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Achieving better measles immunization in developing countries: does higher coverage imply lower inequality?

Filip Meheus¹, Eddy Van Doorslaer

¹Royal Tropical Institute, Mauritskade 63, 1090 HA Amsterdam, Netherlands. f.meheus@kit.nl

Social Science & Medicine (1982)

|February 19, 2008

Summary

Measles immunization coverage improved in most developing countries during the 1990s, but gains often disadvantaged the poor. New "achievement" indices reveal that progress is not always equitable across wealth groups.

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Area of Science:

Global Health
Public Health Policy
Socioeconomic Determinants of Health

Background:

Measles immunization coverage trends are typically reported as mean changes, potentially masking significant socioeconomic disparities.
Understanding the distribution of immunization coverage across different wealth groups is crucial for equitable public health interventions.

Purpose of the Study:

To analyze trends in measles immunization coverage levels and their socioeconomic distribution in 21 developing countries during the 1990s.
To introduce and apply "achievement" indices and "achievement contours" to evaluate progress considering both mean coverage and inequality.

Main Methods:

Utilized two rounds of Demographic and Health Surveys (DHS) data from 21 developing countries for the 1990s.
Developed and employed "achievement" indices that integrate mean coverage rates with measures of inequality.
Visualized country performance using "achievement contours" to illustrate the impact of societal inequality aversion.

Main Results:

Most countries showed an increase in mean measles immunization rates.
Improvements in coverage were frequently unequally distributed, disproportionately benefiting wealthier populations and disadvantaging the poor.
Trends in mean coverage increases were associated with both rising and falling levels of inequality.

Conclusions:

While mean measles immunization coverage improved in many developing nations, the benefits were not evenly distributed, often exacerbating disparities.
The "achievement" index highlights that progress in immunization coverage must be assessed alongside its equity implications, penalizing gains that leave vulnerable populations behind.
Societal preferences for reducing inequality significantly influence the ranking of countries based on their immunization achievements.