Hit Me With Your Best Shot: An Analysis of Maternal and Household Demographics on Child Immunization Status in India

Abstract

Vaccines are a remarkably effective and inexpensive tool for reducing childhood morbidity and mortality. India serves as an apt focal point for tackling immunization disparities because the country possesses one third of the world’s unimmunized children. The urgent need to boost coverage rates among the world’s largest birth cohort prompted a campaign-style approach to immunization, marked by the launch of Mission Indradhanush (MI) in 2014 and Intensified Mission Indradhanush (IMI) in 2017. Both MI and IMI aimed to cover 90% of infants with a full set of required vaccines.

Most of the existing research on immunization in India predates MI, while more contemporary studies assess the campaign’s impact on the immunization coverage rate. This thesis expands upon the current literature by disaggregating the coverage rate increases into an analysis of the characteristics that correlated with incomplete immunizations across the initial two phases of MI.

Controlling for eleven maternal and household characteristics in a multivariable logistic regression, this thesis identifies eight key predictors of incomplete immunizations in the two phases of MI—notably, low wealth, a non-institutional delivery place, and a low level of maternal education.

Specifically, this thesis finds the likelihood that a child had received all immunizations improved with mother’s education level and household wealth. Furthermore, the disparity between the highest and lowest education levels and wealth quintiles increased after MI began. After the first two phases, the odds of a child from the richest wealth quintile being fully immunized was 2.223 times higher than those of a child from the poorest quintile. Mothers with a secondary school education or higher had an odds 1.631 times higher than those of mothers with no schooling for reporting full immunization for their youngest children. The odds of full immunization for a child born in a non-institutional delivery place were 0.515 times lower than those for a child born in an institutional delivery place. Additional predictors of immunization status were religion, mother’s age at childbirth, sex, locality, and distance from immunization site.

This thesis concludes that IMI was warranted after MI, but could be enhanced by directing its efforts to address populations with low wealth, high rates of non-institutional deliveries, and low maternal education. IMI’s multisectoral approach remains promising. Given the findings of this thesis, mass immunization campaigns, such as MI and IMI, are India’s best shot at reducing health disparities and eventually establishing a sustainable routine immunization system.