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Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage.

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dc.contributor.author Dimitrova, Anna
dc.contributor.author Carrasco Escobar, Gabriel
dc.contributor.author Richardson, Robin
dc.contributor.author Benmarhnia, Tarik
dc.coverage.spatial Afganistan
dc.coverage.spatial Albania
dc.coverage.spatial Angola
dc.coverage.spatial Armenia
dc.coverage.spatial Bangladesh
dc.coverage.spatial Benin
dc.coverage.spatial Burundi
dc.coverage.spatial Cambodia
dc.coverage.spatial Camerún
dc.coverage.spatial Chad
dc.coverage.spatial Egipto
dc.coverage.spatial Etiopia
dc.coverage.spatial Ghana
dc.coverage.spatial Guatemala
dc.coverage.spatial Guinea
dc.coverage.spatial Haití
dc.coverage.spatial India
dc.coverage.spatial Indonesia
dc.coverage.spatial Jordan
dc.coverage.spatial Kenia
dc.coverage.spatial Lesotho
dc.coverage.spatial Liberia
dc.coverage.spatial Madagascar
dc.coverage.spatial Malawi
dc.coverage.spatial Maldives
dc.coverage.spatial Mali
dc.coverage.spatial Mauritania
dc.coverage.spatial Birmania
dc.coverage.spatial Nepal
dc.coverage.spatial Nigeria
dc.coverage.spatial Pakistan
dc.coverage.spatial Filipinas
dc.coverage.spatial Rwanda
dc.coverage.spatial Senegal
dc.coverage.spatial Sierra Leona
dc.coverage.spatial Sudáfrica
dc.coverage.spatial Tajikistan
dc.coverage.spatial Tanzania
dc.coverage.spatial Gambia
dc.coverage.spatial Timor Oriental
dc.coverage.spatial Uganda
dc.coverage.spatial Zambia
dc.coverage.spatial Zimbabwe
dc.date.accessioned 2023-02-20T13:28:11Z
dc.date.available 2023-02-20T13:28:11Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/13165
dc.description.abstract BACKGROUND: Globally, access to life-saving vaccines has improved considerably in the past 5 decades. However, progress has started to slow down and even reverse in recent years. Understanding subnational heterogeneities in essential child immunization will be critical for closing the global vaccination gap.METHODS AND FINDINGS: We use vaccination information for over 220,000 children across 1,366 administrative regions in 43 low- and middle-income countries (LMICs) from the most recent Demographic and Health Surveys. We estimate essential immunization coverage at the national and subnational levels and quantify socioeconomic inequalities in such coverage using adjusted concentration indices. Within- and between-country variations are summarized via the Theil index. We use local indicator of spatial association (LISA) statistics to identify clusters of administrative regions with high or low values. Finally, we estimate the number of missed vaccinations among children aged 15 to 35 months across all 43 countries and the types of vaccines most often missed. We show that national-level vaccination rates can conceal wide subnational heterogeneities. Large gaps in child immunization are found across West and Central Africa and in South Asia, particularly in regions of Angola, Chad, Nigeria, Guinea, and Afghanistan, where less than 10% of children are fully immunized. Furthermore, children living in these countries consistently lack all 4 basic vaccines included in the WHO's recommended schedule for young children. Across most countries, children from poorer households are less likely to be fully immunized. The main limitations include subnational estimates based on large administrative divisions for some countries and different periods of survey data collection.CONCLUSIONS: The identified heterogeneities in essential childhood immunization, especially given that some regions consistently are underserved for all basic vaccines, can be used to inform the design and implementation of localized intervention programs aimed at eliminating child suffering and deaths from existing and novel vaccine-preventable diseases. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Vaccines en_US
dc.subject Vaccination and immunization en_US
dc.subject Socioeconomic aspects of health en_US
dc.subject Low and middle income countries en_US
dc.subject Child health en_US
dc.subject Africa en_US
dc.subject Nigeria en_US
dc.subject Conjugate vaccines en_US
dc.subject.mesh Vaccines
dc.subject.mesh Immunization Programs
dc.subject.mesh Health Economics Agents
dc.subject.mesh Developing Countries
dc.subject.mesh Child Health
dc.subject.mesh Africa
dc.subject.mesh Nigeria
dc.subject.mesh Vaccines, Conjugate
dc.title Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage. en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pmed.1004166
dc.relation.issn 1549-1676

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