Understanding Disparities in Vaccination Coverage among Indian Children.

Childhood vaccinations;India;Public Health;Health Sciences;Epidemiological Science

Shrivastwa, NijikaLepkowski, James M. ;

University of Michigan

关键词: Childhood vaccinations;    India;    Public Health;    Health Sciences;    Epidemiological Science;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/111362/nijikas_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

India has one of the lowest immunization rates of any country in the world, and accounts for more than 20 percent of the child deaths under 5 years of age worldwide. Poor vaccination coverage has been identified as one of the leading causes of high child mortality rates in India, despite the government’s longstanding free Universal Immunization Program. The overarching aim of this dissertation research was to identify barriers to receiving the recommended vaccinations among Indian children, using the District Level Household and Facility Survey Data, 2007-08. The first study investigated the association between socio-cultural characteristics and risk of under-vaccination and non-vaccination. The results suggested that the reasons for under- and non-vaccination in India were similar. Inequities in vaccination coverage among social and religious groups were clearly evident after controlling for all the traditional risk factors of vaccination. The second study examined vaccination timeliness utilizing data from children both with and without a vaccination card in a novel application of an existing statistical methodology. Vaccine administration at the recommended time or by the maximum recommended age is considered timely. The results indicated that relatively small percentages (approximately 35%) of Indian children received vaccinations at the ages recommended by India’s national immunization schedule. Furthermore, the state-specific analysis found that considerable variation in vaccination probabilities existed across Indian states.The third paper examined state-level factors that influence childhood vaccination, controlling for individual-level confounders. Average population served by a primary health center and the state-level poverty were variables which explained some of the between state variability in full-vaccination coverage. Additionally, the association of religion with vaccination was found to depend on the percent Muslim population in a state. The findings of this dissertation research further the current knowledge regarding the drivers of childhood vaccinations in India, and demonstrate a novel application of a known methodology for studying vaccination timeliness to assess vaccination program performance; these results may help to shape interventions that reduce disparities in full vaccination among children of different demographic/cultural groups.