Immunization Coverage and Determinants of Immunization Failure Among Children Aged 0-5 Years Admitted to a Tertiary Care Hospital in Ahmedabad, Western India: A Cross-Sectional Study

Abstract

Background: Universal childhood immunization is among the most cost-effective public health interventions, yet full-immunization coverage in India continues to fall short of the 85% target envisaged under the Universal Immunization Programme (UIP), with substantial dropout and missed opportunities contributing to preventable morbidity and mortality. Objectives: To assess the immunization status of children aged 0–5 years admitted to the paediatric department of a tertiary care hospital in Ahmedabad and its association with socio-demographic determinants, and to identify the reasons for failure of immunization. Methods: A hospital-based, cross-sectional, purposive-sampling study was conducted in the Department of Paediatrics of a tertiary care hospital, Ahmedabad, over 24 months (December 2016–November 2018). Five hundred children aged 0–60 months were enrolled. Immunization status was ascertained by structured maternal/paternal interview, cross-verified against immunization (Mamta) cards, and classified as completely, partially, or non-immunized as per the National Immunization Schedule. Data were analysed on Microsoft Excel using Pearson's chi-square test; p<0.05 was considered significant. Results: Of 500 children (266 male, 234 female), 66.6% were completely immunized, 27.2% partially immunized, and 6.2% non-immunized. Coverage was highest for the birth dose (BCG+OPV+HepB, 85.8%) and lowest for measles-2/booster-1 (57.7%). The BCG-to-measles-1 dropout rate was 16.2% and the Pentavalent-1-to-3 dropout was 11.4%. Complete immunization was significantly associated with joint family structure, institutional delivery, delivery attended by a doctor, higher parental education, and higher family income (all p<0.05); gender, birth order, and possession of an immunization card were not significantly associated. Among the 167 partially/non-immunized children, the leading parent-reported reasons for failure were unawareness of the need for subsequent vaccination (26.3%), child sickness at the scheduled time (14.4%), and lack of faith in immunization (11.9%). Conclusion: Immunization coverage among hospitalised children in Ahmedabad remains below the UIP target and is driven largely by modifiable knowledge, attitude and health-system barriers rather than vaccine unavailability. Structured parental counselling from the antenatal period, reminder and tracking systems, and strengthened interpersonal communication by frontline health workers could substantially narrow the coverage gap.