Inequalities in child immunization coverage in Togo: an analysis of Decomposition

doi:10.21203/rs.3.rs-155308/v1

Background

Child vaccination is recognised as a mechanism to improve child survival and health by reducing child deaths. However, there are significant inequalities in the coverage of different childhood vaccinations in both urban and rural areas. In this article, we examine the inequalities between rural and urban areas in the vaccination of children in Togo.

Methods

Using data from the 2017 MICS6 Survey, we examine the probability that a child aged 12–59 months will receive the required vaccinations and break down the sources of inequalities in immunisation coverage between rural and urban areas. This is done using the Oaxaca-Blinder decomposition technique, which identifies the sources and factors that explain differences in outcomes between groups.

Results

Analysis of the results shows that the characteristics of the child, the mother and the household influence the immunization status of the child. For example, children in rural areas are more likely to complete the required vaccinations. We find that a pro urban advantage in characteristics is observed.

Conclusion

There is also a need to specifically target vulnerable children in urban areas, in order to maintain the focus on women's empowerment and to pay special attention to children from poor households.

Nutrition & Dietetics

Immunisation coverage

Vaccination

Inequality of health care

Decomposition

Rural-urban

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Table 1: Descriptive analyses of the variables.

Variables	Frequencies
Age
23-35 months	27,96
36-47 months	31,76
48-59 months	40,28
Birth order
1	47,91
2-3	37,99
4 and more	14,10
Insurance	95,59
Have insurance	4,41
No insurance
Mother education	23,25
None	33,19
Primary	33,15
Secondary and higher	33,66
Wealth Index
Poor	46,24
Less poor	20,40
Rich	33,37
Mother's age	4,89
20-34
35 and over	49,69
Region	50,31
Maritime	10,93
Tray	12,58
Central	15,09
Kara	16,16
Savanes	22,82
Golfe-Urbain	12,07
Lomé-commun	10,34
Prenatal care	18,33
Yes	95,61
No	4,39

Source: Author based on MICS data, 2017.

Table 2: Analyses of the determinants of immunization among children under five years of age by residence.

Cover	Rural			Urban			Together
Cover	Coef.	p-value	Sig	Coef.	p-value	Sig	Coef.	p-value	Sig
Sex	.
Female	.058	.74		.058	0.49		.0468085	0.626
Age
6-11 months	1.676	.009	***	.275	0.92		.5923953	0.021
12-23 months	2.332	0	***	1.23	5.14	***	1.440962	0.000	***
24-35 months	3.555	0	***	2.278	9.73	***	2.526403	0.0000	***
36-59 months	0	.		-4.592	-4.48	***	-4.710048	0.000	***
Birth order
1	.553	.109		.249	1.23		.3069728	0.072	*
2-3	.674	.042	**	.033	0.19		.2051289	0.186
Insurance	0	.		0	.
Have insurance	.445	.161		-.684	-1.65	*	.04391	0.855
Mother education
None	.504	.039	**	.095	0.55		.1788355	0.196
Priamaire	.252	.212		.16	0.96		. 2270821	0.073
Wealth Index
Poor	1.923	.107		.447	2.01	**	.4479708	0.013
Less poor	.257	.287		.2	0.85		.2022487	0.219
Mother's age	0	.		0	.
20-34	-.162	.501		-.057	-0.37		-.1194052	0.351
35 and over	-.05	.916		-.299	-0.86		-.2019694	0.466
Region
Maritime	-.041	.942		.539	2.69	***	.3584943	0.163
Tray	-.02	.957		.754	3.99	***	.5382702	0.025	*
Central	.114	.75		.878	4.78	***	.654935	0.006	**
Kara	.495	.195		.328	1.86	*	.2354295	0.333
Savanes	.74	.029	**	0	.		-.0198029	0.934
Gulf_Urban	.037	.86		-3.62	-8.91	***	.0842101	0.684
Constant	-4.687	0	***	-3.352	0.000		-3.352763	0.000

Source: Author based on data from MICS 6, 2017

Table 3: Decomposition of Oaxaca

Vaccination	Coef.	Std.Err.	z	P>z	[95%Conf.	Interval]
overall
Rural	0.137***	0.009	15.440	0.000	0.120	0.154
Urban	0.136***	0.006	22.430	0.000	0.124	0.148
difference	0.001	0.011	0.100	0.917	-0.020	0.022
endowments	-0.074***	0.019	-3.940	0.000	-0.111	-0.037
coefficients	0.057*	0.035	1.610	0.108	-0.012	0.126
interaction	0.018	0.038	0.470	0.635	-0.057	0.094

Table 4: Breakdown of explained and unexplained portions of the vaccination gap in rural and urban areas.

Mean	prediction	high	(H)	0.137
Mean	prediction	low	(L)	0.136
Raw	differential	(R)	H-L	0.00100
-	due	to	endowments	(E)	-0.0180
-	due	to	coefficients	(C)	0.198
-	due	to	interaction	(EC)	-0.178

Source: Author based on MICS 6 data.

