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Original Article

Immunization status of children and the influence

of social factors: A hospital based study in western
Uttar Pradesh

Satish C. Agrawal a,*, Anita Kumari b

a
Department of Pediatrics, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh 251001, India
b
Department of Pediatrics, SRMS Institute of Medical, Sciences, Bareilly, Uttar Pradesh 243202, India

article info abstract

Article history: Background: Despite the ongoing National Immunization Program, the immunization
Received 13 October 2013 coverage is still not satisfactory, particularly in U.P. Moreover, there is a wide disparity in
Accepted 24 December 2013 coverage, indicating the influence of various social, economic and cultural factors.
Available online xxx Aims: The present study was conducted to know the immunization status of children, 12
e23 months of age, in the Rohilkhand region of U.P. and to assess the effects of various
Keywords: factors influencing it.
Children Settings and design: The present study was carried out as a cross sectional study, between
Immunization September 2012 and February 2013 at the pediatric OPD of SRMS Institute of Medical Sci-
Social factors ences, Bareilly.
Methods: The subjects of the study were OPD children. A total of 450 children, aged 12e23
months were included. Immunization status, with regard to the doses of BCG, OPV, DPT
and measles vaccine given in the 1st year was assessed by interviewing parents and
checking immunization cards. Information about various social factors was also taken.
Percentages and Chi square test were used for analyzing data.
Results: Overall, 40.66% children were found completely immunized, 45.11% were partially
immunized, while 14.22% had received no immunization. The factors, which had a sig-
nificant impact on immunization status were gender of the child, family’s income and
parental education. Birth order, religion and habitation were not found to have significant
impact on the immunization status of children.
Conclusions: There is need for improving economic and educational status of families for
reducing the burden of vaccine preventable diseases.
Copyright ª 2014, Indian Academy of Pediatrics, Infectious Disease Chapter. All rights
reserved.

* Corresponding author. Tel.: þ91 9639883730 (mobile).

E-mail addresses: satishagrawal1947@yahoo.com, drsca47@gmail.com (S.C. Agrawal).
2212-8328/$ e see front matter Copyright ª 2014, Indian Academy of Pediatrics, Infectious Disease Chapter. All rights reserved.
http://dx.doi.org/10.1016/j.pid.2013.12.004

