title: Age-appropriate vaccination against measles and DPT-3 in India - closing the gaps.
abstract: BACKGROUND
  In 2010, India accounted for 65,500 (47%) of the 139,300 measles-related deaths that occurred globally. Data on the quality of age-appropriate measles vaccination in rural India is sparse. We explored the following issues: (i) What proportion of Indian children were appropriately vaccinated against measles at 9 months of age, and DPT-3 at 4 months? (ii) Which health facilities administered measles vaccine to children prior to 9 months of age and DPT-3 prior to 14 weeks?
  
  
  METHODS
  We analyzed data from the 2008 Indian District Level Health Survey (DLHS-3) to determine the extent of age-appropriate measles and DPT-3 vaccinations. Among 192,969 households in the dataset, vaccination cards with detailed records were available for 18,670 children aged between 12 and 23 months.
  
  
  RESULTS
  Among this cohort, 72.4% (13,511 infants) had received the first dose of measles vaccine. Only 30% of vaccinated infants received the measles vaccine at the recommended age of 9 months. Similarly, only 31% of infants in the cohort received DPT-3 vaccine at the recommended age of 14 weeks. About 82% of all prematurely vaccinated children were vaccinated at health sub-centres, ICDS and Pulse Polio centres.
  
  
  CONCLUSIONS
  Age-inappropriate vaccination impacts adversely on the effectiveness of India's measles immunisation program due to sub-optimal seroconversion, if premature, and increased vulnerability to vaccine preventable diseases, if delayed. Capacity building approaches to improve age-appropriate vaccination are discussed.
authors.affiliation: School of Population Health, University of Western Australia, Nedlands, Australia. niyi.awofeso@uwa.edu.au.
authors.forename: Niyi
authors.initials: N
authors.lastname: Awofeso
authors.forename: Anu
authors.initials: A
authors.lastname: Rammohan
authors.forename: Kazi
authors.initials: K
authors.lastname: Iqbal
mesh_terms: D000367:Age Factors; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards*; D004165:Diphtheria / Q000517:prevention & control; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D019983:Guideline Adherence; D006801:Humans; D017589:Immunization Programs; D007194:India; D007223:Infant; D008457:Measles / Q000517:prevention & control; D008458:Measles Vaccine; D011051:Poliomyelitis / Q000517:prevention & control; D012424:Rural Population; D013742:Tetanus / Q000517:prevention & control; D014611:Vaccination / Q000706:statistics & numerical data; D014917:Whooping Cough / Q000517:prevention & control
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine