Understanding inequalities in child immunization in India: a decomposition approach

2021 ◽  
pp. 1-13
Author(s):  
Vinod Joseph Kannankeril Joseph
Keyword(s):  
Socioeconomic Factors ◽  
Low Socioeconomic Status ◽  
Concentration Index ◽  
Immunization Coverage ◽  
Household Wealth ◽  
Child Growth ◽  
Care Utilization ◽  
Decomposition Approach ◽  
Child Immunization ◽  
Full Immunization

Abstract The importance of childhood immunization for healthy child growth and development is well recognized and is considered to be the best and most cost-effective lifesaver. Low socioeconomic status has been shown to be associated with low child immunization and health care utilization, but the inequalities in immunization coverage due to social and economic factors are poorly understood. This study aimed to explore the association between child immunization coverage and various socioeconomic factors and to quantify their contributions to generating inequalities in immunization coverage in India. The study data are from the National Family Health Survey-4 conducted in 2015–16. The association between socioeconomic determinants and child full immunization coverage was estimated using the χ2 test and binary logistic regression. Concentration indices were estimated to measure the magnitude of inequality, and these were further decomposed to explain the contribution of different socioeconomic factors to the total disparity in full immunization coverage. The results showed that the uptake of immunization in 2015–16 was highly associated with mother’s educational status and household wealth. The concentration index decomposition revealed that inequality (immunization disadvantage) was highest among poorer economic groups and among children whose mothers were illiterate. The overall concentration index value indicates that the weaker socioeconomic groups in India are more disadvantaged in terms of immunization interventions. The results offer insight into the dynamics of the variation in immunization coverage in India and help identify vulnerable populations that should be targeted to decrease socioeconomic inequalities in the country.

WEALTH-BASED INEQUALITY IN CHILD IMMUNIZATION IN INDIA: A DECOMPOSITION APPROACH

2017 ◽  
Vol 50 (3) ◽  
pp. 312-325 ◽  
Author(s):  
Avijit Debnath ◽  
Nairita Bhattacharjee
Keyword(s):  
Immunization Coverage ◽  
Decomposition Approach ◽  
Child Immunization ◽  
Vaccine Preventable Diseases ◽  
Modified Method ◽  
Socioeconomic Strata ◽  
Unequal Access ◽  
Facility Survey ◽  
Remarkable Progress ◽  
Main Factor

SummaryDespite years of health and medical advancement, children still suffer from infectious diseases that are vaccine preventable. India reacted in 1978 by launching the Expanded Programme on Immunization in an attempt to reduce the incidence of vaccine-preventable diseases (VPDs). Although the nation has made remarkable progress over the years, there is significant variation in immunization coverage across different socioeconomic strata. This study attempted to identify the determinants of wealth-based inequality in child immunization using a new, modified method. The present study was based on 11,001 eligible ever-married women aged 15–49 and their children aged 12–23 months. Data were from the third District Level Household and Facility Survey (DLHS-3) of India, 2007–08. Using an approximation of Erreyger’s decomposition technique, the study identified unequal access to antenatal care as the main factor associated with inequality in immunization coverage in India.

scholarly journals Change in full immunization inequalities in Indian children 12–23 months: an analysis of household survey data

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Brian Wahl ◽  
Madhu Gupta ◽  
Daniel J. Erchick ◽  
Bryan N. Patenaude ◽  
Taylor A. Holroyd ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Tamil Nadu ◽  
Concentration Index ◽  
Maternal Education ◽  
Immunization Coverage ◽  
Indian Children ◽  
Enabling Factors ◽  
Calculated Concentration ◽  
Immunization Status ◽  
Full Immunization

Abstract Background India has made substantial progress in improving child health in recent years. However, the country continues to account for a large number of vaccine preventable child deaths. We estimated wealth-related full immunization inequalities in India. We also calculated the degree to which predisposing, reinforcing, and enabling factors contribute to these inequalities. Methods We used data from the two rounds of a large nationally representative survey done in all states in India in 2005–06 (n = 9582) and 2015–16 (n = 49,284). Full immunization status was defined as three doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, one dose of Bacillus Calmette–Guérin vaccine, and one dose of measles vaccine in children 12–23 months. We compared full immunization coverage by wealth quintiles using descriptive statistics. We calculated concentration indices for full immunization coverage at the national and state levels. Using predisposing, reinforcing, and enabling factors associated with full immunization status identified from the literature, we applied a generalized linear model (GLM) framework with a binomial distribution and an identity link to decompose the concentration index. Results National full immunization coverage increased from 43.65% in 2005–06 to 62.46% in 2015–16. Overall, full immunization coverage in both 2005–06 and 2015–16 in all states was lowest in children from poorer households and improved with increasing socioeconomic status. The national concentration index decreased from 0.36 to 0.13 between the two study periods, indicating a reduction in poor-rich inequality. Similar reductions were observed for most states, except in states where inequalities were already minimal (i.e., Tamil Nadu) and in some northeastern states (i.e., Meghalaya and Manipur). In 2005–06, the contributors to wealth-related full immunization inequality were antenatal care, maternal education, and socioeconomic status. The same factors contributed to full immunization inequality in 2015–16 in addition to difficulty reaching a health facility. Conclusions Immunization coverage and wealth-related equality have improved nationally and in most states over the last decade in India. Targeted, context-specific interventions could help address overall wealth-related full immunization inequalities. Intensified government efforts could help in this regard, particularly in high-focus states where child mortality remains high.

