title: Investigating socio-economic inequity in access to and expenditures on routine immunization services in Anambra state.
abstract: BACKGROUND
  Addressing existing inequities in the utilization of priority health services such as routine immunization is a current public health priority. Increasing access to routine immunization from the current low levels amongst all socio-economic status groups in Nigeria is challenging. However, little is known on the level of SES inequity in utilization of routine immunization services and such information which will inform the development of strategies for ensuring equitable provision of routine immunization services in the country. The study was a cross sectional household survey, which was undertaken in two randomly selected communities in Anambra State, southeast Nigeria. A pre-tested interviewer administered questionnaire was used to collect data on levels of access to RI by children under-2 years from randomly selected households. In each household, data was collected from the primary care givers or their representative (in their absence). The relationship between access to routine immunization and socio-economic status of households and other key variables was explored in data analysis.
  
  
  RESULTS
  Households from high socio-economic status (well-off) groups utilized routine immunization services more than those that belong to low socio-economic status (poor) groups (X2= 9.97, p < 0.002). It was found that higher percentage of low socio-economic status households compared to the high socio-economic status households received routine immunization services at public health facilities. Households that belong to low socio-economic status groups had to travel longer distance to get to health facilities consequently incurring some transportation cost. The mean expenditures on service charge for routine immunization services (mostly informal payments) and transportation were US$1.84 and US$1.27 respectively. Logistic regression showed that access to routine immunization was positively related to socio-economic status and negatively related to distant of a household to a health facility.
  
  
  CONCLUSIONS
  Ability to pay affects access to services, even when such services are free at point of consumption with lower socio-economic status groups having less access to services and also having other constraints such as transportation. Hence, innovative provision methods that will bring routine immunization services closer to the people and eliminate all formal and informal user fees for routine immunization will help to increase and improve equitable coverage with routine immunization services.
authors.affiliation: Department of Nursing Science, NnamdiAzikiwe University, Nnewi Campus, Nnewi, Nigeria. florence_t2000@yahoo.com.|Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria. florence_t2000@yahoo.com.
authors.forename: Florence T
authors.initials: FT
authors.lastname: Sibeudu
authors.affiliation: Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.|Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria, Enugu Campus, Enugu, Nigeria.
authors.forename: Benjamin S C
authors.initials: BS
authors.lastname: Uzochukwu
authors.affiliation: Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria, Enugu Campus, Enugu, Nigeria.|Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria.
authors.forename: Obinna E
authors.initials: OE
authors.lastname: Onwujekwe
mesh_terms: D000328:Adult; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006292:Health Priorities / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007114:Immunization / Q000379:methods / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D009549:Nigeria; D012423:Rural Health / Q000706:statistics & numerical data; D012923:Social Class; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Access; Expenditures; Inequity; Routine immunization; SES; Socio-economic status; Utilization