Extent of immunization inequality among Ugandan children aged 12-23 months and it's possible determinants : a secondary data analysis of Uganda Demographic and Health Survey 2016

Abstract

One of the goals of health systems worldwide is Universal Health Coverage. UHC aims to provide equal access to health regardless of socioeconomic condition or ability to pay. Underpinning UHC is the right to health and health equity. In Uganda the Health Sector Strategic and Investment plan, the working document of the Second National Health Policy highlights equity in access and demand of health services as one of the key objectives. Under 5 mortality is higher among the rural dwellers and the poorest than urban dwellers and richest respectively. Childhood vaccination is one of the most effective public health interventions in reducing morbidity/mortality from infectious diseases. Research shows that there are regional disparities in immunization completion rates of the basic vaccines among Ugandan children aged 12-23 months. This highlights an inequality. With the renewed interest in health equity, there is limited research into these inequalities and what could be fueling them. Are the cause of the gaps in completion rates of immunization services socioeconomic related? This study sought to determine the if there is socioeconomic related immunization inequality in incomplete immunization among Ugandan Children aged 12-23 months. The researcher utilized data from the 2016 UDHS on childhood vaccination of the 8 basic vaccines. In order to determine the immunization status, data on immunization variables was used and individuals were categorized as either fully immunized or not. Thereafter inequality in incomplete immunization was determined using the Erregyers normalized CI which is a modification of the standard concentration index; that takes into account the binary nature of the outcome variable (incomplete immunization). The index utilized wealth index (as measure of socioeconomic status) and immunization status as health variable. In order to identify the determinants of the inequality, RIF regression decomposition analysis was used to determine the contribution of the individual covariates to the inequality as measured by the Index. A total of 2859 weight observations were used in the study. The percentage of children aged 12-23 not fully immunized was 44.8%. The Erregyers index was 0.01 indicating that incomplete immunization was concentrated among the well off. However, this result was not statistically significant (p value=0.665) therefore, there is no evidence of immunization inequality from this study. Upon decomposition using the RIF OLS regression method, only birth order number, richer wealth status and higher than secondary level of education of the mother were found to be statistically significant with a possibility of contributing to inequality. This points to the need to empower and educate women in order to make informed decisions as regards their children’s health. Uganda is on the right path to Universal Immunization coverage as long as completion rates are boosted.