title: Improved equity in measles vaccination from integrating insecticide-treated bednets in a vaccination campaign, Madagascar.
abstract: OBJECTIVE
  To evaluate the effect of integrating ITN distribution on measles vaccination campaign coverage in Madagascar.
  
  
  METHODS
  Nationwide cross-sectional survey to estimate measles vaccination coverage, nationally, and in districts with and without ITN integration. To evaluate the effect of ITN integration, propensity score matching was used to create comparable samples in ITN and non-ITN districts. Relative risks (RR) and 95% confidence intervals (CI) were estimated via log-binomial models. Equity ratios, defined as the coverage ratio between the lowest and highest household wealth quintile (Q), were used to assess equity in measles vaccination coverage.
  
  
  RESULTS
  National measles vaccination coverage during the campaign was 66.9% (95% CI 63.0-70.7). Among the propensity score subset, vaccination campaign coverage was higher in ITN districts (70.8%) than non-ITN districts (59.1%) (RR=1.3, 95% CI 1.1-1.6). Among children in the poorest wealth quintile, vaccination coverage was higher in ITN than in non-ITN districts (Q1; RR=2.4, 95% CI 1.2-4.8) and equity for measles vaccination was greater in ITN districts (equity ratio=1.0, 95% CI 0.8-1.3) than in non-ITN districts (equity ratio=0.4, 95% CI 0.2-0.8).
  
  
  CONCLUSIONS
  Integration of ITN distribution with a vaccination campaign might improve measles vaccination coverage among the poor, thus providing protection for the most vulnerable and difficult to reach children.
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. jgoodson@cdc.gov
authors.forename: James L
authors.initials: JL
authors.lastname: Goodson
authors.forename: Manisha A
authors.initials: MA
authors.lastname: Kulkarni
authors.forename: Jodi L
authors.initials: JL
authors.lastname: Vanden Eng
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.forename: Annett H
authors.initials: AH
authors.lastname: Cotte
authors.forename: Rachelle E
authors.initials: RE
authors.lastname: Desrochers
authors.forename: Bakolalao
authors.initials: B
authors.lastname: Randriamanalina
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Luman
mesh_terms: D001512:Bedding and Linens; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D006293:Health Promotion / Q000379:methods; D006304:Health Status; D006801:Humans; D007223:Infant; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008270:Madagascar / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D032541:Mass Vaccination / Q000706:statistics & numerical data; D008457:Measles / Q000453:epidemiology / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage*; D009032:Mosquito Control / Q000379:methods*; D011203:Poverty / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000458:organization & administration; D012959:Socioeconomic Factors
chemical_list: D008458:Measles Vaccine