ArticleBMC public health2019
Hepatitis B vaccination coverage across India: exploring the spatial heterogeneity and contextual determinants.
Article in BMC public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed, 62 citations in OpenAlex.
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- Uptake and determinants of routine vaccines among children aged 12-23 months in adansi South district of Ghana. a cross-sectional study.BMC pediatrics · 2025Article
- Evaluation of the coordinated development of health resources, health service utilization, and the regional economy in China and analysis of influencing factors.BMC health services research · 2025Article
- Hepatitis B vaccination coverage rates among under-five children in India: a systematic review and meta-analysis protocol.Frontiers in pediatrics · 2025Article
- Hepatitis B virus infection among children aged 1- 5 years of Mayurbhanj district (Odisha), India: A prospective study protocol.PloS one · 2025Article
- High prevalence of hepatitis B virus among MSM living with HIV in India.Journal of viral hepatitis · 2024Article
- Factors influencing and changes in childhood vaccination coverage over time in Bangladesh: a multilevel mixed-effects analysis.BMC public health · 2023Article
- The burden of cirrhosis and other chronic liver diseases due to hepatitis B in children and adolescents: results from global burden of disease study 2019.Frontiers in public health · 2023Article
- Demographic and socioeconomic determinants of access to care: A subgroup disparity analysis using new equity-focused measurements.PloS one · 2023Article
- Spatial clustering in vaccination hesitancy: The role of social influence and social selection.PLoS computational biology · 2022Article
- Vitamin A supplementation among 9-59 month old children in India: geospatial perspectives and implications for targeted coverage.BMJ global health · 2022Article
- Spatial inequalities in skilled birth attendance in India: a spatial-regional model approach.BMC public health · 2022Article
- Population and sub-national (district) level diversity in missed and dropout of different doses of hepatitis-B vaccine among Indian children aged 12-59 months.PLOS global public health · 2022Article
- Building the evidence for hepatitis B vaccination programs for students and researchers working with biological samples in Indian Institutes of Higher Education.Human vaccines & immunotherapeutics · 2021Article
- Gaps in the coverage of vitamin KPublic health nutrition · 2021Article
- Chronic Hepatitis B: Challenges and Successes in India.Clinical liver disease · 2021Review
- The association between the density of vaccination workers and immunization coverage in Zhejiang province, East China.Human vaccines & immunotherapeutics · 2021Article
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough hepatitis B vaccinations have been integrated in the Universal Immunization Program (UIP) in India over a decade, only half of the children are immunized against hepatitis B. The national average in hepatitis B vaccination conceals large variations across states, districts and socio-economic groups. In this context, the aim of this paper is to examine the spatial heterogeneity and contextual determinants of hepatitis B vaccination across the districts of India.
methodsUsing data of 199,899 children aged 12-59 months from the National Family Health Survey-4 (NFHS-4), 2015-16 we have examined the district level spatial distribution and clustering of hepatitis B vaccination with the help of Moran's I and Local Indicator of Spatial Autocorrelation (LISA) measures. We investigated the low coverage of HBV vaccination using spatial autoregressive models (SAR) at the meso scale. And we applied multivariate binary logistic regression analysis to understand the micro-level predictors of hepatitis B vaccination.
resultsIn 2015-16, 45% of the children aged 12-59 months were not vaccinated against hepatitis B in India. The coverage of hepatitis B vaccine across the districts of India showed a highly significant spatial dependence (Moran's I = 0.580). Bivariate Moran's I confirmed the spatial clustering of hepatitis B vaccination with mother's education, full antenatal care (ANC) utilization, post natal care (PNC) utilization, institutional births and registration of births at the district level. Districts with a very low coverage of HBV vaccine are clustered in the western, north-eastern regions and in some parts of central India. At the unit (child) level, children's hepatitis B immunization status is mostly determined by the socio-economic and demographic characteristics like their mother's educational status, caste, religion, household's wealth condition, birth order, year of birth and the region they belong to.
conclusionsDistrict level variation in hepatitis B vaccination is spatially heterogeneous and clustered in India with a strong neighbourhood effect. Uptake of hepatitis B vaccine among Indian children is predominantly dependent upon their socio-economic and demographic characteristics.
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