Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India

Arpita Ghosh, Ramanan Laxminarayan

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Background Although 93% of 12- to 23-month-old children in India receive at least one vaccine, typically Bacillus Calmette–Guérin, only 75% complete the recommended three doses of diphtheria-pertussis-tetanus (DPT, also referred to as DTP) vaccine. Determinants can be different for nonvaccination and dropout but have not been examined in earlier studies. We use the three-dose DPT series as a proxy for the full sequence of recommended childhood vaccines and examine the determinants of DPT nonvaccination and dropout between doses 1 and 3. Methods We 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). Results Individual- and household-level factors were associated with both DPT nonvaccination and dropout between doses 1 and 3. 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. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)1087-1093
Number of pages7
JournalVaccine
Volume35
Issue number7
DOIs
StatePublished - Feb 15 2017

All Science Journal Classification (ASJC) codes

  • Molecular Medicine
  • General Immunology and Microbiology
  • General Veterinary
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Keywords

  • District Level Household and Facility Survey (DLHS-3) 2007–08
  • Multilevel modeling
  • Partial or incomplete immunization
  • Vaccine uptake

Fingerprint

Dive into the research topics of 'Demand- and supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India'. Together they form a unique fingerprint.

Cite this