A Study on Immunisation Coverage among Children in Hosakote, Mysuru
Harshini Suresh1, Mansoor Ahmed2
1 Postgraduate, Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka, India.
2 Professor, Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka, India.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Mansoor Ahmed, Postgraduate, Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka, India.
E-mail: docmansoor2000@yahoo.com
Introduction
Immunisation coverage is a vital strategy adopted by most programs on child survival globally. A robust immunisation coverage program goes a long way in controlling the Vaccine Preventable Disease (VPDs). It is very important to analyse the factors which are detrimental in achieving 100% immunisation among children.
Aim
To find the extent of immunisation coverage and to identify the factors for failure of immunisation among children in the rural field practice area of Mysore Medical College and Research Institute, Mysuru.
Materials and Methods
A cross-divtional was carried out from November 2019 to January 2020 on children between 0-2 years of age using the World Health Organisation (WHO) thirty clusters sampling method. The sample size was estimated to be 210. Identification of clusters was done as per the WHO manual on 30×7 cluster survey. Interview was conducted using a structured interview format in selected households with study subjects. Data was entered in Microsoft Excel sheet and analysed using chi-square test. Statistical Package for Social Sciences (SPSS) software version 23.0 was used for analysis of data.
Results
Among the study participants, 131 (86%) were fully immunised and 29 (14%) were partially immunised (those who did not receive all the due vaccines till two years of age). Religion, educational status of parents and the presence or absence of immunisation card had significant (p-values=0.01, <0.05, <0.05 respectively) association with the immunisation status. The main reasons for partial immunisation were: parents being unaware of the need for returning for subsequent doses 13 (44.8%), fear of side-effects 12 (41.3%), and vaccine not being available 7 (24.1%). Coverage of all individual vaccines among the children (0-2 years) were mostly above 199 (95%).
Conclusion
This study observed higher immunisation coverage as compared to that of the national immunisation coverage of 62%. In spite of efforts to increase the immunisation coverage in the country there are regional differences in the extent of this coverage which points to the need for better strategies to tackle this problem.
Introduction
Immunisation is a public health success story, saving millions of lives every year. It is also one of the best health investments money can buy. Unfortunately, despite all the progress to date in this regard, far too many children including about 20 million infants each year do not have sufficient access to these vaccines [1].
In India, the Universal Immunisation Programme (UIP) targeting six Vaccine Preventable Diseases (VPDs) (Tuberculosis, Diphtheria, Pertussis, Tetanus, Poliomyelitis and Measles) was launched in 1985. Although UIP has partially succeeded in reducing the burden of VPDs, coverage of primary vaccinations in the country continues to be low, with only 62 percent children fully vaccinated as per the National Family Health Survey-4 (NFHS-4) [2]. As per NFHS-4 the coverage of childhood vaccination in the State of Karnataka in India is 62.6 % for children aged 12-23 months [3].
One of the key indicators of childhood vaccine coverage is the proportion of children given 3 doses of DPT vaccine. By this parameter, India accounted for the single largest number of partially vaccinated children in the world in year 2013 [4]. Worldwide around 21.8 million children did not receive three doses of DPT in the year 2013, among them 6.9 million children were from India alone [5].
Immunisation coverage refers to the proportion of children who have received specific vaccines or who are compliant with the recommended vaccine schedule. This data on immunisation coverage is very important for planning strategies, identifying vulnerable groups or areas that require increased resources, for interventions, for assessing the acceptability of the programme and for predicting the vaccine-preventable disease epidemics [6].
The current goal as per the Global Vaccine Action Plan is to reach atleast 90% of the population nationally, and atleast 80% in every district [7]. Therefore, this cross-sectional study was conducted to estimate the Immunisation coverage and to determine the factors associated with incomplete immunisation among children aged 0-24 months of age in Hosakote Primary Health Care which is the rural field practice area of Mysore Medical College and Research Institute, Mysuru.
