Immunization policies and practices are different for poor children.
In the August issue of “The Lancet Global Health”, Ahmad Hosseinpoor et al. discuss their study on cross-national and national disparities in the rates of immunization with 3 doses of diphteria-tetanus-pertussis (DTP3) vaccine in children of varied socio-economic status (measured in quintiles of assets).
They defined DTP3 immunization coverage “as the percentage of children aged 12-23 months who had received three doses of DTP3-containing vaccine at the time of the DHS or MICS.” The “Demographic and Health surveys” is a trove of nationally representative data of health and population indexes in under-developed countries (no condescending euphemisms). The global “Multiple Indicator Cluster surveys” is a UNICEF program that technically supports governments in carrying out these key national surveys.
The DPT3 immunization coverage varied widely not only between the different 51 countries but within each country itself. The coverage ranged from an abysmal 32% of eligible children in the Central African Republic to an amazing 98% in Jordan. We must say that we are not surprised of the Hashemite kingdom’s results as the enlightened Queen Noor, widow of King Hussein, supervises family policies, instead of cold and dumb bureaucrats.
In general the DTP3 immunization coverage was lower in poor children and tended to rise with increasing wealth in the household, a sign of a scandalous pro-rich inequality in access to a basic Health Care right of human beings. The median DTP3 coverage was 74% in the quintile 1 (lowered economic status) compared to 86% in the quintile 5 (higher economic status)
In 20 countries there was a gap of more than 20% between quintiles 1 and 5; the highest inequality was found in Nigeria, Central African Republic, Pakistan, Ethiopia and Laos. In 15 countries the national coverage rose over time, which benefited more the quintile 1 compared to quintile 5. The only exception was Nigeria where there was a marked bias for the quintile 5. The difference between quintiles 5 and 4 was 40% and the difference between quintiles 5 and 1 was 56% in that West African nation. Even though the poor-rich disparity was observed within each country, most of the countries had improved coverage by focusing in poorer quintiles in the last 10 years.
Not only this paper contributes good data about the rich-poor disparities in immunization coverage in 50 countries but it also exposes how the various forms of exclusion interact with each other to discriminate against the poor. Moreover people live in dynamic communities with criss-crossing axes of exclusion and disparities, which must be considered for health interventions.
The national governments and non-governmental organizations must put more efforts to reach the population segments missed by the routine system of evaluating health needs and outcomes. The medical and nursing staff must leave their comfortable facilities to hit the pavement or dirt road. The functionaries must stop collecting skewed data and start measuring reality. There are still many children waiting for their attention and vaccination.
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Don’t leave me alone.