Background
Methods
Study setting and communities
Cross-sectional survey
Study participants
Sample size
Recruitment
Data collection
“5As” domains | Definition |
---|---|
Access | The ability of individuals to be reached by, or to reach, recommended vaccines |
Affordability | The ability of individuals to afford vaccination, both in terms of financial and non-financial costs (e.g. time) |
Awareness | The degree to which individuals have knowledge of the need for, and availability of, recommended vaccines and their objective benefits and risks |
Acceptance | The degree to which individuals accept, question or refuse vaccination |
Activation | The degree to which individuals are nudged towards vaccination uptake |
Statistical analysis
Focus group discussions
Study participants
Sample size
Recruitment
Data collection
Data analysis
“5As” domains | Sub-themes (from open-coding) |
---|---|
Access | Good access to vaccines, travel out of town as reason for missed or delayed doses, time of travel out of town |
Affordability | Convenient timing of immunization sessions, free vaccination provided by the government a benefit |
Awareness | Benefits of vaccination, names of vaccines (or diseases prevented), knowledge sharing by health care workers, other sources of vaccination information, limited awareness of benefits/risks of vaccination, more information requested |
Acceptance | Positive view of vaccines in general, vaccination as a social responsibility, influence of health care worker on parents, family or peer influence on attitudes, impact of negative news on parental attitudes, experiences with vaccination, fear of vaccine side-effects |
Activation | Government ads and campaigns, prompts and reminders by health care workers, provisions for delayed doses, financial incentives for vaccination |
Uncategorized | Choice of vaccination centers |
Results
Cross-sectional survey
Characteristic | Categories | N (%) | Fully vaccinated, n (%) | Under vaccinated, n (%) | p-value* |
---|---|---|---|---|---|
Socio-demographic | |||||
Child’s gender | Male | 53 (53.0) | 35 (66.0) | 18 (34.0) | 0.805 |
Female | 47 (47.0) | 30 (63.8) | 17 (36.2) | ||
Place of birth | Public facility | 78 (78.0) | 52 (66.7) | 26 (33.3) | 0.198† |
Private facility | 12 (12.0) | 9 (75.0) | 3 (25.0) | ||
Home | 10 (10.0) | 4 (40.0) | 6 (60.0) | ||
Mother’s education | No formal education | 46 (46.0) | 23 (50.0) | 23 (50.0) | 0.029 |
Primary school or higher | 54 (54.0) | 42 (77.8) | 12 (22.2) | ||
Father’s education | No formal education | 39 (39.0) | 20 (51.3) | 19 (48.7) | 0.097 |
Primary school or higher | 61 (61.0) | 45 (73.8) | 16 (26.2) | ||
Mother’s occupation | Homemaker | 51 (51.0) | 43 (84.3) | 8 (15.7) | < 0.001 |
Wage earner | 17 (17.0) | 10 (58.8) | 7 (41.2) | ||
Salary earner/small business owners | 32 (32.0) | 12 (37.5) | 20 (62.5) | ||
Father’s occupation | Unemployed/wage earnera | 62 (60.0) | 47 (76.7) | 15 (23.3) | 0.005 |
Salary earner/small business owners | 38 (38.0) | 18 (47.4) | 20 (52.6) | ||
Religion | Hindu | 83 (83.0) | 57 (68.7) | 26 (31.3) | 0.130 |
Others | 17 (17.0) | 8 (47.1) | 9 (52.9) | ||
Community type | Narikuravar | 53 (53.0) | 27 (50.9) | 26 (49.1) | 0.022 |
Other communitiesb | 47 (47.0) | 38 (80.9) | 9 (19.1) | ||
Type of dwelling | Mud/semi-cemented | 45 (45.0) | 28 (62.2) | 17 (37.8) | 0.503 |
Cemented | 55 (55.0) | 37 (67.3) | 18 (32.7) | ||
