Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Indian Journal of Community Medicine

Coverage Evaluation Survey of Pulse Polio Immunization in Chandigarh

Author(s): H.M. Swami, J.S. Thakur, S.P.S. Bhatia, V. Bhatia, V.K. Bhan

Vol. 25, No. 2 (2000-04 - 2000-06)

Department of Community Medicine, Government Medical College, Sarai Building, Sector 32-A, Chandigarh 160047

Abstract:

Research question: What was the Pulse Polio Immunization (PPI) coverage in Chandigarh?

Objective: To assess the PPI coverage in Chandigarh.

Study design: Cross-sectional.

Setting: Urban, rural and slum areas of Chandigarh.

Participants: Underfive children, parents.

Study variables: Urban, rural and slum, PPI coverage, source of information.

Statistical analysis: Proportions.

Results: A total of 614 children were surveyed of which 56% were males and 44% were females. Overall PPI coverage was 92.3% for both doses with 93.5% for first dose and 96.4% for second dose during 1997-98. PPI coverage for rural, urban and slum areas was 98.4%, 89.8% and 93% respectively. Main source of information for PPI was TV(52.9%) followed by health workers (20.8%). Main reasons for non immunization were: not convenient (46.7%) and have no faith in PPI (20%).

Conclusion: Sustained efforts are required to achieve universal coverage of PPI in Chandigarh.

Keywords: Pulse polio immunization, Coverage, Source of information, Non-immunization

Introduction:

Ministry of Health and Family Welfare, Govt. of India launched the Pulse Polio Immunization (PPI) on a country wide basis in 1995 for eradication of polimyelitis1. In first, second and third year of the programme, two doses of polio vaccine were given on specific days which were declared as National Immunization Days. There was political commitment to the programme leading to unprecedented social mobilization. To assess the reach during PPI days in different states and urban poor population of major cities, coverage evaluation surveys have been done. This study highlights such a survey done in union territory of Chandigarh.

Material and Methods:

The study was done in UT, Chandigarh comprising urban, rural and slum area from February to March 1998. Cluster sampling technique as used in coverage evaluation surveys with modifications was used in the present study. The clusters were drawn from universe by Central Committee which comprised of representatives of Ministry of Health and Family Welfare, UNICEF and Institute of Research in Medical Statistics (IRMS). The survey team consisted of trained medical students and staff, supervised by faculty of department of Community Medicine. The sample size taken was of 600 children in the form of 30 clusters of 20 children each. Initially, 15 clusters were allotted for Chandigarh which were increased to 30 by UNICEF on our request to give proportionate representation to slum area.

The selection of cluster was by PPS systematic sampling. In each selected cluster, 20 children upto 5 years of age were selected. For the selection of desired number of children in the clusters, each cluster was divided into four quadrants. In each quadrant number of houses were estimated and a random number chosen within the number equal to the total houses. In each quadrant, starting with the randomly selected household, the survey was continued till 5 children in the age group of 0-60 months were covered. The information was collected in the standard questionnaire by interview of mothers. Data was entered into computer and analysis was done.

Results:

A total of 614 children in the age-group 0-60 months were covered out of which majority (62.3%) were below three years. About 56% were male and 44% were female children. More than half (53.4%) of children were from slums followed by urban (36.6%) and rural (10%) area giving a proportionate representation to different type of population in Chandigarh.

Table I : Area wise coverage of pulse polio immunization.

Dose Rural (n=61) Urban (n=225) Slum (n=328) Total (n=614)
Dose I 60 (98.4) 206 (91.6) 308 (93.9) 574 (93.5)
Dose II 60 (98.4) 212 (94.2) 320 (97.5) 592 (96.4)
Both 60 (98.4) 202 (89.8) 305 (93.0) 567 (92.3)

Figures in parentheses are percentages

Overall PPI coverage for both doses was 92.3% which was higher for male (93%) as compared to female (91.5%) children. Coverage was higher (98.4%) for rural area as compared to urban (89.8%) and slum (93%) area.

Table II: Coverage level according to religion and caste.

