Equity assessment of childhood immunisation at national and subnational levels in Myanmar: a benefit incidence analysis.

INTRODUCTION: Myanmar, a conflict-affected geographically and ethnically diverse lower middle-income country, was in the donor transition phase for health prior to the political unrest of the last year. This study analyses the distribution of benefit and utilisation of basic childhood vaccinations from the highly donor-dependent Expanded Program on Immunization for populations of different socioeconomic status (SES). METHODS: We conducted a benefit incidence analysis with decomposition analysis to assess the equity of benefit. We used basic childhood immunisations-BCG, measles, diphtheria, pertussis and tetanus (DPT)/pentavalent, oral polio vaccine (OPV) and full vaccination-as measurements for healthcare use. Childhood immunisation data were collected from Myanmar Demographic and Health Survey. Cost of vaccines was obtained from UNICEF document and 'Immunization Delivery Cost Catalogue' and adjusted with regional cost variations. We reported Concentration Index (CI) and Achievement Index (AI) by SES, including wealth quintiles, maternal education and across geographic areas. RESULTS: Nationally, better-off households disproportionately used more services from the programme (CI-Wealth Index (CI-WI) for BCG, measles, DPT/pentavalent, OPV and full immunisation: 0.032, 0.051, 0.120, 0.091 and 0.137, respectively). Benefits had a pro-poor distribution for BCG but a less pro-rich distribution than utilisation for all other vaccines (CI-WI: -0.004, 0.019, 0.092, 0.045 and 0.106, respectively). Urban regions had a more pro-rich distribution of benefit than that in rural areas, where BCG and measles had a pro-poor distribution. Subnational analysis found significant heterogeneity: benefit was less equitably distributed, and AI was lower in conflict-affected states than in government-controlled areas. The major contributors to vaccine inequality were SES, antenatal care visits and paternal education. CONCLUSION: Donors, national government and regional government should better plan to maintain vaccine coverage while improving equity of vaccine services, especially for children of lower SES, mothers with less antenatal care visits and lower paternal education living in conflicted-affected remote regions.

The hidden impact of childhood cancer on the family: a multi-institutional study from Singapore.

INTRODUCTION: The care of children with cancer creates emotional and financial hardships for their families. There is a lack of information on the impact of childhood cancer on the family as a whole in Singapore. Thus, we set out to assess the financial impact as well as its psychosocial impact in our local context. MATERIALS AND METHODS: All patients diagnosed and treated for cancer at the Departments of Paediatrics, KK Women's and Children's Hospital and National University Hospital, Singapore were eligible for this study. Families of these patients completed 2 self-administered questionnaires: (i) About-you and your-family and (ii) the Impact-On-Family scale. For the latter, the total score was obtained by the summation of all scores, where high scores correlated to high impact. RESULTS: Seventy-nine parents were enrolled during the study period from October 2008 to February 2009. Being of Malay/Indian origin was associated with a high overall family burden. On the other hand, being of Malay/Indian origin was also associated with most successful at mastery when a child was diagnosed with cancer (P = 0.001). In addition, when compared to caregivers who remained employed, those who were asked to quit their job, experienced a higher Financial Burden (P = 0.03), a high Familial/Social Burden (P = 0.05) and a high Personal Strain (P = 0.03). CONCLUSION: Childhood cancer impacted family life in Singapore at many levels. In particular, the factors involved are various cultural discourses; employment status of caregivers; and those whose leave/pay are affected.