Explaining immunisation inequality in the rural and urban Barak Valley, India

The study examines the role of institutional engagement in shaping child immunisation outcomes in the Barak Valley region of Assam, India, focusing on frontline health workers. Using primary survey data collected from 400 households across selected rural and urban communities, the analysis finds that more-frequent interactions with accredited social health activists are strongly associated with higher odds of full immunisation. Households that report limited or no contact with frontline health workers are significantly less likely to have fully immunised children. These findings indicate an association between institutional engagement and immunisation coverage. Beyond confirming the importance of frontline health workers, the study suggests that the intensity of institutional engagement is a stronger predictor of complete child immunisation than rural–urban location. The findings suggest that strengthening the quality and continuity of household-level outreach may yield greater public health gains than interventions based solely on geographic targeting, particularly in underserved and resource-constrained regions.