Please cite this article in press as: Agrawal SC, Kumari A, Immunization status of children and the influence of social factors: A
hospital based study in western Uttar Pradesh, Pediatric Infectious Disease (2014), http://dx.doi.org/10.1016/j.pid.2013.12.004
2 p e d i a t r i c i n f e c t i o u s d i s e a s e x x x ( 2 0 1 4 ) 1 e6
1. Introduction
The world in general and the developing world in particular,
besets with the problem of infectious diseases, which take a
heavy toll of life, especially of under five children.1 Immuni-
zation is one of the most effective known interventions to
reduce this morbidity and mortality and its cost-effectiveness
and benefits, particularly to developing countries are beyond
doubt.2,3 In India the overall immunization coverage, as seen
by successive National Family Health Surveys is far from
satisfactory in most of the places.4e6 Moreover, there is wide
disparity with regard to the coverage, among different pop-
ulations, indicating the influence of various social, economic
and cultural factors.7 Though a number of studies are avail-
able, conducted at the national and state levels and also in
different small regions of the country, there has been a
paucity of work in this part of the country, the Rohilkhand
region, a cultural unit with its epicenter at Bareilly, situated in
western Uttar Pradesh (U.P.).
The present study was carried out to have an idea about the
immunization status of children, 12e23 months of age, in this
region (in and around Bareilly) and to assess the effects of
various factors influencing the immunization.
2. Subjects and methods
The present study was carried out between September 2012
and February 2013 at the pediatric outpatients department
(OPD) of Shri Ram Murti Smarak (SRMS) Institute of Medical
Sciences, Bareilly, which is situated on the northern outskirts
of the city and attracts patients mainly from the adjoining
rural and semi-urban areas. The subjects of the study were
children being brought to the hospital OPD as patients. Chil-
dren aged 1 year and above, but under 2 years (up to 23
months), were included in the study. While assessing the
immunization status, only the vaccines used in the national
immunization program (NIP) were taken into account, viz., the
bacillus Calmette Gurein (BCG) vaccine, the oral polio vaccine
(OPV), the diphtheria-pertussis-tetanus (DPT) vaccine and the
measles vaccine. The hepatitis B vaccine was not included in
the study as this vaccine was included by the U.P. government
as a part of routine immunization only in late 2011 and is still
not being given everywhere, especially at the peripheral
health facilities.8 Similarly, the recent Catch up Measles Vac-
cine Campaign, being a recent development, was also not
taken into account. Special care was taken to see that the
doses of OPV administered during the Pulse Polio Program are
not taken into account, as quite often, parents falsely feel
contended as having their children adequately immunized
against polio just by giving these OPV doses. The status was
determined, wherever possible, by the immunization card or
by history obtained from parents. Complete immunization
was defined as receipt of one dose of BCG vaccine soon after
birth, three subsequent doses of DPT and OPV, and one dose of
measles vaccine. ‘No immunization’ was defined as failure to
receive any vaccine listed above. All children who fell between
complete and no immunization were taken as partially
immunized. Although, scientifically speaking, immunization
Please cite this article in press as: Agrawal SC, Kumari A, Immunization status of children and the influence of social factors: A
hospital based study in western Uttar Pradesh, Pediatric Infectious Disease (2014), http://dx.doi.org/10.1016/j.pid.2013.12.004
and vaccination are not synonymous words, for the purpose
of simplicity both the terms have been used interchangeably.
The total number of children was 450, taken randomly,
except for excluding critically ill patients. A proforma had
been prepared to record the details, which were obtained from
the mother (preferably) or the father and this included, be-
sides the general information and the age, the social factors
taken for the study, viz. the gender, the birth order, the reli-
gion, the type of habitation or locality, the family income, and
the educational status of the father and also of the mother
separately.
2.1. Social factors
Determining the sex (gender) and the birth order of the child is
self explanatory; only 2 groups were formed on the basis of
birth order, viz. those who were the 1st or 2nd in birth order,
and those higher than 2nd in birth order. For the purpose of
this study, only 2 religious groups were assigned, viz. Hindus
(which included other groups like Sikhs, Jains, Buddhists etc
as their number was negligible) and Muslims. The type of
habitation was determined by the size of the government’s
administrative unit e those with gram sabha and nagar pan-
chayat were considered rural and semi-urban respectively
and those above this level e municipal board or corporation,
as urban. To assess the family income, all families were
divided into 3 groups, viz., the low-income group, the middle-
income group and the high-income group. In view of the fact
that there exists a variation in the family size and the family
income at different periods, that most of the persons are not
able to tell their exact income and particularly, the contro-
versy attached to who should be called poor, any classification
can at best be an approximate one. For the low-income group,
we used the existing criteria as spelled out by the Planning
Commission for defining below poverty line (BPL); however,
for the purpose of simplicity, the figures were rounded off and
the same figures were used for rural/semi-urban/urban fam-
ilies, though slightly different figures were given by the Plan-
ning Commission, as per capita income per day for rural and
urban families respectively.9 For the present study, a family
(of 5 members on an average) with a monthly income up to Rs
4000 was considered as belonging to the low-income group, a
family income of 40,000 (10 times of that in the low-income
group) or above was considered as high income and those
falling in between as the middle-income group. For the pur-
pose of the parents’ educational status, mothers and fathers
were divided into 3 groups, viz. those with education under
Fig. 1 e Immunization status of the studied children.
 p e d i a t r i c i n f e c t i o u s d i s e a s e x x x ( 2 0 1 4 ) 1 e6 3

Table 1 e Results at a glance: Social factors and their effects.

