Trends in child immunization across geographical regions in India: focus on urban-rural and gender differentials.
Trends in child immunization across geographical regions in India: focus on urban-rural and gender differentials.
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DOI：
10.1371/journal.pone.0073102
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Singh PK
中科院分区：
文献类型：
--
作者：
Singh PK
尽管儿童免疫被认为是一种极具成本效益的救命手段，但印度约有50%的12-23个月的合格儿童没有基本的免疫覆盖。尽管采取了一些方案性举措，但儿童免疫方面的城乡和性别差异对印度的公共卫生议程构成了巨大挑战。本研究评估了1992-2006年印度六个主要地理区域儿童免疫覆盖率的城乡和性别差异。对1992 - 1993年、1998 - 1999年和2005 - 2006年进行的三轮全国家庭健康调查进行了分析。采用双变量分析、城乡和性别不平等比率以及多变量池逻辑回归模型来研究不平等随时间的趋势和模式。对15年来（1992-2006年）变化的分析表明，印度六个地理区域的儿童免疫覆盖率存在相当大的差异。尽管城乡和性别差异随着时间的推移而减少，但居住在农村地区的儿童和女孩仍然处于不利地位。此外，1992年性别不平等最低的东北、西部和南部地区，随着时间的推移，性别差异有所增加。同样，1992-2006年间，西部地区的城乡不平等也有所加剧。本研究表明，定期评估卫生保健系统是至关重要的，以评估组间和组内的差异超过平均改善。必须将强有力的免疫系统与广泛的卫生系统结合起来，并与其他初级卫生保健提供规划协调，以扩大免疫覆盖率。
Although child immunization is regarded as a highly cost-effective lifesaver, about fifty percent of the eligible children aged 12–23 months in India are without essential immunization coverage. Despite several programmatic initiatives, urban-rural and gender difference in child immunization pose an intimidating challenge to India’s public health agenda. This study assesses the urban-rural and gender difference in child immunization coverage during 1992–2006 across six major geographical regions in India. Three rounds of the National Family Health Survey (NFHS) conducted during 1992–93, 1998–99 and 2005–06 were analyzed. Bivariate analyses, urban-rural and gender inequality ratios, and the multivariate-pooled logistic regression model were applied to examine the trends and patterns of inequalities over time. The analysis of change over one and half decades (1992–2006) shows considerable variations in child immunization coverage across six geographical regions in India. Despite a decline in urban-rural and gender differences over time, children residing in rural areas and girls remained disadvantaged. Moreover, northeast, west and south regions, which had the lowest gender inequality in 1992 observed an increase in gender difference over time. Similarly, urban-rural inequality increased in the west region during 1992–2006. This study suggests periodic evaluation of the health care system is vital to assess the between and within group difference beyond average improvement. It is essential to integrate strong immunization systems with broad health systems and coordinate with other primary health care delivery programs to augment immunization coverage.
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