scholarly journals Assessment of Child Immunization Coverage and Associated Factors with Full Vaccination among Children Aged 12–23 Months at Mizan Aman Town, Bench Maji Zone, Southwest Ethiopia

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Asrat Meleko ◽  
Mesfin Geremew ◽  
Frehiwot Birhanu
Keyword(s):  
Educational Level ◽  
Immunization Coverage ◽  
Cost Effective ◽  
Care Utilization ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Child Immunization ◽  
Mortality And Morbidity ◽  
Expanded Program On Immunization ◽  
Coverage Rates

Immunization remains one of the most important and cost-effective public health interventions to reduce child mortality and morbidity. Globally, it is estimated to avert between 2 and 3 million deaths each year. In Ethiopia, immunization coverage rates stagnated and remained very low for many years. Thus, this study was aimed to assess child immunization coverage and factors associated with full vaccination among children aged 12–23 months in Mizan Aman town. The study design was community-based cross-sectional survey. Data was collected by using pretested structured questionnaire. A total of 322 mothers/caretakers were interviewed. Based on vaccination card and mothers/caretakers’ recall, 295 (91.6%) of the children took at least a single dose of vaccine. From total children, 27 (8.4%) were not immunized at all, 159 (49.4%) were partially immunized, and 136 (42.2%) were fully immunized. Mothers/caretakers educational level, fathers’ educational level, place of delivery, maternal health care utilization, and mothers/caretakers knowledge about vaccine and vaccine-preventable disease showed significant association with full child immunization. The finding from this study revealed that child immunization coverage in the studied area was low. Thus the town health office and concerned stakeholders need to work more to improve performance of the expanded program on immunization in this area.

scholarly journals The Effect of Maternal Education and Antenatal Care on Basic Immunization Completeness in Children aged 12-23 Months in Asian and African: Meta-Analysis

2020 ◽  
Vol 5 (6) ◽  
pp. 614-628
Author(s):  
Farida Farida ◽  
◽  
Vitri Widyaningsih ◽  
Bhisma Murti ◽  
◽  
...  
Keyword(s):  
Antenatal Care ◽  
Maternal Education ◽  
Meta Analysis ◽  
Immunization Coverage ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Child Immunization ◽  
Central Java ◽  
Article Analysis ◽  
Full Immunization

Background: Immunization is a process that makes a person immune or immune to infectious diseases, usually by administering vaccines. A child is said to have received complete basic immunization if he has received one BCG immunization, three DPT-HB-Hib immunizations, four polio immunizations, and one measles immunization. This study aims to estimate the effect of maternal education and antenatal care on the provision of complete basic immunization for children aged 12-23 months in Asia and Africa by means of a meta-analysis. Subjects and Method: Meta-analyzes were performed by searching articles from the PubMed, SpringerLink, Science Direct, and Google Scholar databases. The keywords used are "immunization coverage" OR "vaccination coverage" OR "complete immunization" OR "complete vaccination" OR "full immunization" OR "full vaccination" AND children OR "child immunization" OR "child immunization coverage" AND "maternal education ”. The inclusion criteria in this study were full text articles, published in 2012-2020, using English, cross-sectional study design, the final results of the study using the adjusted odd ratio (aOR), and the study sample was children aged 12-23 months in Asia and Africa. Article analysis was performed using RevMan 5.3 software. Results: There were eleven articles analyzed in total. The results showed maternal education and antenatal care could improve the provision of complete basic immunization to children aged 12-23 months in Asia and Africa, maternal education (aOR= 1.52; 95% CI= 1.06 to 2.18; p= 0.020), I 2= 89% and care antenatal (aOR= 2.62; 95% CI= 1.84-3.72; p= 0.002), I 2= 69%. Conclusion: Maternal education and antenatal care influence the provision of complete basic immunization to children aged 12-23 months in Asia and Africa. Keywords: Maternal education, antenatal care, complete basic immunization, children 12-23 months Correspondence: Farida. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: 085654415292.

scholarly journals Associations of Nutritional Status with Full Immunization Coverage and Safe Hygiene Practices among Thai Children Aged 12–59 Months

