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Indian Journal of Community Medicine

Immunisation Status of Children and Mothers in the State of Madhya Pradesh

Author(s): R. J. Yadav, P. Singh

Vol. 29, No. 3 (2004-07 - 2004-09)

Abstract

Objective: The present paper aims to study the immunisation status of children and mothers in the state of Madhya Pradesh and their comparison with the results of all India levels.

Design : Two stage design was adopted with Probability Proportion to Size (PPS) Sampling.

Settings : The study covered seven districts in the state.

Subjects : About 1,400 children (between 1-2 age groups) and mothers (children up one year of age) were studied.

Methods: Detailed information about the immunization status of different vaccines of children and on Tetanus Toxoid, ANC about pregnant women were collected.

Results : It has been observed that about 61 percent children received all the vaccines (BCG, DPT, OPV, Measles) as against about 63 per cent at all India level. Further, only 42 per cent of pregnant women received full package of ANC i.e., minimum three ANC visits, TT2/Booster and IFA tablets. Coverage levels were one of the lowest as compared to other states. The coverage levels were also lower for children of illiterate mothers and in inaccessible villages.

Recommendations : Improvement could be achieved by improving IEC activities specially among females, as well as making this programme success by putting all efforts in the case of Pulse Polio.

Key words : WHO Methodology, Immunisation Status

Introduction

In the past few years, coverage evaluation surveys for Universal Immunisation Programme (UIP) were done through UNICEF. For the year 1999, Department of Family Welfare, Ministry of Health & Family Welfare, requested Indian Council of Medical Research to undertake coverage evaluation surveys (CES) in all the States and Union Territories. The coverage evaluation surveys undertaken by Institute for Research in Medical Statistics (IRMS), one of the institute of ICMR at New Delhi. The number of districts covered from different States were broadly in proportion to their population. Further, while selecting the districts in each major State, due representation has been given, to major geographical region in the State. This survey was carried out in seven districts in the state of Madhya Pradesh giving due representation to different regions. Information has been collected for about fourteen hundreds children and equal number of pregnant women at the rate of 210 per district.

Subjects and Methods

The WHO 30 cluster survey methodology has been used in the coverage evaluation survey. From each district, a sample of 30 villages/wards was selected using PPS systematic sampling. Further, in each selected village/ward, with a random start, samples of seven children (age 12-23 months) have been selected in the form of clusters of contiguous households. The results on immunisation coverage levels have been obtained at the State level and all India level. The results have also been obtained by background characteristics of sample households using post stratified methodology. Three type of schedules namely child coverage schedule, TT immunisation of women schedule and village level schedule have been used in the survey. In the child coverage schedule, the information has been collected on date of birth, age, sex, religion, caste, literacy of parents, availability of card, immunization status, Pulse Polio, vitamin A, source of information and reasons for non immunizations. In the schedule for TT immunisation of pregnant women, age of the child, caste, religion of the head of household, education of couples, availability of immunisation card, immunisation for TT1, T2, booster, antenatal care visits, IFA tables, reasons for no ANC/TT and place of delivery were collected. A village level schedule has been used with details on distance from health facility, metaled road etc. in addition to village size and composition. The survey work was done during June-October 1999 by the IRMS, Delhi.

The characteristics of children and women of the state are presented in table I. It has been observed that sample characteristics of children and pregnant women in the state were broadly in proportion to the characteristics of the state population.

Table I : Sample Characteristics

Characteristics Children
N = 1481
No. (%)
Women
N=1487
No. (%)
Residence : Urban 588 (39.7) 593 (39.9)
Sex : Male 820 (55.4)    
Religion
Hindu 1,360 (91.8) 1,358 (91.3)
Muslim 111 (7.5) 112 (7.5)
Sikh 3 (.2) 11 (.7)
Christian 4 (.3) 4 (.3)
Caste
SC 313 (21.1) 383 (25.8)
ST 99 (6.7) 93 (6.3)
Literacy of Mother / Women
Primary 241 (16.3) 251 (16.9)
Middle 190 (12.8) 225 (15.1)
Hr. Secondary 119 (8.0) 137 (9.2)
Graduate 96 (6.5) 94 (6.3)
Literary of Father / Husband
Primary 264 (17.8) 236 (15.9)
Middle 360 (24.3) 353 (23.7)
Hr. Secondary 273 (18.4) 277 (18.6)
Graduate 234 (15.8) 227 (15.3)
Literacy of Parents Couple
Both Illiterate 310 (20.9) 316 (21.3)
Only Mother Literate 37 (2.5) 60 (4.0)
Only Father Literate 522 (35.2) 444 (29.9)

Table II : Immunisation Coverage of Children (%)

Vaccine Madhya Pradesh India
BCG 82.1 85.9
DPT 1 82.7 87.6
DPT 2 79.9 84.7
DPT 3 75.1 80.8
OPV 1 83.3 87.7
OPV 2 80.6 85.0
OPV 3 76.0 81.0
Measles 65.2 66.5
Vitamin-A 55.2 59.0
Pulse Polio 95.9 96.8
Immunisation Status- Fully Immunised 60.8 63.3
Partially Immunised 27.7 27.1
Not Immunised 11.5 9.6

