The online version of this article (https://doi.org/10.1186/s12879-018-3129-2) contains supplementary material, which is available to authorized users.
Children who receive all doses of scheduled vaccines reduce their susceptibility to vaccine-preventable diseases. In India, full immunization coverage has increased significantly. However, only a small proportion of children are immunized on time. Globally, studies on factors affecting coverage of childhood immunization have found a significant impact by demand and supply-side determinants. This paper explores the demand-side determinants of timely immunization of the third dose of oral polio vaccine (OPV3) among children aged 6–11 months in the catchment areas of CORE Group Polio Project India.
We analyzed secondary de-identified data from a household level ‘Doers and Non-doers survey’ conducted in 2015. Determinants of timely OPV3 immunization were identified by modeling the characteristics of index children and survey respondents, surveyed households, respondents’ media habits, their exposure to immunization services and perceptions towards child immunization, through a multinomial regression analysis.
The eight demand-side predictors based on the background characteristics and perceptions of caregivers determined timely vaccination of OPV3. The strongest predictor of timely OPV3 immunization was found to be the fathers’ educational level. Children of uneducated or lesser educated fathers had increased odds of not receiving the OPV1 vaccination, as compared to children of more educated fathers (OR > 10). Respondents who strongly perceived other (non-health) benefits of child immunization were three times more likely to timely vaccinate their children than those who do not. Furthermore, mothers who disagreed with the positive attributes of child immunization were 25 times more likely to delay or not to take their children for OPV immunization on time.
This study found eight essential factors that are responsible for timely OPV3. Despite limitations in data collection and analysis, immunization programs in India could use the eight identified demand-side determinants of timeliness and tailor communication strategies accordingly. We suggest that program communication efforts be directed at male community members; such messaging should address parents’ perceptions of non-health benefits and stress the positive attributes of child immunization. Further investigation would be helpful to assess the various risk factors of under-vaccination as well as vaccinators’ understating about timely immunization.
Additional file 1: Appendix Tables. Table S1. Sample size covered in the doers and non-doers survey by study district. Table S2. Socio-demographic characteristics of index children, respondent mothers, husbands of respondents and surveyed households by three independent samples of the survey. Table S3. Ownership/access to household level facilities/services by three independent samples of doers and non-doers survey. Table S4. Wealth index of surveyed households by three independent samples of the survey. Table S5. Media habits of respondents by three independent samples of the survey. Table S6. Lifestyle related practices of respondents by three independent samples of the survey. Table S7. Exposure of respondents to immunization sites and interactions with frontline workers by three independent samples of the survey. Table S8. Information sources of respondents on getting their children immunized by three independent samples of the survey. Table S9. Exposure of respondents to selected IEC materials of CGPP India by three independent samples of the survey. Table S10. Awareness level of respondents about vaccine-preventable diseases by three independent samples of the survey. Table S11. Distribution of non-doers respondents by stated reasons behind not vaccinating children on time. Table S12. Components that determined from 12 items on the importance of child immunization, derived through principal. Component. analysis. Table S13. Details of five components determined from 27 items on attributes of the place of delivery, living environment, and child immunization, through principal component analysis. (DOC 375 kb)12879_2018_3129_MOESM1_ESM.doc
Additional file 2: Additional text - Definitions and descriptions. (DOCX 20 kb)12879_2018_3129_MOESM2_ESM.docx
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- Demand-side determinants of timely vaccination of oral polio vaccine in social mobilization network areas of CORE Group polio project in Uttar Pradesh, India
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