Materials and Methods
The present community based cross-sectional study was conducted from November 2019 to January 2020, at Hosakote Rural Health Training Centre (RHTC), the rural field practice area of Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru (MMC&RI). Ethical clearance was obtained from the Institutional Ethics Committee of MMC&RI (vide letter dated 22.10.2019).
Inclusion criteria: Children aged 0-2 years residing in the area under all 5 sub-centres of Hosakote RHTC (Hosakote, Tumnerale, Moodali, Immavu, Hulimavu) were included in the study after obtaining the informed consent from parents/caregivers.
Exclusion criteria: Children whose parents/caregivers did not gave the informed consent.
The standard WHO 30×7 cluster survey method, which is a cluster sampling technique, was used to evaluate the immunisation coverage. Children aged 0-2 years on the day of survey were included in the survey. The determination of sample size was done as per the WHO “The Expanded Program on Immunisation (EPI) coverage survey” [8]. The number of children to be surveyed in each of the 30 clusters was 7 and hence 210 children were included in the study. The study was conducted in five subcentres that come under Hosakote Rural Health Centre. A list of all the wards under the subcentres was taken and 30 wards were selected randomly, which were considered as clusters.
The first house was selected randomly from the geographic centre of each cluster. Then in the chosen direction, all the houses were visited, till 10 eligible children from that cluster were obtained for the study. When there was more than one child in a house aged between 0-2 years, only the youngest eligible child was included for the study.
A semi-structured questionnaire was used to collect socio-demographic details, immunisation status and reasons for partial immunisation using the interview technique. The parent/caregiver of the child was interviewed and the information which they provided was cross checked with the immunisation card of the child. A child was regarded to be fully immunised if he/she had received one dose of Bacille Calmette Guerin (BCG) vaccine, 3 doses of Diptheria Pertusis Tetanus (DPT) vaccine, 3 doses of Oral Polio Vaccine (OPV) and 1 dose of measles vaccine and to be partially immunised if one or more of the above doses were missed and to be un-immunised if none of the above doses were received [9]. Drop out was calculated as percentage point difference between the vaccines of the maximum and the minimum antigen received, expressed as a percentage of the maximum dose, as:
For full immunisation dropouts- (BCG-Measles) X 100/BCG
Statistical Analysis
The collected data was numerically coded and entered in Microsoft Excel 2007, and then analysed using Statistical Package for Social Sciences (SPSS) Software (Trial version 23.0). Chi-square test of significance was applied to test the association between various variables.
Results
Among 210 children [Table/Fig-1], 206 (98.1%) had their immunisation cards available with their caretakers. A total of 181 children (86%) were fully immunised and 29 (14%) were partially immunised [Table/Fig-2]. Main reason for partial immunisation was caregivers not being aware of the need for returning for subsequent doses as presented in [Table/Fig-3].
Sociodemographic distribution of study subjects.
| Characteristics | Frequency (N) | Percentage (%) |
|---|
| Age |
| 0-6 months | 106 | 50.5 |
| 7-12 months | 57 | 27.1 |
| 13-24 months | 47 | 22.4 |
| Gender |
| Male | 114 | 54.3 |
| Female | 96 | 45.7 |
| Religion |
| Hindu | 199 | 94.8 |
| Christian | 5 | 2.4 |
| Muslim | 6 | 2.8 |
| Place of birth |
| Government hospital | 155 | 73.8 |
| Private hospital | 55 | 26.2 |
| Interviewed person |
| Mother | 197 | 93.8 |
| Father | 9 | 4.3 |
| Grandmother | 4 | 1.9 |
| Walking distance to nearest health facility |
| <2 Km | 29 | 13.8 |
| >2 Km | 181 | 86.2 |
| Having immunisation card |
| Yes | 206 | 98.1 |
| No | 4 | 1.9 |
| Immunisation card updated or not |
| Yes | 191 | 92.7 |
| No | 15 | 7.3 |
Showing the association of socio-demographic factors with immunisation status of children.
