Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007-2008.

Vaccination coverage survey - Publication

abstract: BACKGROUND: Since 1988, Brazil\'s Unified Health System

has sought to provide universal and equal access to immunisations.

Inequalities in immunisation may be examined by contrasting

vaccination coverage among children in the highest versus the

lowest socioeconomic strata. The authors examined coverage with

routine infant immunisations from a survey of Brazilian children

according to socioeconomic stratum of residence census tract.

METHODS: The authors conducted a household cluster survey in census

tracts systematically selected from five socioeconomic strata,

according to average household income and head of household

education, in 26 Brazilian capitals and the federal district. The

authors calculated coverage with recommended vaccinations among

children until 18 months of age, according to socioeconomic

quintile of residence census tract, and examined factors associated

with incomplete vaccination. RESULTS: Among 17,295 children with

immunisation cards, 14,538 (82.6%) had received all recommended

vaccinations by 18 months of age. Among children residing in census

tracts in the highest socioeconomic stratum, 77.2% were completely

immunised by 18 months of age versus 81.2%-86.2% of children

residing in the four census tract quintiles with lower

socioeconomic indicators (p<0.01). Census tracts in the highest

socioeconomic quintile had significantly lower coverage for bacille

Calmette-Guérin, oral polio and hepatitis B vaccines than those

with lower socioeconomic indicators. In multivariable analysis,

higher birth order and residing in the highest socioeconomic

quintile were associated with incomplete vaccination. After

adjusting for interaction between socioeconomic strata of residence

census tract and household wealth index, only birth order remained

significant. CONCLUSIONS: Evidence from Brazilian capitals shows

success in achieving high immunisation coverage among poorer

children. Strategies are needed to reach children in wealthier

areas.