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


METHODS
Longitudinal cohort study based on quasi experimental design.


METHODS
Data come from the phased introduction of a measles vaccine intervention in Matlab, Bangladesh in 1982.


METHODS
There were 16 270 Bangladeshi children aged 9-60 months.


METHODS
The intervention cohort received measles vaccine.


METHODS
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<0.10) and robust across alternative measures of SES.


CONCLUSIONS
Children from the poorest quintile were more than twice as likely to die as those from the least quintile in the absence of measles vaccination. Universal distribution of measles vaccination largely nullified SES related mortality differentials within a high mortality population of children.
Department of Population and Family Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21030, USA. dbishai@jhu.edu
David
D
Bishai
Michael
M
Koenig
Mehrab
M
Ali Khan
D001459:Bangladesh / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008457:Measles / Q000401:mortality / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage*; D011203:Poverty; D012923:Social Class; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014611:Vaccination / Q000706:statistics & numerical data*
D008458:Measles Vaccine