Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case

Detalhes bibliográficos
Autor(a) principal: Raffi Lerm, Beatriz
Data de Publicação: 2023
Outros Autores: Silva, Yanick, O. Cata-Preta, Bianca, Giugliani, Camila
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Cadernos de Saúde Pública
Texto Completo: https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8289
Resumo: Immunization is one of the main interventions responsible for the decline in under-5 mortality. This study aimed to assess full immunization coverage trends and related inequalities, according to wealth, area of residence, subnational regions, and maternal schooling level in Guinea-Bissau. Data from the 2006, 2014, and 2018 Guinea-Bissau Multiple Indicator Cluster Surveys (MICS) were analyzed. The slope index of inequality (SII) was estimated by logistic regression for wealth quintiles and maternal schooling level as a measure of absolute inequality. A linear regression model with variance-weighted least squares was used to estimate the annual change of immunization indicators at the national level and for the extremes of wealth, maternal schooling level, and urban-rural areas. Full immunization coverage increased by 1.8p.p./year (95%CI: 1.3; 2.3) over the studied period. Poorer children and children born to uneducated mothers were the most disadvantaged groups. Over the years, wealth inequality decreased and urban-rural inequalities were practically extinguished. In contrast,  inequality of maternal schooling level remained unchanged, thus, the highest immunization coverage was among children born to the most educated women. This study shows persistent low immunization coverage and related inequalities in Guinea-Bissau, especially according to maternal schooling level. These findings reinforce the need to adopt equity as a main principle in the development of public health policies to appropriately reduce gaps in immunization and truly leave no one behind in Guinea-Bissau and beyond.
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spelling Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau caseDesigualdades en la cobertura de vacunación infantil: potenciales lecciones del caso de Guinea-BissauDesigualdades na cobertura vacinal infantil: potenciais lições do caso da Guiné-BissauSaúde da CriançaDisparidades em Assistência à SaúdeImunizaçãoVacinasSalud InfantilDisparidades en Atención de SaludInmunizaciónVacunasChild HealthHealthcare DisparitiesImmunizationVaccinesImmunization is one of the main interventions responsible for the decline in under-5 mortality. This study aimed to assess full immunization coverage trends and related inequalities, according to wealth, area of residence, subnational regions, and maternal schooling level in Guinea-Bissau. Data from the 2006, 2014, and 2018 Guinea-Bissau Multiple Indicator Cluster Surveys (MICS) were analyzed. The slope index of inequality (SII) was estimated by logistic regression for wealth quintiles and maternal schooling level as a measure of absolute inequality. A linear regression model with variance-weighted least squares was used to estimate the annual change of immunization indicators at the national level and for the extremes of wealth, maternal schooling level, and urban-rural areas. Full immunization coverage increased by 1.8p.p./year (95%CI: 1.3; 2.3) over the studied period. Poorer children and children born to uneducated mothers were the most disadvantaged groups. Over the years, wealth inequality decreased and urban-rural inequalities were practically extinguished. In contrast,  inequality of maternal schooling level remained unchanged, thus, the highest immunization coverage was among children born to the most educated women. This study shows persistent low immunization coverage and related inequalities in Guinea-Bissau, especially according to maternal schooling level. These findings reinforce the need to adopt equity as a main principle in the development of public health policies to appropriately reduce gaps in immunization and truly leave no one behind in Guinea-Bissau and beyond.La inmunización es una de las principales intervenciones responsables de la disminución de la mortalidad de niños menores de cinco años. Este estudio tuvo como objetivo explorar las tendencias en la cobertura total de inmunización y las desigualdades relacionadas con la riqueza, el área de domicilio, las regiones subnacionales y la educación