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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Explaining socioeconomic inequalities in immunisation coverage in India
T2 - new insights from the fourth National Family Health Survey (2015–16)
AU - Srivastava, Swati
AU - Fledderjohann, Jasmine
AU - Upadhyay, Ashish Kumar
PY - 2020/6/16
Y1 - 2020/6/16
N2 - BackgroundChildhood vaccinations are a vital preventive measure to reduce disease incidence and deaths among children. As a result, immunisation coverage against measles was a key indicator for monitoring the fourth Millennium Development Goal (MDG), aimed at reducing child mortality. India was among the list of countries that missed the target of this MDG. Immunisation targets continue to be included in the post-2015 Sustainable Development Goals (SDG), and are a monitoring tool for the Indian health care system. The SDGs also strongly emphasise reducing inequalities; even where immunisation coverage improves, there is a further imperative to safeguard against inequalities in immunisation outcomes. This study aims to document whether socioeconomic inequalities in immunisation coverage exist among children aged 12–59 months in India.MethodsData for this observational study came from the fourth round of the National Family Health Survey (2015–16). We used the concentration index to assess inequalities in whether children were fully, partially or never immunised. Where children were partially immunised, we also examined immunisation intensity. Decomposition analysis was applied to examine the underlying factors associated with inequality across these categories of childhood immunisation.ResultsWe found that in India, only 37% of children are fully immunised, 56% are partially immunised, and 7% have never been immunised. There is a disproportionate concentration of immunised children in higher wealth quintiles, demonstrating a socioeconomic gradient in immunisation. The data also confirm this pattern of socioeconomic inequality across regions. Factors such as mother’s literacy, institutional delivery, place of residence, geographical location, and socioeconomic status explain the disparities in immunisation coverage.ConclusionsIn India, there are considerable inequalities in immunisation coverage among children. It is essential to ensure an improvement in immunisation coverage and to understand underlying factors that affect poor uptake and disparities in immunisation coverage in India in order to improve child health and survival and meet the SDGs.
AB - BackgroundChildhood vaccinations are a vital preventive measure to reduce disease incidence and deaths among children. As a result, immunisation coverage against measles was a key indicator for monitoring the fourth Millennium Development Goal (MDG), aimed at reducing child mortality. India was among the list of countries that missed the target of this MDG. Immunisation targets continue to be included in the post-2015 Sustainable Development Goals (SDG), and are a monitoring tool for the Indian health care system. The SDGs also strongly emphasise reducing inequalities; even where immunisation coverage improves, there is a further imperative to safeguard against inequalities in immunisation outcomes. This study aims to document whether socioeconomic inequalities in immunisation coverage exist among children aged 12–59 months in India.MethodsData for this observational study came from the fourth round of the National Family Health Survey (2015–16). We used the concentration index to assess inequalities in whether children were fully, partially or never immunised. Where children were partially immunised, we also examined immunisation intensity. Decomposition analysis was applied to examine the underlying factors associated with inequality across these categories of childhood immunisation.ResultsWe found that in India, only 37% of children are fully immunised, 56% are partially immunised, and 7% have never been immunised. There is a disproportionate concentration of immunised children in higher wealth quintiles, demonstrating a socioeconomic gradient in immunisation. The data also confirm this pattern of socioeconomic inequality across regions. Factors such as mother’s literacy, institutional delivery, place of residence, geographical location, and socioeconomic status explain the disparities in immunisation coverage.ConclusionsIn India, there are considerable inequalities in immunisation coverage among children. It is essential to ensure an improvement in immunisation coverage and to understand underlying factors that affect poor uptake and disparities in immunisation coverage in India in order to improve child health and survival and meet the SDGs.
KW - Immunisation
KW - India
KW - National family health survey
KW - Concentration index
KW - Decomposition analysis
KW - Standardization
KW - Immunisation intensity
KW - Sustainable development goals
U2 - 10.1186/s12887-020-02196-5
DO - 10.1186/s12887-020-02196-5
M3 - Journal article
VL - 20
JO - BMC Pediatrics
JF - BMC Pediatrics
SN - 1471-2431
M1 - 295
ER -