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Home > Archives > Volume 20, No 11 (2022) > Article

DOI: 10.14704/nq.2022.20.11.NQ66188

Assessment of differentials of risk factors for full antenatal care and complete immunisation coverage between rural and urban population of India - A multilevel modelling approach

Pawan Dubey, Neelima Alka Singh, Rabindra Nath Mishra, Akash Mishra


Background: India, is one of the key contributors in both maternal and child death globally with notable gap between rural and urban across the country. Large scale surveys likeNational Family Health Survey (NFHS) follow hierarchical characters in which subjects within the clustersare often correlated. Individual level analysis to identify the predictors of an outcome ignores within the cluster variability; while multilevel model incorporates it. The present analysis was to identify the predictor of full ANC and complete immunisation separately for rural and urban as well as differentials between them by using multilevel logistic model for Indian population. Methodology: The data on women age 15-49 years given birth in last five years and children of age 12-23 months obtained from India’s (NFHS-IV) was considered. The estimates of effect size of the predictors for full ANC and complete immunisation by using multilevel logistic modelswere assessed separately for rural and urban and thereafter, difference between rural and urban in odds ratio (OR) for each category of predictors was compared. Results: Each selected predictor was found significant for any of the categories. However, some predictor’s categories like age that show significant effect size in rural did not emerge in urban.For both outcomes, the most important were women’s education, child birth order, wealth quintile. Education and wealth quintile were positively associated with the outcome; while negatively with child birth order. Rural urban difference emerged to be significant in caste categories for both full ANC (p = 0.047 & p = 0.001 for OBC and other caste) and full immunisation (p = 0.044& p = 0.048 for OBC and other caste); while wealth quintile only for full ANC (p = 0.029, 0.002 &< 0.001 for middle, richer and richest) with low OR. Conclusion:In addition to poor education and mothers progressing to higher order births, caste group and wealth quintile groups should be the focused to women specially living in rural areas.


Hierarchical data, Maternal and child health, Odds ratio, NFHS-IV

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