Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India

Abstract

BackgroundAlthough 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette–Guérin, only 75% complete the recommended three doses of diphtheria-pertussis-tetanus (DPT, also referred to as DTP) vaccine. Determinants can be different for nonvaccination and dropout but have not been examined in earlier studies. We use the three-dose DPT series as a proxy for the full sequence of recommended childhood vaccines and examine the determinants of DPT nonvaccination and dropout between doses 1 and 3.MethodsWe analyzed data on 75,728 6- to 23-month-old children in villages across India to study demand- and supply-side factors determining nonvaccination with DPT and dropout between DPT doses 1 and 3, using a multilevel approach. Data come from the District Level Household and Facility Survey 3 (2007–08).ResultsIndividual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3. Children whose mothers had no schooling were 2.3 times more likely not to receive any DPT vaccination and 1.5 times more likely to drop out between DPT doses 1 and 3, compared with children whose mothers had 10 or more years of schooling. Although supply-side factors related to availability of public health facilities and immunization-related health workers in villages were not correlated with dropout between DPT doses 1 and 3, children in districts where 46% or more villages had a healthcare subcentre were 1.5 times more likely to receive at least one dose of DPT vaccine compared with children in districts where 30% or fewer villages had subcentres.ConclusionsNonvaccination with DPT in India is influenced by village- and district-level contextual factors over and above individuals’ background characteristics. Dropout between DPT doses 1 and 3 is associated more strongly with demand-side factors than with village- and district-level supply-side factors.

Factors associated with routine childhood vaccine uptake and reasons for non-vaccination in India: 1998–2008

“…Many earlier studies from India have conducted similar analyses combining immunization information based on maternal recall and vaccination cards and in our study, a vast majority of the unvaccinated children (89%) would have been excluded if the analyses were restricted to information based on maternal recall alone [7,12,22,23,26,28,44,45]. Third, a recent study observed age misreporting and likely underreporting of recent pregnancies among female respondents, highlighting potential selection and information biases in large scale surveys such as the DLHS [46].…”

“…Previous research from India tends to highlight socio-demographic characteristics associated with uptake such as child's gender, order of birth, place of delivery, maternal age at childbirth, parental education, caste and religious preference, household wealth and location (urban or rural) , [6][7][8]11,12]. Of late, non-socio-demographic demand-side issues such as awareness regarding the need for and timing of routine childhood vaccinations, fears regarding some or all routine vaccines and parental beliefs regarding false contraindications to routine vaccinations have been reported as reasons linked to partialvaccination and non-vaccination of Indian children [4, 12,13]. As, the Indian Government aims to boost full immunization coverage of UIP vaccines to 90% through the Mission Indradhanush initiative by 2020, it is important to track the various socio-demographic and non-socio-demographic factors influencing suboptimal vaccination over the years to identify key areas of intervention and further research.…”

Inequalities in Rotavirus Vaccine Uptake in Ethiopia: A Decomposition Analysis

“…This is not surprising because our model took into account mostly demand-side determinants. However, various studies documented several supply-side factors as a predictor for immunization coverage [9,10,[72][73][74], such as cold chain management, vaccine availability, and adequacy of staffing which we are not able to include in our model due to lack of such information in the dataset we used. Moreover, there may be other demand-side factors that could be associated with underlining socio-economic inequality and that need to be examined in future studies.…”

Determining Significant Factors Affecting Vaccine Demand and Factor Relationships Using Fuzzy DEMATEL Method

“…There are several classifications made by researchers to classify determinants of vaccine uptake. Ghosh et al [ 6 ] classify immunization coverage factors in two categories according to their literature review, supply-side and demand-side. According to their research demand-side factors covers birth order, sex, maternal education, and employment status, occupation type, immunization related beliefs, mother’s health knowledge, health-seeking behavior, household wealth index, religion, and caste.…”