Variable Total number of Completely immunized Partially immunized Children with no p value
children (n ¼ 450) children (n ¼ 183) children (n ¼ 203) immunization
(n ¼ 64)
Sex
Male 290 132 (45.51%) 120 (41.37%) 38 (13.10%) 0.019
Female 160 51 (31.87%) 83 (51.87%) 26 (16.25%)
Birth order
2 or less 202 90 (44.55%) 82 (40.59%) 30 (14.85%) 0.210
>2 248 93 (37.5%) 121 (48.79%) 34 (13.70%)
Religion
Hindu 232 100 (43.10%) 104 (44.82%) 28 (12.06%) 0.159
Muslim 218 83 (38.07%) 95 (43.57%) 40 (18.34%)
Habitation
Rural 212 79 (37.26%) 98 (46.22%) 35 (16.50%) 0.202
Semi-urban 155 63 (40.64%) 69 (44.51%) 23 (14.83%)
Urban 83 41 (49.39%) 36 (43.37%) 6 (7.22%)
Income group
Low 246 87 (35.35%) 119 (48.37%) 40 (16.26%) 0.006
Middle 164 71 (43.29%) 69 (42.07%) 24 (14.63%)
High 40 25 (62.50%) 15 (37.50%) 0 (0%)
Father’s educational status
Uneducated 283 101 (35.68%) 136 (48.05%) 46 (16.25%) 0.000
Matriculate 112 40 (35.71%) 54 (48.21%) 18 (16.07%)
Graduate 55 42 (76.36%) 13 (23.63%) 0 (0%)
Mother’s educational status
Uneducated 363 129 (35.53%) 171 (47.10%) 63 (17.35%) 0.000
Matriculate 65 35 (53.84%) 29 (44.61%) 1 (1.53%)
Graduate 22 19 (86.36%) 3 (13.63%) 0 (0%)

matriculation, those having been educated up to matricula- and the remaining 64 children (14.22%) had received no im-
tion level or above, but not yet graduates, and those who were munization. Table 1 shows the complete demographic profile
graduates or above. with various social factors and their effect on the immuniza-
For statistical evaluation, Chi-square test was done and a p tion status of children in the studied sample. It can be clearly
value of <0.05 was considered significant. appreciated by comparing the number of completely immu-
nized, partially immunized and non-immunized children
with different groups based on a specific factor that all the
3. Results studied social factors have an appreciable impact with some
having a significant statistical correlation (p value <0.05); this
Results are summarized in Fig. 1 and Tables 1 and 2. Regarding correlation is highly significant with some factors, viz. the
the overall immunization status, as can be seen in Fig. 1 (and family income and particularly, the educational status of
also in Table 1), 183 children (40.66%) were found completely parents.
immunized, 203 children (45.11%) were partially immunized In cases of children with partial or no immunization, the
reasons for not getting their children vaccinated or not
completing vaccination based on the parents’ answers are
Table 2 e Reasons of defaulting for immunization listed in Table 2. As in some cases more than 1 reason was
(partial/no immunization e n [ 450). cited, there is considerable overlapping and the total sum is
S.n. Reasons Number Percentage more than the total number of cases (or >100 in the case of
1. Lack of knowledge 170 37.7 percentage).
2. Forgetfulness 152 33.7
3. Illness of the child 115 25.5
4. Family problems (illness of other 98 21.7
family member(s), death in the 4. Discussion
family, marriage etc.)
5. Lack of initiative (non-visit of 95 21.1
The complete immunization coverage in our study is found to
health worker, health facility
be 40.66%. The overall immunization coverage in India,
situated far away from home)
6. Fear of adverse effect of vaccine 65 14.4 despite showing improvement remains far from satisfactory.
7. Did not get time (busy in work) 45 10.0 As per the NFHS-3 data (2005e06), a slight improvement, from
8. Bad experience following 35 7.7 42% to 43.5%, was noted since NFHS-2 (1998e99).5,6 However,
vaccination (death, illness in the figures from U.P. remained abysmally low; improving from
family, neighborhood) 20% to 23% only, the full immunization coverage being lowest
9. Others (migration etc) 43 9.5
in India except Nagaland.6 Other studies carried out in

