Caste-ethnic disparity in vaccine use among 0-to 5-year-old children in Nepal: a decomposition analysis

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. 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. 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. Nepal's national vaccine programs should increase focus on reaching geographically distant populations, and continue to develop vaccination-related education efforts.