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Measles vaccination improves the equity of health outcomes: evidence from Bangladesh

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  • David Bishaia
  • Michael Koenig
  • Mehrab Ali Khan

Abstract

Objectives: This paper asks whether measles vaccination can reduce socioeconomic differentials in under five mortality rates (U5MR) in a setting characterized by extreme poverty and high levels of childhood mortality. Design: Longitudinal cohort study based on quasi experimental design. Setting: Data come from the phased introduction of a measles vaccine intervention in Matlab, Bangladesh in 1982. Subjects: There were 16 270 Bangladeshi children aged 9–60 months. Intervention: The intervention cohort received measles vaccine. Main outcome measures: Socioeconomic differentials in U5MR between the lowest and highest socioeconomic status (SES) quintiles in a cohort of 8135 vaccinated children and a cohort of unvaccinated age matched controls. Mantel–Haenszel rate ratios for the lowest to highest SES quintile were computed. SES was measured by factor analysis of maternal schooling, land holdings, dwelling size, and number of rooms. Results: The U5MR ratio of lowest SES to highest was 2.27 (95% CI=1.62–3.19) in the unvaccinated population and 1.42 (95%CI=0.94–2.15) in the vaccinated population. The difference between unvaccinated and vaccinated U5MR ratios was statistically significant (p

Suggested Citation

  • David Bishaia & Michael Koenig & Mehrab Ali Khan, 2003. "Measles vaccination improves the equity of health outcomes: evidence from Bangladesh," Health Economics, John Wiley & Sons, Ltd., vol. 12(5), pages 415-419, May.
    • Handle: RePEc:wly:hlthec:v:12:y:2003:i:5:p:415-419
    DOI: 10.1002/hec.732
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    1. Vijayaraghavan, Maya & Martin, Rebecca M. & Sangrujee, Nalinee & Kimani, Geoffrey N. & Oyombe, Sammy & Kalu, Akpaka & Runyago, Alfred & Wanjau, George & Cairns, Lisa & Muchiri, Steven N., 2007. "Measles supplemental immunization activities improve measles vaccine coverage and equity: Evidence from Kenya, 2002," Health Policy, Elsevier, vol. 83(1), pages 27-36, September.
    2. Diane Dancer & Anu Rammohan & Murray D. Smith, 2008. "Infant mortality and child nutrition in Bangladesh," Health Economics, John Wiley & Sons, Ltd., vol. 17(9), pages 1015-1035, September.
    3. Forster, Timon & Kentikelenis, Alexander E. & Stubbs, Thomas H. & King, Lawrence P., 2020. "Globalization and health equity: The impact of structural adjustment programs on developing countries," Social Science & Medicine, Elsevier, vol. 267(C).
    4. McGovern, Mark E. & Canning, David, 2015. "Vaccination and All Cause Child Mortality 1985-2011: Global Evidence from the Demographic and Health Surveys," Working Paper 227741, Harvard University OpenScholar.

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