Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-19T23:24:07.543Z Has data issue: false hasContentIssue false
  • English
  • Français

Understanding inequalities in child immunization in India: a decomposition approach

Published online by Cambridge University Press:  16 March 2021

Vinod Joseph Kannankeril Joseph Open the ORCID record for Vinod Joseph Kannankeril Joseph [Opens in a new window]
Vinod Joseph Kannankeril Joseph*
Affiliation:
International Institute for Population Sciences (IIPS), Mumbai, India
Get access Rights & Permissions [Opens in a new window]

Abstract

The importance of childhood immunization for healthy child growth and development is well recognized and is considered to be the best and most cost-effective lifesaver. Low socioeconomic status has been shown to be associated with low child immunization and health care utilization, but the inequalities in immunization coverage due to social and economic factors are poorly understood. This study aimed to explore the association between child immunization coverage and various socioeconomic factors and to quantify their contributions to generating inequalities in immunization coverage in India. The study data are from the National Family Health Survey-4 conducted in 2015–16. The association between socioeconomic determinants and child full immunization coverage was estimated using the χ2 test and binary logistic regression. Concentration indices were estimated to measure the magnitude of inequality, and these were further decomposed to explain the contribution of different socioeconomic factors to the total disparity in full immunization coverage. The results showed that the uptake of immunization in 2015–16 was highly associated with mother’s educational status and household wealth. The concentration index decomposition revealed that inequality (immunization disadvantage) was highest among poorer economic groups and among children whose mothers were illiterate. The overall concentration index value indicates that the weaker socioeconomic groups in India are more disadvantaged in terms of immunization interventions. The results offer insight into the dynamics of the variation in immunization coverage in India and help identify vulnerable populations that should be targeted to decrease socioeconomic inequalities in the country.

