@article{Pattath:300587,
      recid = {300587},
      author = {Pattath, Balasubramanyam and Nayar, Rashmi and Mantha,  Nivedita and Debnath, Sisir and Deo, Sarang},
      title = {Routine childhood vaccination in India from 2005–2006 to  2015–2016 temporal trends and geographic variation},
      address = {2022},
      number = {ARTICLE},
      abstract = {Objective India has experienced a substantial increase in  the coverage of routine childhood vaccines in recent years.  However, a large fraction of these vaccines is not  delivered in a timely manner, i.e., at the recommended age.  Further, substantial disparities exist in both coverage and  timeliness across states. We aim to quantify the changes in  coverage and timeliness of routine childhood vaccination in  India over time, their variation across states, and changes  in these variations over time. Methods We used data from  two rounds of India’s National Family Health Surveys,  NFHS-3 (2005–06) and NFHS-4 (2015–16) on bacille  Calmette–Guerin vaccine (BCG), three doses of diphtheria,  pertussis, and tetanus vaccine (DPT1, DPT2, DPT3), and  measles-containing vaccine (MCV). We used the Turnbull  estimator to estimate the cumulative distribution function  (CDF) of administering each vaccine by a certain age while  accounting for two-sided censoring in the survey data. We  then used these estimated CDFs to calculate coverage and  timeliness at the national and state levels. Findings At  the national level, both vaccination coverage and  timeliness estimates increased from NFHS-3 to NFHS-4 for  all vaccines. The increase in timeliness ranging from 27.3%  for DPT3 to 74.0% for MCV continued to be lower than  coverage, ranging from 75.3% (95% CI 57.7–87.2) for DPT3 to  74.0% (95% CI 42.2–33.0) for MCV, for all vaccines.  Cross-state variation in timeliness was greater than the  variation in coverage. Variation in both timeliness and  coverage reduced from NFHS-3 to NFHS-4. However, this  reduction was greater for timeliness than for coverage.  Conclusions A large fraction of the children in India  receive vaccines later than the recommended age thereby  keeping them exposed to vaccine-preventable diseases.  Interventions that specifically focus on improving the  timely delivery of vaccines are needed to improve the  overall effectiveness of the routine immunization program.},
      url = {http://repository.graduateinstitute.ch/record/300587},
      doi = {https://doi.org/10.1016/j.vaccine.2022.10.024},
}