title: Association between maternal health literacy and child vaccination in India: a cross-sectional study.
abstract: BACKGROUND
  Education of mothers may improve child health. We investigated whether maternal health literacy, a rapidly modifiable factor related to mother's education, was associated with children's receipt of vaccines in two underserved Indian communities.
  
  
  METHODS
  Cross-sectional surveys in an urban and a rural site. We assessed health literacy using Indian child health promotion materials. The outcome was receipt of three doses of diphtheria-tetanus-pertussis (DTP3) vaccine. We used multivariate logistic regression to investigate the relationship between maternal health literacy and vaccination status independently in each site. For both sites, adjusted models considered maternal age, maternal and paternal education, child sex, birth order, household religion and wealth quintile. Rural analyses used multilevel models adjusted for service delivery characteristics. Urban analyses represented cluster characteristics through fixed effects.
  
  
  RESULTS
  The rural analysis included 1170 women from 60 villages. The urban analysis included 670 women from nine slum clusters. In each site, crude and adjusted models revealed a positive association between maternal health literacy and DTP3. In the rural site, the adjusted OR was 1.57 (95% CI 1.11 to 2.21, p=0.010) for those with medium health literacy, and OR=1.30 (95% CI 0.89 to 1.91, p=0.172) for those with high health literacy. In the urban site, the adjusted OR was 1.10 (95% CI 0.65 to 1.88, p=0.705) for those with medium health literacy, and OR=2.06 (95% CI 1.06 to 3.99, p=0.032) for those with high health literacy.
  
  
  CONCLUSIONS
  In these study settings, maternal health literacy is independently associated with child vaccination. Initiatives targeting health literacy could improve vaccination coverage.
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada Département d'administration de la santé, École de santé publique, Université de Montréal, Montreal, Canada.
authors.forename: Mira
authors.identifier: http://orcid.org/0000-0001-5642-787X
authors.initials: M
authors.lastname: Johri
authors.affiliation: Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada Département de médicine sociale et préventive, École de santé publique, Université de Montréal, Montreal, Canada.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Sylvestre
authors.affiliation: Pratham Education Foundation (ASER Centre), New Delhi, India.
authors.forename: Sakshi
authors.initials: S
authors.lastname: Dudeja
authors.affiliation: Pratham Education Foundation (ASER Centre), New Delhi, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Chandra
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada l'Université de Daloa, Daloa, Cote d'Ivoire.
authors.forename: Georges K
authors.initials: GK
authors.lastname: Koné
authors.affiliation: National Health Systems Resource Centre (NHSRC), Ministry of Health and Family Welfare, Government of India, New Delhi, India.
authors.forename: Jitendar K
authors.initials: JK
authors.lastname: Sharma
authors.affiliation: Pratham Education Foundation (ASER Centre), New Delhi, India.
authors.forename: Smriti
authors.initials: S
authors.lastname: Pahwa
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage* / Q000592:standards; D004522:Educational Status; D005220:Fathers / Q000706:statistics & numerical data*; D005260:Female; D057220:Health Literacy; D006801:Humans; D007115:Immunization Schedule; D007194:India; D007223:Infant; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D008507:Medically Underserved Area; D009035:Mothers / Q000706:statistics & numerical data*; D055361:Multilevel Analysis; D012423:Rural Health; D012923:Social Class; D014504:Urban Health
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine
keywords: CHILD HEALTH; DEVELOPING COUNTR; EDUCATION; IMMUNIZATION; MULTILEVEL MODELLING
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