Please cite this article in press as: Agrawal SC, Kumari A, Immunization status of children and the influence of social factors: A
hospital based study in western Uttar Pradesh, Pediatric Infectious Disease (2014), http://dx.doi.org/10.1016/j.pid.2013.12.004
4 p e d i a t r i c i n f e c t i o u s d i s e a s e x x x ( 2 0 1 4 ) 1 e6
different parts of U.P. and adjoining states of North India
observed complete immunization rates of 30%, 44%, and 33.3%
respectively.10e12 Interestingly, the studies made in and
around Delhi show higher rates, varying from 69% to over 71%,
though one study showed a percentage as low as 25%.13e15
The rates for partial immunization and no immunization in
all these studies varied between 15% and 48%, and between 8.5
and 34%, while the comparable rates in our study are 45.11%
and 14.22% respectively.10e15 The vast difference between
these coverage rates can be explained by differences in setting
and of course the facilities available in different parts of North
India, Delhi, in most studies, evidently showing much better
results, better even than pan-India coverage. One large study,
consisting of about 19,000 children, carried out in 90 districts,
scattered in different parts of India is worth mention, which
gave rates of complete immunization in the districts lying in
U.P. as 51% and with other BIMARU states (Bihar, Madhya
Pradesh, Rajasthan and U.P.) had much poorer performance
than the national average.16 Another survey, found complete
immunization in 48% children from four BIMARU states
against the national average of 63%, these 4 states constituting
70% of the country’s unvaccinated children.17
4.1. Influence of social factors
4.1.1. Sex (gender)
While studying the effects of social factors on the immuni-
zation status (Table 1), we found significantly higher vaccine
coverage among boys. The rates of complete immunization
showed 45.10% in males against a figure of 31.87% in females,
while the male to female coverage was just reversed for
partially immunized (41.37e51.87%) and non-immunized
children (13.10e16.25%). This difference was found statisti-
cally significant. Almost in all other studies, this difference
was reported including the NFHS-3 data which reported a
gender gap of 5% for most of the vaccines, the gap being higher
in the so called more developed states.3,10,12e14,18 Gender gap
was noted in several other studies including the UNICEF sur-
vey e 2009e10 and the Ministry of Health and Family Welfare
coverage evaluation survey e 2001e02.19,20
4.1.2. Birth order
Birth order also came out to be an important factor to influence
the vaccination coverage in our study, children in the lower
birth order showing a better coverage but this difference was
not found statistically significant (Table 1). The NFHS-3 data
also showed a declining vaccination trend with increasing birth
order.6 Several other studies also show the effect of birth order
on immunization coverage, including a Goa study.10e13,21
4.1.3. Religion
Influence of religion is known to be widespread, on several
aspects of life as it is related with culture, customs and life-
style. In the present study, while 43.10% Hindu children were
found to be fully immunized, the corresponding rate in
Muslim children was 38.07% only; the rates were reversed in
case of non-immunized children (Table 1). This apparently big
difference though, was not found statistically significant. A
Hindu-Muslim gap with regard to immunization coverage was
also observed by Nath et al and Masand et al11,12 NFHS-3
Please cite this article in press as: Agrawal SC, Kumari A, Immunization status of children and the influence of social factors: A
hospital based study in western Uttar Pradesh, Pediatric Infectious Disease (2014), http://dx.doi.org/10.1016/j.pid.2013.12.004
survey reported that Muslim households had lower com-
plete vaccination and higher non-vaccination than Hindu
families.6 UNICEF coverage evaluation survey - 2010 also
showed higher vaccination rate in Hindu infants (61.2%) as
compared to Muslim infants, as did the Department of Family
Welfare Survey.19,20
4.1.4. Habitation (rural, semi-urban and urban areas)
A higher percentage of urban children (49.39%) was found to
be fully immunized than those living in semi-urban (40.64%)
or rural areas (37.26%). The trend was opposite in case of non-
immunized children. This difference in our study, however,
was not found to be statistically significant (Table 1). The
NFHS-3 survey had also found 57.6% of urban children fully
vaccinated against a much lower percentage of 38 in case of
