Social Inequalities in Vaccination among Children Aged 0-5 in Madagascar: The Role of Parental SES

Sean A. P. Clouston, Stony Brook University, State University of New York (SUNY)

Social inequalities in health are a major topic of study in the developed world. Though interest in global inequalities is increasing, many studies focus on inter- rather than intra-national inequalities. This study uses data for children aged 0-5 from the Madagascar Demographic and Health Survey from 2008-09. Multilevel logistic models are used to account for shared variability. Results show strong social inequalities in vaccination: wealthier households were more likely to vaccinate their children, and parents’ education similarly increased vaccination. Social inequalities in vaccination status exist in developing countries. If vaccination is clustered, and unequal, then herd immunity cannot work and the poorest are at risk of developing serious disease and children are at risk of mortality from infectious disease. We challenge the international community to examine and consider the role of social inequalities in reducing inequalities and increasing vaccination coverage.