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Association between maternal health literacy and child vaccination in India: a cross-sectional study
  1. Mira Johri1,2,
  2. S V Subramanian3,
  3. Marie-Pierre Sylvestre1,4,
  4. Sakshi Dudeja5,
  5. Dinesh Chandra5,
  6. Georges K Koné1,6,
  7. Jitendar K Sharma7,
  8. Smriti Pahwa5
  1. 1Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada
  2. 2Département d'administration de la santé, École de santé publique, Université de Montréal, Montreal, Canada
  3. 3Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
  4. 4Département de médicine sociale et préventive, École de santé publique, Université de Montréal, Montreal, Canada
  5. 5Pratham Education Foundation (ASER Centre), New Delhi, India
  6. 6l'Université de Daloa, Daloa, Cote d'Ivoire
  7. 7National Health Systems Resource Centre (NHSRC), Ministry of Health and Family Welfare, Government of India, New Delhi, India
  1. Correspondence to Dr Mira Johri, Unité de Santé Internationale, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03–458, 850, rue St-Denis, Montréal (Québec), Canada H2X 0A9; mira.johri{at}


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.


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