{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T19:19:59Z","timestamp":1771960799638,"version":"3.50.1"},"reference-count":37,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,3,29]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Childhood vaccination coverage in Nagaland has lagged almost all states in India for more than two decades. This study aims to find drivers and barriers of childhood vaccination in Nagaland from the perspective of demand, supply and local health governance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A cross-sectional study was designed using a survey conducted by the Directorate of Health and Family in 2015.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Households, community-based health centres and health committees were surveyed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>285 children aged under 2 years with vaccination cards and data on households, health centres and health committees were included.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>Variables indicating whether a child received each of bacillus\ncalmette\u2013gu\u00e9rin (BCG), diphtheria-tetanus-pertussis (DTP3), oral polio (OPV3) and measles vaccination and all of them were outcome variables. Associated factors were identified using multilevel logistic regressions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Antenatal care at least three times was significantly associated with BCG, DTP3, OPV3 and full vaccination with adjusted ORs ranging from 2.4 (95% CI 1.1 to 5.1) to 3.3 (1.1 to 9.9). The availability of bus to health centre was slightly significant for BCG and OPV3 with the adjusted ORs of 2.0 (0.9 to 4.5) and 2.1 (0.9 to 4.8), respectively. Health committees\u2019 budget provision to health centres was significant for OPV3 and full vaccination with the respective adjusted ORs of 15.7 (1.0 to 234.1) and 15.9 (1.2 to 214.7), the wide 95% CIs of which were driven by a small sample size. Health committees\u2019 review of expenditure of health centres was significant for measles and full vaccination with the adjusted ORs of 4.0 (1.4 to 11.4) and 5.2 (1.4 to 19.4), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study suggests that enhancing the utilisation of antenatal care and providing reliable transportation between villages and health centres are required to improve childhood vaccination coverage. Also, the significant association of budget administration of health committees suggests that supporting local health committees for effective financial management is important.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-045070","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T18:41:56Z","timestamp":1618425716000},"page":"e045070","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Determinants of childhood vaccination in Nagaland, India: a cross-sectional study with multilevel modelling"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6417-5956","authenticated-orcid":false,"given":"Young Eun","family":"Kim","sequence":"first","affiliation":[{"name":"Development Research Group and EAPCE Research Center, World Bank, Kuala Lumpur, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"key":"2025101813360137000_11.4.e045070.1","unstructured":"WHO . \u201cGlobal and regional immunization profile,\u201d, 2019. Available: https:\/\/www.who.int\/immunization\/monitoring_surveillance\/data\/gs_gloprofile.pdf?ua=1 [Accessed 3 Mar 2021]."},{"key":"2025101813360137000_11.4.e045070.2","unstructured":"International Institute for Population Sciences, \u201cNational Family Health Survey, India, 2020. Available: http:\/\/rchiips.org\/nfhs\/ [Accessed 3 Mar 2021]."},{"key":"2025101813360137000_11.4.e045070.3","doi-asserted-by":"crossref","unstructured":"Longvah T et al . \u201cMother and child nutrition among the Chakhesang tribe in the state of Nagaland, North-East India,\u201d. Matern. 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Available: http:\/\/164.100.154.238\/communitisation\/village-health-nutrition-day.html [Accessed 4 Sep 2020]."},{"key":"2025101813360137000_11.4.e045070.8","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1016\/j.vaccine.2016.04.016","article-title":"Factors associated with incomplete or delayed vaccination across countries: a systematic review","volume":"34","author":"Tauil","year":"2016","journal-title":"Vaccine"},{"key":"2025101813360137000_11.4.e045070.9","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.vaccine.2016.12.041","article-title":"Monitoring equity in vaccination coverage: a systematic analysis of demographic and health surveys from 45 Gavi-supported countries","volume":"35","author":"Arsenault","year":"2017","journal-title":"Vaccine"},{"key":"2025101813360137000_11.4.e045070.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c2220"},{"key":"2025101813360137000_11.4.e045070.11","doi-asserted-by":"publisher","DOI":"10.1002\/hec.2939"},{"key":"2025101813360137000_11.4.e045070.12","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3129-2"},{"key":"2025101813360137000_11.4.e045070.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2019.03.039"},{"key":"2025101813360137000_11.4.e045070.14","doi-asserted-by":"crossref","first-page":"6559","DOI":"10.1016\/j.vaccine.2017.08.026","article-title":"Factors associated with routine childhood vaccine uptake and reasons for non-vaccination in India: 1998-2008","volume":"36","author":"Francis","year":"2018","journal-title":"Vaccine"},{"key":"2025101813360137000_11.4.e045070.15","doi-asserted-by":"crossref","first-page":"3078","DOI":"10.1016\/j.vaccine.2019.04.058","article-title":"Vaccination coverage and factors associated with routine childhood vaccination uptake in rural Vellore, southern India, 2017","volume":"37","author":"Francis","year":"2019","journal-title":"Vaccine"},{"key":"2025101813360137000_11.4.e045070.16","doi-asserted-by":"crossref","first-page":"5104","DOI":"10.1016\/j.vaccine.2019.06.006","article-title":"Impact of vaccine stockouts on immunization coverage in Nigeria","volume":"37","author":"Gooding","year":"2019","journal-title":"Vaccine"},{"key":"2025101813360137000_11.4.e045070.17","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.vaccine.2019.09.097","article-title":"Differential determinants and reasons for the non- and partial vaccination of children among Nigerian caregivers","volume":"38","author":"Sato","year":"2020","journal-title":"Vaccine"},{"key":"2025101813360137000_11.4.e045070.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0212270","article-title":"Barriers to effective uptake and provision of immunization in a rural district in Uganda","volume":"14","author":"Malande","year":"2019","journal-title":"PLoS One"},{"key":"2025101813360137000_11.4.e045070.19","doi-asserted-by":"crossref","first-page":"6723","DOI":"10.1016\/j.vaccine.2010.07.077","article-title":"Factors affecting compliance with measles vaccination in Lao PDR","volume":"28","author":"Phimmasane","year":"2010","journal-title":"Vaccine"},{"key":"2025101813360137000_11.4.e045070.20","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.08.059543"},{"key":"2025101813360137000_11.4.e045070.21","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.vaccine.2016.12.024","article-title":"Demand- and Supply-side determinants of diphtheria-pertussis-tetanus nonvaccination and dropout in rural India","volume":"35","author":"Ghosh","year":"2017","journal-title":"Vaccine"},{"key":"2025101813360137000_11.4.e045070.22","unstructured":"Government of India, \u201cThe Nagaland Communitisation of Public Institutions and Services Act, 2002,\u201d 2002. 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