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

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• 作者：Arpita Ghosh^a ; ^{arpita.ghosh@phfi.org} ; Ramanan Laxminarayan^b ; ^c ; ^{ramanan@cddep.org}
• 关键词：ANM ; auxiliary nurse midwife ; ASHA ; accredited social health activist ; CES ; Coverage Evaluation Survey ; DLHS ; District Level Household and Facility Survey ; DPT ; diphtheria-pertussis-tetanus ; OPV ; oral polio vaccine ; PHC ; primary health centre ; UNICEF ; United Nations Children&rsquo ; s Fund
• 刊名：Vaccine
• 出版年：2017
• 出版时间：15 February 2017
• 年：2017
• 卷：35
• 期：7
• 页码：1087-1093
• 全文大小：525 K
• 卷排序：35

文摘

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.MethodsWe 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).ResultsIndividual- 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.ConclusionsNonvaccination 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.