Risk of Under-Vaccinations Vs. Non-Vaccinations Among Children in India

BACKGROUND:

India contributes to more than 20 percent of the child deaths in the world. Poor vaccination coverage has been identified as a leading cause of high child mortality rates in India, in spite of a free vaccination program for children. To improve vaccination program performance, it is important to attain the recommended proportion of full immunization and vaccinate children at the recommended ages. The aim of this study is to characterize the risk factors for under-vaccinations and non-vaccinations among children in India.

METHODS:

This study utilized the District Level Household and Facility Survey Data, 2008 (DLHS-3) from India. The vaccination status of the child was categorized as fully vaccinated, under-vaccinated and unvaccinated. A fully vaccinated child is defined as any child 12 to 24 months old having received all recommended vaccines, i.e., one dose each of Bacillus Calmette-Guerin (BCG) and measles, and at least 3 doses each of Diphtheria-Pertussis-Tetanus (DPT) and Polio. An under-vaccinated child is defined as any child receiving at least one but not all recommended routine vaccines. An unvaccinated child is defined as one who has not received any vaccines.  Multinomial logistic regression models were used to estimate the odds of under-vaccination compared to full-vaccination, and odds of non-vaccination compared to full-vaccination, along with the 95% confidence interval (CI) for each predictor of interest. Predictors used in the analysis were sex, birth order, place of delivery (institutional/ non-institutional), maternal age, education and work status, exposure to immunization messages, religion, and caste of the family. The analysis was adjusted for place of residence (rural/urban) and wealth index of the household.

RESULTS:

Using the DLHS data, the estimated proportion of fully vaccinated and under-vaccinated children were 21% and 28% respectively. Multivariable regression analysis revealed that the odds of being fully vaccinated were higher in children whose mothers and fathers had more years of schooling (adjusted odds ratio [aOR]: 1.01 per year; 95% CI: 1.00, 1.02), who were Sikh (aOR: 1.34; CI: 1.17, 1.52), and who had an institutional delivery.  The type of delivery facility and place of vaccination was found to be associated with under-vaccination status.

CONCLUSIONS:

Approximately half of the birth cohort did not get any vaccines. The difference in the risk set associated with under-vaccination and non-vaccination suggest that multifaceted and tailored strategies are required to address factors contributing to incomplete and non-vaccination among children in India.