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March 1, 2010

Association Between Child Immunization and Availability of Health Infrastructure in Slums in India

Author Affiliations

Author Affiliations: Departments of Global Health and Population (Ms Ghei) and Society, Human Development, and Health (Dr Subramanian), Harvard School of Public Health, Boston, Massachusetts; Urban Health Resource Centre, New Delhi, India (Dr Agarwal); and School of Public Health, University of Michigan, Ann Arbor (Dr Subramanyam).

Arch Pediatr Adolesc Med. 2010;164(3):243-249. doi:10.1001/archpediatrics.2009.277

Objective  To examine the association between presence of an urban health center (UHC) in proximity to a slum and immunization status of slum children in a city in India.

Design  Cross-sectional study.

Setting  Slums of Agra, India.

Participants  Data were obtained from a baseline survey conducted by the US Agency for International Development Environmental Health Project in 2005 in slums in Agra. The study population consisted of 1728 children aged 10 to 23 months. Information about children's immunization was obtained from interviews with mothers aged 15 to 44 years.

Main Exposure  Availability and proximity to a UHC that provides immunization services.

Main Outcome Measures  Immunization status of children, which was measured as “complete” if the child had received 1 dose of BCG vaccine, 3 doses each of diphtheria, pertussis, and tetanus and oral polio vaccines, and 1 dose of measles vaccine; “partial” if any 1 or more vaccines were missing; and “not” if no vaccine was received. Adjusted relative risk ratios compared children receiving complete or partial immunization with those not immunized.

Results  Adjusted models showed that presence of a UHC within 2 km of a slum was associated with more than twice the likelihood of children being completely (relative risk ratio, 2.03; 95% confidence interval, 1.12-3.66) or partially (relative risk ratio, 2.33; 95% confidence interval, 1.55-3.50) immunized.

Conclusions  We found that presence of a UHC was positively associated with immunization status of children in slums. These results suggest a need for greater public attention to expand coverage of slums through UHCs.