LAUSR

Abstract Objective Despite the continuous global and national effort, India is far away from achieving universal immunization coverage. The primary objective of this paper is to find the spatial pattern and correlates of the full immunization coverage gap in the districts of India. Data and methods We used data from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015–16. Moran's I, univariate and bivariate Local Indicator of Spatial Association (LISA) analysis had been used to assess the spatial autocorrelation, clustering, and risk factors of the full immunization coverage gap in the districts of India. Results The full immunization coverage gap among children has reduced by 33% over 2005–15. Around half of the children in 163 districts of India were deprived of full immunization. The spatial pattern of immunization coverage identified 99 districts as hot spots, whereas 111 as cold spots. Results from the bivariate LISA map signifies that the districts with higher coverage gap in full immunization also had higher deficit in pre-natal and post-natal care and skilled birth attendant. The spatial regression model revealed that female literacy, female-headed households, antenatal, and post-natal care have a significant association with full immunization coverage in India. Conclusion The existence of clusters indicates the presence of unevenness in immunization coverage and has several implications that should be addressed for better health of the population. Efforts are to be made to ensure the universalization of education, along with accessible and affordable healthcare for all ensuring universal health coverage in India.