Hepatitis B vaccination coverage across India: exploring the spatial heterogeneity and contextual determinants

Area of Science:

• Public Health
• Epidemiology
• Spatial Analysis

Background:

• Hepatitis B vaccination is part of India's Universal Immunization Program, yet coverage remains suboptimal, affecting only half of eligible children.
• Significant variations in hepatitis B vaccination rates exist across different states, districts, and socio-economic groups within India.

Purpose of the Study:

• To investigate the spatial heterogeneity and contextual determinants of hepatitis B vaccination coverage at the district level in India.
• To identify geographical clusters of low hepatitis B vaccination coverage and understand associated factors.

Main Methods:

• Utilized data from 199,899 children (12-59 months) from the National Family Health Survey-4 (2015-16).
• Employed Moran's I and Local Indicator of Spatial Autocorrelation (LISA) for spatial distribution and clustering analysis.
• Applied spatial autoregressive models (SAR) and multivariate binary logistic regression to identify determinants at meso and micro levels.

Main Results:

• In 2015-16, 45% of children aged 12-59 months were not vaccinated against hepatitis B.
• Significant spatial dependence (Moran's I = 0.580) was observed in hepatitis B vaccine coverage across districts.
• Low coverage clusters were identified in western, north-eastern, and central India, associated with maternal education, ANC/PNC utilization, and institutional births.
• Child-level immunization status was influenced by maternal education, caste, religion, wealth, birth order, and region.

Conclusions:

• Hepatitis B vaccination coverage in India exhibits significant spatial heterogeneity and clustering, indicating a strong neighborhood effect.
• Socio-economic and demographic characteristics are primary determinants of hepatitis B vaccine uptake among Indian children.