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Rimal RN, Ganjoo R, Jamison A, Parida M, Tharmarajah S. Social norms, vaccine confidence, and interpersonal communication as predictors of vaccination intentions: Findings from slum areas in Varanasi, India. Vaccine 2024:S0264-410X(24)00666-2. [PMID: 38909001 DOI: 10.1016/j.vaccine.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/09/2024] [Accepted: 06/01/2024] [Indexed: 06/24/2024]
Abstract
In recent years, India has seen significant improvements in childhood immunization, but rates among the urban poor remain stagnant. Disruptions during COVID-19 pandemic have created further challenges. This paper focuses on how social norms, vaccine confidence, and interpersonal communication independently and jointly affect vaccine intentions among caregivers of infants living in six slum areas in Varanasi, India. Data for this study come from the baseline assessments conducted before implementing the Happy Baby Program, an intervention to improve vaccination attitudes and intentions. In-person interviews (N = 2,058) were conducted with caretakers of children up to two years old. Analyses showed that interpersonal communication about vaccines, descriptive norms, injunctive norms, and vaccine confidence were each associated with intentions to vaccinate in both a bivariate and, except for injunctive norms, a multivariate model. In addition, we found significant interactions among these variables, suggesting that the roles of interpersonal communication and vaccine confidence attenuated the relationship between social norms and vaccination intention. Overall, our model explained 46.2 % of the variance in vaccine intention. Given the strengths of the relationships observed in this study, intervention strategies should focus on enhancing social norms and vaccine confidence to promote vaccination.
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Affiliation(s)
- Rajiv N Rimal
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Amelia Jamison
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, USA
| | - Manoj Parida
- Development Corner (DCOR), Bhubaneshwar, Odisha, India
| | - Saraniya Tharmarajah
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, USA
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Birhanu F, Yitbarek K. Wealth-based inequity in full child vaccination coverage: An experience from Mali, Bangladesh, and South Africa. A multilevel poison regression. PLoS One 2023; 18:e0293522. [PMID: 38117824 PMCID: PMC10732374 DOI: 10.1371/journal.pone.0293522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/15/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES Every child around the globe should get routine childhood vaccination, which is mostly affected by the country's economic capacity besides the socioeconomic differences. However, how well countries with different economic capacities address equitable child vaccination remains unanswered. METHODS Cross-sectional data from the latest Demographic and Health Survey (DHS) database of Mali, Bangladesh, and South Africa was used for this study. The dependent variable was full child vaccination, and wealth-based inequality was assessed using rate-ratio, concentration curve, and concentration index. A multilevel Poisson regression analysis was used to determine the predictors of inequalities. A risk ratio (RR) with a p-value of 0.05 was used to declare statistical significance. All analysis was weighted. RESULTS Full child vaccination status was 30.15%, 62.18%, and 46.94% in Mali, Bangladesh, and South Africa respectively. Even if the disparity is higher in Mali, the full vaccination favors the better-off family both in Mali, and Bangladesh respectively [CInd: 0.05, 95% CI: 0.01, 0.09], [CInd: 0.02, 95% CI: 0.001, 0.03], wealth status did not have an effect in South Africa. The multilevel poison regression indicated maternal age, occupation, wealth of household, and frequency of watching television to positively affect full vaccination, whereas the number of children in the house negatively affected full vaccination. CONCLUSION Wealth-based inequality in child vaccination was higher in Mali followed by Bangladesh. There was no observable significant equity gap in South Africa. Wealth status, maternal occupation, maternal age, frequency of watching television, and number of children were predictors of full child vaccination.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Science, Mizan-Tepi University, Mizan Aman, Southwest Ethiopia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Atteraya MS, Song IH, Ebrahim NB, Gnawali S, Kim E, Dhakal T. Inequalities in Childhood Immunisation in South Asia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1755. [PMID: 36767118 PMCID: PMC9914161 DOI: 10.3390/ijerph20031755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 06/18/2023]
Abstract
Identifying the inequalities associated with immunisation coverage among children is crucial. We investigated the factors associated with complete immunisation among 12- to 23-month-old children in five South Asian countries: Afghanistan, Bangladesh, India, Nepal, and Pakistan, using nationally representative data sets from the Demographic and Health Survey (DHS). Descriptive statistics, bivariate association, and logistic regression analyses were employed to identify the prevalence and the factors in each country that affect the likelihood of full childhood immunisation coverage. The complete childhood immunisation coverage varied significantly within each country in South Asia. Afghanistan had the lowest immunisation rates (42.6%), whereas Bangladesh ranked the highest in complete childhood immunisation rates, at 88.2%. Similarly, 77.1% of Indian children, 79.2% of Nepali children, and 62.2% of Pakistani children were completely immunised. Household wealth status strongly correlated with full childhood immunisation in Afghanistan, India, and Pakistan at the bivariate level. The results from the logistic regression showed that a higher maternal educational level had a statistically significant association with complete childhood immunisation in all countries compared to mothers who did not attend any school. In conclusion, the study revealed the inequalities of complete childhood immunisation within South Asia. Governments must be proactive in their endeavours to address universal and equitable vaccine coverage in collaboration with national and international stakeholders and in line with the relevant Sustainable Development Goals.
