Routineimpfungen im Kindesalter und ihre Assoziation mit perinataler Betreuung

Eine Querschnittsstudie zum Zusammenhang zwischen institutioneller Entbindung, früher postnataler Nachsorge und Grundimmunisierung im ländlichen Nord-Indien

The association of institutional delivery and timely postnatal care with childhood vaccination

A cross-sectional study in rural Bihar, India

by Mareike Schön
Doctoral thesis
Date of Examination:2025-06-18
Date of issue:2025-05-26
Advisor:Prof. Dr. Thomas Paul
Referee:Prof. Dr. Thomas Paul
Referee:Prof. Dr. Knut Brockmann
Persistent Address: http://dx.doi.org/10.53846/goediss-11250

 

 

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Abstract

English

Incomplete or missing doses in routine childhood immunizations remain a significant public health concern. Health systems in low- and middle-income countries (LMICs) often face challenges in ensuring full vaccination coverage among children, which compromises their protection against communicable diseases. This study used data from child vaccination cards collected during a cross-sectional primary survey of 1,967 households to assess vaccination status. It examined the association between timely postnatal care (PNC), place of delivery, and both any-dose coverage (at least one dose of each vaccine) and full vaccination among children aged 10 to 20 months in Bihar, India. Bivariate and multivariable logistic regression models were employed. The analysis included vaccines targeting tuberculosis, hepatitis B, polio, diphtheria/pertussis/tetanus (DPT), and measles. Additionally, predictors of perinatal healthcare utilization were explored using multivariable logistic regression. 47.9% of the 1,011 children with card verification were fully vaccinated. Timely PNC was positively associated with full vaccination (adjusted odds ratio (aOR) 1.48, 95% confidence interval (CI) 1.06-2.08) and with the administration of at least one dose (any-dose) of polio vaccine (aOR 3.37 95% CI 1.79-6.36), hepatitis B/pentavalent vaccine (aOR 2.11 95% CI 1.24-3.59), and DPT/pentavalent vaccine (aOR 2.29 95% CI 1.35-3.88). Additionally, delivery in a public health care facility was positively associated with at least one dose of hepatitis B/pentavalent vaccine administration (aOR 4.86 95% CI 2.97-7.95). Predictors for timely PNC were institutional delivery (public and private) (aOR 2.7 95% CI 1.96-3.72, aOR 2.38 95% CI 1.56-3.64), at least one ANC visit (aOR 1.59 95% CI 1.18-2.15), wealth quintile (Middle aOR 1.57 95% CI 1.02-2.41, Richer aOR 1.51 95% CI 1.01-2.25, Richest aOR 2.06 95% CI 1.28-3.31) and household size (aOR 0.95 95% CI 0.92-0.99). Predictor for institutional delivery (public) was at least one ANC visit (aOR 2.18 95% CI 1.73-2.74). Predictors for institutional delivery (private) were at least one ANC visit (aOR 3.18 95% CI 2.44-5.63), religion (aOR 2.21 95% CI 1.14-4.28) and wealth quintile (Richer aOR 4.99 95% CI 1.80-13.82, Richest aOR 6.06 95% CI 2.25-16.30). The findings reveal a positive association between timely postnatal care and childhood vaccination coverage. Additionally, delivery in a public health facility is linked to a higher likelihood of receiving at least one dose of the hepatitis B vaccine, thereby reducing the incidence of zero-dose children. Enhancing the uptake of timely postnatal care, promoting institutional deliveries, and strengthening immunization services prior to discharge from health facilities may contribute to improved vaccination rates among children.
Keywords: childhood; postnatal care; vaccination; Bihar; institutional delivery; India
Schlagwörter: postnatale Betreuung; Bihar; Grundimmunisierung; Geburtsort; Indien; perinatale Beteuung