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Vaccination and All Cause Child Mortality 1985-2011: Global Evidence from the Demographic and Health Surveys

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  • McGovern, Mark E.
  • Canning, David

Abstract

Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimate the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determine the relationship between vaccination coverage and under five mortality at the survey cluster level. Our data include approximately one million children in 68,490 clusters in 62 countries. We consider the childhood measles, Bacille Calmette-Guérin (BCG), Diphtheria-Pertussis-Tetanus (DPT), Polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjust for selection bias caused by the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimate that children in clusters with complete vaccination coverage have relative risk of mortality 0.73 (95% Confidence Interval: 0.68, 0.77) that of children in a cluster with no vaccination. While widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing their coverage rates in order to reduce child mortality.

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  • McGovern, Mark E. & Canning, David, 2015. "Vaccination and All Cause Child Mortality 1985-2011: Global Evidence from the Demographic and Health Surveys," Working Paper 227741, Harvard University OpenScholar.
    • Handle: RePEc:qsh:wpaper:227741
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    References listed on IDEAS

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    1. David E. Bloom & David Canning & Erica S. Shenoy, 2012. "The effect of vaccination on children's physical and cognitive development in the Philippines," Applied Economics, Taylor & Francis Journals, vol. 44(21), pages 2777-2783, July.
    2. Michael A. Koenig & David Bishai & Mehrab Ali Khan, 2001. "Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh," Population and Development Review, The Population Council, Inc., vol. 27(2), pages 283-302, June.
    3. Felicity T Cutts & Hector S Izurieta & Dale A Rhoda, 2013. "Measuring Coverage in MNCH: Design, Implementation, and Interpretation Challenges Associated with Tracking Vaccination Coverage Using Household Surveys," PLOS Medicine, Public Library of Science, vol. 10(5), pages 1-11, May.
    4. David E. Bloom & David Canning & Mark Weston, 2005. "The Value of Vaccination," World Economics, World Economics, 1 Ivory Square, Plantation Wharf, London, United Kingdom, SW11 3UE, vol. 6(3), pages 15-39, July.
    5. Koenig, M.A. & Roy, N.C. & McElrath, T. & Shahidullah & Wojtyniak, B., 1998. "Duration of protective immunity conferred by maternal tetanus toxoid immunization: Further evidence from Matlab, Bangladesh," American Journal of Public Health, American Public Health Association, vol. 88(6), pages 903-907.
    6. Canning, David & Razzaque, Abdur & Driessen, Julia & Walker, Damian G. & Streatfield, Peter Kim & Yunus, Mohammad, 2011. "The effect of maternal tetanus immunization on children's schooling attainment in Matlab, Bangladesh: Follow-up of a randomized trial," Social Science & Medicine, Elsevier, vol. 72(9), pages 1429-1436, May.
    7. David Bishaia & Michael Koenig & Mehrab Ali Khan, 2003. "Measles vaccination improves the equity of health outcomes: evidence from Bangladesh," Health Economics, John Wiley & Sons, Ltd., vol. 12(5), pages 415-419, May.
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    Cited by:

    1. Mark E. McGovern, 2019. "How much does birth weight matter for child health in developing countries? Estimates from siblings and twins," Health Economics, John Wiley & Sons, Ltd., vol. 28(1), pages 3-22, January.
    2. Marianna Battaglia & Nina Pallarés, 2020. "Family Planning and Child Health Care: Effect of the Peruvian Programa de Salud Reproductiva y Planificación Familiar, 1996–2000," Population and Development Review, The Population Council, Inc., vol. 46(1), pages 33-64, March.
    3. Maria Teresa Solis-Soto & Deepak Paudel & Francesco Nicoli, 2020. "Relationship between vaccination and nutritional status in children: Analysis of recent Demographic and Health Surveys," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 42(1), pages 1-14.
    4. Rikuya Hosokawa & Toshiyuki Ojima & Tomoya Myojin & Jun Aida & Katsunori Kondo & Naoki Kondo, 2020. "Associations between Healthcare Resources and Healthy Life Expectancy: A Descriptive Study across Secondary Medical Areas in Japan," IJERPH, MDPI, vol. 17(17), pages 1-16, August.
    5. Jorge Garcia-Hombrados, 2022. "Child marriage and infant mortality: causal evidence from Ethiopia," Journal of Population Economics, Springer;European Society for Population Economics, vol. 35(3), pages 1163-1223, July.
    6. Gupta, Aashish, 2019. "Where there is smoke: Solid fuel externalities, gender, and adult respiratory health in India," SocArXiv 45fn6, Center for Open Science.
    7. Gauri Kartini Shastry & Daniel L Tortorice, 2021. "Effective Foreign Aid: Evidence from Gavi’s Vaccine Program," Working Papers 2102, College of the Holy Cross, Department of Economics.
    8. Ojewumi Titus Kolawole & Akanni Akinyemi & Bola L. Solanke, 2023. "Household Vulnerability and Childhood Immunization Status in Nigeria," SAGE Open, , vol. 13(3), pages 21582440231, July.
    9. Jorge García Hombrados, 2017. "Child Marriage and Infant Mortality: Evidence from Ethiopia," Working Paper Series 1317, Department of Economics, University of Sussex Business School.

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    JEL classification:

    • J10 - Labor and Demographic Economics - - Demographic Economics - - - General
    • I10 - Health, Education, and Welfare - - Health - - - General

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