Peer-reviewed article
Urban-Rural Disparities in Childhood Immunization Coverage: Evidence from Jaipur, India
S P Sharma, Mahendra Badhala, Anamika Tomar, Vaseem Naheed Baig ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study compared childhood immunization coverage between urban slums and rural areas in Jaipur, India. Rural areas achieved 92.3% full immunization coverage, while urban slums reached only 82.0%, a significant gap. The difference was particularly pronounced for later vaccine doses, with rural areas maintaining higher completion rates. Urban barriers included limited mobility, restricted service access, and vaccine hesitancy, while rural areas benefited from an ASHA health worker model.
Key points
- Full immunization coverage was 92.3% in rural areas versus 82.0% in urban slums (p<0.001)
- Urban-rural disparities were largest for later doses: Pentavalent 3 (81.7% urban vs 91.8% rural) and Measles (85.0% urban vs 93.2% rural)
- Rural success attributed to ASHA-led community health worker model achieving near-universal coverage
- Urban barriers include limited mobility, restricted service access, and vaccine hesitancy
- Study recommends slum-focused microplans, extended service hours, and dedicated urban community health workers
Limitations
The study is cross-sectional and cannot establish causation or track changes over time. Results are specific to Jaipur district and may not generalize to other urban-rural contexts in India or elsewhere.
Abstract
Introduction: Childhood immunization coverage in India has improved nationally, yet urban-rural disparities persist, particularly in rapidly urbanizing states such as Rajasthan. Urban slum populations often face significant barriers, including limited mobility, restricted access to essential services, and vaccine hesitancy. Objective: To assess and compare the full immunization coverage among children aged 6-23 months in urban and rural areas of Jaipur district, Rajasthan. Methods: A community-based cross-sectional study was conducted from October 2023 to March 2024 in the rural (Dadiya) and urban (Jhalana) field practice areas of RUHS College of Medical Sciences, Jaipur. A sample of 711 children aged 6–23 months was selected using the WHO 30×7 cluster sampling method. Immunization status was verified using vaccination cards and caregiver history. Data were analyzed using SPSS v22.0 with descriptive statistics and chi-square tests. Results: Full immunization coverage (FIC) was significantly lower in urban areas (82.0%, 95% CI: 77.2–86.1%) compared to rural areas (92.3%, 95% CI: 89.5–94.5%) (p<0.001). Dose-specific analysis revealed a higher dropout rate for later vaccines, including Pentavalent 3 (urban 81.7% vs. rural 91.8%) and Measles (urban 85.0% vs. rural 93.2%). Conclusions: Rural Rajasthan’s ASHA-led model achieved near-universal FIC, whereas urban slums experienced systemic barriers leading to higher dropout rates for later doses. Targeted interventions, such as slum-focused microplans, extended service hours, and urban community health workers, are urgently needed to reduce disparities.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- ASHA-led community health worker model in rural areas; comparison with standard urban service provision
- Population
- Children aged 6-23 months in urban slums (Jhalana) and rural areas (Dadiya) of Jaipur district, Rajasthan, India; sample of 711 children
Key finding
Rural ASHA-led model achieved 92.3% full immunization coverage (95% CI: 89.5–94.5%)