Peer-reviewed article
Factors affecting timeliness in vaccination of under-five children in India: A cross-sectional study using the NFHS 5 survey during COVID-19.
Gattam DB, Khazi MS, Kumari N, Jahan A ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined vaccination timeliness in over 232,000 Indian children under five using national survey data. While vaccination at birth was timely in 94.6% of cases, timeliness declined significantly for later doses, dropping to 67.5% by 14 weeks. Children born with low birth weight, whose mothers had no education or fewer antenatal visits, or who lived in rural areas or lower socioeconomic households were more likely to receive vaccines late. The COVID-19 pandemic did not significantly worsen vaccination timeliness compared to the pre-pandemic period.
Key points
- Vaccination timeliness at birth was 94.6%, but declined to 74.2% at 6 weeks and 67.5% at 14 weeks
- Untimeliness at 14 weeks was primarily caused by delays in Polio 3 (60.2%) and Rotavirus 3 (58.0%) vaccines
- Low birth weight, maternal factors (fewer antenatal visits, no education, non-institutional delivery), rural residency, and lower socioeconomic status were associated with vaccine delays
- Children in Central and Northeast zones had the highest rates of untimely vaccination
- Vaccination timeliness was comparable between pre- and post-COVID-19 pandemic periods despite service disruptions
Limitations
The study is cross-sectional and cannot establish causation, only associations. The data reflect a specific time period during COVID-19 and may not capture longer-term pandemic effects or changes in vaccination programmes after the survey period.
Abstract
Immunization is an essential intervention that protects millions of children against vaccine-preventable diseases across the world. Although vaccination coverage has improved over the years, ensuring timely administration continues to be a major challenge affecting child health in India. The COVID-19 pandemic further aggravated this situation. A cross-sectional study using the Kids Recode dataset of the National Family Health Survey 5 was conducted, which inlcuded 232920 children under 5 y of age. Timeliness was considered as 4 d earlier and up to 28 d after the standard date in comparison with the National Immunization Schedule. Regression analysis was used on Survey Data to assess the impact of factors related to children, mothers, households, communities, and the COVID-19 pandemic on timeliness by deriving adjusted Prevalence Ratios. Timeliness at birth was highest (94.6%), however, it declined for subsequent doses at 6 weeks (74.2%), and 14 weeks (67.5%). Untimeliness at 14 weeks was mainly due to Polio 3 (60.2%) and Rotavirus 3 (58.0%) vaccines. Factors associated with untimeliness included - low birth weight, fewer antenatal visits, non-institutional delivery, no maternal education, rural residency and belonging to lower socioeconomic strata. Children residing in the Central and Northeast zones had the highest prevalence of untimeliness in receiving vaccines. Despite the COVID-19 pandemic disruptions, the timeliness of vaccination was comparable between the pre- and post-pandemic periods. This study shows that the untimeliness of vaccination is influenced by factors related to the child, mother, household and community. Comprehensive interventions involving various stakeholders are required to improve the timeliness of vaccination.