Keywords

ImmunizationInequalityIndia
Type
Research Article
Information
Journal of Biosocial Science , Volume 54 , Issue 3 , May 2022 , pp. 371 - 383
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agrawal, A, Kolhapure, S, Di Pasquale, A, Rai, J and Mathur, A (2020) Vaccine hesitancy as a challenge or vaccine confidence as an opportunity for childhood immunization in India. Infectious Diseases and Therapy 9(3), 421–432.CrossRefGoogle ScholarPubMed
Arokiasamy, P and Pradhan, J, (2011) Measuring wealth-based health inequality among Indian children: the importance of equity vs efficiency. Health Policy and Planning 26(5), 429–440.CrossRefGoogle ScholarPubMed
Barros, AJ and Hirakata, VN (2003) Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Medical Research Methodology 3, 21.CrossRefGoogle ScholarPubMed
Bora, JK and Saikia, N (2018) Neonatal and under-five mortality rate in Indian districts with reference to Sustainable Development Goal 3: an analysis of the National Family Health Survey of India (NFHS), 2015–2016. PloS One 13(7), e0201125.CrossRefGoogle ScholarPubMed
Debnath, A and Bhattacharjee, N (2018) Wealth-based inequality in child immunization in India: a decomposition approach. Journal of Biosocial Science 50(3), 312–325.CrossRefGoogle ScholarPubMed
Devasenapathy, N, Ghosh-Jerath, S, Sharma, S, Allen, E, Shankar, A and Zodpey, S (2016) Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study. BMJ Open 6, e013015.CrossRefGoogle ScholarPubMed
Doherty, E, Walsh, B and O’Neill, C (2014) Decomposing socioeconomic inequality in child vaccination: results from Ireland. Vaccine 32(27), 3438–3444.CrossRefGoogle ScholarPubMed
Esri (2017) ArcGIS Desktop: Release 10.5. Environmental Systems Research Institute, Redlands, CA,Google Scholar
Ganguly, E, Gupta, R, Widge, A, Reddy, RP, Balasubramanian, K and Reddy, PS (2018) Increasing full child immunization rates by government using an innovative computerized immunization due list in rural India. Inquiry: The Journal of Health Care Organization, Provision and Financing 55, 46958017751292.Google ScholarPubMed
Ghosh, A (1991) Eighth plan: challenges and opportunities – XII: health, maternity and child care: key to restraining population growth. Economic and Political Weekly 26(16), 1017–1022.Google Scholar
Gupta, A, Kumar, P and Olalemi, A (2017) Decomposing the socio-economic inequalities in utilization of full antenatal care in Jharkhand State, India. International Journal of Population Studies 2, doi: 10.18063/IJPS.2016.02.003.CrossRefGoogle Scholar
Gurnani, V, Haldar, P, Aggarwal, MK, Das, MK, Chauhan, A, Murray, J et al. (2018) Improving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy. BMJ 363, k4782.CrossRefGoogle ScholarPubMed
Gwatkin, DR, Rutstein, S, Johnson, K, Suliman, E, Wagstaff, A and Amouzou, A (2007) Socio-economic differences in health, nutrition, and population within developing countries: an overview. Nigerian Journal of Clinical Practice 10(4), 272–282.Google ScholarPubMed
ICF (2020) The DHS Program Spatial Data Repository. Retrieved from spatialdata.dhsprogram.com Google Scholar
IIPS and ICF (2017) National Family Health Survey (NFHS-4), 2015-16: India. International Institute for Population Sciences, Mumbai.Google Scholar
Kakwani, N (1986) Income inequality and poverty: methods of estimation and policy applications. Journal of Business Economic Statistics 4, 1.Google Scholar
Kakwani, NC (1977) Measurement of tax progressivity: an international comparison. The Economic Journal 87(345), 71–80.CrossRefGoogle Scholar
Kashyap, A, Shrivastava, S and Krishnatray, P (2019) Vaccine hesitancy: the growing parent–provider divide. Asia Pacific Media Educator 29, 259–278.CrossRefGoogle Scholar
Krishnamoorthy, Y, Kannusamy, S, Sarveswaran, G, Majella, MG, Sarkar, S and Narayanan, V (2019) Factors related to vaccine hesitancy during the implementation of Measles–Rubella campaign 2017 in rural Puducherry: a mixed-method study. Journal of Family Medicine and Primary Care 8(12), 3962–3970.CrossRefGoogle ScholarPubMed
Lahariya, C (2015) “Health system approach” for improving immunization program performance. Journal of Family Medicine and Primary Care 4, 487.CrossRefGoogle ScholarPubMed
Lauridsen, J and Pradhan, J (2011) Socio-economic inequality of immunization coverage in India. Health Economics Review 1(1), 11–11.CrossRefGoogle ScholarPubMed
Mathew, JL (2012) Inequity in childhood immunization in India: a systematic review. Indian Pediatrics 49(3), 203–223.CrossRefGoogle ScholarPubMed
MoFHW (2013) Universal Immunization Program. Immunization Division, Ministry of Health & Family Welfare, Government of India, New Delhi.Google Scholar
MoFHW (2016) Immunisation Handbook for Medical Officers. Ministry of Health and Family Welfare, Government of India, New Delhi.Google Scholar
MoFHW (2018) Comprehensive Multi-Year Plan (cMYP) 2018–22. Universal Immunization Programme Reaching Every Child. Immunization Division, Ministry of Health & Family Welfare, Government of India, New Delhi.Google Scholar
Mohanty, SK and Pathak, PK (2009) Rich–poor gap in utilization of reproductive and child health services in India, 1992–2005. Journal of Biosocial Science 41(3), 381–398.CrossRefGoogle Scholar
