Socioeconomic inequalities in child vaccination coverage in Tanzania over time: a decomposition analysis using the 2004/05, 2010 and 2015/2016 demographics and health surveys

Main Article Content

M J Ntegwa
L Rossouw


Background. Despite global strides to reduce child morbidity and mortality, the number of infant and child deaths from preventable causes in low-and middle-income countries remains unacceptably high. A cost-effective strategy to improve child health outcomes is through child vaccination and subsequent immunisation. Despite free child vaccination in the public healthcare sector in Tanzania, the country’s vaccination rates have plateaued and remain concentrated among children from wealthier households.

Objective. To identify the factors contributing to inequality in childhood vaccination in Tanzania.

Methods. This retrospective study used secondary data from the Tanzania Demographic and Health Survey for 2004/05, 2010 and 2015/16. Inequalities were measured using the Erreygers’ corrected concentration indices. These inequalities were then decomposed to gain a deeper understanding of the contributing factors.

Results. Child vaccinations are higher among children from wealthier households in Tanzania, and this disparity has intensified over time. Socioeconomic differences in wealth, residential locations, mass media exposure and maternal education have become increasingly important drivers of these inequalities among Tanzanians.

Conclusions. Socioeconomic divisions in Tanzania threaten to perpetuate inequalities in access to healthcare and subsequent health. Child vaccination should be provided equitably to all children regardless of their household’s socioeconomic background. Moreover, efforts should be made to address these gaps between the vulnerable and the more privileged groups in society.

Article Details

How to Cite
Socioeconomic inequalities in child vaccination coverage in Tanzania over time: a decomposition analysis using the 2004/05, 2010 and 2015/2016 demographics and health surveys. (2024). South African Journal of Child Health, 18(1), e1960.

How to Cite

Socioeconomic inequalities in child vaccination coverage in Tanzania over time: a decomposition analysis using the 2004/05, 2010 and 2015/2016 demographics and health surveys. (2024). South African Journal of Child Health, 18(1), e1960.


UNIGME. Levels and trends in child mortality: Report 2021. https://reliefweb. int/report/world/levels-and-trends-child-mortality-report-2021 (accessed 14 August 2023).

Olusegun OL, Ibe RT, Ikorok MM. Curbing maternal and child mortality: The Nigerian experience. Int J Nurs Midwifery 2012;4(3):33-39. doi.10.5897/ IJNM11.030

Oliwa JN, Marais BJ. Vaccines to prevent pneumonia in children – a developing country perspective. Paediatr Respir Rev 2017;22:23-30. prrv.2015.08.004

Bloom DE, Canning D, Weston M. The value of vaccination. World Econ 2005;6(3):15-40.

Bärnighausen T, Bloom DE, Canning D, O’Brien J. Accounting for the full benefits of childhood vaccination in South Africa. S Afr J Med 2008;98(11):842- 846.

Peck M, Gacic-Dobo M, Diallo MS, Nedelec Y, Sodha SS, Wallace AS. Global routine vaccination coverage, 2018. Morb Mortal Wkly Rep 2019;68(42):937- 942. icon

NBS, ICF Macro. Tanzania Demographic and Health Survey and Malaria Indicator Survey 2015-2016 report. Dar es Salaam, Tanzania; 2016.

Tesema GA, Tessema ZT, Tamirat KS, Teshale AB. Complete basic childhood vaccination and associated factors among children aged 12–23 months in East Africa: a multilevel analysis of recent demographic and health surveys. BMC Public Health 2020;20(1):1-14.

Ataguba JE, Ojo KO, Ichoku HE. Explaining socio-economic inequalities in immunisation coverage in Nigeria. Health Policy Plan 2016;31(9):1212-1224.

Bobo FT, Hayen A. Decomposition of socioeconomic inequalities in child vaccination in Ethiopia: results from the 2011 and 2016 demographic and health surveys. BMJ Open 2020;10(10):1–11. bmjopen-2020-039617

Joseph KJV. Understanding inequalities in child immunisation in India: a decomposition approach. J Biosoc Sci 2021;1-13. S0021932021000110

Mutua MK, Mohamed SF, Porth JM, Faye CM. Inequities in on-time childhood vaccination: evidence from Sub-Saharan Africa. Am J Prev Med 2021;60(1):S11-S23.

Asuman D, Ackah CG, Enemark U. Inequalities in child immunisation coverage in Ghana: evidence from a decomposition analysis. Health Econ Rev 2018;8(9):1-13. 018-0193-7

Corsi DJ, Bassani DG, Kumar R, Awasthi S, Jotkar R, Kaur N, et al. Gender inequity and age-appropriate immunisation coverage in India from 1992 to 2006. BMC Int Health Hum Rights 2009;9(SUPPL.1):1-12. https://doi. org/10.1186/1472-698X-9-S1-S3

Pal R. Decomposing inequality of opportunity in immunisation by circumstances: Evidence from India. Eur J Dev Res 2016;28(3):431-446. https://

Filmer D, Pritchett L. Estimating wealth effects without expenditure data-or tears : an application to educational enrollments in states of India. Demography 2011;38(1):115-132. https://doi.


Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social determinants of health discussion Paper 2 (Policy and Practice). Geneva, Switzerland; 2010. https:// SDHDP2.pdf ?ua=1

O’Donnell O, Van Doorslaer E, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. WBI Learning Resources Series. 2008. hl=en&btnG=Search&q=intitle:Analyzing+Hea lth+Equity+Using+Household+Survey+Data#5 (accessed 14 August 2023).

Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med


Erreygers G. Correcting the concentration index. J Health Econ. 2009;28(2):504-515. https://doi. org/10.1016/j.jhealeco.2008.02.003

O’Donnell O, O’neill S, Ourti T Van, Walsh B. Conindex: Estimation of concentration indices. Stata J 2016;16(1):112-138. https://doi. org/10.1177/1536867X1601600112

Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econom 2003;112(1):207-223. https://

Efron B, Tibshirani R. Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Stat Sci 1986;1(1):54- 77.

Yiengprugsawan V, Lim LL, Carmichael GA, Dear KB, Sleigh AC. Decomposing socioeconomic inequality for binary health outcomes: An improved estimation that does not vary by choice of reference group. BMC Res Notes 2010;3(57):1-5.

Lyimo D, Kamugisha C, Yohana E, et al. Improving the efficiency and standards of a national immunisation program review: lessons learnt from United Republic of Tanzania. Pan Afr Med J 2017;28:1-7. https://www.panafrican-med-journal. com/content/article/28/209/full

Fuertes CV, Johns NE, Goodman TS, Heidari S, Munro J, Hosseinpoor AR. The association between childhood immunisation and gender inequality: a multi-country ecological analysis of zero- dose DTP prevalence and DTP3 immunisation coverage. Vaccines 2020;10(7):1032. https://www.

Adedokun ST, Uthman OA, Adekanmbi VT, Wiysonge CS. Incomplete childhood immunisation in Nigeria: a multilevel analysis of individual and contextual factors. BMC Public Health 2017;17(1):1-10. s12889-017-4137-7

Saleska JL, Choi KR. A behavioral economics perspective on the COVID-19 vaccine amid public mistrust. Transl Behav Med 2021;11(3):821-825.

Glewwe P. Why does mother’s schooling raise child health in developing countries? Evidence from Morocco. J Hum Resour 1999;34(1):124- 159.

Andriano L, Monden CWS. The causal effect of maternal education on child Mortality: Evidence from a quasi-experiment in Malawi and Uganda. Demography 2019;56(5):1765-1790. https://doi. org/10.1007/s13524-019-00812-3

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>