Inequities in co-coverage of preventive intervention for children: analyses of DHS data from low- and middle income countries
METHODS: We analyzed 66 LMIC for which nationally representative data were available from Demographic and Health Surveys (DHS). Only the most recent year for each country was considered from 1994 to 2011. Adequate (but not perfect) co-coverage was defined as having received at least six out of nine interventions (BCG, polio and measles vaccination, vitamin A supplementation and use of insecticide-treated bednet for children; tetanus toxoid for mothers, antenatal care; skilled delivery and safe water supply), for children aged 12-59 months. Socioeconomic inequality was assessed through wealth quintiles based on asset indices.
RESULTS: The average number of interventions among all countries was 4.6 (3.8 in the poorest and 5.6 in the richest quintile). The number of interventions increased according to the survey year (from 2.7 in 1994-97 to 5.4 in 2009-11). The overall percentage of children receiving 6+ interventions was 43%. Countries from Central and Eastern Europe and the Commonwealth of Independent States (34.2%) have lower coverage of 6+ interventions compared to South Asia (51.5%). Analyses by wealth quintiles showed a linear increase in percentage receiving 6+ interventions (mean co-coverage was only 26.3% in the poorest and 63.8% in richest quintile).
CONCLUSIONS: Although many of the countries studied managed to achieve high coverage level for isolated interventions, their performance in delivering all – or at least most – preventive interventions to all children was poor. Socioeconomic inequities in co-coverage are evident. Public policies are needed to improve co-coverage, especially in the poorer population.