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Affiliation(s)
| | - In Han Song
- Department of Social Welfare, Yonsei University, Seoul 03722, Republic of Korea
| | - Nasser B. Ebrahim
- Department of Public Health, Keimyung University, Daegu 42601, Republic of Korea
| | - Shreejana Gnawali
- International Affairs Team, Keimyung University, Daegu 42601, Republic of Korea
| | - Eungi Kim
- Department of Library and Information Science, Keimyung University, Daegu 42601, Republic of Korea
| | - Thakur Dhakal
- Department of Life Science, Yeungnam University, Gyeongsan 38541, Republic of Korea
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Mathew JL, Riopelle D, Ratho RK, Bharti B, Singh MP, Suri V, Carlson BF, Wagner AL, Boulton ML. Measles seroprevalence in persons over one year of age in Chandigarh, India. Hum Vaccin Immunother 2022; 18:2136453. [PMID: 36279515 DOI: 10.1080/21645515.2022.2136453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Measles continues to result in focal outbreaks in India, despite over three decades of universal infant vaccination. The aims of this study were to examine measles immunity in the population of Chandigarh, India, and to compare immunity by vaccination vs. natural infection. In a cross-sectional study of individuals 1-60 years selected from 30 communities within Chandigarh during 2017-2018, measles immunity was assessed using serological surveys. Seropositivity was compared across demographic groups, and by prior history of vaccination and natural history of infection. Among those 1-20 years old, measles seropositivity, and histories of measles vaccination or prior measles diagnosis were separately assessed as outcomes in logistic regression models, with demographic factors as independent variables. Among 1690 participants, 94% were seropositive, and 6% had borderline or negative antibody levels. Of those positive, 30% had prior vaccination, 16% had a history of natural infection, and 54% had an unknown history. Over 50% of individuals among those >20 years old, had unknown history of immunity. In the multivariable regression models, vaccination was more common in younger ages (P < .0001), and in males compared to females (P = .0220), and in those with more education (P < .0001). The majority of the population was seropositive, and seropositivity increased with age. Older age groups were more likely to be protected because of previous natural infection, whereas younger age groups were protected by vaccination. There was inequity in vaccination coverage by gender, and maternal education status.
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Affiliation(s)
| | - Dakota Riopelle
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - R K Ratho
- Department of Virology, PGIMER, Chandigarh, India
| | | | - Mini P Singh
- Department of Virology, PGIMER, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, MI, USA
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MuhammadJoy TM. Does childhood financial status relate to satisfaction in late life: Findings from the Longitudinal Aging Study in India. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Srivastava S, Kumar P, Chauhan S, Banerjee A. Household expenditure for immunization among children in India: a two-part model approach. BMC Health Serv Res 2021; 21:1001. [PMID: 34551769 PMCID: PMC8459463 DOI: 10.1186/s12913-021-07011-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/10/2021] [Indexed: 01/12/2023] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07011-0.
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Affiliation(s)
- Shobhit Srivastava
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Pradeep Kumar
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India.
