Ms. Sanskriti Shukla will present her MTP2 as per the details below:

Date: 24th June, 2026

Time: 1100 - 1200 hrs.

Venue: C-TARA Conference Room No.1

Title: Missing colours of the rainbow: Analysis of child immunization in India

Guide: Prof. Amit Y. Arora

Co-Guide: Prof. Satish B. Agnihotri

Examiners: Prof. Parmeshwar D. Udmale and Prof. Saket Chaudhary

Abstract:

Child immunization remains one of the most effective public health interventions for reducing child mortality and preventing vaccine-preventable diseases. Despite significant progress under India's Universal Immunization Programme (UIP), disparities in vaccination coverage persist across regions, particularly among tribal, migrant, remote, and socio-economically vulnerable populations. Recent measles outbreaks have further underscored the need to strengthen routine immunization systems and disease surveillance.

This study examines the spatial patterns, determinants, and field realities of child immunization and measles incidence in India through four objectives: (1) assessing district-level immunization coverage using NFHS-4 and NFHS-5 data, (2) analysing spatial and temporal trends of measles incidence using IDSP data (2009–2025), (3) identifying socio-demographic and economic determinants of immunization status using multinomial logistic regression on NFHS-5 data, and (4) exploring health-system, supply-chain, and community-level factors affecting immunization through field studies.

A mixed-methods approach was adopted, combining secondary data analysis with field-based investigations. Quantitative analyses included district-level mapping, trend analysis, seasonality assessment, hotspot identification, using NFHS and IDSP datasets. Fieldwork was conducted in Nandurbar and Raigad (Maharashtra), Uttar Bastar Kanker (Chhattisgarh), and East Khasi Hills (Meghalaya) through interviews, focus group discussions, observations of routine immunization sessions, and assessments of cold-chain and health-system infrastructure.

The findings reveal significant regional and intra-state variation in immunization coverage and measles vulnerability. Between NFHS-4 and NFHS-5, Maharashtra recorded improvements in full immunization coverage; however, spatial analysis identified persistent low-coverage clusters in tribal districts such as Nandurbar, while Meghalaya continued to exhibit lower coverage levels compared to the national average. Analysis of IDSP data showed recurring seasonal measles outbreaks, with higher incidence concentrated in districts characterized by low immunization coverage. MLR indicated that maternal education, household wealth, place of residence, and birth order were important determinants of immunization status, though their influence varied across states. Field investigations further highlighted contrasting realities: Raigad demonstrated relatively strong health infrastructure and service accessibility, whereas Nandurbar, Kanker, and parts of East Khasi Hills faced challenges related to difficult terrain, dispersed settlements, migration, transportation constraints, staff shortages, and gaps in cold-chain maintenance. These findings suggest that improving immunization outcomes requires context-specific interventions that strengthen last-mile service delivery, enhance follow-up mechanisms for vulnerable populations, and address local health-system constraints beyond merely increasing coverage levels.

Keywords: Child Immunization, Measles, Universal Immunization Programme, NFHS, IDSP, Spatial Analysis, Tribal Health, Routine Immunization