Peer-reviewed article
Explaining socioeconomic inequalities in immunisation coverage in India: new insights from the fourth National Family Health Survey (2015–16)
Swati Srivastava, Jasmine Fledderjohann, Ashish Kumar Upadhyay ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This observational study used data from India's fourth National Family Health Survey (2015–16) to look at whether immunisation coverage differs by wealth among children aged 12–59 months. It found that only 37% of children were fully immunised, 56% partially immunised and 7% never immunised. Immunised children were concentrated in richer households, and this pattern appeared across regions. Mother's literacy, institutional delivery, place of residence, geographical location and socioeconomic status helped explain the gaps.
Key points
- 37% of children aged 12–59 months were fully immunised, 56% partially immunised and 7% never immunised.
- Immunised children were disproportionately concentrated in higher wealth quintiles, showing a socioeconomic gradient.
- The pattern of socioeconomic inequality was found across regions.
- Mother's literacy, institutional delivery, place of residence, geographical location and socioeconomic status explained the disparities.
- The authors conclude that improving coverage and understanding the factors behind poor uptake is essential for child survival and the SDGs.
Limitations
The abstract describes an observational, cross-sectional-style analysis, so it can show associations and contributing factors but not cause and effect. It does not describe any intervention or how survey data quality, such as vaccination recall, might affect results.
Abstract
Abstract Background Childhood vaccinations are a vital preventive measure to reduce disease incidence and deaths among children. As a result, immunisation coverage against measles was a key indicator for monitoring the fourth Millennium Development Goal (MDG), aimed at reducing child mortality. India was among the list of countries that missed the target of this MDG. Immunisation targets continue to be included in the post-2015 Sustainable Development Goals (SDG), and are a monitoring tool for the Indian health care system. The SDGs also strongly emphasise reducing inequalities; even where immunisation coverage improves, there is a further imperative to safeguard against inequalities in immunisation outcomes. This study aims to document whether socioeconomic inequalities in immunisation coverage exist among children aged 12–59 months in India. Methods Data for this observational study came from the fourth round of the National Family Health Survey (2015–16). We used the concentration index to assess inequalities in whether children were fully, partially or never immunised. Where children were partially immunised, we also examined immunisation intensity. Decomposition analysis was applied to examine the underlying factors associated with inequality across these categories of childhood immunisation. Results We found that in India, only 37% of children are fully immunised, 56% are partially immunised, and 7% have never been immunised. There is a disproportionate concentration of immunised children in higher wealth quintiles, demonstrating a socioeconomic gradient in immunisation. The data also confirm this pattern of socioeconomic inequality across regions. Factors such as mother’s literacy, institutional delivery, place of residence, geographical location, and socioeconomic status explain the disparities in immunisation coverage. Conclusions In India, there are considerable inequalities in immunisation coverage among children. It is essential to ensure an improvement in immunisation coverage and to understand underlying factors that affect poor uptake and disparities in immunisation coverage in India in order to improve child health and survival and meet the SDGs.