Nutrients ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 34
Author(s):  
Chisa Shinsugi ◽  
Ann Mizumoto
Keyword(s):  
Nutritional Status ◽  
Immunization Coverage ◽  
Cost Effective ◽  
Child Growth ◽  
Nutrition Status ◽  
Prevention Measures ◽  
Household Level ◽  
Hygiene Practices ◽  
Poor Nutritional Status ◽  
Full Immunization

Prevailing prevention measures against morbidity, such as vaccination and safe hygiene practices, vary among local cultural contexts, and little is known about the extent to which these behaviors mitigate poor nutritional status in young children in Southeast Asia. We examined the associations between nutrition status with full immunization coverage, and water, sanitation and hygiene status among children aged 12–59 months in the 2015–2016 Thailand Multiple Indicator Cluster Survey (n = 9060). When adjusted for confounding factors, children with incomplete immunization status were more likely to be stunted (adjusted odds ratio (aOR) 1.47; 95% confidence interval (CI): 1.24–1.75, p < 0.001), wasted (aOR 1.67, 95% CI: 1.31–2.12, p < 0.001), and overweight (aOR 1.24, 95% CI: 1.01–1.51, p < 0.05), whereas children who used unimproved water sources were more likely to be overweight (aOR 2.43, 95% CI: 1.27–4.64, p < 0.01). The further implementation of simple and cost-effective health promotion activities and practices at the household level may be important interventions for healthy child growth and development, particularly under restricted living conditions due to COVID-19.

scholarly journals Child Nutrition Among Circular Migrant Families Working in the Brick Kilns of Bihar, India (P10-052-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Reshma Roshania ◽  
Rakesh Giri ◽  
Melissa Fox Young ◽  
G Sai Mala ◽  
Amy Webb Girard ◽  
...  
Keyword(s):  
Immunization Coverage ◽  
Wealth Index ◽  
Household Wealth ◽  
Nutrition Status ◽  
Cluster Sampling ◽  
Z Score ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Brick Kilns ◽  
Migrant Families

Abstract Objectives The objective of this study was to estimate the prevalence of child malnutrition and the determinants of nutrition status among circular migrant families working in the brick industry in Bihar, India, focusing on differences by origin. Methods We used a stratified, cluster sampling design consisting of a cross-sectional survey in 552 randomly selected brick kilns (clusters) throughout Bihar. Circular migration was defined as residence outside the home block for at least 60 days for employment plus at least one home return in the previous year. Per kiln, three circular migrant households with children 0–35 months of age were randomly selected. We collected kiln, household and child-level data including anthropometric measurements for each selected child (n = 1198). Descriptive, bivariate and logistic regression analyses were conducted in SAS. The primary outcomes were stunting (<-2 SD height-for-age z score) and wasting (<-2 SD weight-for-height z score). The primary exposure of interest was intrastate vs. interstate origin; covariates included household wealth index, parity of the mother, and child age and gender. Results Prevalence of stunting was lower among interstate migrants (47%) compared to intrastate migrants (55%, aOR: 0.66, 95%CI: 0.50–0.88). Wasting was higher among interstate migrants (43%) compared to intrastate migrants (34%, aOR:1.51, 95%CI: 1.17–1.94). Among children 6–23 months, 13% had a minimum acceptable diet; MAD was higher among interstate migrants (17%), compared to intrastate migrants (10%) (P = 0.014). Full immunization coverage among circular migrants was 39%, lower than the overall state (62%, NFHS IV). Open defecation was reported by over 90% of circular migrants. Conclusions Our results are likely to inform the ongoing policy discourse on circular migrants’ access to health and nutrition benefits. State of origin emerged as an important predictor of nutrition status, operating differently for acute and chronic malnutrition; we will further explore pathways of nutrition by origin in future analyses. Funding Sources Bill & Melinda Gates Foundation.

scholarly journals The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: Analysis from four recent Demographic and Health Surveys in Nepal

2019 ◽  
Author(s):  
Kiran Acharya ◽  
Yuba Raj Paudel ◽  
Dinesh Dharel
Keyword(s):  
Vaccination Coverage ◽  
Maternal Education ◽  
Immunization Coverage ◽  
Wealth Quintile ◽  
Educational Status ◽  
Household Wealth ◽  
Demographic And Health Surveys ◽  
Relative Index ◽  
Index Of Inequality ◽  
Over Time

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in child health care use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens:Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.Results Full immunization coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from -32.3 [-45.5,-19.1] in 2001 to an SII of-8.4 [-18.6,-1.7] in 2016. Similarly, the SII for education decreased from -61.8 [-73.5,-50.1] in 2001 to an SII of -30.5 [-40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full immunization coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (-0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

scholarly journals Child Immunization Coverage – A Critical Review

2016 ◽  
Vol 18 (05) ◽  
pp. 48-53
Author(s):  
Sourabh Shastri ◽  
Anand Sharma ◽  
Prof. Vibhakar Mansotra
Keyword(s):  
Critical Review ◽  
Immunization Coverage ◽  
Child Immunization
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