Not covered enough: inadequate age appropriate immunisation in urban slums of Delhi: a community based cross sectional survey

ABSTRACT

Background: The urban average of childhood immunization coverage rates are partial against children living in slums and mask the disparity within the urban poor. The objective of study was to measure the age appropriate immunization as per India’s Universal Immunization Program (UIP) schedule, explore determinants of coverage and reasons for incomplete immunization in urban slums of New Delhi.Methods: A cross sectional survey was carried out in selected urban slums of West and South East districts of New Delhi. WHO’s coverage cluster survey sampling methodology was used. Three hundred mothers of under five children were selected. Age appropriate immunization status of the children was recorded on physical examination of the vaccination card.Results: Fifty eight percent (56% West; 60% South East district) of sample population was age appropriately immunized. The odds of age appropriate immunization were higher for institutional delivery (OR 10.5, 95% CI 4.27-23.6) and among third born children (OR 1.8, 95% CI 1.04-3.30). The odds were equal for people from Delhi or migrated from different state (OR 1.015, 95% CI 0.62-1.64). Most common reason for incomplete immunization were obstacles (72.8%) and lack of information (23.2%).Conclusions: There was a consistent drop in coverage among vaccines with more than one dose and by the subsequent dose of vaccine. The difference in coverage estimates among studies emphasise the need for identifying the key reasons of incomplete immunization and finding area specific solutions to improve coverage.