PMID- 32362524 OWN - NLM STAT- MEDLINE DCOM- 20210315 LR - 20210315 IS - 1873-2518 (Electronic) IS - 0264-410X (Linking) VI - 38 IP - 25 DP - 2020 May 22 TI - Socioeconomic inequality trends in childhood vaccination coverage in India: Findings from multiple rounds of National Family Health Survey. PG - 4088-4103 LID - S0264-410X(20)30503-X [pii] LID - 10.1016/j.vaccine.2020.04.023 [doi] AB - OBJECTIVES: This article examines the inequality patterns in childhood vaccination coverage at various socio-economic levels using all four rounds of nationally representative National Family Health Surveys (NFHS) in India. METHODS: The analytic sample restricted to the most recent singleton surviving children aged 12-23 months in each survey, was 11,599 in NFHS-1 (1992-93); 10,209 in NFHS-2 (1998-99); 9582 in NFHS-3 (2005-06) and 49,284 in NFHS-4 (2015-16). Complete childhood vaccination is defined as a child aged 12-23 months who received one dose of BCG (Bacille Calmette Guerin), one dose of measles, and three doses each of DPT (Diphtheria, Pertussis, Tetanus), and polio vaccine (excluding the polio vaccine given at birth) at any time before the survey-according to the vaccination card or the mother's recall. To understand inequalities in childhood vaccination, four measures were computed for each survey rounds' data-absolute measures of inequality, the slope index of inequality (SII), and two relative measures: the ratio between the extreme groups and the concentration index (CIX) to see the degree of disparity. RESULTS: The pro-rich and pro-education inequality in childhood vaccination coverage increased between 1998-99 and 2005-06 and declined considerably thereafter. This study found that inequality in childhood vaccination coverage has been minimized at a macro level such as rural-urban, male-female, religion, ethnicity, and in select geographies, but not universally at the micro-level. Findings indicate that pro-rich and pro-education inequalities were large among specific sub-groups of population: children in rural areas, children living in the northern region of the country and among scheduled tribes-as absolute and relative inequalities remained significantly high. CONCLUSION: These findings recommend robust program monitoring and policy-level support at the micro level to optimize the use of existing resources across all segments of the population in the country. CI - Copyright (c) 2020 Elsevier Ltd. All rights reserved. FAU - Khan, Nizamuddin AU - Khan N AD - Population Council, Zone 5A, Ground Floor, India Habitat Centre, Lodi Road, New Delhi 110003, India. Electronic address: nkhan@popcouncil.org. FAU - Saggurti, Niranjan AU - Saggurti N AD - Population Council, Zone 5A, Ground Floor, India Habitat Centre, Lodi Road, New Delhi 110003, India. Electronic address: nsaggurti@popcouncil.org. LA - eng PT - Journal Article DEP - 20200430 PL - Netherlands TA - Vaccine JT - Vaccine JID - 8406899 SB - IM MH - Child MH - Child, Preschool MH - Female MH - Health Surveys MH - Humans MH - Immunization Programs MH - India MH - Infant MH - Male MH - Rural Population MH - Socioeconomic Factors MH - *Vaccination MH - *Vaccination Coverage OTO - NOTNLM OT - Childhood immunization OT - India OT - NFHS OT - Socio-economic inequalities OT - Vaccination coverage COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2020/05/05 06:00 MHDA- 2021/03/16 06:00 CRDT- 2020/05/05 06:00 PHST- 2019/09/30 00:00 [received] PHST- 2020/03/26 00:00 [revised] PHST- 2020/04/09 00:00 [accepted] PHST- 2020/05/05 06:00 [pubmed] PHST- 2021/03/16 06:00 [medline] PHST- 2020/05/05 06:00 [entrez] AID - S0264-410X(20)30503-X [pii] AID - 10.1016/j.vaccine.2020.04.023 [doi] PST - ppublish SO - Vaccine. 2020 May 22;38(25):4088-4103. doi: 10.1016/j.vaccine.2020.04.023. Epub 2020 Apr 30.