Immunization Coverage And Barriers Among Children Of The Konda Reddi-Tribal Community Of Khammam District, Telangana: A Cross-Sectional Study

Childhood immunization is one of the most effective & cost-effective public health intervention for reducing morbidity and mortality among children under-five years of age. Government of India launched Expanded Programme on Immunization (EPI) in 1978 to immunize children against six vaccine preventable diseases which are tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis & measles. Later on, Government added vaccines against hepatitis B, Haemophilus influenzae type b (Hib), rotavirus, pneumococcus & other diseases in UIP basket under National Health Mission(NHM) initiative (Government of India, 2014).

Inequalities in immunization coverage still remain at state, district and population subgroup levels, despite considerable improvements at the national level. India's tribal populations are one of the most marginalized population groups when it comes to immunization. The National Family Health Survvey (NFHS-III (2005-06)) reported that immunization coverage among Scheduled Tribe children was much lower (39.5%) when compared to children belonging to other social groups. Uneven distribution and low uptake are attributed to remote living conditions, poverty, illiteracy, cultural practices, lack of health infrastructure and accessibility, and misconceptions about vaccines (Park, 2019; Sarala Raju et al., 2015).

The Konda Reddi (Hill Reddis), recognized as one of India's 75 Most Vulnerable Tribal Groups (MVTGs), mainly reside in the hilly forests and riverbank areas near the Godavari gorge in Khammam district of Telangana. Their remote location, low education levels (37.7% literacy within the population studied), minimal earnings for survival, and reliance on traditional magico-religious health care systems form a complicated set of challenges that hinder them from accessing modern preventive health services, such as immunizations.

Although many studies have reported on vaccination rates and the challenges faced in tribal groups throughout India (Meena, 2014; Mondal et al., 2014; Anish et al., 2010), there is limited information regarding the Konda Reddi community in Telangana. Gaining insights into the vaccination situation within this community—such as the rates of vaccination, factors influencing participation, and the types of challenges faced—is crucial for designing effective and culturally appropriate vaccination outreach initiatives.

This study was carried out mainly to evaluate how many children are vaccinated and to find out the obstacles to vaccination among children of Konda Reddi tribal mothers in Aswaraopeta Mandal, located in Khammam District, Telangana.

OBJECTIVES

1. To evaluate the vaccination rates among children from the Konda Reddi tribe.

2. To discover the obstacles and reasons behind not getting vaccinated or missing vaccine doses.

3. To analyze how the education level of couples and household income affects vaccination rates.

4. To suggest strategies backed by evidence and considerate of cultural values to enhance vaccination coverage for the Konda Reddi.

MATERIALS AND METHODS

1. Study Design and Setting

A descriptive cross-sectional study grounded in the community was carried out in Aswaraopeta Mandal, located in the Khammam District of Telangana State, India. This district is home to the largest proportion of tribal individuals in Telangana, where the Scheduled Tribe population accounts for 14.08% of the overall population in the district (Census of India, 2011). The study focused on six villages that have notable Konda Reddi communities — Gogulapudi, Kannaigudem, Gopannagudem, Reddygudem, Anantharam, and Chennapuram — which were chosen as research sites.

2. Population Study and Size

The study's participants included Konda Reddi women who had given birth to at least one child within the three years before data gathering took place. A total of 300 households were chosen through the Probability Proportional to Size (PPS) technique, whereby the number of households selected from each village was based on its population proportion. The mother of the youngest child born in the past three years from each chosen household served as the main respondent. The information collected focused on the most recently born child to reduce any potential recall bias.

3. Data Process and Collection Tool

Data were collectd using a structured interview schedule that was conducted in Telugu by trained field investigators. The schedule aimed to obtain information regarding: (i) the vaccination status of the child, (ii) the specific vaccines that were administered, (iii) the reasons for any missed vaccinations or non-immunization, and (iv) the socioeconomic and demographic characteristics of the household. Beyond the input from mothers, informal conversations were conducted with community elders, traditional healers, and local Auxiliary Nurse Midwives (ANMs) to gain insight into the cultural context surrounding the acceptance or refusal of immunization.

