The role of public health programmes in reducing socioeconomic inequities in childhood immunization coverage.

OBJECTIVES This paper asks whether intensive outreach services can eliminate socioeconomic differentials in vaccine coverage. METHODS In 1990, the Matlab Maternal and Child Health/Family Planning Project (MCH-FP) surveyed 4238 respondents in an intervention area that received outreach and 3708 respondents in a comparison area in rural Bangladesh. Interacted multiple regression methods assessed the degree to which various socioeconomic indicators predicted the probability of vaccine receipt in each area. RESULTS Low parental schooling, small dwelling size and female gender were significantly associated with incomplete vaccination in the comparison area, where only the limited government services existed. Residence in the MCH-FP outreach area greatly reduced, and in some cases eliminated, the effects of these socioeconomic barriers to vaccine receipt. CONCLUSIONS Public health programmes utilizing outreach can reduce prevailing gender and socioeconomic differentials in vaccine receipt.