Purpose: 

This study was conducted;

* To map the pattern of immunization coverage of children in the rural and urban area and across 30 districts in Odisha;

* To measure the extent of disparities in immunization coverage of the children across different vaccinations and to figure out the best and worst performing districts in respect to immunization in Odisha.

* To identify the proximate determinants of immunization in the state

* To examine the effect of the determinants on immunization

Design/methodology/approach: 

Secondary data from Annual Health Survey (2010-2011, 2011-12 and 2012-13), District Level Household Survey (DLHS 2002-04 & 2007-2008), National Family Health Survey (NFHS-3) 2005-06 , Coverage Evaluation Survey (2009), SRS (2012), Economic survey, 2013-14, Statistical Abstract, 2013, and research and publications of Health and FW  were considered for analysis. Experts were consulted at various point of time to make the analysis more specific aiming towards the targeted goal. The immunization coverage in the study was limited to the children of 12-23 months in 30 districts of Odisha. The data analysis was made by using simple statistical tools i.e. descriptive statistics, coefficient of variation, correlation and linear regression model. The effect of proximate determinants on the immunization status was examined by using the regression model. Full immunization percentage had been taken as dependent variable; gross domestic product had been used as proxy of economic status and independent variable. Two other independent variables had been introduced namely percentage of schedule caste population and female literacy rate.

Findings: 

Not only the average immunization was found to be lower but the dispersion around the mean (reflected through coefficient of variation) was found to be 28 %. It implied that the districts with lower immunization remained neglected without much attention which could be the possible reason behind the increased disparity between the high and low immunized districts.

There was only 4 percent difference in rural and urban coverage.

The female literacy rate and district income (GDDP) were found to be positively correlated to full immunization while sex ratio, infant mortality rate and proportion of ST population were inversely related to immunization. Besides infant mortality was found to decline with increase immunization coverage.

Actual Immunization of children starts at birth, but the recording of immunization status was found to be made between 12- 23 months. Thus it could be inferred that actual number of immunization may be much higher than the recorded number which is matter for serious consideration.

Immunisation status in districts like Puri (47%), Malkangiri (below 30%), Rayagada (below 35 %), Kalahandi (below 45 %), Kandhamal (below 45 %) and Ganjam (below 45 %) seeks Special Attention.

The inter district variation is slightly higher than 27 percent which is mainly due to the large differences between the highest and the lowest performing districts.

The inter-district variation in urban area has reduced significantly by 39 percent as against 19 percent in rural area; it seems much emphasis has not been given to reduce inter- district variation in rural area.

Research limitations/implications: The entire study was based on secondary data that has its own limitations; moreover the data coverage over the time frame considered was not uniform. Another limitation was non availability of time series data from one particular source. Immunization by gender, social groups was not available at the district level; for which comparison across gender and caste groups on immunization could not be done.

Implications: It is important to develop a tracking system so that immunization status can be tracked accurately and efficiently. The government should intervene to increase the female literacy particularly adult female literacy and should also try to improve their economic status by financially empowering them. Policies should also be framed for wider coverage of immunization in the districts with higher proportion of ST population with more emphasis on the immunization of the girl children. Government should also develop a plan for periodic monitoring of record and auditing of electronic health records to track outcomes and identify gaps.