rural children.6 A similar urban-rural gap was reported in the
ICMR 1999 survey, the UNICEF 2009e10 survey and the
Department of Family Welfare survey done in 2002, all of
which reported an urban-rural gap ranging from 9% to 24% for
fully immunized children.16,19,20
4.1.5. Economic status
There was a significant difference between the immunization
rates in children from families from different income groups.
While 35.35% children from low income families showed com-
plete immunization, percentage of such children was a
whooping 62.50% from the high-income group, the rate being
43.29% in the middle-income group children. On the contrary,
there was not a single non-immunized child from the high-in-
come group against 16.26% such children from low income
families. A clear difference can be seen in case of partially
immunized children also (Table 1). This result shows a signifi-
cant statistical correlation between the family income and im-
munization coverage. Various studies have used different
criteria to assess economic/socioeconomic status of families.
NFHS-3 survey applied a classification using wealth index a
composite score comprising living standard based on domestic
assets.6 Most other studies have used Kuppuswamy’s scale,
which takes into account besides economic condition, several
social criteria.12e14 We, however, have used pure economic cri-
terion to study its impact, as other social factors are being
studied independently. The NFHS-3 survey reported 40% urban
poor children fully vaccinated against over 65% non-poor chil-
dren, showing a statistically significant difference.6 Similarly,
the UNICEF 2009-10 survey also reported a direct correlation
between the economic status of families and vaccination
coverage.19 The earlier UNICEF survey of 2005 had shown that
families living in kachcha houses had only 40% of their children
fully immunized against much higher figures of 57% and 65%
among the children living in semi-pucca and pucca houses
respectively.22 Masand et al from Rajasthan reported that 47%
children belonging to Kuppuswamy’s upper class I and II were
completely immunized as compared to 23% children of class III,
IV and V.12
4.1.6. Parents’ educational status
We also tried to assess the influence of parental educational
level on the immunization coverage of their children. This
was assessed for both the parents (fathers and mothers)
separately.
 p e d i a t r i c i n f e c t i o u s d i s e a s e x x x ( 2 0 1 4 ) 1 e6
While evaluating the effect of the father’s educational
status, a big difference was seen between the children of un-
educated fathers and those of educated ones. While only
35.68% children of uneducated fathers showed complete im-
munization, this rate became more than double e 76.36% in
the children of graduate fathers. An interesting finding was
that there was no case of non-immunized child in the group of
graduate fathers (Table 1). This difference was found statis-
tically significant. Most studies on immunization have
focused on the mother’s education; fewer have ventured to
study the father’s, many of them studying a composite
parental education level. There was found a direct correlation
between parental education and vaccination status in the
UNICEF survey e 2005.22 The ICMR survey (1999) found a direct
relationship with paternal literacy, showing a difference of
about 14% between groups with fathers of different educa-
tional levels.16 A cross-sectional study of children in two vil-
lages of Delhi also showed an impact of the father’s education
on the immunization.23
The influence of the maternal education has been studied
more extensively. In the present study, a highly significant
correlation was noticed between maternal education and the
immunization status of children (Table 1). The rate of com-
plete immunization was 35.53% in the group of uneducated
mothers, while the same was 53.84% in matriculate mothers
and an impressive 86.36% in the group of graduate mothers.
Even more noticeable difference was seen in cases of partial
and no immunization. Only one child (1.53%) from the
matriculate mothers’ group was found non-immunized and
the number was zero in the graduate mothers. The UNICEF
2009 and the ICMR 1999 survey had shown a similar correla-
tion.19,16 In a study conducted in two urbanized villages in
Delhi and a study from West Bengal also showed better
vaccination rates in children of more educated mothers.23,24
Masand et al found father’s education having a minimal
impact on the immunization status of their children, as
