The basket of vaccines under government’s universal immunisation programme may be growing, but only 75% children complete the recommended three doses of diphtheria-pertussis-tetanus (DPT) vaccine in India, a new study shows.
The study conducted by experts from US’ Center for Disease Dynamics, Economics & Policy, which was published last week in journal Vaccine analysed factors affecting DPT vaccine uptake among children in India.
In 2014, Indian children accounted for 22% of the 18.7 million children worldwide who had not received three doses of DPT by age one.
Coverage with the third dose of DPT is a widely used indicator of the performance of countries’ routine immunization services.
Low DPT3 coverage is caused by a combination of low uptakes of dose 1 and high dropout rates among infants who receive the first dose but not the second or third.
During 2014, nearly 2.5 million children in India did not receive a single DPT dose, while more than 1.5 million received only one or two DPT doses.
Although 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette–Guérin (BCG), only 75% complete the recommended three doses of DPT.
The researchers— Ramanan Laxminarayan and Arpita Ghosh, analyzed data on 75,728 (6- to 23-month-old) children in villages across India to study demand- and supply-side factors determining nonvaccination with DPT and dropout between DPT doses 1 and 3, using a multilevel approach.
Data come from the District Level Household and Facility Survey 3 (2007–08).
Individual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3.
The analysis showed that children whose mothers had no schooling were 2.3 times more likely not to receive any DPT vaccination and 1.5 times more likely to drop out between DPT doses 1 and 3, compared with children whose mothers had 10 or more years of schooling.
Although supply-side factors related to availability of public health facilities and immunization-related health workers in villages were not correlated with dropout between DPT doses 1 and 3, children in districts where 46% or more villages had a healthcare subcentre were 1.5 times more likely to receive at least one dose of DPT vaccine compared with children in districts where 30% or fewer villages had subcentres.
Supply-side factors include availability and access to healthcare facilities, infrastructure, staffing, vaccine and service delivery management, budget allocation, and knowledge of the workers who administer vaccines.
Nonvaccination with DPT in India is influenced by village- and district-level contextual factors over and above individuals’ background characteristics. Dropout between DPT doses 1 and 3 is associated more strongly with demand-side factors than with village- and district-level supply-side factors.
Demand side factors associated with vaccination coverage in children typically include child’s birth order and sex, parents’ level of education, their employment status and type of occupation, immunization-related beliefs, mother’s general health knowledge and awareness, health-seeking behavior, caste, religion, and household wealth index.