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Factors affecting timeliness in vaccination of under-five children in India: A cross-sectional study using the NFHS 5
Divya Bharathi Gattam1, Mohammed Shoyaib Khazi2, Nitu Kumari3
1Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, India.
Insights
Ensuring timely childhood immunizations in India remains a challenge, with factors like low birth weight and rural residency contributing to delays. The COVID-19 pandemic did not significantly impact vaccination timeliness, highlighting the need for comprehensive interventions.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Immunization is crucial for child health, protecting against vaccine-preventable diseases globally.
- Ensuring timely vaccine administration in India faces challenges, exacerbated by the COVID-19 pandemic.
- Vaccination timeliness is a key indicator of effective public health interventions for child survival.
Purpose of the Study:
- To assess vaccination timeliness among children under five in India.
- To identify factors associated with delayed vaccine administration, including child, maternal, household, and community characteristics.
- To evaluate the impact of the COVID-19 pandemic on childhood immunization timeliness.
Main Methods:
- A cross-sectional study utilizing the Kids Recode dataset from the National Family Health Survey 5 (NFHS-5).
- Included 232,920 children under five years of age.
- Regression analysis was performed to determine adjusted Prevalence Ratios for factors influencing vaccination timeliness, with timeliness defined as within 4 days before to 28 days after the scheduled date.
Main Results:
- Timeliness was highest at birth (94.6%) but declined significantly for later doses: 6 weeks (74.2%) and 14 weeks (67.5%).
- Major contributors to untimeliness at 14 weeks were Polio 3 (60.2%) and Rotavirus 3 (58.0%) vaccines.
- Factors associated with untimeliness included low birth weight, fewer antenatal visits, non-institutional delivery, lack of maternal education, rural residence, lower socioeconomic status, and residence in Central and Northeast zones.
- Vaccination timeliness remained comparable between pre- and post-COVID-19 pandemic periods.
Conclusions:
- Childhood vaccination untimeliness in India is influenced by a complex interplay of child, maternal, household, and community-level factors.
- Targeted interventions addressing these determinants are necessary to improve immunization schedules.
- Despite pandemic disruptions, overall vaccination timeliness did not show significant decline, suggesting resilience in the system but persistent underlying challenges.
Abstract:
Immunization is an essential intervention that protects millions of children against vaccine-preventable diseases across the world. Although vaccination coverage has improved over the years, ensuring timely administration continues to be a major challenge affecting child health in India. The COVID-19 pandemic further aggravated this situation. A cross-sectional study using the Kids Recode dataset of the National Family Health Survey 5 was conducted, which inlcuded 232920 children under 5 y of age. Timeliness was considered as 4 d earlier and up to 28 d after the standard date in comparison with the National Immunization Schedule. Regression analysis was used on Survey Data to assess the impact of factors related to children, mothers, households, communities, and the COVID-19 pandemic on timeliness by deriving adjusted Prevalence Ratios. Timeliness at birth was highest (94.6%), however, it declined for subsequent doses at 6 weeks (74.2%), and 14 weeks (67.5%). Untimeliness at 14 weeks was mainly due to Polio 3 (60.2%) and Rotavirus 3 (58.0%) vaccines. Factors associated with untimeliness included - low birth weight, fewer antenatal visits, non-institutional delivery, no maternal education, rural residency and belonging to lower socioeconomic strata. Children residing in the Central and Northeast zones had the highest prevalence of untimeliness in receiving vaccines. Despite the COVID-19 pandemic disruptions, the timeliness of vaccination was comparable between the pre- and post-pandemic periods. This study shows that the untimeliness of vaccination is influenced by factors related to the child, mother, household and community. Comprehensive interventions involving various stakeholders are required to improve the timeliness of vaccination.
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