INEQUITY IN CHILDHOOD IMMUNIZATION IN INDIA

Saturday, 21st of July 2012

INEQUITY IN CHILDHOOD IMMUNIZATION IN INDIA

Key messages below; full text, http://www.indianpediatrics.net/mar2012/203.pdf

• There are limited nation-wide data exploring inequity in childhood immunization in India; among these the three National Family Health Surveys are methodologically the most robust. Data from an apparently methodologically robust ICMR survey in 1999 was not corroborated by contemporary NFHS survey data.

• Data from smaller, focused surveys often yielded conclusions similar to the NFHS data; however in some cases there were clear differences in the conclusions.

• There is a high level of disparity in vaccination coverage in different states. The traditionally poor performing states have greater inequities; however there is significant inequity even among better performing states.

• There are considerable inequities in childhood vaccination by various individual (gender, birth order), family (area of residence, wealth, parental education), social (religion, caste), and societal (access to health-care, community literacy level) characteristics.

• In general, girls fare worse than boys; there is an almost 5% relative difference between boys and girls. Higher birth order infants have lower vaccination rate; the precise reasons for this have not been elucidated.

• Urban infants have higher coverage than rural infants and those living in urban slums. There is an almost direct relationship between household wealth and vaccination rates.

• The vaccination rates are lower among infants with mothers having no or low literacy, and families with insufficient empowerment of women. Paternal literacy has an inconsistent positive relationship with infant vaccination.

• There is a relationship between religion and caste, and childhood vaccination; however data are limited to determine whether these are independent influences or reflections of other inequities.

• Access to health services and other infrastructure, is associated with better vaccination coverage of infants.

• The precise impact of specific risk factors operating singly or in combination cannot be calculated from this systematic review; however it provides directions for targeting the most vulnerable sections of the population.