Vaccination coverage in India: A small area estimation approach

Abstract

Information on population health indicators in India come from a number of surveys that vary in periodicity, scope and detail. In the case of immunization, the most recent coverage indicators are derived from the first round of Annual Health Survey (AHS-1, 2010-11), but these were conducted only in 9 of 35 states and union territories. The most recent national surveys of immunization coverage were conducted in 2009 (Coverage Evaluation Survey) by UNICEF. Therefore, reliable immunization coverage data for the entire country since 2009 is lacking. We used an established approach of small area estimation to predict coverage rates of several vaccinations for the remaining 26 states (not covered by AHS-1) in 2011. In our method, we considered a linear mixed model that combines data from five cross sectional surveys representing five different time points. Our model encompasses sampling error of the survey estimates, area specific random effects, autocorrelated area by time random effects and hence, borrows strength across areas and time points both. Model-based estimates for 2011 are almost identical to the AHS-1 estimates for the nine states, suggesting that our model provides reliable prediction of vaccination coverage as AHS-1 estimates are highly precise because of their large sample size. Results indicate that coverage inequality between rural and urban areas has been reduced significantly for most states in India. The National Rural Health Mission has had both supply side and demand side effects on the immunization programme in rural India. In combination, these effects may have contributed to the reduction of vaccination coverage gaps between urban and rural areas.

Not covered enough: inadequate age appropriate immunisation in urban slums of Delhi: a community based cross sectional survey

“…The age appropriate immunization coverage was found to be higher than the full immunization coverage reported by Devasenapathy et al and lower as recorded by Sharma et al conducted in different urban resettlement colonies of Delhi. 22,23 There was a trend of coverage drop among vaccines with more than one dose and with increasing age as also reported by Pramanik et al 15 Majority of children (98%) received vaccination from the public health facility, consistent with NFHS 4 reported data of 92.2% for the urban area of Delhi. 21 This highlights the availability of government clinics or Aaganwadi centers at or near the urban slums and it took on an average four minutes fifty seconds for the beneficiary to reach the center for vaccine administration.…”

“…12 This observation was similar to the reports of integrated child health and immunization survey, rounds 1 and 2, where the coverage of first dose of DPT or pentavalent vaccine was 92% in first born and fell to 85% in third born child. 15,24 The declining coverage could be because of families' becoming less vigilant about vaccination in higher order infants but at the same time experience with first-born familiarized mothers with the vaccination schedule. Factors like institutional delivery, less time taken to reach center for administration of vaccine was found to be significantly associated with age appropriate immunization and consistent with results of other studies suggesting better availability of health care facilities positively impact age appropriate immunization.…”

Variation in cost and performance of routine immunisation service delivery in India

“…Unit costs were highest in Banaskantha district in Gujarat probably because of low immunisation coverage rate (39%) in this district as per the data used for district stratification. 6 Unit costs, including vaccine costs, were generally higher in the districts of Gujarat and Kerala likely because of usage of pentavalent vaccine in these two states during the study period. Pentavalent vaccine was more expensive than the DPT and hepatitis B vaccines taken together (US$2.11 per dose versus US$0.12 per dose) ( table 3 ).…”

Predictors of Vaccination in India for Children Aged 12–36 Months

“…India's immunization coverage remained unacceptably low in 2008, with only slightly more than half of all children 26 Additionally, a web-based Mother and Child Tracking System that collects childhood immunization data was introduced by the government in 2009; however, it has relatively low enrollment and other data capture-related problems. More recently, the Indian Government declared in 2012 that a renewed focus on strengthening routine immunization services was needed, which was followed by the establishment of an Immunization Technical Support Unit at the Public Health Foundation of India in collaboration with other partners to revamp the ongoing efforts to improve vaccination coverage.…”