Caste-ethnic disparity in vaccine use among 0- to 5-year-old children in Nepal: a decomposition analysis
OBJECTIVES: To examine what factors, if any, could account for caste/ethnic disparities in vaccine utilization between upper caste and indigenous, and upper caste and low caste (Dalit) groups in Nepal. METHODS: Using the Institute of Medicine (IOM) approach to calculate disparity, we estimate the disparity between upper caste and indigenous, and between upper caste and Dalit 0- to 5-year-old children in Nepal. Then we use Fairlie's non-linear regression-based decomposition technique to account for those disparities in immunization. RESULTS: Using nationally representative data (the Nepal Living Standard Survey II and III), we construct a pooled cross-sectional series and calculate the disparity between upper caste and indigenous (8.047 %), and between upper caste and Dalit (7.215 %). Both of these comparisons are significant at less than 1 % significance level. Decomposition results show that a major portion of the disparity can be attributed to the difference in access to immunization services, followed by differences in household income and parental education. CONCLUSIONS: Nepal's national vaccine programs should increase focus on reaching geographically distant populations, and continue to develop vaccination-related education efforts.