Vaccination card | Not available | 49 (49.0) | 26 (53.1) | 23 (46.9) | 0.006 |
Yes | 51 (51.0) | 39 (76.5) | 12 (23.5) | ||
Non-socio-demographic | |||||
Mode of travel to immunization facility (proxy for distance to facility) | Walking | 54 (54.0) | 32 (59.3) | 22 (40.7) | 0.200 |
Private or public transport | 46 (46.0) | 33 (71.7) | 13 (28.3) | ||
I think immunization is important to keep my child healthy | Not agree (N) | 5 (5.0) | 1 (20.0) | 4 (80.0) | 0.075† |
Agree (SA,A)c | 95 (95.0) | 64 (67.4) | 31 (32.6) | ||
I am familiar with the recommended immunization schedule for children | Not agree (N,DA, SDA) | 44 (44.0) | 22 (50.0) | 22 (50.0) | 0.035 |
Agree (SA,A) | 56 (56.0) | 43 (76.8) | 13 (23.2) | ||
Reported hesitancy about one or more childhood vaccines | Hesitant (N,SH,VH) | 22 (22.0) | 14 (63.6) | 8 (36.4) | 0.869 |
Not hesitant (NH,NTH)d | 78 (78.0) | 51 (65.4) | 27 (34.6) | ||
Received information about the recommended immunization schedule during antenatal visits | No or not sure | 9 (9.0) | 2 (22.2) | 7 (77.8) | 0.007 |
Yes | 91 (91.0) | 63 (69.2) | 28 (30.8) | ||
Incentive for receiving three doses of pentavalent vaccine | No or not sure | 51 (51.0) | 27 (52.9) | 24 (47.1) | 0.015 |
Yes | 49 (49.0) | 38 (77.6) | 11 (22.4) |
Vaccine antigen | Card or parental recall (n = 100) | Card only (n = 51) | ||
---|---|---|---|---|
Number vaccinated | Proportion (95% CI)b | Number vaccinated | Proportion (95% CI) | |
BCG | 97 | 97.0 (92.4–98.8) | 48 | 94.1 (84.8–97.9) |
Pentavalent- 1 | 90 | 90.0 (83.0–94.3) | 48 | 94.1 (85.2–97.8) |
Pentavalent- 2 | 86 | 86.0 (78.3–91.3) | 50 | 98.0 (89.7–99.7) |
Pentavalent- 3 | 81 | 81.0 (70.2–88.5) | 46 | 90.2 (76.0–96.4) |
OPV- 1 | 92 | 92.0 (84.6–96.0) | 50 | 98.0 (89.7–99.7) |
OPV- 2 | 86 | 86.0 (78.3–91.3) | 50 | 98.0 (89.7–99.7) |
OPV- 3 | 80 | 80.0 (68.9–87.8) | 45 | 88.2 (74.8–95.0) |
Measles or MR | 75 | 75.0 (65.3–82.7) | 46 | 90.2 (76.9–96.2) |
Fully vaccinateda | 65 | 65.0 (52.5–75.8) | 39 | 76.5 (58.2–88.4) |
Characteristic | Categories | N (%) | Prevalence Odds Ratio (95% CI) | |
---|---|---|---|---|
Unadjusted | Adjusted | |||
Mother’s education | No formal education | 46 (46.0) | Ref | Ref |
Primary school or higher | 54 (54.0) | 3.50 (1.15–10.64)** | 0.99 (0.20–4.94) | |
Mother’s occupation | Home maker | 51 (51.0) | Ref | Ref |
Wage earner | 17 (17.0) | 0.27 (0.09–0.82)** | 0.21 (0.07–0.64)** | |
Salary earner/small business owners | 32 (32.0) | 0.11 (0.04–0.31)** | 0.18 (0.04–0.73)** | |
Father’s occupation | Unemployed/wage earner | 62 (62.0) | Ref | Ref |
Salary earner/small business owners | 38 (38.0) | 0.29 (0.12–0.68)** | 1.30 (0.40–4.22) | |
Community type | Other communitiesa | 47 (47.0) | Ref | Ref |
Narikuravar | 53 (53.0) | 0.25 (0.08–0.81)** | 0.33 (0.06–1.91) | |
Vaccination card | Not available | 49 (49.0) | Ref | Ref |
Yes | 51 (51.0) | 2.88 (1.38–5.99)** | 1.59 (0.61–4.19) | |
I am familiar with the recommended immunization schedule for children | Not agree (N,DA, SDA)b | 44 (44.0) | Ref | Ref |
Agree (SA,A) | 56 (56.0) | 3.31 (1.09–10.02)** | 2.89 (0.90–9.28)* | |
Received information about the recommended immunization schedule during antenatal visits | No or not sure | 9 (9.0) | Ref | Ref |
Yes | 91 (91.0) | 7.89 (1.86–33.28)** | 4.55 (0.58–35.38) | |
Incentive for receiving three doses of pentavalent vaccine | No or not sure | 51 (51.0) | Ref | Ref |
Yes | 49 (49.0) | 3.07 (1.26–7.49)** | 1.18 (0.26–5.28) |
