Household expenditure for immunization among children in India: a two-part model approach

Background Despite the Indian government’s Universal Immunization Program (UIP), the progress of full immunization coverage is plodding. The cost of delivering routine immunization varies widely across facilities within country and across country. However, the cost an individual bears on child immunization has not been focussed. In this context, this study tries to estimate the expenditure on immunization which an individual bears and the factors affecting immunization coverage at the regional level. Methods Using the 75th round of National Sample Survey Organization data, the present paper attempts to check the individual expenditure on immunization and the factors affecting immunization coverage at the regional level. Descriptive statistics and multivariate regression analysis were used to fulfil the study objectives. The two-part model has been employed to inspect the determinants of expenditure on immunization. Results The overall prevalence of full immunization was 59.3 % in India. Full immunization was highest in Manipur (75.2 %) and lowest in Nagaland (12.8 %). The mean expenditure incurred on immunization varies from as low as Rs. 32.7 in Tripura to as high as Rs. 1008 in Delhi. Children belonging to the urban area [OR: 1.04; CI: 1.035, 1.037] and richer wealth quintile [OR: 1.14; CI: 1.134–1.137] had higher odds of getting immunization. Moreover, expenditure on immunization was high among children from the urban area [Rs. 273], rich wealth quintile [Rs. 297] and who got immunized in a private facility [Rs. 1656]. Conclusions There exists regional inequality in immunization coverage as well as in expenditure incurred on immunization. Based on the findings, we suggest looking for the supply through follow-up and demand through spreading awareness through mass media for immunization.

A fuzzy multi-criteria framework to identify barriers and enablers of the next-generation vaccine supply chain

PurposeDue to the introduction of new vaccines in the child immunization program and inefficient vaccine supply chain (VSC), the universal immunization program (UIP), India is struggling to provide a full schedule of vaccination to the targeted children. In this paper, the authors investigate the critical factors for improving the performance of the existing VSC system by implementing the next-generation vaccine supply chain (NGVSC) in India.Design/methodology/approachThe authors design a fuzzy multi-criteria framework using a fuzzy analytical hierarchical process (FAHP) and fuzzy multi-objective optimization on the basis of ratio analysis (FMOORA) to identify and analyze the critical barriers and enablers for the implementation of NGVSC. Further, the authors carry out a numerical simulation to validate the model.FindingsThe outcome of the analysis contends that demand forecasting is the topmost supply chain barrier and sustainable financing is the most important/critical enabler to facilitate the implementation of the NGVSC. In addition, the simulation reveals that the results of the study are reliable.Social implicationsThe findings of the study can be useful for the child immunization policymakers of India and other developing countries to design appropriate strategies for improving existing VSC performance by implementing the NGVSC.Originality/valueTo the best of the authors’ knowledge, the study is the first empirical study to propose the improvement of VSC performance by designing the NGVSC.

Covid-19 vs. BCG Universal Immunization: Statistical Significance in the Early Phase of the Pandemics

A possible correlation between the impact of Covid-19 and universal immunization program against tuberculosis with Bacillus Calmette-Guérin (BCG) vaccine was suggested previously, based on apparent correlation between lower impact of the epidemics and a record of national BCG immunization program. In this work a time-adjusted dataset of Covid-19 statistical data by national and subnational health jurisdictions at the time point of six months after the local arrival of the epidemics was used to perform a statistical analysis of the significance of the correlation hypothesis between universal BCG immunization and a milder early phase Covid-19 scenario. With the data accumulated up to the point of the analysis, the significance of the correlation hypothesis was evaluated both qualitatively and quantitatively with the conclusion that it has achieved statistically significant level of confidence. The conclusions of this research can be used in development of epidemiological policy as well as the rationale to investigate the origin and mechanisms of a broad immunity protection that can be associated with an early-age exposure to BCG vaccine. Doi: 10.28991/SciMedJ-2021-03-SI-8 Full Text: PDF

Determinants of Immunization Coverage and Associated Factors among Children aged under Two-Year-Old in the National Immunization Program of Mewat district, Haryana (2019-2020)

Background: Vaccination against childhood communicable diseases through Expanded Program on Immunization is one of the most cost-effective public health interventions. Additional 1.5 million child deaths can be prevented if global vaccination coverage is improved. Mewat district has one of India’s lowest immunization rates despite a long-standing Universal Immunization Program and continues to sustain a high prevalence of vaccine-preventable diseases. This study investigates determinants of immunization status among children aged 0-23 months. Methods: A community-based cross-sectional study was conducted from December 2019 to June 2020, among 800 children aged 0-23months, randomly selected in one rural and one urban ward each from all 4 blocks of Mewat. Socio-demographic conditions and vaccine-related data were collected using a semi-structured questionnaire. Immunization was assessed by vaccination card and by mother’s recall where the card was unavailable. Results:Mewat has increased full immunization coverage from 13.1% in 2015-16 to 59.4%. Immunization card was available with 68.5% (292/426) beneficiaries. Dropout rates for Pentavalent1 to Pentavalent3 was 27.5% and 54% for Bacillus Calmette-Guerin to measles. After adjusting for the state of residence, religion, gender, paternal education, health professional presence during birth, place of vaccination and knowledge of mother on due dose were significantly associated with full immunization. Awareness gap and fear of side effects for vaccines were main reasons of vaccine hesitancy. Conclusion: Full immunization coverage in the district is sub optimal and behind the desired coverage goal, mainly due to vaccine hesitancy. Enhancing community knowledge about the benefits of vaccination is recommended.

