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Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007–2008
  1. Rita Barradas Barata1,
  2. Manoel Carlos Sampaio de Almeida Ribeiro1,
  3. José Cássio de Moraes1,
  4. Brendan Flannery2,
  5. on behalf of the Vaccine Coverage Survey 2007 Group*
  1. 1Department of Social Medicine, School of Medical Sciences of Santa Casa, São Paulo, Brazil
  2. 2Pan American Health Organization, Brasília, Brazil
  1. Correspondence to Dr Rita Barradas Barata, Department of Social Medicine, School of Medical Sciences of Santa Casa, Rua Dr. Cesario Mota Jr 61, São Paulo 01221020, Brazil; rita.barradasbarata{at}


Background Since 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract.

Methods The authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination.

Results Among 17 295 children with immunisation cards, 14 538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%–86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than those with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant.

Conclusions Evidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas.

  • Epidemiology
  • ethnicity
  • health status
  • health policy
  • surveillance

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  • * Vaccine Coverage Survey 2007 Group are listed in appendix 1.

  • Funding The vaccination coverage survey was wholly financed by the Brazilian Ministry of Health. The Brazilian national immunisation programme commissioned the survey but played no role in its design, data analysis or preparation of the final report. Results of the survey were presented to the Brazilian Ministry of Health. In several capitals, field staff were recruited from local immunisation programmes and trained as interviewers to conduct fieldwork.

  • Competing interests None declared.

  • Ethics approval Research Ethics Committee of Santa Casa Hospital in São Paulo, Brazil.

  • Provenance and peer review Not commissioned; externally peer reviewed.