ArticleCureus2026
Equity in Full Immunization Coverage Among Children Aged 12-23 Months in Urban and Rural Areas of Hyderabad, India: A Community-Based Cross-Sectional Study.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPersistently low and inequitable childhood immunization coverage remains an important public health concern, particularly among socially and economically disadvantaged populations. Field-practice-level data that align with the national surveys are needed to understand local drivers of immunization inequity.
objectivesThis study aimed to determine the association between selected sociodemographic factors and full immunization status, to assess the extent and pattern of socioeconomic inequality in full immunization coverage, and to describe disparities by gender, geographic location, and urban-rural residence among children aged 12-23 months.
methodsA community-based cross-sectional study was conducted from August to October 2023 among 400 children aged 12-23 months (200 urban, 200 rural), selected by multistage random sampling from the field-practice areas of Osmania Medical College, Hyderabad, Telangana, India. Full immunization status was verified against Mother and Child Protection Cards and Anganwadi Centre records. Associations were assessed using the chi-squared test; socioeconomic inequality was quantified using the Erreygers Concentration Index, and Fairlie decomposition was used to identify contributors to the socioeconomic gap.
resultsAmong 400 children, 228 (57.0%) were fully immunized and 172 (43.0%) were non-fully immunized. Full immunization was significantly associated with socioeconomic status (SES), place of residence, sex, and birth order. Coverage was higher among children from the upper socioeconomic class (152/224, 67.86%) than the lower socioeconomic class (76/176, 43.18%; p<0.001), among urban (130/200, 65.0%) than rural children (98/200, 49.0%; p=0.002), and among males (140/226, 61.95%) than females (88/174, 50.57%; p=0.030). Maternal age, maternal education, and religion were not significantly associated with immunization status. A pro-rich distribution was evident (Concentration Index +0.1067; Erreygers Index +0.2432; Wagstaff Index +0.2481), with an absolute SES gap of 24.68 percentage points. Fairlie decomposition explained 1.96 percentage points (7.9%) of the observed gap; urban residence (+136.9%) and Hindu religion (+60.1%) widened the gap, whereas first birth order (-53.1%), male sex (-25.4%), and maternal literacy (-24.8%) narrowed it. The SES equity gap was wider among females (+34.15 percentage points) than males (+18.57) and among urban (+52.74) than rural children (-5.11). Closing the SES gap could increase overall coverage by 10.86 percentage points, corresponding to a population attributable fraction of 16.0%.
conclusionFull immunization coverage in this population remains below global targets and shows a pattern by SES, residence, and gender, with disadvantage compounding among lower-SES girls and lower-SES urban households. Because measured sociodemographic factors explained less than one-tenth of the observed inequality, closing this gap will likely require health system and supply-side interventions alongside household-targeted approaches.
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