Urban-Rural Disparities in Childhood Immunization Coverage: Evidence from Jaipur, India

Introduction: Childhood immunization coverage in India has improved nationally, yet urban-rural disparities persist, particularly in rapidly urbanizing states such as Rajasthan. Urban slum populations often face significant barriers, including limited mobility, restricted access to essential services, and vaccine hesitancy. Objective: To assess and compare the full immunization coverage among children aged 6-23 months in urban and rural areas of Jaipur district, Rajasthan. Methods: A community-based cross-sectional study was conducted from October 2023 to March 2024 in the rural (Dadiya) and urban (Jhalana) field practice areas of RUHS College of Medical Sciences, Jaipur. A sample of 711 children aged 6–23 months was selected using the WHO 30×7 cluster sampling method. Immunization status was verified using vaccination cards and caregiver history. Data were analyzed using SPSS v22.0 with descriptive statistics and chi-square tests. Results: Full immunization coverage (FIC) was significantly lower in urban areas (82.0%, 95% CI: 77.2–86.1%) compared to rural areas (92.3%, 95% CI: 89.5–94.5%) (p<0.001). Dose-specific analysis revealed a higher dropout rate for later vaccines, including Pentavalent 3 (urban 81.7% vs. rural 91.8%) and Measles (urban 85.0% vs. rural 93.2%). Conclusions: Rural Rajasthan’s ASHA-led model achieved near-universal FIC, whereas urban slums experienced systemic barriers leading to higher dropout rates for later doses. Targeted interventions, such as slum-focused microplans, extended service hours, and urban community health workers, are urgently needed to reduce disparities.