Complete basic vaccination in Nepal: Barriers and trends over the last decade

Over the past decade, Nepal experienced conflict claiming the lives of 15,000 people and displacing 100,000. At the same time, the economy improved along with key health and population outcomes. The percent of children receiving complete basic vaccinations (CBV) increased from 43% in 1996 to 83% in 2006, the percentage of girls enrolled in school rose from 57% to 87%, and the under-5 mortality rate fell by over half from 139 deaths/1000 live births in 1996 to 61 ten years later.

However, such improvements at the national level mask increasing inequalities in health outcomes. We examine the likelihood of children receiving CBV by 23 months in 1996, 2001 and 2006 using nationally representative Nepal Demographic and Health Surveys. Methods include bivariate analysis using DHS wealth quintiles, and logistic regression.

Wealth has a strong stratifying effect on CBV that has increased over time. By 2006, children in the second through highest quintiles were 2-3.5 times more likely to have received CBV than the poorest children.

Recommendations include targeted interventions to expand CBV to the poorest Nepali children. These findings are relevant not only for Nepal, but also point to the dangers of economic inequality at home and abroad. Nigeria serves as an example of the implications for the rest of the country and region when one subarea of a country fails to vaccinate their children. In a globalized world, when poor children in Nepal and other countries do not have sufficient access to critical vaccines, we are all at risk.