India's Universal Immunisation Programme to prevent children from preventable disease: retention and dropout approach

Abstract

BackgroundThe Universal Immunisation Programme was integrated with the Reproductive and Child Health Programme to improve childhood immunisation in India. However, there is a lack of empirical research on understanding about childhood immunisation by the standard schedule of WHO. This study aimed to estimate the level of retention and dropouts from one vaccination to the next among Indian children aged 12–23 months. MethodsWe use data from the nationwide District Level Household and Facility Survey (DLHS-3), which was carried out in all 596 districts and covered 64 702 children aged 12–23 months in India during 2007–08. We used the Kaplan–Meier method to assess the retention rate of childhood immunisation. FindingsOnly 52·5% (33 959 of 64 702) of children aged 12–23 months have received the full course of vaccination. Children of the poorest and illiterate mothers have the lowest rate of full immunisation. 86·1% (55 688 of 64 702) of children would have been fully vaccinated if each child had been administered all three doses of diphtheria, pertussis, and tetanus (DPT) and polio vaccines and measles vaccine. The retention rate of childhood immunisation was in maximum decline between the second round of DPT and polio (70%, 95% CI 69–71) and the third round (56%, 55–57). On the other hand, if all children are brought under the health-system network by way of registering all births for BCG, the existing dropout rate at different stages of vaccination will yield 60·8% (33 869 of 55 688) of children being fully immunised. InterpretationThe findings of this assessment reveal that immunisation coverage varies from one vaccine to another and declines over the schedule prescribed by the WHO. BCG, third-round DPT, and third-round polio vaccination coverage may play a critical role in full immunisation, as the dropout rates were higher for these vaccinations. Specially designed interventions are needed to meet Millennium Development Goals regarding the under-5 mortality rate, infant mortality rate, and proportion of 1-year-old children immunised against measles. FundingDY was supported by the Government of India/National Eligibility Test Doctoral Fellowship award from the University Grants Commission and Ministry of Health and Family Welfare, Government of India. The funders had no role in study design, data collection, analysis, or preparation of the abstract.