Missed Opportunities, Dropout and Reported Barriers to Primary Immunization Among Children Aged 12–23 Months in Urban Davangere, Karnataka: A Cross-Sectional Study

Abstract

Background: Coverage surveys count how many children are immunized but rarely show where in the schedule children are lost, or why. We examined dropout, missed opportunities and reponed barriers in one urban field practice area. Material & Methods: Community-based cross-sectional study of all 663 enumerated children aged 12-23 months in an urban field practice area of Davangere, Karnataka (January 2019-January 2020). Immunization status was verified from the Mother and Child Protection (MCP) card with maternal recall and Bacillus Calmette-Guérin (BCG) scar for the 16 without one. Results:  Of 663 children. 439 (66.2%) were completely immunized, 222 (33.5%) partially and 2 (0.3%) not at all. Coverage fell from 99.7% (BCG) to 79.6% (Pentavalent 3) and 70.0% (measles-rubella. MR), BCG-to-MR dropout was 29.80%, compared with the reported national estimate of 8.6%. Among partially immunized children, 218 (98.2%) caregivers reported illness kept the child away and 111 (50.0%) that the vaccinator withheld vaccination for illness. After adjustment, no maternal schooling (adjusted odds ratio [aOR] 7.06, 95% confidence interval [CI] 1.39-35.88), primary maternal education (aOR 9.74, CI; 2.02-46.92) and male sex (aOR 1.79, CI; 1.26-2.54) were associated with higher odds of partial or no immunization, and MCP card availability with lower odds (aOR 0.25, Cl; 0.07-0.85). Estimates with reference groups had wide intervals and are imprecise. Conclusions:  First contact was near-universal; completion was not. Illness-related deferral, much of it avoidable, dominated reported barriers. Defaulter tracking from Pentavalent-3 onward, vaccinator reorientation on true contraindications and support for card retention merit local priority.