| Characteristics | Fully immunised N=181 | Partially immunised N=29 | p-value (Chi-square test) |
|---|
| Gender |
| Male | 103 (56.9%) | 11 (37.9%) | 0.07 |
| Female | 78 (43.1%) | 18 (62.1%) |
| Religion |
| Hindu | 174 (96.1%) | 25 (86.2%) | 0.01 |
| Christian | 2 (1.10%) | 3 (10.4%) |
| Muslim | 5 (2.8%) | 1 (3.4%) |
| Education of father |
| Illiterate | 34 (18.8%) | 16 (55.2%) | <0.05 |
| Primary school | 18 (9.9%) | 12 (41.4%) |
| Middle school | 75 (46.9%) | 1 (3.4%) |
| High school | 40 (22.1%) | 0 |
| Graduate | 14 (7.7%) | 0 |
| Education of mother |
| Illiterate | 53 (29.3%) | 20 (68.9%) | <0.05 |
| Primary school | 18 (9.9%) | 8 (27.6%) |
| Middle school | 85 (46.9%) | 1 (3.5%) |
| High school | 20 (11%) | 0 |
| Graduate | 5 (2.9%) | 0 |
| Place of birth |
| Government hospital | 134 (74%) | 21 (72.4%) | 0.823 |
| Private hospital | 47 (25.9%) | 8 (27.6%) |
| Birth order of index child |
| 1 | 88 (48.6%) | 15 (51.7%) | 0.963 |
| 2 | 59 (32.5%) | 10 (34.5%) |
| 3 | 25 (13.8%) | 3 (10.4%) |
| >4 | 9 (4.9%) | 1 (3.4%) |
| Having immunisation card |
| Yes | 181 (100%) | 25 (86.2%) | <0.05 |
| No | 0 | 4 (100%) |
p-value <0.05 considered significant
Reasons for partial immunisation (N=29).
| Reasons for partial immunisation | N (%) |
|---|
| Unaware of the need for returning for subsequent dose | 13 (44.8) |
| Fear of side effects | 12 (41.3) |
| Vaccine not available | 7 (24.1) |
| Child brought ill and vaccine not given | 6 (20.6) |
| Parent too busy | 3 (10.3) |
The numbers are not mutually exclusive
In [Table/Fig-2], the variables which were found to have significant association with full immunisation status of children were religion of the child (p-value=0.01), father and mother’s education status (p-value <0.05) and the availability of immunisation card (p-value <0.05).
Coverage of individual vaccines among children 0-24 months was mostly above 199 (95%) except Pentavalent 3rd dose and IPV 2nd dose which had coverage of 196 (93.3%), 195 (93%) and 190 (90.5%), respectively as per [Table/Fig-4].
Coverage of different vaccines among children.
| Vaccine | N (%) |
|---|
| BCG | 205 (97.6) |
| OPV zero dose | 206 (98) |
| Hep B Zero dose | 206 (98) |
| Pentavalent 1st dose | 204 (97.1) |
| IPV 1st dose | 204 (97.1) |
| OPV 1st dose | 202 (96.2) |
| Pentavalent 2nd dose | 200 (95.2) |
| OPV 2nd dose | 200 (95.2) |
| Pentavalent 3rd dose | 196 (93.3) |
| OPV 3rd dose | 195 (93) |
| IPV 2nd dose | 190 (90.5) |
| Measles 1st dose | 202 (96.2) |
| DPT booster | 204 (97.1) |
| MR booster | 204 (97) |
| OPV booster | 204 (97.2) |
BCG: Bacillus calmette guerin; OPV: Oral polio vaccine; Hep B: Hepatitis B; IPV: Injectable polio vaccine; DPT: Diptheria pertusis tetanus; MR: Measles rubella
Rotavirus vaccine was made available in Karnataka after September 2019. So, in this study only 69 (32%) children were eligible for rotavirus vaccine as they were all born after this period according to the information available from their immunisation cards. Among them, 61 (88.4%) and 53 (76.8%) children received Rotavirus 1st and 2nd dose, respectively. The dropout rate for BCG to Measles in this study was 0.49%.