Table 5: Results of the decomposition of the urban-rural gap in immunization coverage

D:	0	1	0,5	0,267	*
Unexplained (U){C+(1-D)CE}:	0.075	0.057	0.066	0.069	0.019
*Explained (V) {E+DCE}:**	-0,074	-0,56	-0,065	-0,068	-0,018
% unexplained {U/R}:	6690,2	5062,6	5876,4	6169,1	1695,2
% explained (V/R):	-6590,2	-4962,6	-5776,4	-6069,1	-1595,2

Source: Author based on MICS 6 data.

Table 6: Identification of the variable that explains most of the gap between urban and rural areas in terms of vaccination.

Variables	E (D=0)	C	EC	1	0.500	0.320	*
Female	0	0	0	0	0	0	0
6-11 months	0	0.00600	0.00100	0.00100	0.00100	0.00100	0.00100
12-23 months	0.00100	0.00500	0	0.00200	0.00200	0.00100	0.00100
24-35 months	0	0.0120	0	0	0	0	0
36-59 months	0.00200	0.0170	-0.00100	0.00100	0.00100	0.00100	0.00100
2-3	0	0.0140	0	0	0	0	0
4 and more	0.00200	-0.00400	0.00100	0.00300	0.00200	0.00200	0.00200
Health insurance	-0.00200	0.00300	0.00400	0.00200	0	-0.00100	0
Primary	0	-0.0100	-0.00100	0	0	0	0
Secondary and higher	-0.00200	-0.00700	-0.0100	-0.0110	-0.00700	-0.00500	-0.00400
Less poor	0.00200	-0.0460	0.0150	0.0160	0.00900	0.00600	0.00200
Rich	-0.0280	-0.0220	-0.156	-0.184	-0.106	-0.0780	-0.0300
20-34	-0.00100	-0.00800	-0.00100	-0.00200	-0.00100	-0.00100	-0.00100
35 and over	0	0.00100	0	0	0	0	0
Tray	-0.00200	-0.00300	0.00100	0	-0.00100	-0.00100	-0.00200
Central	-0.00400	-0.00400	0.00200	-0.00200	-0.00300	-0.00300	-0.00300
Kara	0.00300	0.0150	-0.0110	-0.00800	-0.00300	-0.00100	0.00200
Savanna	0.0110	0.0380	-0.0290	-0.0190	-0.00400	0.00100	0.00800
Lomé_	0	0	0.00200	0.00200	0.00100	0.00100	-0.0100
Golfe_	0	0	0.00400	0.00400	0.00200	0.00100	-0.0100
cons	0	0.190	0	0	0	0	0
Total	-0.0180	0.198	-0.178	-0.197	-0.107	-0.0750	0.00100

Source: Author based on MICS 6 data.

Table 7: Estimates of coefficients, averages, and predictions for each variable in each group.

	High model		Low model		Pooled
Variables	Coef.	Mean	Pred.	Coef.	Mean	Pred.	Coef.
Female	-0.00500	0.501	-0.00300	-0.00600	0.517	-0.00300	-0.00500
6-11 months	0.0760	0.115	0.00900	0.0190	0.0970	0.00200	0.0380
12-23 months	0.154	0.210	0.0320	0.128	0.200	0.0260	0.137
24-35 months	0.394	0.200	0.0790	0.334	0.200	0.0670	0.354
36-59 months	-0.0300	0.374	-0.0110	-0.0740	0.396	-0.0290	-0.0600
2-3	0.0150	0.380	0.00600	-0.0220	0.381	-0.00800	-0.00900
4 and more	-0.0520	0.101	-0.00500	-0.0270	0.160	-0.00400	-0.0310
Health insurance	0.0440	0.0760	0.00300	-0.0520	0.0310	-0.00200	0.00200
Primary	-0.0200	0.355	-0.00700	0.00900	0.334	0.00300	0.00600
Secondary and higher	-0.0440	0.462	-0.0200	-0.00700	0.201	-0.00100	-0.0150
Rural	0	0	0	0	1	0	-0.0440
Less poor	-0.230	0.153	-0.0350	-0.0240	0.224	-0.00500	-0.0230
Rich	-0.249	0.843	-0.210	-0.0380	0.102	-0.00400	-0.0410
20-34	-0.0170	0.771	-0.0130	-0.00500	0.663	-0.00300	-0.0110
35 and over	-0.00500	0.0470	0	-0.0190	0.0500	-0.00100	-0.0160
Tray	0.00600	0.0650	0	0.0220	0.152	0.00300	0.0190
Central	0.0140	0.0780	0.00100	0.0330	0.187	0.00600	0.0290
Kara	0.0550	0.0580	0.00300	-0.0180	0.212	-0.00400	-0.0100
Savanna	0.0790	0.0680	0.00500	-0.0450	0.306	-0.0140	-0.0320
Lomé_	0.00600	0.317	0.00200	0	0	0	-0.0320
Golfe_	0.00900	0.382	0.00400	0	0	0	-0.0250
cons	0.298	1	0.298	0.108	1	0.108	0.135
Total	0.137	0.136

Source: Author based on MICS 6 data.

Inequalities in child immunization coverage in Togo: an analysis of Decomposition

Status:

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Abstract

Background

Methods

Results

Conclusion

Figures

Full Text

Tables

Status:

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