Assessment of vaccine coverage and associated factors among children in urban agglomerations of Kochi, Kerala, India

Context: Urban population in India is growing exponentially. The public sector urban health delivery system has so far been limited in its reach and is far from adequate. Aims: This study aims to estimate routine immunization coverage and associated factors among children (12–23 months and 60–84 months) in the urban Kochi Metropolitan Area of Kerala. Settings and Design: A cross-sectional study was conducted in Kochi Metropolitan area. Materials and Methods: A cluster sampling technique was used to collect data on immunization status from 310 children aged between 12 and 23 months and 308 children aged between 60 and 84 months. Statistical Analysis: Crude coverage details for each vaccine were estimated using percentages and confidence intervals. Bivariate and multivariate analysis were conducted to identify factors associated with immunization coverage. Results: Among the children aged 12–23 months, 89% (95% CI 85.5%-92.5%) were fully immunized, 10% were partially immunized, and 1% unimmunized. Less than 10 years of schooling among mothers (OR 2.40, 95% CI 1.20–4.81) and living in a nuclear family (OR 1.72, 95% CI 1.06–3.14) were determinants associated with partial or unimmunization of children as per multivariate analysis. The coverage of individual vaccines was found to decrease after 18 months from 90% to 75% at 4–5 years for Diphtheria Pertussis Tetanus (DPT) booster. Bivariate analysis found lower birth order and belonging to the Muslim religion as significant factors for this decrease. Conclusion: Education of the mother and nuclear families emerged as areas of vulnerability in urban immunization coverage. Inadequate social support and competing priorities with regard to balancing work and home probably lead to delay or forgetfulness in vaccination. Therefore, a locally contextualized comprehensive strategy with strengthening of the primary health system is needed to improve the immunization coverage in urban areas