Journal Article

Group-based trajectory models of integrated vaccine delivery and equity in low- and middle-income countries

Ravi, Sanjana J., Vecino-Ortiz, Andrés I., Potter, Christina M., Merritt, Maria W., Patenaude, Bryan N.

2024

Overview

Background Integrated vaccine delivery – the linkage of routine vaccination with provision of other essential health services – is a hallmark of robust primary care systems that has been linked to equitable improvements in population health outcomes. Methods We gathered longitudinal data relating to routine immunization coverage and vaccination equity in 78 low- and middle-income countries that have ever received support from Gavi, the Vaccine Alliance, using multiple imputation to handle missing values. We then estimated several group-based trajectory models to describe the relationship between integrated vaccine delivery and vaccination equity in these countries. Finally, we used multinomial logistic regression to identify predictors of group membership. Results We identified five distinct trajectories of geographic vaccination equity across both the imputed and non-imputed datasets, along with two and four trajectories of socioeconomic vaccination equity in the imputed and non-imputed datasets, respectively. Integration was associated with reductions in the slope index of inequality of measles vaccination in the countries analyzed. Integration was also associated with an increase in the percentage of districts reporting high measles vaccination coverage. Conclusions Integrated vaccine delivery is most strongly associated with improvements in vaccination equity in settings with high baseline levels of inequity. Continued scholarship is needed to further characterize the relationship between integration and health equity, as well as to improve measurement of vaccination coverage and integration.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Datasets / Demographic aspects / Developing Countries / Disease / Dosage and administration / Economic aspects / Equality and Human Rights / Geography / Health aspects / Health care / Health care disparities / Health Equity / Health Policy / Health Promotion and Disease Prevention / Health services / Health Services Research / Humans / Immunization / Integration / Low income groups / Measles / Measles-mumps-rubella vaccine / Medicine / Medicine & Public Health / Poliomyelitis / Poliomyelitis vaccine / Prevention / Primary care / Public Health / Risk factors / Social aspects / Social Justice / Social Policy / Tetanus / Trajectory analysis / Vaccination / Vaccination Coverage / Vaccines / Working groups