Abstract
BackgroundAlthough child immunization is regarded as a highly cost-effective lifesaver, about fifty percent of the eligible children aged 12–23 months in India are without essential immunization coverage. Despite several programmatic initiatives, urban-rural and gender difference in child immunization pose an intimidating challenge to India’s public health agenda. This study assesses the urban-rural and gender difference in child immunization coverage during 1992–2006 across six major geographical regions in India.Data and MethodsThree rounds of the National Family Health Survey (NFHS) conducted during 1992–93, 1998–99 and 2005–06 were analyzed. Bivariate analyses, urban-rural and gender inequality ratios, and the multivariate-pooled logistic regression model were applied to examine the trends and patterns of inequalities over time.Key FindingsThe analysis of change over one and half decades (1992–2006) shows considerable variations in child immunization coverage across six geographical regions in India. Despite a decline in urban-rural and gender differences over time, children residing in rural areas and girls remained disadvantaged. Moreover, northeast, west and south regions, which had the lowest gender inequality in 1992 observed an increase in gender difference over time. Similarly, urban-rural inequality increased in the west region during 1992–2006.ConclusionThis study suggests periodic evaluation of the health care system is vital to assess the between and within group difference beyond average improvement. It is essential to integrate strong immunization systems with broad health systems and coordinate with other primary health care delivery programs to augment immunization coverage.
Highlights
India accounts for the highest number of under-five deaths in the world [1]
Vaccine preventable diseases account for nearly 20% of all deaths occurring annually among children under five years of age, and immunization has a vital role to play in achieving the goals specified in the Millennium Declaration [3]
The full immunization coverage increased to 44% in 2005–06, about 50% of the eligible children in nine states did not receive full immunization
Summary
India accounts for the highest number of under-five deaths in the world [1]. The average annual rate of decline in under-five mortality at 3.1% during 1990–2009 was considered insufficient to achieve the fourth Millennium Development Goal (MDG) of minimizing under-five mortality to 39 per 1000 live births by 2015 [2]. Vaccine preventable diseases account for nearly 20% of all deaths occurring annually among children under five years of age, and immunization has a vital role to play in achieving the goals specified in the Millennium Declaration [3]. An assessment of the global measles mortality shows that India accounted for nearly 47% of the estimated measles mortality in 2010, followed by the World Health Organisation (WHO) Africa region at 36% [4]. Child immunization is regarded as a highly cost-effective lifesaver, about fifty percent of the eligible children aged 12–23 months in India are without essential immunization coverage. This study assesses the urban-rural and gender difference in child immunization coverage during 1992–2006 across six major geographical regions in India. Urban-rural and gender inequality ratios, and the multivariate-pooled logistic regression model were applied to examine the trends and patterns of inequalities over time
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