Focus group discussions
Access
My child has missed vaccines. We were out of town for a long time while she was younger. As far as I know, she only received two vaccines.(Father, Irular community)
There are parents [in the community] who delay vaccines by a month or two, may be because they travel out of the town [ … ].(Mother, Irular community)
After new year we go out (January-March), during Pongal [a southern Indian harvest festival] we stay out for 20 to 25 days.(Father, Narikuravar community)
Affordability
The government is giving vaccination free, if we had to get those vaccines in private clinics it would cost us 1000 or 2000 INR [15 – 30 USD], we cannot afford that, so we take the vaccines given by the government.(Father, Irular community)
This time [10 – 12 am] is the best for us, if we leave the house by 10, we are able to get the vaccine by 11 and return home.(Mother, Narikuravar community)
Awareness
If we vaccinate our children, they are healthy and well, no problems will come to them. Many other children get measles, but my child does not have it because she has been vaccinated.(Mother, Narikuravar community)
We want to know more about the diseases, how they come and how vaccines help reduce them, this advice would be very helpful to us. [ … ] We want to keep our children safe and healthy, that is very important to us.(Father, Irular community)
The problem in villages like ours is that fathers generally go for work 6 days a week, we are free on Sundays only. So we don’t get a chance to go for vaccination sessions. Most people don’t have much awareness about vaccines.(Father, Quarry worker community)
The nurse sometimes seats a few of us parents and explains why the vaccine is being given and when the next vaccine is due. They tell us where the vaccine must be given also [site of administration].(Mother, Quarry worker community)
Before they [VHN/doctor] vaccinate our children, they do not give us enough information. For example, they say, this is the 1.5-month vaccine, they do not tell us the name or what it is for, similarly with the 2.5- and 3.5-month vaccines [the mother is referring to the pentavalent vaccine].(Mother, Quarry worker community)
We do not know anything there, it is a new place. We do not know where to get it done [vaccinations]. We wait till we return back home, and get our child vaccinated then.(Mother, Narikuravar community)
Acceptance
If there is anyone [an unvaccinated child] like that, we tell them to vaccinate their child. It is good for the child. There are 12 months in a year and 24 hours in a day, what if anything happens to the child at that time? It is important to vaccinate children to keep them protected at all times.(Mother, Narikuravar community)
Many parents got scared because of that [the news], some did not want to give their children polio drops. People saw some news on TV and some video, and got afraid, will anything like this happen to our children?(Mother, Narikuravar community)
There are many parents who are afraid that their child may get fever after vaccination, or that their child may have some defects.(Mother, Irular community)
Activation
[ … ] Even if we miss immunization sessions in the Anganwadi [public childcare centers], she [the VHN] comes in search of the specific houses with such children and organizes special sessions to get them vaccinated the following day.(Father, Irular community)