Explaining immunisation inequality in the rural and urban Barak Valley, India

The study looks at why some children in the Barak Valley of Assam, India, are fully immunised and others are not. It uses a survey of 400 households in rural and urban communities. Households with more frequent contact with accredited social health activists (frontline health workers) were more likely to have fully immunised children. Households with little or no contact were significantly less likely to have fully immunised children. The authors suggest that how often and how well households are reached matters more than whether they live in a rural or urban area.

Key points

• Primary survey data were collected from 400 households in selected rural and urban communities of the Barak Valley, Assam.
• More frequent interactions with accredited social health activists were strongly associated with higher odds of full immunisation.
• Households reporting limited or no contact with frontline health workers were significantly less likely to have fully immunised children.
• Intensity of institutional engagement was a stronger predictor of full immunisation than rural–urban location.
• The authors suggest that strengthening the quality and continuity of household-level outreach may yield greater public health gains than geographic targeting alone.

Limitations

The abstract describes an association from a cross-sectional-style household survey, so it cannot show that contact with health workers causes higher immunisation. It also covers only one region of India with 400 households, so results may not apply elsewhere.