Voices From the Outbreak: Exploring the Role of Migration, Literacy, and Healthcare Accessibility in Immunization Coverage of Banda District in the Bundelkhand Region of Uttar Pradesh, India.

BACKGROUND

During August-September 2024, a diphtheria outbreak involving 10 children was reported from Devkher village of Naraini Block, Banda district, Uttar Pradesh, India. Despite the availability of diphtheria-containing vaccines under India's Universal Immunization Program, immunization gaps continue to persist in underserved rural communities.

OBJECTIVE

To explore the social, geographic, and systemic factors contributing to immunization gaps during the diphtheria outbreak in Devkher village.

MATERIALS AND

METHODS

A mixed-methods qualitative exploratory study was conducted between September and October 2024 in Devkher village. In-depth interviews were conducted among caregivers of affected children and frontline healthcare workers, including auxiliary nurse midwives (ANMs) and accredited social health activists (ASHAs). Descriptive outbreak-related data were obtained from local health records. Field observations and community-level contextual assessments were performed to understand geographic accessibility and healthcare outreach barriers. Thematic analysis was used for qualitative data interpretation.

RESULTS

Major themes identified included migration-related disruption of vaccination schedules, poor awareness regarding immunization and booster doses, misinformation, inadequate documentation of vaccination status, and mistrust toward the healthcare system. Peripheral habitation, distance from healthcare facilities, and limited outreach services were identified as important contextual barriers contributing to delayed immunization and healthcare utilization.

CONCLUSION

Immunization gaps observed during the outbreak were influenced by interconnected social, geographic, and systemic factors. Strengthening outreach among migratory populations, improving immunization tracking systems, and enhancing community trust and healthcare accessibility are essential to prevent future outbreaks.