|Increased immunization coverage addresses the equity gap in Nepal|
||Ashish KC, Viktoria Nelin, Hendrikus Raaijmakers, Hyung Joon Kim, Chahana Singh, and Mats Målqvist
||Bulletin of the World Health Organization, 95:261-269; DOI: http://dx.doi.org/10.2471/BLT.16.178327
||Objective To compare immunization coverage and equity distribution of coverage
between 2001 and 2014 in Nepal.
Methods We used data from the Demographic Health Surveys carried out in
2001, 2006 and 2011 together with data from the 2014 Multiple Indicator Cluster
Survey. We calculated the proportion, in mean percentage, of children who had
received bacille Calmette–Guérin (BCG) vaccine, three doses of polio vaccine, three
doses of diphtheria–pertussis–tetanus (DPT) vaccine and measles vaccine. To
measure inequities between wealth quintiles, we calculated the slope index of
inequality (SII) and relative index of inequality (RII) for all surveys.
Findings From 2001 to 2014, the proportion of children who received all
vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI:
67.5–70.1) to 82.4% (95% CI: 80.7–84.0). While coverage of BCG, DPT and measles
immunization statistically increased during the study period, the proportion of children
who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7–
93.9) to 88.1% (95% CI: 86.8–89.3). The poorest wealth quintile showed the greatest
improvement in immunization coverage, from 58% to 77.9%, while the wealthiest
quintile only improved from 84.8% to 86.0%. The SII for children who received all
vaccines improved from 0.070 (95% CI: 0.061–0.078) to 0.026 (95% CI: 0.013–
0.039) and RII improved from 1.13 to 1.03.
Conclusion The improvement in immunization coverage between 2001 and
2014 in Nepal can mainly be attributed to the interventions targeting the