4. Variables and its Classification

The main outcome measure was the immunization status: vaccinated (had received at least one vaccine) versus. Not immunized/skipped vaccinations. The explanatory variables consisted of the couple's education level (both being illiterate versus. At least one person who can read and write) and family income (low income: below the median Rs. 2,445 per month versus. High income: above average). The reasons for not getting vaccinated were divided into demand-side obstacles (insufficient knowledge, fear, and refusal), and supply-side obstacles(distance, unavailability, and low-quality services).

5. Statistical Analysis

Descriptive statistics, including frequencies and percentages, were calculated for each variable. Chi-square tests were used to evaluate the statistical significance of the relationships between immunization status and explanatory variables. A p-value below 0.05 was regarded as statistically significant. All analyses were carried out with the help of SPSS Version 20.0.

6. Ethical Thought and Considerations

All participants in the study provided verbal consent before the interviews took place. Participants were guaranteed confidentiality and informed that their involvement was entirely voluntary. The study's design and data collection methods followed the ethical standards outlined in the Declaration of Helsinki as well as the institution's ethical guidelines.

RESULTS

1. Socio-Demographic Profile and Study Population

Table 1 shows the main socio-demographic features of the 300 Konda Reddi households included in the study. Most (62%) of the women who responded were unable to read or write, and a comparable share (64%) of their husbands were also illiterate. Almost all respondents (99%) relied on agricultural work as their main source of income. The typical monthly income for a household amounted to Rs. 2,445, with 62% of families earning between Rs. 1,501 and rupees. A monthly amount of 2,500. The typical family size was 4.2 individuals, with 69% living in nuclear family structures.

Table 1: Socio-Demographic Profile of Study Population (N=300)

Source: Primary field data, Aswaraopeta Mandal, Khammam District, Telangana.

2. Immunization Coverage Rates in Konda Reddi Children

Out of the 300 children studied, 243 (81.0%) had received at least one vaccine. The remaining 57 children (19.0%), some had not received any vaccinations or had skipped one or more scheduled vaccines. Table 2 shows the vaccination Coverage along with the breakdown of reasons for not getting vaccinated.

Source: Primary field data, Aswaraopeta Mandal, Khammam District, Telangana.

3. Obstacles to Immunization

Table 3 summaries the reasons provided by the 57 mothers whose children were either unvaccinated or had missed their scheduled immunizations. The most common reason given was that 'the child was sick' during the immunization appointment (33.3%; n=19), identifying it as the primary barrier from the demand side. This was followed by 'no confidence in vaccination' (24.6%; n=14) and 'concern about adverse effects' (15.8%; n=9). Supply-side barriers encompassed 'health facility being too far / no transport' (14.0%; n=8). Other reasons mentioned included 'the mother was unwell' (7.0%; n=4) and 'family issues' (5.3%; n=3).

Table 3: Reasons for Non-Immunization or Missed Vaccines (n=57)

Source: Primary field data, Aswaraopeta Mandal, Khammam District, Telangana.

4. Classification of Barriers: Demand vs. Supply

A classification of barriers shows that the vast majority (85.9%) of reasons for not getting vaccinated are demand-side barriers indicating a lack of awareness, cultural beliefs, and health-related attitudes within the community. Just 14.0% of the reasons are related to supply-side obstacles, such as distance and insufficient transportation. Table 4 shows this combined categorization.

Table 4: Classification of Immunization Barriers (n=57)

Source: Primary field data, Aswaraopeta Mandal, Khammam District, Telangana.

5. The impact of education and income on Immunization Coverage

Table 5, which displays differences in immunization coverage based on the education level of couples and family income. Immunization rates were notably higher in households where at least one partner could read and write (90.4%) than in those where both were unable to read and write (54.5%). When considering income levels, every woman in the high-income group (100%) ensured their children were vaccinated, whereas 39.4% of women in the low-income group did not vaccinate their children. Both associations were determined to be statistically significant (p < 0.01).

Table 5: Immunization Coverage by Couple's Education and Family Income

Source: Primary field data, Aswaraopeta Mandal, Khammam District, Telangana.