MWCD (2017) Rapid Survey on Children. Ministry of Women and Child Development, Government of India, New Delhi.Google Scholar
O’Donnell, O, Van Doorslaer, E, Wagstaff, A and Magnus, L (2008) Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. World Bank, Washington, DC.Google Scholar
Padhi, S (2001) Infant and child survival in Orissa: an analysis with NFHS data. Economic and Political Weekly 36(34), 3316–3326.Google Scholar
Patra, N (2006) Universal immunization programme in India: the determinants of childhood immunization. Paper presented at the 42nd Annual Conference of the Indian Econometric Society (TIES), GND University, Amritsar, India.CrossRefGoogle Scholar
Pebley, AR, Goldman, N and Rodríguez, G (1996) Prenatal and delivery care and childhood immunization in Guatemala: do family and community matter? Demography 33(2), 231–247.CrossRefGoogle ScholarPubMed
Priya, PK, Pathak, VK and Giri, AK (2020) Vaccination coverage and vaccine hesitancy among vulnerable population of India. Human Vaccines & Immunotherapeutics 16(7), 1502–1507.CrossRefGoogle Scholar
Rammohan, A, Awofeso, N and Fernandez, RC (2012) Paternal education status significantly influences infants’ measles vaccination uptake, independent of maternal education status. BMC Public Health 12(1), 336.CrossRefGoogle ScholarPubMed
Sharma, S, Akhtar, F, Singh, RK and Mehra, S (2020) Understanding the three As (Awareness, Access, and Acceptability) dimensions of vaccine hesitancy in Odisha, India. Clinical Epidemiology and Global Health 8(2), 399–403.CrossRefGoogle Scholar
Shrivastwa, N, Gillespie, BW, Kolenic, GE, Lepkowski, JM and Boulton, ML (2015) Predictors of vaccination in India for children aged 12–36 months. American Journal of Preventative Medicine 49 (Supplement 4), S435–S444.CrossRefGoogle ScholarPubMed
Singh, KHJ, Joseph, K J V, Gautam, S, Sharma, S and Yadav, J (2019a) Measles vaccination coverage in the northeastern states, India: inequality and spatial distribution perspective. International Journal of Medical and Health Research 5(8), 137–146.Google Scholar
Singh, PK (2013) Trends in child immunization across geographical regions in India: focus on urban–rural and gender differentials. PloS One 8(9), e73102.CrossRefGoogle ScholarPubMed
Singh, PK, Kumar, C, Rai, RK and Singh, L (2014) Factors associated with maternal healthcare services utilization in nine high focus states in India: a multilevel analysis based on 14,385 communities in 292 districts. Health Policy and Planning 29(5), 542–559.CrossRefGoogle ScholarPubMed
Singh, S, Sahu, D, Agrawal, A and Vashi, MD (2019b) Barriers and opportunities for improving childhood immunization coverage in slums: a qualitative study. Preventive Medicine Reports 14, 100858.CrossRefGoogle ScholarPubMed
Statacorp (2017) Stata Statistical Software: Release 15. StataCorp LLC College Station, TX.Google Scholar
UN-DESA (2019) World Mortality 2019. United Nations Department of Economic and Social Affairs, Population Division, New York.Google Scholar
UN-IGME (2019) Levels & Trends in Child Mortality: Report 2019, Estimates Developed by the United Nations Inter-agency Group for Child Mortality Estimation. United Nations Inter-agency Group for Child Mortality Estimation, New York.Google Scholar
Van Doorslaer, E, Masseria, C, Koolman, X and OECD Health Equity Research Group (2006) Inequalities in access to medical care by income in developed countries. Canadian Medical Association Journal 174(2), 177–183.CrossRefGoogle ScholarPubMed
Wagstaff, A (2000) Socioeconomic inequalities in child mortality: comparisons across nine developing countries. Bulletin of the World Health Organization 78(1), 19–9.Google ScholarPubMed
Wagstaff, A, Paci, P and Van Doorslaer, E (1991) On the measurement of inequalities in health. Social Science & Medicine 33(5), 545–557.CrossRefGoogle ScholarPubMed
Wagstaff, A, Van Doorslaer, E and Watanabe, N (2003) On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. Journal of Econometrics 112(1), 207–223.CrossRefGoogle Scholar
Wagstaff, A and Watanabe, N (2003) What difference does the choice of SES make in health inequality measurement? Health Economics 12(10), 885–890.CrossRefGoogle ScholarPubMed
WHO (2012) WHO Recommendations for Routine Immunization: A User’s Guide to the Summary Tables. World Health Organization, Geneva.Google Scholar
WHO (2017) World Health Statistics 2017: Monitoring Health for the SDGs, Sustainable Development Goals. World Health Organization, Geneva. URL: https://www.who.int/gho/publications/world_health_statistics/2017/EN_WHS2017.pdf Google Scholar
WHO (2019a) Immunization. World Health Organization, Geneva. URL: https://www.who.int/news-room/facts-in-pictures/detail/immunization Google Scholar
WHO (2019b) Immunization Coverage. World Health Organization, Geneva. URL: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage Google Scholar
WHO (2019c) World Health Statistics – 2019: Monitoring Health for the SDGS, Sustainable Development Goals. World Health Organization, Geneva. URL: https://apps.who.int/iris/bitstream/handle/10665/311696/WHO-DAD-2019.1-eng.pdf Google Scholar