The UN Children’s Fund has identified poverty as a major determinant when it comes to a child accessing routine immunisation against vaccine-preventable diseases.
The UN body disclosed this in its
‘State of The World’s Children 2023’ report, adding that there are millions of
such children in Africa, referred to as ‘zero-dose children’, adding that they
are children who failed to receive any routine vaccination.
According to the UNICEF report,
data shows that children from the very poorest households with income in the
bottom 10 per cent of the population are less likely to be immunised than
children in the wealthiest 10 per cent.
It stated that during the year
under review, 22.6 per cent of children in the poorest households were
zero-dose children, in contrast with the wealthiest group, which had 4.9 per
cent of zero-dose children.
The data also indicated that the
gaps between the wealthiest and poorest were widest in low-income countries and
narrowest in upper-middle-income countries.
“West and Central Africa
presented the largest gap between rich and poor, as 48.6 per cent of children
from the poorest households were zero-dose children, compared with 6.3 per cent
of children in the wealthiest.
The report, which also indicated
that 67 million children missed out entirely or partially on routine
immunisation from 2019 to 2021 due to COVID-19, added that with 2.2 million,
Nigeria was home to the second largest number of zero-dose children in the
world.
The fund analysed 74 low and
middle-income countries to arrive at the report.
It also stated that among the 10
countries with the highest gaps in vaccination coverage between rich and the
poor, seven were in sub-Saharan Africa.
In addition to poverty, it noted
that location plays a significant role in whether a child is immunised or not.
“In the 74 low and middle-income
countries analysed for UNICEF, 9.4 per cent of children in urban areas were
zero-dose children and 15.1 per cent in rural areas.
“As with poverty, the greatest
gap in immunisation by location was in West and Central Africa, where the
prevalence of zero-dose children was 16.2 per cent in urban areas, and 34.6 per
cent in rural areas.”
The report also pointed out that
multiple forms of marginalisation served as a barrier to childhood
immunisation.
It added that though the data
showed an overall gender balance in immunisation rates, there are other ways
that gender disparities become barriers to immunisation.
“The data analysed for the report
focused on two categories: a mother’s lack of education and her lack of
empowerment.
“In most communities, mothers
have the primary responsibility for children’s health.
“However, social and cultural
norms in homes and communities can limit their status and decision-making
authority, which can interfere with their ability to act on their own and on
their children’s behalf.
“Therefore, women most often have
the burden of overcoming barriers of time and distance to immunise their
children. There, the family members are required to take time from work and
travel to have a child immunised.
“They carry this responsibility
in spite of lack of status, economic stability and information”, the fund
stated.
It also noted that the prevalence
of zero-dose children declined as a mother’s level of education increased.
The report revealed that there
was 23.5 per cent prevalence of zero-dose children among mothers without any
education, 13.1 per cent prevalence of zero-dose children among mothers with a
primary education, and 6.9 per cent prevalence of zero-dose children among
mothers with at least a secondary education.
“Of the 74 countries studied,
only 33 had empowerment data. In Nigeria, the data showed the greatest gap in
vaccination coverage is linked to the level of empowerment experienced by
mothers.
“There, the prevalence of
zero-dose children among mothers with a low level of empowerment was 53.2 per
cent compared with 10.8 per cent prevalence among mothers with a high level of
empowerment,” the report further stated.
Other factors that influence
zero-dose immunisation according to UNICEF are ethnicity, crisis, displacement,
availability, accessibility and affordability.
For crisis, it said that
instability, violence and disruption could wreak havoc on health systems and
hinder children’s opportunities to be immunised.
“Crisis can displace health
workers, halt financing, impair supply chains and cause damage to roads,
electricity grids, and water and sanitation systems.
“During the conflict, collateral
and purposeful attacks on healthcare facilities make accessing health services
dangerous,” it stated.
The report indicated that some
people migrate from their homes to camps for refugees or internally displaced
persons, while others find themselves in informal settlements or communities,
which makes it difficult to find and estimate the number of children who need
vaccinations.
The fund, however, said that
reaching zero-dose and under-vaccinated children means making vaccination as
available, convenient and inexpensive as possible.
It said that achieving this goal
requires interventions that take account of availability, accessibility and
affordability barriers with examples of such interventions being incentives
that address the concerns of poor families.
Also, prompts and reminders can
also be effective, particularly if they are linked to vaccination records.
“Overcoming barriers of
availability, accessibility and affordability is critical to overcoming
inequity in immunisation and reaching zero-dose and under-vaccinated children.
Ultimately, overcoming these barriers will save lives.
“Indeed, immunization saves about
4.4 million lives a year. If the world reaches 2030 global goals for
immunization to reach zero-dose and under-vaccinated children, the number of
lives saved could climb to 5.8 million.”
The fund said that securing
funding and political will globally, nationally and locally are essential to
ensuring that every child gets vaccinated.
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