Inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana, 1993-2014.

Background: We examined the inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana using nationally representative data from the 1993-2014 Ghana Demographic and Health Surveys (GDHSs).
Methods: Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1993-2014 GDHSs were analyzed. We disaggregated full immunization by five equity stratifiers: wealth quintile, education, sex, residence, and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio, and Population Attributable Fraction. Statistical significance was pegged at 95% Uncertainty Interval.
Results: From 1993 to 2014, full immunization was higher among children born to mothers of the richest wealth index compared with those born to mothers of the poorest wealth index. Children with highly educated mothers dominated in full immunization coverage from 1993 (86.67%; UI = 70.38, 94.68] to 2014 (79.90%; UI = 73.94, 84.78). Within the same period, children of women without education recorded the least prevalence. Full immunization coverage was high among urban children in 1993 (71.07%; UI = 63.20, 77.84) but favoured rural children in 2008 (80.09%; UI = 74.30, 84.84) and 2014 (79.50%; UI = 74.00, 84.09) compared to urban children. More females were fully immunized in 1993 (56.68%; UI = 50.32, 62.82). In 2003, 2008 and 2014, Volta region (82.29%; UI = 70.32, 90.11), Brong Ahafo (93.94%; UI = 82.00, 98.14) and Upper East (95.27%; UI = 87.35, 98.32) regions dominated in full immunization coverage respectively.
Conclusion: The inequality estimates revealed significant socio-economic inequality in full immunization coverage between 1993 and 2014 in Ghana. Similarly, urban children and children of women with secondary or higher education were predominantly fully immunized. To accelerate full immunization, policy makers should consider these disparities in the implementation of policies on childhood immunization in Ghana.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. There was no funding for this study.
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