It has been observed that though the immunization programme touched about 88 percent of target children only about 61 percent received all the vaccines (BCG, DPT, OPV, Measles). The proportion of children who were not immunized were about of same magnitude of country as a whole. (Table II)

Table III : Antenatal Care of Pregnant Women (%)

ANC Madhya Pradesh India
Three or more ANC visits 46.7 62.0
Partial ANC visits 38.8 26.6
No ANC visits 14.5 11.4
Tetanus Toxoid Immunisation
TT 1 85.5 86.4
TT 2 / Booster 77.6 77.9
None 28.0 13.6
None 28.0 13.6
IFA Tablets 73.8 72.5
Full ANC Package (3 ANC, IFA, TT2/ Booster) 41.9 52.5

About 78 percent of pregnant women received both the doses of TT/ Booster. Further, about 42 percent of pregnant women received full package of ANC i.e., minimum three ANC visits, TT2/ Booster and IFA tablets in the state as compared to about 53 per cent of women for India as a whole. (Table III).

Table IV : Coverage Levels by Background Characteristics (%)

Characteristics Children
Fully
Immunised
Pregnant
TT2 /
Booster
Women
Full
ANC
Overall 60.8 77.6 41.9
Residence
Urban 66.8 80.9 45.0
Rural 57.0 75.1 39.8
Sex
Male 63.7    
Female 57.1    
Religion
Hindu 61.5 77.6 41.5
Muslim 50.5 76.8 44.6
Sikh 66.7 63.6 54.5
Christian 100.0 100.0 50.0
Caste
SC 60.5 81.2 37.6
ST 27.3 58.0 26.9
Others 64.0 77.8 44.9
Literacy of Mother/ Women
Illiterate 48.7 69.6 34.3
Primary 74.8 81.7 46.2
Middle 74.9 85.8 49.3
Hr. Sec. 78.2 87.9 59.9
Graduate 80.2 93.6 54.3
Literacy of Father / Husband
Illiterate 40.9 62.2 28.2
Primary 58.1 75.0 40.7
Middle 59.7 69.6 47.3
Hr. Sec. 71.4 86.0 46.6
Graduate 82.5 90.3 54.2
Literacy of Parents / Couple
Both Illiterate 37.4 59.5 26.6
Only Mother Literate 70.3 76.6 36.7
Only Father Literate 55.4 76.8 39.9
Both Literate 76.6 86.4 52.2

Significant difference has been observed among the fully immunized children of literate parents specially for literate mother as compared to illiterate parents. Similar trends has been observed for the ANC of pregnant women.

The results indicated that the female literacy plays an important role. (Table IV).

Table V : Immunisation Status (%) by Distance From SC/PHC

Immunisation
Status
Distance of PHC / SC (Km)
<1 1-2 2-5 >5
Fully 71.0 42.0 63.9 45.0
Partially 18.6 42.0 31.6 31.0
None 10.4 15.9 4.4 24.0

Immunization status was better in the villages which are near to PHC/SC as compared to those who are inaccessible and remote. (Table V)

Table VI : Reasons For Non Immunization of Different Vaccines (%) of Children and Pregnant Mothers

Reason Children Mother
  BCG DPT OPV Measles TT ANC/IFA
Lack of information 33.8 44.2 41.4 43.9 55.7 47.8
Lack of motivation 31.4 25.2 27.5 19.8 14.8 15.6
Obstacles 34.8 30.7 31.1 36.3 29.5 36.6
Children immunized 82.1 75.1 76.0 65.2 77.6 73.8

Lack of information and obstacles has been observed as important factors for non immunization of vaccines of children as well as for pregnant mothers also. (Table VI)

Discussion

While comparing the findings with other national level surveys, the proportion of fully immunized children may differ. It may be because of selection of different districts in these surveys where results may representative of districts and not state as a whole.

For improving the situation, efforts should be made to have Information, Education and Communication (IEC) activities targeted to educate the mothers specially, in rural areas. Improvement could also be achieved by reducing the drop out rate and improving the female literacy.

Acknowledgement

The authors are grateful to Department of Family Welfare, Ministry of Health and Family Welfare, Government of India for sponsoring the study, to the Director General, Indian Council of Medical Research for granting permission to the Institute to undertake the study. The authors are thankful to the District Authorities of the Madhya Pradesh state for providing logistic support and extending assistance in the conduct of the study and to the officers and staff of the Division of Training & Field Survey and other divisions of the institute who shared the responsibilities of data collection and timely completion of work relating to the project.

Reference

  1. Singh, P. and Yadav, RJ : Immunization status of Children of India. Indian Pediatrics., 2000; 37:1194-99.
  2. Institute for Research in Medical Statistics, New Delhi. Coverage Evaluation Survey 1999.
  3. Ministry of Health and Family Welfare, India, Evaluation of Routine immunisation 1997-98.
  4. Ministry of Health and Family Welfare, Govt. of India. Rapid Household Survey RCH Project 1999.

Institute for Research in Medical Statistics,
Indian Council of Medical Research, New Delhi.
E-mail : [email protected]

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