Rural and Hindu children have the highest immunization rates

September 14, 2015

ANN ARBOR—Children in rural India have higher vaccination rates than those in cities, and Hindu kids are more likely to get their shots than Muslim youth, say University of Michigan researchers.

Their study is believed to be the first that compares vaccination rates across religious groups in India. It’s also significant because the findings that rural kids are better vaccinated are contrary to earlier studies.

The research by U-M’s School of Public Health found that urban children between the ages of 1-3 years have an 80 percent chance of not being vaccinated when compared to children in rural areas.

“Urban areas have pockets of slums where health care services are not reaching,” said lead author Nijika Shrivastwa, who recently finished her doctorate in epidemiology at U-M.

People in rural areas, she added, often have access to health care in government hospitals that deliver free vaccinations. Community health workers and public health centers have also done a good job of spreading vaccination message in villages, she said.

Although India is a leading producer and exporter of vaccines, the country is home to nearly a third of the world’s unimmunized children. Only 57 percent of children younger than 3 are fully vaccinated.

“This study highlights the need to develop a much better understanding of the social factors that influence childhood vaccination and the role that infrequently examined issues—such as caste, religion, sex, residence and poverty—play in determining whether or not a child receives potentially life-saving immunizations in India,” said Dr. Matthew Boulton, senior author of the study and senior associate dean for global public health at U-M.

The study broke down the vaccination rate based on residence, religion, wealth, gender, maternal age and education.

The researchers found that the vaccination rate also differs considerably based on religion. Children from Muslim families have significantly poorer vaccination outcomes, while Sikh children are better immunized when compared to Hindu children. Sikh children are 14 percent more likely to be better vaccinated and Muslim kids are 122 percent more likely not to be vaccinated.

Shrivastwa explained that previous studies on vaccination coverage categorized religion as Hindu or non-Hindu, and this is the first time the non-Hindu religions were sorted further.

“Even after controlling for wealth, maternal education, household income and location, there are huge differences in the immunization rate,” Shrivastwa said. “There are probably cultural and/or religious factors that act as an impediment to vaccination.”

The study looked at the vaccination rate of about 108,000 children under 3 years old in the District Level Household and Facility survey data from 2008, a nationally representative sample. DLHS was started in 1997 to assess government health care facilities and people’s perceptions about the quality of services.

The new DLHS-4 sample was collected in 2013, but the results have not been made public yet.

Shrivastwa said the government of India is rapidly building public health infrastructure and manpower to improve vaccination rates, but other socioeconomic, cultural and religious factors are not being addressed.

“There is a lack of education and awareness for parents on the benefits of vaccination,” she said. “That’s one of the reasons why childhood deaths from vaccine-preventable illness in India remain at unacceptably high levels.”

The study, “Predictors of vaccination in India for children aged 12-36 months,” is jointly published in a special supplement in Vaccine and the American Journal of Preventive Medicine. Other U-M authors of the study are Brenda Gillespie and Giselle Kolenic of the Center for Statistical Consultation and Research and James Lepkowski of the Institute of Social Research.


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