Peer-reviewed article
Equity in Full Immunization Coverage Among Children Aged 12-23 Months in Urban and Rural Areas of Hyderabad, India: A Community-Based Cross-Sectional Study
Shadan Butool, Rafath Unnisa Begum, Prafful K Butti, Tameema Kauser, Hafsa Sayeed et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This cross-sectional study surveyed 400 children aged 12-23 months (200 urban, 200 rural) in field practice areas of Osmania Medical College, Hyderabad, India, in 2023. Of these, 57.0% were fully immunized. Coverage was higher among children from upper socioeconomic households, urban areas, and males. The authors found a pro-rich pattern of inequality, and the measured household factors explained only a small part of the gap. They suggest health system and supply-side measures are likely needed alongside household-targeted approaches.
Key points
- 228 of 400 children (57.0%) were fully immunized, which is below global targets.
- Coverage was 67.86% in the upper socioeconomic class and 43.18% in the lower class (p<0.001).
- Urban coverage was 65.0% and rural coverage 49.0% (p=0.002). Male coverage was 61.95% and female coverage 50.57% (p=0.030).
- The absolute socioeconomic gap was 24.68 percentage points. Measured factors explained only 7.9% of it in the decomposition.
- The socioeconomic gap was wider among females (+34.15 points) and urban children (+52.74 points) than among males (+18.57) and rural children (-5.11).
Limitations
This is a cross-sectional study from one area of Hyderabad, so it cannot show cause and effect and may not apply to other settings. The measured sociodemographic factors explained little of the inequality, so the drivers of the gap remain largely unidentified.
Abstract
Background: Persistently low and inequitable childhood immunization coverage remains an important public health concern, particularly among socially and economically disadvantaged populations.Fieldpractice-level data that align with the national surveys are needed to understand local drivers of immunization inequity.Objectives: This study aimed to determine the association between selected sociodemographic factors and full immunization status, to assess the extent and pattern of socioeconomic inequality in full immunization coverage, and to describe disparities by gender, geographic location, and urban-rural residence among children aged 12-23 months.Methods: A community-based cross-sectional study was conducted from August to October 2023 among 400 children aged 12-23 months (200 urban, 200 rural), selected by multistage random sampling from the fieldpractice areas of Osmania Medical College, Hyderabad, Telangana, India.Full immunization status was verified against Mother and Child Protection Cards and Anganwadi Centre records.Associations were assessed using the chi-squared test; socioeconomic inequality was quantified using the Erreygers Concentration Index, and Fairlie decomposition was used to identify contributors to the socioeconomic gap.Results: Among 400 children, 228 (57.0%) were fully immunized and 172 (43.0%) were non-fully immunized.Full immunization was significantly associated with socioeconomic status (SES), place of residence, sex, and birth order.Coverage was higher among children from the upper socioeconomic class (152/224, 67.86%) than the lower socioeconomic class (76/176, 43.18%; p<0.001), among urban (130/200, 65.0%) than rural children (98/200, 49.0%; p=0.002), and among males (140/226, 61.95%) than females (88/174, 50.57%; p=0.030).Maternal age, maternal education, and religion were not significantly associated with immunization status.A pro-rich distribution was evident (Concentration Index +0.1067; Erreygers Index +0.2432; Wagstaff Index +0.2481), with an absolute SES gap of 24.68 percentage points.Fairlie decomposition explained 1.96 percentage points (7.9%) of the observed gap; urban residence (+136.9%)and Hindu religion (+60.1%)widened the gap, whereas first birth order (-53.1%),male sex (-25.4%), and maternal literacy (-24.8%)narrowed it.The SES equity gap was wider among females (+34.15 percentage points) than males (+18.57) and among urban (+52.74)than rural children (-5.11).Closing the SES gap could increase overall coverage by 10.86 percentage points, corresponding to a population attributable fraction of 16.0%.Conclusion: Full immunization coverage in this population remains below global targets and shows a pattern by SES, residence, and gender, with disadvantage compounding among lower-SES girls and lower-SES urban households.Because measured sociodemographic factors explained less than one-tenth of the observed inequality, closing this gap will likely require health system and supply-side interventions alongside household-targeted approaches.