PDF(Pubmed)
Abstract：
BACKGROUND: Over the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn\'t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality.
METHODS: Data for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12-23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination.
RESULTS: The coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers\' awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake.
CONCLUSIONS: There was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.
METHODS: Data for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12-23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination.
RESULTS: The coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers\' awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake.
CONCLUSIONS: There was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.
摘要：
背景：在过去的二十年中，尼泊尔儿童健康指标在国家一级有了显著改善。然而，这一进展在各个人口子集之间并不一致。这项研究确定了与儿童完全接种疫苗相关的决定因素，评估了与财富相关的不平等，并深入研究了推动这种不平等的关键因素。
方法：本研究的数据来自最新的全国代表性的2022年尼泊尔人口与健康调查。根据国家免疫计划，总共有959名12-23个月的儿童接受了常规的儿童基础抗原，被考虑进行分析。进行二元逻辑回归模型以鉴定与结果变量(完全接种的摄取)相关的因素。使用浓度曲线和Erreygers归一化浓度指数来评估完全疫苗接种中的不等式。家庭财富五分位数指数得分用于衡量与财富相关的不平等，并进行了分解分析，以确定解释儿童疫苗接种中与财富相关的不平等的决定因素。
结果：全国儿童全疫苗接种覆盖率为79.8%。几个因素,包括孕产妇保健服务利用率变量(例如，产前保健,机构交付)，与访问医疗机构有关的财务挑战，和母亲对病房内健康母亲小组会议的认识，与儿童全面接种疫苗有关。浓度曲线低于等值线，相对Erreygers标准化浓度指数为0.090，表明在富裕群体的儿童中，完全接种疫苗的比例更高。分解分析确定了机构交付(20.21%)，参观卫生设施所需的资金(14.25%)，孕产妇教育(16.79%)，产妇年龄(8.53%)，种姓(3.03%)是导致儿童全面接种疫苗时财富相关不平等的重要因素。
结论：尼泊尔儿童在全面接种疫苗方面存在明显的财富相关不平等。涉及负责任的利益攸关方的多部门行动对于减少不平等现象至关重要，包括促进获得孕产妇保健服务的机会，提高来自社会经济弱势社区的母亲的教育水平。
方法：本研究的数据来自最新的全国代表性的2022年尼泊尔人口与健康调查。根据国家免疫计划，总共有959名12-23个月的儿童接受了常规的儿童基础抗原，被考虑进行分析。进行二元逻辑回归模型以鉴定与结果变量(完全接种的摄取)相关的因素。使用浓度曲线和Erreygers归一化浓度指数来评估完全疫苗接种中的不等式。家庭财富五分位数指数得分用于衡量与财富相关的不平等，并进行了分解分析，以确定解释儿童疫苗接种中与财富相关的不平等的决定因素。
结果：全国儿童全疫苗接种覆盖率为79.8%。几个因素,包括孕产妇保健服务利用率变量(例如，产前保健,机构交付)，与访问医疗机构有关的财务挑战，和母亲对病房内健康母亲小组会议的认识，与儿童全面接种疫苗有关。浓度曲线低于等值线，相对Erreygers标准化浓度指数为0.090，表明在富裕群体的儿童中，完全接种疫苗的比例更高。分解分析确定了机构交付(20.21%)，参观卫生设施所需的资金(14.25%)，孕产妇教育(16.79%)，产妇年龄(8.53%)，种姓(3.03%)是导致儿童全面接种疫苗时财富相关不平等的重要因素。
结论：尼泊尔儿童在全面接种疫苗方面存在明显的财富相关不平等。涉及负责任的利益攸关方的多部门行动对于减少不平等现象至关重要，包括促进获得孕产妇保健服务的机会，提高来自社会经济弱势社区的母亲的教育水平。
