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Incomplete immunization prevalence of 26% among children under five years in IndiaFactors linked to incomplete childhood immunization in India

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Key Takeaway
Note that several factors, including maternal illiteracy and missing cards, are associated with incomplete child immunization.

This meta-analysis synthesized data from observational studies involving a large population of children under five years old in India. The total sample size across the included studies was 428,000. The primary objective was to determine the prevalence of incomplete immunization and identify associated risk factors within this specific demographic.

The study focused on identifying variables that correlate with incomplete immunization status. While a specific intervention protocol was not applicable due to the observational nature of the source data, the analysis examined several determinants including documentation availability, delivery settings, maternal education levels, socioeconomic status, birth order, and child gender.

The primary outcome of the meta-analysis was the pooled prevalence of incomplete immunization, which was reported as 26% (95% CI: 21%-32%). This figure provides a baseline for understanding the scope of immunization gaps in the region. The results indicate that more than one-quarter of the children in the studied population did not complete their required immunization schedules.

Several secondary outcomes identified specific determinants associated with incomplete immunization. The absence of an immunization card was strongly associated with higher rates of incomplete immunization (OR 9.46; 95% CI: 3.28-27.28). Non-institutional delivery also showed a significant association (OR 3.59; 95% CI: 1.96-6.56). Maternal illiteracy was associated with higher rates of incomplete immunization (OR 3.25; 95% CI: 2.22-4.78), and low socioeconomic status showed a positive association (OR 2.03; 95% CI: 1.51-2.71). Additionally, higher birth order (OR 1.88; 95% CI: 1.17-3.03) and female gender (OR 1.34; 95% CI: 1.06-1.69) were associated with increased likelihood of incomplete immunization.

Safety and tolerability data were not reported, as is typical for a meta-analysis of observational studies rather than clinical trials. The study's methodology was noted to have substantial heterogeneity (I = 99.9%), which may impact the precision of the pooled estimates.

These results provide critical context for regional public health strategies. By identifying specific barriers such as maternal illiteracy and lack of documentation, healthcare providers and policymakers can target interventions more effectively. The high odds ratio associated with missing immunization cards suggests that administrative and logistical improvements could significantly impact coverage.

Limitations include the observational nature of the underlying studies, which means these findings indicate associations rather than direct causation. Furthermore, the high heterogeneity (I = 99.9%) reflects significant variation in study designs or populations across the included research. Future research is needed to determine which specific interventions can most effectively mitigate the impact of maternal illiteracy and lack of institutional delivery on childhood immunization rates.

Ensuring every child receives their scheduled vaccinations is a critical part of public health. For parents and caregivers, keeping track of these milestones can be difficult depending on where they live and what resources they have available. This research looks at why some children in India do not complete their full series of immunizations, which helps health officials understand where to focus their efforts to protect more children from preventable diseases.

The researchers conducted a meta-analysis, which is a study that combines the results of many different previous studies to find broader patterns. This specific analysis looked at data from 428,000 children under the age of five in India. By looking at such a large group of children, the researchers were able to identify several common factors that are linked to whether a child finishes their vaccination schedule or not.

The study found that about 26 percent of the children surveyed had incomplete immunization records. Several specific factors were strongly associated with these incomplete records. For example, children who did not have an official immunization card were much more likely to have incomplete vaccinations. Other significant factors included mothers who could not read or write, births that took place outside of a hospital or clinic, and families with lower income levels. The study also noted that girls and children who were not the first child in their family were slightly more likely to have incomplete records.

It is important to note that this was an observational study, which means it shows links between certain conditions and outcomes rather than proving that one thing caused another. Additionally, the data came from many different sources, which can sometimes make it harder to draw firm conclusions about any single specific location. Because of these factors, the results should be seen as a broad overview of trends rather than a definitive rule for every individual family.

For parents and healthcare providers today, these findings highlight where extra support might be needed. The data suggests that providing physical immunization cards, improving access to hospital births, and increasing maternal education are all important steps in ensuring children stay healthy. While this study does not change immediate medical advice, it provides a clear map for health programs to target their resources more effectively to reach every child.

What this means for you:
Several social and logistical factors, like lack of records or lower education, are linked to incomplete childhood vaccinations.

Study Details

Study typeMeta analysis
Sample sizen = 428,000
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: Despite substantial improvements in childhood vaccination coverage under India's Universal Immunization Programme (UIP) and initiatives such as Mission Indradhanush, incomplete immunization remains a significant public health challenge. This systematic review and meta-analysis aimed to estimate the pooled prevalence of incomplete immunization among children under five years in India and identify its major determinants. METHODS: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, Google Scholar, IndMed, and grey literature was conducted for studies published between January 2015 and December 2025. Observational studies reporting prevalence and/or determinants of incomplete immunization among children aged 0-59 months in India were included. Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment was performed. Heterogeneity was assessed using the I statistic, while publication bias was evaluated using contour-enhanced funnel plots, Egger's regression test, and Begg's rank correlation test. RESULTS: Forty-five cross-sectional studies involving more than 428,000 participants were included. The pooled prevalence of incomplete immunization was 26% (95% CI: 21%-32%), with substantial heterogeneity (I = 99.9%). Higher prevalence was observed in northern and multistate studies compared with southern and northeastern regions. Significant determinants of incomplete immunization included absence of an immunization card (OR 9.46, 95% CI: 3.28-27.28), non-institutional delivery (OR 3.59, 95% CI: 1.96-6.56), maternal illiteracy (OR 3.25, 95% CI: 2.22-4.78), low socioeconomic status (OR 2.03, 95% CI: 1.51-2.71), higher birth order (OR 1.88, 95% CI: 1.17-3.03), and female gender (OR 1.34, 95% CI: 1.06-1.69). Sensitivity analyses confirmed robustness of findings. CONCLUSIONS: Approximately one in four children in India remains incompletely immunized. Persistent socioeconomic, maternal, and healthcare access barriers contribute substantially to inequities in vaccination coverage. Strengthening institutional delivery, maternal education, immunization tracking systems, and targeted outreach for vulnerable populations is essential to achieve Immunization Agenda 2030 targets in India.
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