VoICE Immunization Evidence: Geographic inequity
Significant evidence of geographic inequity in vaccine coverage exists within countries, within states, and between populations living in rural, peri-urban, and urban areas.
A study in a population of urban poor in Delhi, India, which examined household and neighborhood-level determinants of childhood immunization, found that less than half of children between 1 and 3.5 years of age received complete immunization as recommended. This was significantly lower than the overall state-level average of 70% immunization coverage.
Devasenapathy, N., Ghosh Jerath, S., Sharma, S., et al. 2016. Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study. BMJ Open. 6:e013015.
Inequity in vaccination coverage in India was found between states, within states, in urban vs. rural. Lower parental education resulted in lower coverage, girls had lower coverage than boys and infants born to families with a large number of children also had lower coverage than others. A direct relationship between household wealth and coverage was also found.
Mathew, J.L. 2012. Inequity in childhood immunization in India: a systematic review. Indian Pediatrics. 49:203-23.