compared to education status of the mother.12 Similarly, in a
study of 1e7 year old children, the parental literacy had a
beneficial effect, such that up to 20% more children were
immunized.25 In a study from the US, authors found ‘children
of more educated mothers significantly less likely to be under-
immunized at all ages’.26 Surprisingly, however, in a Lucknow
study, mother’s literacy status was not found to significantly
affect the immunized status of the child in the absence of
confounding factors.11
4.2. Reasons for partial/no immunization
While doing the present study, an attempt was also made to
find, through interviewing parents, the reasons for not getting
their children immunized (either when scheduled or not at
all). The reasons are listed in Table 2. The most commonly
observed reason for partial or no immunization was lack of
proper knowledge about the time of the next dose or the
correct schedule. Other noteworthy reasons were forgetful-
ness, illness of some other person in the family, some do-
mestic problem, or simply lack of initiative or concern.
Apprehension of adverse effect was also cited as a reason by
an appreciable number of parents. Most other workers also
have mentioned almost similar reasons.10e14
Please cite this article in press as: Agrawal SC, Kumari A, Immunization status of children and the influence of social factors: A
hospital based study in western Uttar Pradesh, Pediatric Infectious Disease (2014), http://dx.doi.org/10.1016/j.pid.2013.12.004
5
4.3. Strengths and limitations of the study
The present study had a reasonably large sample, larger than
most studies carried out in other small regions of the country.
Therefore, the results carry a good credibility. However, being
a hospital-based study, this cannot be taken as truly reflective
of the community. An ideal set-up is a randomized field study,
which could better represent a community.
Conflicts of interest
All authors have none to declare.
references
1. Anonymous. Maternal, Newborn, Child and Adolescent Health:
Child Health Epidemiology. WHO; 2013. Available from: www.
who.int/maternal_child_adolescent/epidemiolgy/child/en.
Accessed 21.06.13.
2. Walker DG, Hutubessy R, Beutels P. WHO guide for
standardization of economic evaluation of immunization
programmes. Vaccine. 2010 Mar 8;28(11):2356e2359. Epub 2009
Jun 28.
3. Ozawa S, Mirelman A, Stack ML, Walker DG, Levine OS. Cost-
effectiveness and economic benefits of vaccines in low-and-
middle income countries: a systematic review. Vaccine. 2012
Dec 17;31(1):96e108. http://dx.doi.org/10.1016/
j.vaccine.2012.10.103. Epub 2012 Nov 8.
4. International Institute for Population Sciences (IIPS). National
Family Health Survey (MCH and Family Planning), 1992e93. India.
Mumbai: IIPS; 1995.
5. International Institute for Population Sciences (IIPS) and ORC
Macro. National Family Health Survey (NFHS-2), 1998e99. India.
Mumbai: IIPS; 2000.
6. International Institute for Population Sciences (IIPS) and
Macro International. National Family Health Survey (NFHS-3),
2005e06. India. Mumbai: IIPS; 2008.
7. Mathew JL. Inequity in childhood immunization in India: a
systemic review. Indian Pediatr. 2012;49:203e223.
8. Khyati S. U.P. Government Includes Hepatitis B Vaccination in
Routine Immunization Plan. Lucknow: The Indian Express; Oct
4, 2011.
9. Anonymous. Poverty Definition Issues Resolved: Montek, Ramesh.
New Delhi: Press Trust of India; Oct3, 2011. Available from:
www.buisness-standard/article/economy-policy. Accessed
21.06.13.
10. Saxena P, Prakesh D, Saxena V, Kansal S. Assessment of
routine immunization in urban slums of Agra district. Indian J
Prev Soc Med. 2008;39(1):60e62.
11. Nath B, Singh JV, Awasthi S, Bhushan V, Kumar V, Singh SK. A
study on determinants of immunization coverage among
12e23 months old children in urban slums of Lucknow
district, India. Indian J Med Sci. 2007;61:598e606.
12. Masand R, Dixit AM, Gupta RK. Study of immunization status
of rural children (12e23 months age) of district Jaipur,
Rajasthan and factors influencing it: a hospital based study. J
Indian Med Assoc. 2012;110:795e799.
13. Kar M, Reddaiah VP, Kant S. Primary immunization status of
children in slums areas of South Delhi: the challenge of
reaching urban poor. Indian J Commun Med. 2001;26:151e154.
14. Khokar A, chitkara A, Talwar R, Sachdev TR, Rasania SK. A
study of reasons for partial immunization and non-
immunization among children aged 12e23 months from an
6 p e d i a t r i c i n f e c t i o u s d i s e a s e x x x ( 2 0 1 4 ) 1 e6

