Unveiling Spatial Heterogeneity: A Study of Diverse Child Immunization Indicators Across Indian Districts

Abstract

This paper explores the spatial variation and determinants of child immunization coverage across districts in India by using the data of National Family Health Survey- 5. Previous studies have not adequately addressed regional differences in vaccination rates and underlying factors at the district level. The present study aims to fill this gap using sophisticated geostatistical techniques, with a special focus on full immunization, Bacillus Calmette Guerin, diphtheria-pertussis-tetanus, polio, and measles vaccines. The spatial distribution of immunization coverage across districts is analyzed, with three coverage categories: low, medium, and high. Economically disadvantaged states like Assam, Bihar, and Uttar Pradesh, as well as relatively affluent states, show varied coverage rates. This study examines the impact of the multiple determinants on immunization coverage, encompassing factors such as maternal and child health services, out-of-pocket expenditure, maternal education, and rates of institutional birth. Spatial autocorrelation is assessed using univariate Moran’s I, identifying clusters of high and low coverage. The study uses spatial regression models, spatial lag and spatial error, to account for spatial dependencies in the data. Significant factors positively associated with vaccination coverage include breastfeeding children with adequate diets, mother and child protection cards, maternal antenatal care, neonatal tetanus and postnatal care. However, out-of-pocket expenditure, health insurance, and women’s education exhibit limited impact on coverage. The findings of the current study emphasize the spatially dependent nature of childhood immunization coverage, revealing crucial determinants that influence regional variation and could guide targeted interventions for improved vaccination rates.