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

Abstract

Background Although hepatitis B vaccinations have been integrated in the Universal Immunization Program (UIP) in India over a decade, only half of the children are immunized against hepatitis B. The national average in hepatitis B vaccination conceals large variations across states, districts and socio-economic groups. In this context, the aim of this paper is to examine the spatial heterogeneity and contextual determinants of hepatitis B vaccination across the districts of India. Methods Using data of 199,899 children aged 12–59 months from the National Family Health Survey-4 (NFHS-4), 2015–16 we have examined the district level spatial distribution and clustering of hepatitis B vaccination with the help of Moran’s I and Local Indicator of Spatial Autocorrelation (LISA) measures. We investigated the low coverage of HBV vaccination using spatial autoregressive models (SAR) at the meso scale. And we applied multivariate binary logistic regression analysis to understand the micro-level predictors of hepatitis B vaccination. Results In 2015–16, 45% of the children aged 12–59 months were not vaccinated against hepatitis B in India. The coverage of hepatitis B vaccine across the districts of India showed a highly significant spatial dependence (Moran’s I = 0.580). Bivariate Moran’s I confirmed the spatial clustering of hepatitis B vaccination with mother’s education, full antenatal care (ANC) utilization, post natal care (PNC) utilization, institutional births and registration of births at the district level. Districts with a very low coverage of HBV vaccine are clustered in the western, north-eastern regions and in some parts of central India. At the unit (child) level, children’s hepatitis B immunization status is mostly determined by the socio-economic and demographic characteristics like their mother’s educational status, caste, religion, household’s wealth condition, birth order, year of birth and the region they belong to. Conclusions District level variation in hepatitis B vaccination is spatially heterogeneous and clustered in India with a strong neighbourhood effect. Uptake of hepatitis B vaccine among Indian children is predominantly dependent upon their socio-economic and demographic characteristics.

Vaccination against hepatitis B virus in hemodialysis patients: trends in dialysis centers of Northern Pakistan

“…This suggests that more male patients are on hemodialysis and CKD is also more common CKD patients and education in a study conducted by Amjad et al 14 , which differs from our results. Studies from the general population and healthcare workers showed that education was significantly associated with vaccination status against HBV, comparable to our results [24][25][26] . Individuals who have more education may be better aware of the preventive role of vaccination, which may be the cause of better vaccination status in higher educated people.…”

Vaccination against hepatitis B virus in hemodialysis patients: trends in dialysis centers of Northern Pakistan

“…This is the same as the United States Renal Data System 2011 Annual Data Report that showed that the initiation of dialysis was much higher in males as compared to females 18 . However, a meta-analysis reported that in some studies CKD was more common in females, while in other was significantly associated with vaccination status against HBV, comparable to our results [24][25][26] . Individuals who have more education may be better aware of the preventive role of vaccination, which may be the cause of better vaccination status in higher educated people.…”

The burden of anthropometric failure and child mortality in India

“…Additionally, checking the pattern of missing we found that the missing pattern is not random (MAR) and thus we could not impute. Though we followed the DHS guidelines, another limitation of vaccination data from National family Health Survey is that it is based upon mother's recall when vaccination card not found at the time survey, which introduces a non-sampling bias in the estimation process 50,51 . Additionally, the dataset lacks the information on cause specific mortality and in a country like India, diarrhoeal infection, acute respiratory infection and low utilization of post natal care largely contributes to child mortality 37,52,53 with state and regional variation to which we could not adjust while compiling the infant and child mortality rates to execute the district level meso scale analysis.…”