Abstract
BackgroundChildren who receive all doses of scheduled vaccines reduce their susceptibility to vaccine-preventable diseases. In India, full immunization coverage has increased significantly. However, only a small proportion of children are immunized on time. Globally, studies on factors affecting coverage of childhood immunization have found a significant impact by demand and supply-side determinants. This paper explores the demand-side determinants of timely immunization of the third dose of oral polio vaccine (OPV3) among children aged 6–11 months in the catchment areas of CORE Group Polio Project India.MethodsWe analyzed secondary de-identified data from a household level ‘Doers and Non-doers survey’ conducted in 2015. Determinants of timely OPV3 immunization were identified by modeling the characteristics of index children and survey respondents, surveyed households, respondents’ media habits, their exposure to immunization services and perceptions towards child immunization, through a multinomial regression analysis.ResultsThe eight demand-side predictors based on the background characteristics and perceptions of caregivers determined timely vaccination of OPV3. The strongest predictor of timely OPV3 immunization was found to be the fathers’ educational level. Children of uneducated or lesser educated fathers had increased odds of not receiving the OPV1 vaccination, as compared to children of more educated fathers (OR > 10). Respondents who strongly perceived other (non-health) benefits of child immunization were three times more likely to timely vaccinate their children than those who do not. Furthermore, mothers who disagreed with the positive attributes of child immunization were 25 times more likely to delay or not to take their children for OPV immunization on time.ConclusionsThis study found eight essential factors that are responsible for timely OPV3. Despite limitations in data collection and analysis, immunization programs in India could use the eight identified demand-side determinants of timeliness and tailor communication strategies accordingly. We suggest that program communication efforts be directed at male community members; such messaging should address parents’ perceptions of non-health benefits and stress the positive attributes of child immunization. Further investigation would be helpful to assess the various risk factors of under-vaccination as well as vaccinators’ understating about timely immunization.
Highlights
Children who receive all doses of scheduled vaccines reduce their susceptibility to vaccinepreventable diseases
A study based on district level household survey (DLHS–3) data reported that a lack of timeliness vaccination of key childhood vaccines like DPT3 and MCV1 is one of the main challenges in India
This study found that only a small proportion of children aged 0–60 months in India are immunized on time: 30% of children received BCG vaccine by 4 weeks; 28% received DPT1 by 8 weeks; and only 12% received MCV1 by the recommended age of 9 months [6]
Summary
Children who receive all doses of scheduled vaccines reduce their susceptibility to vaccinepreventable diseases. Only a small proportion of children are immunized on time. Studies on factors affecting coverage of childhood immunization have found a significant impact by demand and supply-side determinants. This paper explores the demand-side determinants of timely immunization of the third dose of oral polio vaccine (OPV3) among children aged 6–11 months in the catchment areas of CORE Group Polio Project India. This study found that only a small proportion of children aged 0–60 months in India are immunized on time: 30% of children received BCG vaccine by 4 weeks (recommended at birth); 28% received DPT1 by 8 weeks (recommended at 6 weeks); and only 12% received MCV1 by the recommended age of 9 months [6]. Another study conducted in high immunization coverage areas of South India found that delay in vaccination for more than two weeks from the due date for DPT1, DPT2, DPT3 and measles was 7.4, 41.9%, 6 4.4 and 38.8%, respectively [7]
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