PMID- 30485291
OWN - NLM
STAT- MEDLINE
DCOM- 20190422
LR  - 20200309
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 11
DP  - 2018
TI  - Exploring the spatial heterogeneity in different doses of vaccination coverage in 
      India.
PG  - e0207209
LID - 10.1371/journal.pone.0207209 [doi]
LID - e0207209
AB  - BACKGROUND: Despite the universalization of immunization against the six 
      vaccine-preventable diseases (VPDs), the coverage of full immunization among the 
      children under age five has remained a challenge globally. The 2015-16 National 
      Family Health Survey (NFHS) indicated large disparity in the coverage of 
      different vaccination doses (BCG, Polio, DPT and Measles) including full 
      immunization across the districts of India. The spatial distribution of poor 
      performing districts in terms of vaccination and the district level spatial, 
      contextual determinants contributing to the low coverage have been poorly 
      studied. Using the recent household survey (NFHS, 2015-16), this study examined 
      the spatial heterogeneity and the factors associated with low vaccination 
      coverage among the children aged 12-23 months across India. DATA AND METHODS: 
      This study used the data from fourth round of National Family Health Survey 
      conducted in 2015-16. District-level prevalence of each of the vaccination doses 
      including full immunization, were analysed. Moran's I, Univariate and Bivariate 
      LISA, Ordinary least square (OLS) and spatial models were employed to achieve the 
      overall aim of the study. RESULTS: At the national level, the prevalence of full 
      immunization was 62 percent. Specific vaccination coverage for BCG, three doses 
      of polio, three doses of DPT and measles were 92, 73, 78 and 81 percent, 
      respectively. The value of the bivariate Moran's I statistics confirmed the 
      spatial dependence between specific vaccination and the set of independent 
      variables. District-level prevalence of the specific vaccine and full 
      immunization showed significant spatial clustering across India. The adjusted 
      coefficients from the spatial error model confirmed that district-level 
      proportion of utilization of post-natal care, institutional births, neonatal 
      tetanus protection of the last birth, women's education and coverage of health 
      insurance showed statistically significant association with every doses of 
      vaccination coverage. CONCLUSION: The full and specific immunization coverage was 
      considerably low in the geographical hotspots as compared to the national 
      coverage. Maternal and child health care services utilization, financial 
      assistance to the mothers through JSY scheme and mother's education were found to 
      determine full immunization as well as the specific vaccination coverage. 
      Appropriate intervention should be designed to reduce the geographical disparity 
      in the coverage of specific and full immunization across India and thus safeguard 
      child health protecting the children from the vaccine preventable diseases across 
      the geography.
FAU - Khan, Junaid
AU  - Khan J
AUID- ORCID: 0000-0003-4662-2318
AD  - International Institute for Population Sciences (IIPS), Mumbai, India.
FAU - Shil, Apurba
AU  - Shil A
AD  - International Institute for Population Sciences (IIPS), Mumbai, India.
FAU - Prakash, Ravi
AU  - Prakash R
AD  - Karnataka Health Promotion Trust (KHPT), Bangalore, India.
LA  - eng
PT  - Journal Article
DEP - 20181128
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (BCG Vaccine)
RN  - 0 (Diphtheria-Tetanus-Pertussis Vaccine)
RN  - 0 (Measles Vaccine)
RN  - 0 (Poliovirus Vaccines)
SB  - IM
MH  - BCG Vaccine/administration & dosage
MH  - Child Health Services
MH  - Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage
MH  - Female
MH  - Geography
MH  - Health Surveys
MH  - Healthcare Disparities/statistics & numerical data
MH  - Humans
MH  - Immunization Programs/statistics & numerical data
MH  - India
MH  - Infant
MH  - Least-Squares Analysis
MH  - Male
MH  - Measles Vaccine/administration & dosage
MH  - Poliovirus Vaccines/administration & dosage
MH  - Regression Analysis
MH  - Vaccination Coverage/*statistics & numerical data
PMC - PMC6261550
COIS- The authors have declared that no competing interests exist.
EDAT- 2018/11/30 06:00
MHDA- 2019/04/23 06:00
PMCR- 2018/11/28
CRDT- 2018/11/29 06:00
PHST- 2018/04/04 00:00 [received]
PHST- 2018/10/27 00:00 [accepted]
PHST- 2018/11/29 06:00 [entrez]
PHST- 2018/11/30 06:00 [pubmed]
PHST- 2019/04/23 06:00 [medline]
PHST- 2018/11/28 00:00 [pmc-release]
AID - PONE-D-18-09736 [pii]
AID - 10.1371/journal.pone.0207209 [doi]
PST - epublish
SO  - PLoS One. 2018 Nov 28;13(11):e0207209. doi: 10.1371/journal.pone.0207209. 
      eCollection 2018.