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The impact of the national polio immunization campaign on levels and equity in immunization coverage: evidence from rural North India

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  • Bonu, Sekhar
  • Rani, Manju
  • Baker, Timothy D.

Abstract

Few studies have investigated the impact of immunization campaigns conducted under the global polio eradication program on sustainability of polio vaccination coverage, on coverage of non-polio vaccines (administered under Expanded Program on Immunization (EPI)), and on changes in social inequities in immunization coverage. This study proposes to fill the gaps in the evidence by investigating the impact of a polio immunization campaign launched in India in 1995. The study uses a before-and-after study design using representative samples from rural areas of four North Indian states. The National Family Health Survey I (NFHS I) and NFHS II, conducted in 1992-93 and 1998-99 respectively, were used as pre- and post-intervention data. Using pooled data from both the surveys, multivariate logistic regression models with interaction terms were used to investigate the changes in social inequities. During the study period, a greater increase was observed in the coverage of first dose of polio compared to three doses of polio. Moderate improvements in at least one dose of non-polio EPI vaccinations, and no improvements in complete immunization against non-polio EPI diseases were observed. The polio campaign was successful, to some extent, in reducing gender-, caste- and wealth-based inequities, but had no impact on religion- or residence-based inequities. Social inequities in non-polio EPI vaccinations did not reduce during the study period. Significant dropouts between first and third dose of polio raise concerns of sustainability of immunization coverage under a campaign approach. Similarly, little evidence to support synergy between polio campaign and non-polio EPI vaccinations raises questions about the effects of polio campaign on routine health system's functions. However, moderate success of the polio campaign in reducing social inequities in polio coverage may offer valuable insights into the routine health systems for addressing persistent social inequities in access to health care.

Suggested Citation

  • Bonu, Sekhar & Rani, Manju & Baker, Timothy D., 2003. "The impact of the national polio immunization campaign on levels and equity in immunization coverage: evidence from rural North India," Social Science & Medicine, Elsevier, vol. 57(10), pages 1807-1819, November.
    • Handle: RePEc:eee:socmed:v:57:y:2003:i:10:p:1807-1819
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    Cited by:

    1. Averi Chakrabarti & Karen A Grépin & Stéphane Helleringer, 2019. "The impact of supplementary immunization activities on routine vaccination coverage: An instrumental variable analysis in five low-income countries," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-11, February.
    2. Rifat Atun & Thyra de Jongh & Federica V. Secci & Kelechi Ohiri & Olusoji Adeyi, 2009. "Clearing the Global Health Fog : A Systematic Review of the Evidence on Integration of Health Systems and Targeted Interventions," World Bank Publications - Books, The World Bank Group, number 5946.
    3. Abbas, Faisal & Bang, James T. & Mitra, Aniruddha, 2023. "Remittances and Vaccine Hesitancy in the Punjab Province of Pakistan," GLO Discussion Paper Series 1308, Global Labor Organization (GLO).
    4. Rammohan, Anu & Awofeso, Niyi, 2015. "District-level variations in childhood immunizations in India: The role of socio-economic factors and health infrastructure," Social Science & Medicine, Elsevier, vol. 145(C), pages 163-172.
    5. Meheus, Filip & Van Doorslaer, Eddy, 2008. "Achieving better measles immunization in developing countries: does higher coverage imply lower inequality?," Social Science & Medicine, Elsevier, vol. 66(8), pages 1709-1718, April.
    6. Yaqub, Ohid & Nightingale, Paul, 2012. "Vaccine innovation, translational research and the management of knowledge accumulation," Social Science & Medicine, Elsevier, vol. 75(12), pages 2143-2150.
    7. Parashar, Sangeeta, 2005. "Moving beyond the mother-child dyad: Women's education, child immunization, and the importance of context in rural India," Social Science & Medicine, Elsevier, vol. 61(5), pages 989-1000, September.
    8. Bonu, Sekhar & Rani, Manju & Razum, Oliver, 2004. "Global public health mandates in a diverse world: the polio eradication initiative and the expanded programme on immunization in sub-Saharan Africa and South Asia," Health Policy, Elsevier, vol. 70(3), pages 327-345, December.
    9. Katharina Muhlhoff, 2021. "Why Covid19 will not be gone soon: Lessons from the institutional economics of smallpox vaccination in 19th Century Germany," Working Papers 0208, European Historical Economics Society (EHES).
    10. Luke, Nancy & Munshi, Kaivan, 2007. "Social affiliation and the demand for health services: Caste and child health in South India," Journal of Development Economics, Elsevier, vol. 83(2), pages 256-279, July.
    11. Mühlhoff, Katharina, 2022. "Convincing the “Herd” of immunity: Lessons from smallpox vaccination in 19th century Germany," Economics & Human Biology, Elsevier, vol. 47(C).

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