Multiple factors affect vaccination status among Indian children, finds study

BMJ 2015; 351 doi: (Published 10 September 2015) Cite this as: BMJ 2015;351:h4859
  1. Cheryl Travasso
  1. 1Mumbai

Vaccination status of children in India is influenced by where they are born, their caste and religion, antenatal care, and whether their mother has been vaccinated against tetanus, a study has found.

The study, published in the American Journal of Preventive Medicine, found that these associations remained after adjusting for state of residence, gender, age, household wealth, and mother’s education.1

The researchers attempted to identify cultural and sociodemographic factors that affected vaccination, using data from 108 057 children included in the nationally representative District Level Household and Facility Survey in 2008. Data from this survey previously showed that 57% of Indian children aged between 1 and 3 were fully vaccinated—meaning they had received one dose of BCG vaccine, three doses of the diphtheria, pertussis, and tetanus vaccine, and one dose of the measles vaccine—31% were undervaccinated, and 12% were not vaccinated.

The analysis found that Muslim children were more than twice as likely to be non-vaccinated (adjusted odds ratio 2.2, 95% confidence interval 2.03 to 2.44) than Hindu children (the reference group) and were also more likely to be undervaccinated (1.42, 1.33 to 1.52). Children born in Buddhist, Jain, Jewish, or Zoroastrian families were less likely to be non-vaccinated or undervaccinated. There was no difference in non-vaccination rates between children born in Hindu, Christian, and Sikh families.

Caste was also associated with vaccination status. Children belonging to scheduled castes, scheduled tribes, and other less privileged classes, which are historically and socioeconomically disadvantaged groups in India, were more likely to be undervaccinated or non-vaccinated than children born in more privileged households.

Location of birth also influenced vaccination rates. Children born at home were more likely to be undervaccinated or non-vaccinated than those born in government institutions (1.81, 1.63 to 2.00), as were those born in private institutions (1.45, 1.25 to 1.68). This could have policy implications as private facilities do not receive any financial or other incentives for childhood vaccination.

A higher number of antenatal care visits to mothers helped to lower the odds of their children being undervaccinated, and children born to mothers who received the tetanus vaccine had lower odds of being non-vaccinated (0.25, 0.21 to 0.29) and undervaccinated (0.68, 0.61 to 0.75) than those whose mothers did not receive the vaccine.

The researchers explained that they initially expected the predictors for non-vaccination to be different than those for undervaccination, but the analysis found the predictors to be similar, although their effect sizes varied. They also pointed out that the high coverage of BCG vaccination at birth indicated a certain level of access to healthcare services but that the poor overall coverage of vaccination in the months after birth was perhaps due to poor understanding of the need for vaccination, lack of motivation, or difficulty in accessing immunisation services.


Cite this as: BMJ 2015;351:h4859


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