Income-based inequality in full immunization coverage of children aged 12-23 months in Eastern India: A decomposition analysis

Shantanu Sharma · Sonali Maheshwari · Ajit Kumar Jaiswal · Sunil Mehra

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Vaccine Coverage and Hesitancy Global Maternal and Child Health Public Health and Social Inequalities

Abstract

Introduction Notably, less than two-thirds of under-5 children received full immunization in 2016 in India. It is critical to understand the inequalities in access to immunization for determining an effective health policy agenda to ensure universal health coverage. Hence, we performed a study to assess the determinants of income-based inequality in the full immunization of children aged 12–23 using Fairlie decomposition analysis. Methods This cross-sectional study was a part of a community-based project that aimed to improve maternal and child health in the backward states of India, namely Bihar and Assam. The study was conducted in the rural and urban areas of Munger and Darrang districts of Bihar and Assam, respectively. The degree of income-related inequality in full immunization coverage was obtained through the concentration index. The Fairlie decomposition was employed to quantify the absolute contribution of socio-demographic factors explaining the group differences (higher or lower income) in the probability of having full immunization. Results There were 73 fully and 82 non-fully immunized children. The concentration curve was lying above the line of equality, which implied that full immunization coverage was concentrated towards the lower-income group. Maternal education (7.5%) and place of residence (5.1%) widened the inequality gap, and caste (−13.5%) and age of the child (−2.5%) narrowed down the inequality gap for full immunization among lower and higher-income groups. Conclusions The socio-economic inequalities in access to full immunization can be mitigated by multi-sectoral interventions with a focus on children with less-educated mothers and living in urban slums.

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References

2007Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation 2005An extension of the Blinder-Oaxaca decomposition technique to logit and probit models 2008Correcting the Concentration Index 2003What's in a country average? Wealth, gender, and regional inequalities in immunization in India 2018Improving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy 2011Socio-economic inequality of immunization coverage in India 2019Delayed vaccination and its predictors among children under 2 years in India: Insights from the national family health survey–4 2020Explaining socioeconomic inequalities in immunisation coverage in India: new insights from the fourth National Family Health Survey (2015–16)

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