87% in 2016. The risk factors associated with the evolution of malaria were the age of the child (4 years (aOR=1.82 [1.14-2.89]) and 5 years (aOR=1.98 [1.21-3.25]). The richest wealth quintile was a protective factor against malaria with aOR=0.02 [0-0.18]. Other protective factors against malaria were the construction characteristics of the houses. These are houses with improved wall and roof materials with aOR 0.45 [0.24-0.85] and 0.48 [0.25-0.93] respectively.Conclusion Factors associated with the evolution of malaria in Senegal are children’s age, level of wealth of the household and type of dwelling in the house. It should be noted that the level of development of countries, by influencing better living conditions for communities, remains an important prerequisite for the elimination of malaria in the African sub region and in Senegal in particular.

scholarly journals National trends of childhood vaccination coverage in Bangladesh: Understanding gaps from 2011, 2014 and 2017-18 Demographic and Health Surveys data

2021 ◽  
Author(s):  
Satyajit Kundu ◽  
Subarna Kundu ◽  
Bright Opoku Ahinkorah ◽  
Abdul-Aziz Seidu ◽  
Joshua Okyere ◽  
...  
Keyword(s):  
Vaccination Coverage ◽  
Urban Areas ◽  
Health Surveys ◽  
Maternal Education ◽  
Vaccine Coverage ◽  
Immunization Coverage ◽  
Childhood Vaccination ◽  
Demographic And Health Surveys ◽  
Changes Over Time ◽  
Over Time

Abstract Background Vaccination is a safe and cost-effective strategy for protecting children from life-threatening diseases. This study aimed to investigate the changes over time in proportion of vaccination coverage across demographic subgroups in Bangladesh. Method Vaccination coverage for children 12–59 months of age was obtained from Bangladesh’s 2011, 2014, and 2017-18 Demographic and Health Surveys. Three multivariable binary logistic regression models with complete vaccination status at each survey data were used to generate adjusted odds ratios to uncover immunization variations across socio-demographic categories. Further, to detect potential geographic disparities, changes over time were analyzed at both the country and district levels. Findings Vaccination coverage grew from 88.1% in 2011 to 89.2% in 2017–2018, indicating a gap of more than ten percent for complete immunization coverage among children aged 12–59 months. Children aged 23–35 were more likely to have full vaccination compared to those aged 12–23 in 2011 (AOR = 1.6, 95% CI = 1.3–1.9), 2014 (AOR = 1.6, 95% CI = 1.3-2.0), and 2017-18 (AOR = 1.4, 95% CI = 1.1–1.7). The likelihood of full vaccination of children increased with maternal education with the highest odds among women with higher education in 2011 (AOR = 7.2, 95% CI = 4.0-12.9), 2014 (AOR = 4.0, 95% CI = 2.7–5.9), and 2017-18 (AOR = 5.8, 95% CI = 3.5–9.6) compared to those with no formal education. Children born to mothers who lived in urban areas were more likely to have full vaccination in 2011 (AOR = 1.5, 95% CI = 1.3–1.8), 2014 (AOR = 1.4, 95% CI = 1.2–1.7), and 2017-18 (AOR = 1.4, 95% CI = 1.1–1.7) compared to those who lived in rural areas. Children born to mothers who had at least 4 ANC visits were more likely to have full vaccination compared to those with less than 3 ANC visits in 2011 (AOR = 1.6, 95% CI = 1.2-2.0), 2014 (AOR = 1.5, 95% CI = 1.2-2.0), and 2017-18 (AOR = 1.6, 95% CI = 1.2–2.1 During these three surveys, Rangpur division had the highest vaccine coverage rate, while Sylhet division had the lowest vaccination coverage. Conclusion Although there was an improvement in these nationally representative surveys from 2011 to 2017-18, a portion of children still needs to be vaccinated to ensure full immunization coverage. To achieve 100% immunization coverage for all Bangladeshi children, policymakers must integrate vaccine programs with personalized health messaging and assurances of health safety for impoverished children and low-educated mothers. Increased institutional deliveries and prenatal care visits by mothers could assist increase their children's vaccination coverage.

scholarly journals Rising trends and persisting inequalities in cesarean section rates in Nepal: evidence from demographic and health surveys 2006-2016

2020 ◽  
Author(s):  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Chandra Mani Dhungana
Keyword(s):  
Higher Education ◽  
Cesarean Section ◽  
Maternal Mortality ◽  
Health Surveys ◽  
Maternal Mortality Ratio ◽  
Mountain Region ◽  
Income Quintile ◽  
Maternal And Newborn Health ◽  
Demographic And Health Surveys ◽  
Place Of Delivery

Abstract BackgroundSustainable development goals require member countries to reduce maternal mortality below 70 per 100,000 live births by 2030. Addressing inequalities in access to emergency obstetric care is crucial for reducing the maternal mortality ratio. This study was done to examine the time trends and socio-demographic inequalities in the utilization of cesarean section (CS) in Nepal during 2006-2016.MethodsWe used data from the Nepal Demographic and Health Surveys (NDHS) conducted during 2006-2016. Women who had a live birth in the last five years of the survey (most recent birth if there were two or more child birth) were the unit of analysis for this study. Absolute and relative inequalities in CS rates by different characteristics were measured in-terms of rate difference and rate ratios, respectively. Bivariate analyses and multivariate logistic regression models were used to assess the rate of cesarean sections by background socio-demographic characteristics of women. ResultsAge and parity adjusted CS rates were found to have increased almost three-fold (from 3.2%,95% CI:2.1-4.3 in 2006 to 10.5%;95% CI:8.9-11.9 in 2016) over the decade. In 2016, women from Mountain region (3.0%;95% CI:1.1-4.9), those from poorest wealth quintile (2.4%,95% CI:(1.2-3.7) and those living in province 6(2.4%,95% CI:1.3-3.5) had CS rate below 5%. Whereas, women from the richest income quintile (25.1%,95% CI :20.2-30.1), with higher education (21.2%,95% CI:14.7-27.8) and those delivering in private facilities (37.1%,95% CI:30.5-43.7) had CS rate above 15%. The absolute inequality in CS rate increased for maternal educational status, income quintiles, ecological region, province and place of delivery over the period. Relative inequality increased for provinces and place of delivery. Women from the richest income quintile (OR-3.3,95% CI: 1.6-7.0) and those delivered in private/NGO-run facilities (OR-3.6;95% CI:2.7-4.9) were more than three times more likely to deliver by CS compared to women from the poorest income quintile and those delivering in public facilities, respectively. ConclusionTo improve maternal and newborn health, strategies need to be revised to address the underuse of C-section in poor, mountain region and province 6. Simultaneously, policies and guidelines are needed to reduce overuse in rich women, women with higher education and those delivered in private facilities.

scholarly journals The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: Analysis from four recent Demographic and Health Surveys in Nepal

2019 ◽  
Author(s):  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Dinesh Dharel
Keyword(s):  
Vaccination Coverage ◽  
Maternal Education ◽  
Immunization Coverage ◽  
Wealth Quintile ◽  
Educational Status ◽  
Household Wealth ◽  
Demographic And Health Surveys ◽  
Relative Index ◽  
Index Of Inequality ◽  
Over Time

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in child health care use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens:Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.Results Full immunization coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from -32.3 [-45.5,-19.1] in 2001 to an SII of-8.4 [-18.6,-1.7] in 2016. Similarly, the SII for education decreased from -61.8 [-73.5,-50.1] in 2001 to an SII of -30.5 [-40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full immunization coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (-0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

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