materna en Guinea-Bissau. Se analizaron datos de la Encuesta de Indicadores Múltiples (MICS) de Guinea-Bissau de 2006, 2014 y 2018. El índice absoluto de desigualdad (SII) se calculó mediante regresión logística para quintiles de riqueza y educación materna como medida de desigualdad absoluta. Se ajustó un modelo de regresión lineal con mínimos cuadrados ponderados por varianza para estimar la variación anual de los indicadores de inmunización a nivel nacional y para los extremos de riqueza, educación materna y áreas urbano-rurales. Hubo un aumento de 1,8p.p./año (IC95%: 1,3; 2,3) en la cobertura total de inmunización durante el período de estudio. Los niños más pobres y los nacidos de madres sin educación formal componían los grupos más desfavorecidos. A lo largo de los años, hubo una reducción de la desigualdad de riqueza, y las discrepancias urbano-rurales casi desaparecieron. Por otro lado, no hubo cambio en el nivel de desigualdad según la educación materna, y prevaleció una mayor cobertura entre los hijos de mujeres con mayor nivel de educación. Este estudio muestra la persistente baja cobertura de vacunación y las desigualdades asociadas en Guinea-Bissau, principalmente con relación a la educación materna. Los resultados apuntan la necesidad de adoptar la equidad como un principio fundamental en el desarrollo de políticas de salud pública para reducir las brechas de inmunización y no dejar a nadie atrás ni adelante en Guinea-Bissau.A imunização é uma das principais intervenções responsáveis pelo declínio da mortalidade de crianças menores de cinco anos. Este estudo teve como objetivo explorar as tendências da cobertura vacinal total e as desigualdades relacionadas a riqueza, área de residência, regiões subnacionais e educação materna na Guiné-Bissau. Foram analisados dados do Inquérito de Indicadores Múltiplos (MICS) da Guiné-Bissau de 2006, 2014 e 2018. O índice absoluto de desigualdade (SII) foi calculado por meio de regressão logística para quintis de riqueza e escolaridade materna como medida de desigualdade absoluta. Um modelo de regressão linear foi ajustado com mínimos quadrados ponderados pela variância para estimar a variação anual dos indicadores de imunização em nível nacional e para os extremos de riqueza, educação materna e áreas urbano-rurais. Houve um aumento de 1,8p.p./ano (IC95%: 1,3; 2,3) na cobertura vacinal total ao longo do período estudado. Crianças mais pobres e nascidas de mães sem educação formal foram os grupos mais desfavorecidos. Ao longo dos anos, a desigualdade de riqueza diminuiu e as discrepâncias urbano-rurais foram praticamente extintas. Em contrapartida, não houve mudança no padrão de desigualdade de acordo com a escolaridade materna, prevalecendo a maior cobertura entre crianças nascidas de mulheres mais escolarizadas. Este estudo mostra a persistente baixa cobertura vacinal e as desigualdades relacionadas na Guiné-Bissau, principalmente considerando a educação materna. Estes resultados reforçam a necessidade de adotar a equidade como princípio fundamental no desenvolvimento de políticas de saúde pública para reduzir adequadamente as lacunas na imunização e não deixar ninguém para trás na Guiné-Bissau e além.Reports in Public HealthCadernos de Saúde Pública2023-07-02info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/xmlapplication/pdfhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8289Reports in Public Health; Vol. 39 No. 1 (2023): JanuaryCadernos de Saúde Pública; v. 39 n. 1 (2023): Janeiro1678-44640102-311Xreponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZenghttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8289/18515https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8289/18516Copyright (c) 2023 Cadernos de Saúde Públicainfo:eu-repo/semantics/openAccessRaffi Lerm, BeatrizSilva, YanickO. Cata-Preta, BiancaGiugliani, Camila2023-07-02T19:44:08Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/8289Revistahttps://cadernos.ensp.fiocruz.br/ojs/index.php/csphttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/oaicadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2024-03-06T13:09:27.835976Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true
dc.title.none.fl_str_mv Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case
Desigualdades en la cobertura de vacunación infantil: potenciales lecciones del caso de Guinea-Bissau
Desigualdades na cobertura vacinal infantil: potenciais lições do caso da Guiné-Bissau
title Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case
spellingShingle Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case
Raffi Lerm, Beatriz
Saúde da Criança
Disparidades em Assistência à Saúde
Imunização
Vacinas
Salud Infantil
Disparidades en Atención de Salud
Inmunización
Vacunas
Child Health
Healthcare Disparities
Immunization
Vaccines
title_short Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case
title_full Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case
title_fullStr Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case
title_full_unstemmed Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case
title_sort Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case
author Raffi Lerm, Beatriz
author_facet Raffi Lerm, Beatriz
Silva, Yanick
O. Cata-Preta, Bianca
Giugliani, Camila
author_role author
author2 Silva, Yanick
O. Cata-Preta, Bianca
Giugliani, Camila
author2_role author
author
author
dc.contributor.author.fl_str_mv Raffi Lerm, Beatriz
Silva, Yanick
O. Cata-Preta, Bianca
Giugliani, Camila
dc.subject.por.fl_str_mv Saúde da Criança
Disparidades em Assistência à Saúde
Imunização
Vacinas
Salud Infantil
Disparidades en Atención de Salud
Inmunización
Vacunas
Child Health
Healthcare Disparities
Immunization
Vaccines
topic Saúde da Criança
Disparidades em Assistência à Saúde
Imunização
Vacinas
Salud Infantil
Disparidades en Atención de Salud
Inmunización
Vacunas
Child Health
Healthcare Disparities
Immunization
Vaccines
description Immunization is one of the main interventions responsible for the decline in under-5 mortality. This study aimed to assess full immunization coverage trends and related inequalities, according to wealth, area of residence, subnational regions, and maternal schooling level in Guinea-Bissau. Data from the 2006, 2014, and 2018 Guinea-Bissau Multiple Indicator Cluster Surveys (MICS) were analyzed. The slope index of inequality (SII) was estimated by logistic regression for wealth quintiles and maternal schooling level as a measure of absolute inequality. A linear regression model with variance-weighted least squares was used to estimate the annual change of immunization indicators at the national level and for the extremes of wealth, maternal schooling level, and urban-rural areas. Full immunization coverage increased by 1.8p.p./year (95%CI: 1.3; 2.3) over the studied period. Poorer children and children born to uneducated mothers were the most disadvantaged groups. Over the years, wealth inequality decreased and urban-rural inequalities were practically extinguished. In contrast,  inequality of maternal schooling level remained unchanged, thus, the highest immunization coverage was among children born to the most educated women. This study shows persistent low immunization coverage and related inequalities in Guinea-Bissau, especially according to maternal schooling level. These findings reinforce the need to adopt equity as a main principle in the development of public health policies to appropriately reduce gaps in immunization and truly leave no one behind in Guinea-Bissau and beyond.
publishDate 2023
dc.date.none.fl_str_mv 2023-07-02
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dc.identifier.uri.fl_str_mv https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8289
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dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8289/18515
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8289/18516
dc.rights.driver.fl_str_mv Copyright (c) 2023 Cadernos de Saúde Pública
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2023 Cadernos de Saúde Pública
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/xml
application/pdf
dc.publisher.none.fl_str_mv Reports in Public Health
Cadernos de Saúde Pública
publisher.none.fl_str_mv Reports in Public Health
Cadernos de Saúde Pública
dc.source.none.fl_str_mv Reports in Public Health; Vol. 39 No. 1 (2023): January
Cadernos de Saúde Pública; v. 39 n. 1 (2023): Janeiro
1678-4464
0102-311X
reponame:Cadernos de Saúde Pública
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str FIOCRUZ
institution FIOCRUZ
reponame_str Cadernos de Saúde Pública
collection Cadernos de Saúde Pública
repository.name.fl_str_mv Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)
repository.mail.fl_str_mv cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br
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