PMID- 37112763
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230501
IS  - 2076-393X (Print)
IS  - 2076-393X (Electronic)
IS  - 2076-393X (Linking)
VI  - 11
IP  - 4
DP  - 2023 Apr 16
TI  - What Determines the District-Level Disparities in Immunization Coverage in India: 
      Findings from Five Rounds of the National Family Health Survey.
LID - 10.3390/vaccines11040851 [doi]
LID - 851
AB  - India's Universal Immunization Programme has been performing at a sub-optimal 
      level over the past decade, with there being a wide disparity in terms of 
      immunization coverage between states. This study investigates the covariates that 
      affect immunization rates and inequality in India at the individual and district 
      levels. We used data from the five rounds of the National Family Health Survey 
      (NFHS), conducted from 1992-1993 to 2019-2021. We used multilevel binary logistic 
      regression analysis to examine the association between demographic, 
      socio-economic and healthcare factors and a child's full immunization status. 
      Further, we used the Fairlie decomposition technique to understand the relative 
      contribution of explanatory variables to a child's full immunization status 
      between districts with different immunization coverage levels. We found that 76% 
      of children received full immunization in 2019-2021. Children from less wealthy 
      families, urban backgrounds, Muslims, and those with illiterate mothers were 
      found to have lower chances of receiving full immunization. There is no evidence 
      that gender and caste disparities have an impact on immunization coverage in 
      India. We found that having a child's health card is the most significant 
      contributor to reducing the disparities that exist regarding children's full 
      immunization between mid- and low-performing districts. Our study suggests that 
      healthcare-related variables are more crucial than demographic and socio-economic 
      variables when determining ways in which to improve immunization coverage in 
      Indian districts.
FAU - Saikia, Nandita
AU  - Saikia N
AUID- ORCID: 0000-0001-6735-6157
AD  - Public Health and Mortality Studies, International Institute for Population 
      Sciences, Mumbai 400088, India.
AD  - Centre for the Studies of Regional Development, Jawaharlal Nehru University, New 
      Delhi 110067, India.
FAU - Kumar, Krishna
AU  - Kumar K
AUID- ORCID: 0000-0002-6822-900X
AD  - Centre for the Studies of Regional Development, Jawaharlal Nehru University, New 
      Delhi 110067, India.
FAU - Bora, Jayanta Kumar
AU  - Bora JK
AD  - VART Consulting Ltd. (P), Delhi NCR 201002, India.
FAU - Mondal, Souvik
AU  - Mondal S
AD  - Centre for the Studies of Regional Development, Jawaharlal Nehru University, New 
      Delhi 110067, India.
FAU - Phad, Santosh
AU  - Phad S
AD  - Public Health and Mortality Studies, International Institute for Population 
      Sciences, Mumbai 400088, India.
FAU - Agarwal, Sumeet
AU  - Agarwal S
AD  - Department of Electrical Engineering, Indian Institute of Technology Delhi, New 
      Delhi 110016, India.
LA  - eng
GR  - NA/Biotechnology Industry Research Assistance Council/
PT  - Journal Article
DEP - 20230416
PL  - Switzerland
TA  - Vaccines (Basel)
JT  - Vaccines
JID - 101629355
PMC - PMC10144648
OTO - NOTNLM
OT  - Fairlie decomposition
OT  - India
OT  - district level
OT  - immunization coverage
OT  - inequalities
OT  - socio-economic and healthcare utilization
COIS- The authors declare no conflict of interest.
EDAT- 2023/04/28 06:42
MHDA- 2023/04/28 06:43
PMCR- 2023/04/16
CRDT- 2023/04/28 01:53
PHST- 2023/01/13 00:00 [received]
PHST- 2023/02/10 00:00 [revised]
PHST- 2023/04/14 00:00 [accepted]
PHST- 2023/04/28 06:43 [medline]
PHST- 2023/04/28 06:42 [pubmed]
PHST- 2023/04/28 01:53 [entrez]
PHST- 2023/04/16 00:00 [pmc-release]
AID - vaccines11040851 [pii]
AID - vaccines-11-00851 [pii]
AID - 10.3390/vaccines11040851 [doi]
PST - epublish
SO  - Vaccines (Basel). 2023 Apr 16;11(4):851. doi: 10.3390/vaccines11040851.