Discussion
In spite of significant progress in immunisation services globally, several factors have hindered the achievement of 100% coverage in India. Hence, this study tried to assess the immunisation coverage and factors associated with poor vaccination, among children aged 0-2 years in Hosakote PHC of Mysore district.
This study revealed that 86 percent of children in 0-2 years age group were fully immunised which is much higher than the NFHS-4 data of Mysore district (52.1%) and Karnataka (62.6%) [2,3]. Studies by Koppad R et al., Kizhatil A et al., Gupta PK et al., observed similar patterns of immunisation coverage when compared to this study [10-12], whereas a few other studies have quoted low coverage, as highlighted in the [Table/Fig-5] [9-15]. The higher coverage in this study can be attributed to the success of Mission Indradhanush and the active campaigns conducted by the Accredited Social Health Activist (ASHA) workers in the community for creating awareness among parents/caregivers regarding the importance of vaccinations [13].
Summary of other similar studies [9-12, 14-19].
| Author name/Study Year | Geographical location | Full immunisation (%) | Partial immunisation (%) | Dropout rate | Most common reason for partial immunisation |
|---|
| Goyal S et al., (2015-2016) [9] | Rohtak, Haryana | 73.15% | 23.85% | 13.88% | Lack of awareness regarding need for immunisation |
| Koppad R et al., (2016) [10] | Shimoga, Karnataka | 98% | 2% | - | - |
| Kizhatil A et al., (2017) [11] | Ernakulam, Kerala | 82% | 18% | 3.7% | Lack of awareness about immunisation, |
| Gupta PK et al., (2013) [12] | Pune, Maharashtra | 83.6% | 11.9% | 11.1% | Time of immunisation was inconvenient |
| Malkar VR et al., (2010) [14] | Beed, Maharashtra | 78.5% | 20.48% | - | - |
| Pandey LN et al., (2013-2015) [15] | Jaipur, Rajasthan. | 76.19% | 22.86% | - | Child ill- not brought to the centre, fear of side effects. |
| Agrawal K et al., (2015) [16] | Dhule, Maharashtra | 58.6% | 37.1% | 22.95% | Lack of awareness to return for subsequent vaccine doses |
| Jatti GM et al., (2011) [17] | Miraj City, Maharashtra | 60.5% | 39.5% | 22.72% | Negligence of parents toward immunisation |
| Munda NK et al., (2014-2015) [18] | Ormanjhi, Jharkhand | 57.8% | 33% | - | Lack of awareness of immunisation, No faith in immunisation |
| Srivastava AK and Shankar G, (2016) [19] | Bagalkot, Karnataka | 83% | 16% | - | Lack of awareness of the schedule |
| Present study | Mysuru, Karnataka | 86% | 14% | 0.49% | Lack of awareness to return for subsequent vaccine doses |
The dropout rate was 0.49% during January 2020 in the present study. Higher dropout rate was seen in other studies in India as quoted in the [Table/Fig-5], which could possibly be due to lack of awareness among the caregivers or due to regional variation in the immunisation coverage [16,17].
Limitation(s)
The study was restricted to one PHC of Mysuru district. So, the result cannot be generalised to the whole population because of the probable variations in the socio-demographic characteristics.
Conclusion(s)
This study shows that the immunisation coverage among the children of Hosakote PHC area is quite high (86%) as compared to state average (62.6%). The most important reason for partial immunisation was the lack of awareness among the caregivers about the need of returning for subsequent doses and fear of side effects. These hurdles can be overcome by undertaking Information, Education and Communication (IEC) activities focusing on these issues in the affected populations.
p-value <0.05 considered significantThe numbers are not mutually exclusiveBCG: Bacillus calmette guerin; OPV: Oral polio vaccine; Hep B: Hepatitis B; IPV: Injectable polio vaccine; DPT: Diptheria pertusis tetanus; MR: Measles rubella
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