urban community of Delhi. Indian J Prev Soc Med. 20-%202002%20-20IPPI,%20Routine%20Immunization%20and

2005;36:836e839.
15. Mathew JL, Babber H, Yadav S. Reasons for non immunization
of children in an urban, low income group in North India. Trop
Doct. 2002;32:135e138.
16. Singh P, Yadav RJ. Immunization status of children of India.
Indian Pediatr. 2000;37:1194e1199.
17. Singh P, Yadav RJ. Immunisation status of children in
BIMARU states. Indian J Pediatr. 2001;68:495e500.
18. Srivastava SP, Nayak NP. The disadvantaged girl child in
Bihar: study of health care practices and selected nutritional
indices. Indian Pediatr. 1995;32:911e913.
19. UNICEF. 2009 Coverage Evaluation Survey. Government of India,
Ministry of Health & Family Welfare and UNICEF. Available
from: www.unicef.org/india/health_ 5578.htm and www.
unicef.org/india/National_Fact_ Sheet_CES_2009.pdf.
Accessed 21.06.13.
20. Department of Family Welfare, Ministry of Health and
Family Welfare, Government of India. Coverage Evaluation
Survey e 2002. IPPI, Routine Immunization and Maternal Care.
National Report. Available from: http://202.71.128.172/nihfw/
nchrc/sites/default/files/Coverage%20Evaluation%20Survey%
%20Maternal%20Care%20-%20National%20Report_0_0.pdf.
Accessed 21.06.13.
21. Dalal A, Silveira MP. Imunization status of children in Goa.
Indian Pediatr. 2005;42:401e402.
22. Anon. Coverage Evaluation Survey. All India Report 2005.
Available from: http://202.71.128.172/nihfw/nchrc/sites/
default/files/All%20India%20Report%202005%20Coverage%
20Evaluation%20Survey-1044_2.pdf. Accessed on 21.06.13.
23. Chhabra P, Nair P, Gupta A, Sandhir M, Kannan AT.
Immunization in urbanized villages of Delhi. Indian J Pediatr.
2007;74:131e134.
24. Som S, Pal M, Chakrabarty S, Bharati P. Socioeconomic impact
on child immunisation in the districts of West Bengal, India.
Singap Med J. 2010;51:406e412.
25. Elliott C, Farmer K. Immunization status of children under 7
years in the Vikas Nagar area, North India. Child Care Health
Dev. 2006;32:415e421.
26. Bobo JK, Gale JL, Thapa PB, Wassilak SGF. Risk factors for
delayed immunization in randomized samples of 1163
children from Oregon and Washington. Pediatrics.
1993;91:308e314.

Please cite this article in press as: Agrawal SC, Kumari A, Immunization status of children and the influence of social factors: A
hospital based study in western Uttar Pradesh, Pediatric Infectious Disease (2014), http://dx.doi.org/10.1016/j.pid.2013.12.004