Socioeconomic inequalities in child vaccination coverage in Tanzania over time: a decomposition analysis using the 2004/05, 2010 and 2015/2016 demographics and health surveys

Abstract

Background. Despite global strides to reduce child morbidity and mortality, the number of infant and child deaths from preventable causes in low-and middle-income countries remains unacceptably high. A cost-effective strategy to improve child health outcomes is through child vaccination and subsequent immunisation. Despite free child vaccination in the public healthcare sector in Tanzania, the country’s vaccination rates have plateaued and remain concentrated among children from wealthier households. Objective. To identify the factors contributing to inequality in childhood vaccination in Tanzania. Methods. This retrospective study used secondary data from the Tanzania Demographic and Health Survey for 2004/05, 2010 and 2015/16. Inequalities were measured using the Erreygers’ corrected concentration indices. These inequalities were then decomposed to gain a deeper understanding of the contributing factors. Results. Child vaccinations are higher among children from wealthier households in Tanzania, and this disparity has intensified over time. Socioeconomic differences in wealth, residential locations, mass media exposure and maternal education have become increasingly important drivers of these inequalities among Tanzanians. Conclusions. Socioeconomic divisions in Tanzania threaten to perpetuate inequalities in access to healthcare and subsequent health. Child vaccination should be provided equitably to all children regardless of their household’s socioeconomic background. Moreover, efforts should be made to address these gaps between the vulnerable and the more privileged groups in society.