Abstract
Background
Governments and multilateral organizations – Gavi, UNICEF – can catalyze the allocation of ample vaccine supply in a timely manner to ensure adequate vaccine coverage. However, deficits in equitable coverage will not be resolved by targeting supply-side constraints. Financial, social, and geographic barriers to access limit vaccine uptake and constrain vaccination demand. The mother’s educational achievement is a known factor influencing vaccination status. Yet, little is known on how much maternal education contributes to childhood immunization, whether this contribution is collinear to socioeconomic status, and how lower educational achievements compound with other disadvantages to restrict pediatric visits and vaccine uptake.
Methods
The Vaccine Economics Research for Sustainability and Equity (VERSE) Equity Toolkit produces a composite equity metric that accounts for maternal education level along with wealth (socioeconomic status) and several other known determinants of coverage. We applied it to all available DHS (2000-2022) for 53 countries. We estimated and compared the influence of maternal education over the years, controlling for key demand- and supply-side constraints (socioeconomic status, region, rural residence, health insurance, and the sex of the child), for two vaccines and one vaccination status: diphtheria-tetanus-pertussis and the measles vaccines (first dose), and being fully immunized for age. We follow-up with an in-depth literature review for two countries – India and Uganda – to discuss how inequity in coverage evolved over time to give maternal education a dominant role in vaccine uptake.
Results
Maternal education has a dominant influence on vaccination status in many low- and middle-income countries. However, this influence differed in scale and by vaccination outcome. Overall, maternal education level explained 0% to 56% of the variation in full-immunization, DTP1 and measles coverage. Maternal education is the dominant driver of inequity for 43% and 26% of countries for DTP1 and full immunization, respectively. Wealth is the dominant factor for 40% and 38% of countries, followed by region of residence for 6% and 21%. Results for measles will be updated shortly.
Conclusion
Understanding and quantifying the influence of maternal education on vaccination coverage is a conducive and necessary part of a concerted effort to promote education, reduce the adverse impact of illiteracy, and improve access to healthcare services such as vaccination.