Exploring the spatial heterogeneity in different doses of vaccination coverage in India

Abstract

BackgroundDespite the universalization of immunization against the six vaccine-preventable diseases (VPDs), the coverage of full immunization among the children under age five has remained a challenge globally. The 2015–16 National Family Health Survey (NFHS) indicated large disparity in the coverage of different vaccination doses (BCG, Polio, DPT and Measles) including full immunization across the districts of India. The spatial distribution of poor performing districts in terms of vaccination and the district level spatial, contextual determinants contributing to the low coverage have been poorly studied. Using the recent household survey (NFHS, 2015–16), this study examined the spatial heterogeneity and the factors associated with low vaccination coverage among the children aged 12–23 months across India.Data and methodsThis study used the data from fourth round of National Family Health Survey conducted in 2015–16. District-level prevalence of each of the vaccination doses including full immunization, were analysed. Moran’s I, Univariate and Bivariate LISA, Ordinary least square (OLS) and spatial models were employed to achieve the overall aim of the study.ResultsAt the national level, the prevalence of full immunization was 62 percent. Specific vaccination coverage for BCG, three doses of polio, three doses of DPT and measles were 92, 73, 78 and 81 percent, respectively. The value of the bivariate Moran’s I statistics confirmed the spatial dependence between specific vaccination and the set of independent variables. District-level prevalence of the specific vaccine and full immunization showed significant spatial clustering across India. The adjusted coefficients from the spatial error model confirmed that district-level proportion of utilization of post-natal care, institutional births, neonatal tetanus protection of the last birth, women’s education and coverage of health insurance showed statistically significant association with every doses of vaccination coverage.ConclusionThe full and specific immunization coverage was considerably low in the geographical hotspots as compared to the national coverage. Maternal and child health care services utilization, financial assistance to the mothers through JSY scheme and mother’s education were found to determine full immunization as well as the specific vaccination coverage. Appropriate intervention should be designed to reduce the geographical disparity in the coverage of specific and full immunization across India and thus safeguard child health protecting the children from the vaccine preventable diseases across the geography.

A cross-sectional study on selected child health outcomes in India: Quantifying the spatial variations and identification of the parental risk factors

“…Partial-or-no-immunization was found to be higher for the Central (Uttar Pradesh and Madhya Pradesh), Northern (Rajasthan) and North-eastern region respectively 27 . These results corroborate with the existing literatures which suggest that Northern (Rajasthan), Central (Madhya Pradesh, Uttar Pradesh), North-eastern, and Western (Gujarat, some parts of Maharashtra) region of the country still have a lower prevalence of full immunization 17,28,29 .…”

“…Studies conducted in different country settings like-Asia, Africa, Latin America, and the Middle East show positive association between parental education and child's nutritional status 47 and in this study also a parental education gradient in stunting and anaemia is observed which indicates lower burden of child stunting and anaemia among the children of higher educated parents. In a different study it has been shown that education level and occupation of the mother and the father is associated with the knowledge of childhood vaccination 17 . This study also reinforces the fact that educated parents are aware about the childhood vaccination of the full immunization doses and children of the educated parents do not miss the doses compared to those children whose parents do not have any formal education.…”

“…To examine geographical clustering of child health outcomes, univariate local Moran's I and Local indicator of Spatial Association (LISA) cluster maps were created. We created the spatial weight matrix (w) of order one using the Queen's contiguity method (neighbors sharing a common boundary of non-zero length) to quantify the spatial proximity between each possible pair of observational entities 17 .…”

Haemophilus influenzae type b vaccination and anthropometric, cognitive, and schooling outcomes among Indian children

“…Childhood vaccination rates vary widely across regions and socioeconomic groups in India . Standard of living, access to postnatal care and subsidized vaccines, maternal schooling, and health insurance coverage have all been linked positively to vaccination rates . These factors could make Hib‐vaccinated and ‐unvaccinated children systematically different, potentially biasing least squares regression–based estimates of the associations of the vaccine with our outcomes of interest because such differences may also be linked to these outcomes.…”

Temporal Trend and Inequality in Immunization Coverage in India

“…The Government of India recently launched the Mission Indradhanush (UIP) in 2014 with the target of achieving universal immunization coverage https://www.nhp.gov.in/mission-indradhanush1_ pg. Irrespective of these attempts, nearly one-third of the children remain to be far away from vaccinations in India [8][9][10][11][12].…”