Analysis of State-Specific Differences in Childhood Vaccination Coverage in Rural India

Abstract

There is little research on state-level differences in child health outcomes in India. The aim of this study was to identify state-level characteristics that relate to childhood immunizations. Most state-level characteristics came from the 2011 Indian Census. Individual-level data and other state-level characteristics were obtained from the 2007–2008 District Level Household and Facility Survey. Predictors of full vaccination were assessed with logistic regression models. Among 86,882 children 12–36 months, 53.2% were fully vaccinated. Children living in bigger households (≥7 members), born in non-institutional settings, and female had lower odds of complete vaccination. Individuals living in states in the mid-range of poverty had lower odds of full vaccination compared to those in lower or higher poverty states (3rd vs. 1st quintile: odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.30, 0.42). Greater average population per primary health center was associated with decreased odds of full vaccination (5th vs. 1st quintile: OR: 0.37, 95% CI: 0.30, 0.47). Vaccination coverage in India can be explained by a complex interplay of individual- and state-level factors. Solutions to increasing vaccination must be multisectoral and acknowledge the cultural and socio-economic diversity that influences an individual child’s vaccination coverage along with within-state disparities.

Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries

“…Another important consideration is how the relationship of socioeconomic status (SES) varies with vaccine hesitancy, and whether this is context-specific. Low vaccine uptake in LMICs has mostly been associated with individuals of lower SES [17][18][19][20][21], although this has been tied to disparities in access, affordability, and awareness, and less so on acceptance or hesitancy [22,23]. In contrast, more affluent individuals in high-income countries appear to be more vaccine hesitant and may have lower vaccine uptake [24][25][26].…”

Study of determinants of immunization status among under-five children attending OPD in a rural health center of the tertiary health care institute

“…[ 22 23 ] It must be emphasized that improving access to Primary Health Centres could help address inequities in vaccination coverage in areas characterized by lower levels of maternal education. [ 24 ]…”

“…This is compounded by the lack of awareness among these populations about the measures needed to promote positive health. [ 24 ] This invites the prompt mobilization of healthcare outreach by healthcare functionary and strong political commitment toward rural infrastructure development. [ 9 28 ]…”

Implementation fidelity and acceptability of an intervention to improve vaccination uptake and child health in rural India: a mixed methods evaluation of a pilot cluster randomized controlled trial

“…It is estimated that among the 19.5 million children worldwide who did not receive all basic vaccines in the first year of life in 2016, 16% were from India [18]. India has achieved considerable improvements in child vaccination coverage; however, significant challenges to closing the immunization gap remain, especially those related to beneficiary demand for immunization [19].…”

“…India has achieved considerable improvements in child vaccination coverage; however, significant challenges to closing the immunization gap remain, especially those related to beneficiary demand for immunization [19]. Sociodemographic factors, levels of knowledge, and public beliefs may affect vaccination coverage in children [18,19]. Educational approaches targeting the general population and adapted to local beliefs are necessary to address these barriers [19].…”