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Predictors of Vaccination in India for Children Aged 12-36 Months
Nijika Shrivastwa1, Brenda W Gillespie2, Giselle E Kolenic2
1Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Insights
India’s childhood immunization coverage remains low. Key predictors for under- and non-vaccination include religion, caste, and maternal care, highlighting disparities in the Universal Immunization Program.
Area of Science:
- Public Health
- Epidemiology
- Global Health
Background:
- India faces challenges with low childhood immunization rates despite the Universal Immunization Program (UIP).
- Understanding factors influencing vaccination status is crucial for improving public health outcomes.
Purpose of the Study:
- To identify predictors of under- and non-vaccination among Indian children aged 12-36 months.
- To inform targeted interventions for improving immunization coverage.
Main Methods:
- Utilized District Level Household and Facility Survey Data (DLHS3) from India (2008).
- Employed multinomial logistic regression to analyze vaccination status (fully, under-, non-vaccinated).
- Included socioeconomic, cultural, household, maternal, and childhood characteristics as predictors.
Main Results:
- In 2008, only 57% of children were fully vaccinated; 31% were under-vaccinated, and 12% were non-vaccinated.
- Significant predictors included religion, caste, place of delivery, antenatal care visits, and maternal tetanus vaccination.
- These factors demonstrated large effect sizes, indicating substantial impact on vaccination status.
Conclusions:
- India's immunization coverage in 2008 was suboptimal, with over 40% of children not fully vaccinated.
- Addressing disparities related to demographic and cultural factors is essential for enhancing UIP effectiveness.
- Further research into these predictors can guide interventions to reduce vaccination gaps.
Introduction:
India has one of the lowest immunization rates worldwide despite a longstanding Universal Immunization Program (UIP) that provides free childhood vaccines. This study characterizes the predictors for under- and non-vaccination among Indian children aged 12-36 months.
Methods:
This study utilized District Level Household and Facility Survey Data, 2008 (DLHS3), from India. DLHS3 is a nationally representative sample collected from December 2007 through December 2008; this analysis was conducted during 2014. Children's vaccination status was categorized as fully, under-, and non-vaccinated based on whether children received all, some, or none of the UIP-recommended vaccines (one dose each of bacillus Calmette-Guérin and measles, and three doses of diphtheria-pertussis-tetanus). A multinomial logistic regression model estimated the odds of under-vaccination compared with full vaccination, and odds of non-vaccination compared with full vaccination. Analytic predictors included socioeconomic, cultural, household, maternal, and childhood characteristics.
Results:
The analysis included 108,057 children; the estimated proportions of fully, under-, and non-vaccinated children were 57%, 31%, and 12%, respectively. After adjusting for state of residence, age, gender, household wealth, and maternal education, additional significant predictors of children's vaccination status were religion, caste, place of delivery, number of antenatal care visits, and maternal tetanus vaccination, all of which demonstrated large effect sizes.
Conclusions:
India's immunization coverage remained low in 2008, with just slightly more than half of all children aged 12-36 months fully vaccinated with UIP-recommended vaccines. A better understanding of the predictors for vaccination can help shape interventions to reduce disparities in full vaccination among children of differing demographic/cultural groups.
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