Examining wealth-related inequality in childhood vaccination in Fiji using the UNICEF Multiple Indicator Cluster Survey 2021.

Background: Despite a 95% immunisation rate in Fiji, disparities exist in the distribution of immunisation in children from different socioeconomic backgrounds. We used data from the 2021 Fiji Multiple Indicator Cluster Survey (MICS) to determine socioeconomic inequalities contributing to differences in immunisation coverage.

Methods: Data were extracted from the 'Household', 'Fertility/Birth history' and 'Children under 5' modules from the 2021 Fiji MICS to determine wealth quintiles and calculate vaccination rates for children aged 12-23 mo. Logistic regression was performed with factors of interest. Erreygers' corrected concentration index (ECI) was calculated and used to measure socioeconomic inequality.

Results: Out of 417 children; 85.6% (357/417) were fully immunised, 12.0% (50/417) partially immunised and 2.4% (10/417) had no immunisations. Factors associated with increased probability of being fully immunised included being in the highest wealth quintile after adjusting for the number of children in the household. Children from larger households were more likely to be partially immunised after adjusting for household wealth. The ECI for fully vaccinated children was positive, whereas the ECI was negative for partially vaccinated children. Logistic regression also indicated a pro-rich inequality in vaccination.

Conclusions: Our results help guides policy decisions on the delivery of immunisation services, enabling more equitable childhood immunisation in Fiji.