The Number of Infants with Hepatitis B virus (HBV) added Each Day in India

Hepatitis B virus (HBV) is one of the major global public health problems.HBV infection is the 10th leading cause of death.(1) In India, HBsAg prevalence,(an indicator of chronic HBV infection) among general population ranges from 2% to 8%.(2) HBV vaccination has been integrated in the Universal Immunization Program (UIP) for last 10 years. All new borns are expected to receive HBV vaccination at 0 day and subsequently at 6, 10 and 14 weeks. Majority of women do not know they are HBV infected. Often they do not have no symptoms. When a pregnant woman has hepatitis B, it can spread to her baby at birth. This can happen during a vaginal delivery or a c-section. Babies and young children can also get hepatitis B from close contact with family members or others who might be infected. When babies become infected with hepatitis B, they have about a 90% chance of developing a lifelong, chronic infection.

Why is the Vaccination Rate Low in India?

India has had an established universal immunization program since 1985 and immunization services are available for free in healthcare facilities. Despite this, India has one of the lowest vaccination rates globally and contributes to the largest pool of under-vaccinated children in the world. Why is the vaccination rate low in India? This paper explores the importance of historical events in shaping India’s current vaccination practices. We examine India’s aggressive family planning program implemented during the period of emergency rule in the 1970s, under which millions of individuals were forcibly sterilized. We find that greater exposure to the forced sterilization policy has had negative effects on the current vaccination rate. We also find that institutional delivery and antenatal care are currently low in states where policy exposure is high. Together, the evidence suggests that the forced sterilization policy has had a persistent effect on current health-seeking behavior in India.JEL ClassificationN35, I15, I18, O53, Z1

Demographics of Vaccine Hesitancy in Chandigarh, India

The impact of vaccine hesitancy on childhood immunization in low- and middle-income countries remains largely uncharacterized. This study describes the sociodemographic patterns of vaccine hesitancy in Chandigarh, India. Mothers of children <5 years old were sampled from a two-stage cluster, systematic sample based on Anganwadi child care centers in Chandigarh. Vaccine hesitancy was measured using a 10-item Vaccine Hesitancy Scale, which was dichotomized. A multivariable logistic regression assessed the association between socioeconomic factors and vaccine hesitancy score. Among 305 mothers, >97% of mothers thought childhood vaccines were important, effective, and were a good way to protect against disease. However, many preferred their child to receive fewer co-administered vaccines (69%), and were concerned about side effects (39%). Compared to the “other caste” group, scheduled castes or scheduled tribes had 3.48 times greater odds of vaccine hesitancy (95% CI: 1.52, 7.99). Those with a high school education had 0.10 times the odds of vaccine hesitancy compared to those with less education (95% CI: 0.02, 0.61). Finally, those having more antenatal care visits were less vaccine hesitant (≥4 vs. <4 visits OR: 0.028, 95% CI: 0.1, 0.76). As India adds more vaccines to its Universal Immunization Program, consideration should be given to addressing maternal concerns about vaccination, in particular about adverse events and co-administration of multiple vaccines.

The Assessment of Parents’ Awareness of Children Immunization as per Universal immunization program (UIP)

There are numerous diseases which cause infection in the human beings, it may get cured with medication or without the medication and some of them are become fatal. There are some diseases which get cured completely but leaves behind some damage in human, like polio. This damage not cause physically but also cause mental trauma to children. So, it is better to prevent the disease before manifestation, for that immunization is the best way to prevent and protect from disease by giving medication like a vaccine. Large populations of parents are not aware of the benefits of the immunization. Awareness regarding the vaccination among a small town population is less. The aim by this Survey is parents' awareness of children immunization as per Universal immunization program (UIP). For survey, conducted the cross-sectional observational questionnaire-based community survey in the Yelikeli village of Wardha district, where the assessment of the children immunizations should do up to the age of 5 years. In 94% population of parents are known about the vaccination, which has to be given to their children of age between 1-4 years. Around 82% of parents get information regarding immunization by Anganwadi sevika. The survey concludes that the government immunization coverage reached to the small village. Most effective mode to provide information about the vaccination program was door to door advertisement which reduces the chances of missing doses of vaccination and because of that parent is well aware of the UIP schedule. The vaccine is enough sufficient to avert severe disease.