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
| | - Adrita Banerjee
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
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Wahl B, Gupta M, Erchick DJ, Patenaude BN, Holroyd TA, Sauer M, Blunt M, Santosham M, Limaye RJ. Change in full immunization inequalities in Indian children 12-23 months: an analysis of household survey data. BMC Public Health 2021; 21:841. [PMID: 33933038 PMCID: PMC8088616 DOI: 10.1186/s12889-021-10849-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND India has made substantial progress in improving child health in recent years. However, the country continues to account for a large number of vaccine preventable child deaths. We estimated wealth-related full immunization inequalities in India. We also calculated the degree to which predisposing, reinforcing, and enabling factors contribute to these inequalities. METHODS We used data from the two rounds of a large nationally representative survey done in all states in India in 2005-06 (n = 9582) and 2015-16 (n = 49,284). Full immunization status was defined as three doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, one dose of Bacillus Calmette-Guérin vaccine, and one dose of measles vaccine in children 12-23 months. We compared full immunization coverage by wealth quintiles using descriptive statistics. We calculated concentration indices for full immunization coverage at the national and state levels. Using predisposing, reinforcing, and enabling factors associated with full immunization status identified from the literature, we applied a generalized linear model (GLM) framework with a binomial distribution and an identity link to decompose the concentration index. RESULTS National full immunization coverage increased from 43.65% in 2005-06 to 62.46% in 2015-16. Overall, full immunization coverage in both 2005-06 and 2015-16 in all states was lowest in children from poorer households and improved with increasing socioeconomic status. The national concentration index decreased from 0.36 to 0.13 between the two study periods, indicating a reduction in poor-rich inequality. Similar reductions were observed for most states, except in states where inequalities were already minimal (i.e., Tamil Nadu) and in some northeastern states (i.e., Meghalaya and Manipur). In 2005-06, the contributors to wealth-related full immunization inequality were antenatal care, maternal education, and socioeconomic status. The same factors contributed to full immunization inequality in 2015-16 in addition to difficulty reaching a health facility. CONCLUSIONS Immunization coverage and wealth-related equality have improved nationally and in most states over the last decade in India. Targeted, context-specific interventions could help address overall wealth-related full immunization inequalities. Intensified government efforts could help in this regard, particularly in high-focus states where child mortality remains high.
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Affiliation(s)
- Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Floor 5, Baltimore, MD, 21231, USA.
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Floor 5, Baltimore, MD, 21231, USA
| | - Bryan N Patenaude
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Floor 5, Baltimore, MD, 21231, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Taylor A Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Floor 5, Baltimore, MD, 21231, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Molly Sauer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Floor 5, Baltimore, MD, 21231, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Madeleine Blunt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Floor 5, Baltimore, MD, 21231, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Floor 5, Baltimore, MD, 21231, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Rupali Jayant Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, Floor 5, Baltimore, MD, 21231, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Impact of Multiple Risk Factors on Vaccination Inequities: Analysis in Indian Infants Over 2 Decades. Am J Prev Med 2021; 60:S34-S43. [PMID: 33183900 DOI: 10.1016/j.amepre.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Several authors have explored the effect of individual risk factors on vaccination inequity in Indian infants. This study explores the combined impact of >1 risk factor on the probability of full vaccination. METHODS The proportion of fully vaccinated infants (aged 1-2 years) was calculated from the National Family Health Survey conducted during 1997-1998 (National Family Health Survey-2, n=10,211), 2005-2006 (National Family Health Survey-3, n=9,582), and 2015-2016 (National Family Health Survey-4, n=48,715). Full vaccination was defined as receiving Bacille Calmette‒Guerin (1 dose); diphtheria, pertussis, tetanus (3 doses); oral polio (3 doses); and measles (1 dose) vaccines. The association between full vaccination status and 6 factors (infant sex, birth order, family wealth status, maternal education level, residence type, and religion) was analyzed individually, followed by the combined impact of ≥1 of the first 4, using logistic regression models. RESULTS The AORs for full vaccination in the 3 surveys, respectively, were 1.09, 1.13, and 1.00 for male versus female infants; 0.68, 0.71, and 0.88 for birth order >1 versus birth order 1; 1.54, 1.96, and 1.20 for greater wealth versus lowest wealth stratum; 2.21, 2.27, and 1.27 for any maternal education versus none; 1.08, 1.10, and 1.08 for Hindu versus other religion; and 1.51, 1.10, and 0.88 for urban versus rural residence. The respective ORs of full vaccination in the 3 surveys by the number of risk factors were as follows: 1.26, 1.54, and 1.27 for 3 risk factors; 2.41, 3.23, and 1.68 for 2 risk factors; 4.42, 6.45, and 2.18 for 1 risk factor; and 7.32, 9.84, and 2.61 for no risk factor. CONCLUSIONS The presence of multiple risk factors had a cumulative negative impact on infant vaccination in India. Despite an improvement over 2 decades, significant inequities persist. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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