  No. Dose I Dose II Both
Religion
Hindu 491 457 (93.1) 476 (96.9) 453 (92.3)
Muslim 33 32 (97.0) 33 (100.0) 32 (97.0)
Christian 2 2 (100.0) 2 (100.0) 2 (100.0)
Sikh 85 80 (94.1) 79 (92.9) 78 (91.7)
Others 3 3 (100.0) 2 (66.7) 2 (66.7)
Total 614 574 (93.4) 592 (96.4) 567 (92.3)
Caste
SC 185 171 (92.4) 181 (97.8) 171 (92.4)
ST 11 9 (81.8) 10 (90.9) 9 (81.8)
Others 418 394 (94.4) 401 (95.9) 387 (92.6)
Total 614 574 (93.4) 592 (96.4) 567 (92.3)

Figures in parentheses are percentages

Coverage level according to religion and caste is shown in Table II.

Table III: Source of awareness about PPI days.

Awareness Both doses
Health workers 128 (20.8)
AWW 34. (5.5)
Relative 9 (1.5)
Friend 33 (5.4)
Teacher 13 (2.1)
TV 325 (52.9)
Radio 6 (1.0)
Others 66 (10.7)

Figures in parentheses are percentages

Major Source of awareness about PPI days was TV (52.9%) followed by health workers (20.8%) as shown in Table III.

Table IV: Reasons for non-immunization.

Reasons Dose I Dose II Both doses
Nobody available 8 (20.0) 5 (22.7) 2 (13.4)
Not aware of need 5 (12.5) 4 (18.2) 2 (13.4)
Not convenient 9 (22.5) 7 (31.8) 7 (46.7)
Have no faith 4 (10.0) 3 (13.6) 3 (20.0)
Child ill 4 (10.0) 0   0  
Not aware of days 3 (7.5) 1 (4.5) 0  
Doctor advice 1 (2.5) 1. (4.5) 0  
Others 6 (15.0) 1 (4.5) 1 (6.7)
Total 40 (100.0) 22 (100.0) 15 (100.0)

Reasons for non immunization are shown in Table IV. Out of 15 children who had not even received single dose of PPI, surprisingly, seven (46.7%) did so because it was not convenient by time and place.

Discussion:

Overall PPI coverage of 92.3% found in Chandigarh is higher than 89% reported last year (unpublished data). However, this coverage was lower than 93.3% reported last year on all India basis and was a matter of concern2. Chandigarh, the city beautiful, with a high literacy rate and better health facilities is supposed to be better than other areas in the country, is lagging behind in this national endeavour. Moreover, it was disturbing that coverage was even lower in urban areas compared to rural and slum areas of the city. There is a need to plan for additional efforts to improve the coverage particularly in urban population. It was possible for us to comment on area-wise coverage as we have given proportionate representation in selection of clusters from urban, slum and rural areas. It was observed independently that almost at every place, 3-4 PPI posts were functioning at one place. There was a need to locate each post in their respective area to improve accessibility and proper coverage of beneficiaries e.g. posts can be opened in anganwadi centres, schools and other social institutions besides health institutions. Mass media, specially TV and press play a significant role in mobilizing urban population which should be actively involved to emphasise the importance of PPI besides inter personal communication through health workers. The communication efforts should continue to reinforce the need and utility of the additional OPV drops, dates of PPI and also make special efforts in informing the unreached and partially reached to get both the doses.

Analysing the reasons for non immunization it was interesting that main reasons given were (i) not convenient (46.7%) by time and place (ii) having no faith (20%) which were different from `nobody available to take the child to PPI booths' and `not aware of the need' as per national evaluation2 and also the common reasons for non participation in previous year. These reasons need to be addressed appropriately by proper management, proper relocation of PPI booths, effective communication efforts and professional bodies should educate family physicians to advise their clients on the additional doses irrespective of earlier immunization. The neighbourers or volunteers could be motivated by health workers to take those children to PPI booths whose parents or nobody is available for this purpose. Besides this, the need for PPI should be emphasized to mothers during routine immunization of children, by involvement of opinion leaders and by all other available means.

References:

  1. Lal S: Towards eradication of polimyelitis (Editorial). Indian Journal Community Medicine 1997; 22: 139-44.
  2. Evaluation of Pulse Polio Immunization. Ministry of Health and family Welfare, Govt. of India 1997.
Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica