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

Indian Journal of Community Medicine

Assessment of Vaccination Performance by Lot Quality Technique in An Urban Community of Miraj

Author(s): V S Tapare, P S Borle

Vol. 31, No. 3 (2006-07 - 2006-09)

V S Tapare, P S Borle

Introduction

National Immunization Programme in India has a primary objective of reducing morbidity and mortality due to vaccine preventable diseases. The programme employed a strategy based on immunization targets, which were quantitative, easy to monitor. Although the immunization coverage increased, the corresponding decline in vaccine preventable diseases was lower than expected1. It was realized that in the zeal to achieve targets, inadequate attention was given to the quality of immunization services. Mere providing vaccination does not guarantee a reduction in disease morbidity and mortality2. Full course of potent vaccine given at right age, at right interval, by right technique with a valid documentation constitutes ‘quality’ criteria of vaccination services. To evaluate quality of vaccination programme, the most commonly used methods are supervisory checklist, medical audit, review of routine reports and cluster survey (WHO methodology). Rapid assessment methods based on statistical technique3 are presently under development. Lot Quality Technique is the recent technique developed to assess the vaccination performance rapidly. The present study attempts to highlight methodology and application of lot quality technique to assess child vaccination performance in an urban community of Miraj. The purpose of utilization of lot quality technique is to identify quickly and scientifically the areas with poor performance and provide information for developing strategies to improve service quality.

Material and Methods

The inspection of individuals to determine their acceptability of quality is known as ‘Sampling Inspection’. In sampling inspection, the population is the finite group of individuals usually referred to as ‘Lot’. Lots are usually geographical areas in which the target population lives. It can also be zones, wards or even districts in a province. Lot sample size depends on total sample size and number of lots. Lots are inspected and assessed to decide its acceptability based on decision value decided previously.

Data collection and analysis: The present study was undertaken in an urban field practice area of PSM department attached to Govt. Medical College, Miraj. A cross-sectional survey was carried out on 11 October 2004. The area was divided into four lots based on geographic divisions. The total children aged 12-23 months formed target population. Sample size for the study was worked out to be 80, based on 5% level of accuracy and 95% level of significance4. The estimated sample size for each lot was 20. A decision value (highest number of individuals in a lot not receiving a quality service and yet lot is acceptable) of 5 was selected based on lot sample size of 20 and low and high threshold set at 60% and 80% respectively.

Trained investigators collected the information on 11/10/2004 from 20 children in each lot born between 11/10/2002 and 11/10/2003. Only one child was selected from each household. Households were selected by simple random sampling method. Information regarding birth date, vaccination card, dates of vaccines received, presence of BCG scar and reasons for incomplete or no vaccination was colleted through pre-tested questionnaire schedule. Dates of vaccines received were verified from office record in case vaccination card was not available. Response rate was 100%. Criteria that meet the ‘Quality’ vaccination include those children who have received all vaccinations recommended in National Immunization Schedule at appropriate age and interval with presence of immunization card and BCG scar in those who received BCG vaccine. Information collected was analyzed to check number of children fulfilling the quality criteria of vaccination, lot-wise. Lot performance was judged unacceptable if it finds more than 5 children not accepting quality criteria. To get an overall single estimate of individual qualities of vaccination, data was aggregated from all four lots. Reasons for non-quality immunization were analyzed in aggregate.

Results

The number of children in lot sample not satisfying quality criteria were 5 in lot A and C, 4 in D and 8 in B. As the number of children in lots A, C and D is either same or fewer than decision value of 5, performance of these lots is acceptable. In lot B more than 5 children did not satisfy the quality criteria lot performance is not acceptable.

Overall full vaccination coverage in whole sample was 87.50%. Immunization card was present in 81.25% children only. Within 8 weeks after birth, only 86.25% children received BCG while first dose of DPT and OPV was completed in 77.50% and 95% children respectively. 93.75% children received measles vaccine at right age. Appropriate dose interval between 1st and 2nd dose of DPT/OPV was observed in 91.25% children while it was 80% between 2nd and 3rd dose. Of the children vaccinated with BCG, 87.50% developed BCG scar. Median age for receiving BCG and Measles vaccine was reported to be 6 days (range: 1- 200 days) and 10 months (range: 7-15 months) respectively. For DPT-I and OPV-I dose, reported median age was 48 days (range: 42-60 days). Average (median) dose interval of DPT/OPV between 1st and 2nd dose was 28 days (range: 28-100 days) while it was 42 days (range: 28-140 days) between 2nd and 3rd dose.

Table I: Overall Estimate of Individual Vaccination Qualities

Vaccination Qualities Acceptable criteria Prevalence
1. Coverage Received all vaccines 87.50%
2. Immunization card Present 81.25%
3. Age at vaccination
BCG < 8 weeks 86.25%
DPT-I < 8 weeks 77.50%
OPV-I < 8 weeks 95.00%
Measles 9-12 months 93.75%
4. Dose interval (DPT/OPV)
1st and 2nd dose 4-6 weeks 91.25%
2nd and 3rd dose 4-6 weeks 80.00%
5. BCG scar Present 87.50%

Family obstacles (41%), lack of information (31%), and lack of motivation (18%) has been observed as important factors for non-quality immunization (i.e. incomplete/no vaccination, age and dose interval not followed, lack of immunization card and BCG scar).

Discussion

Globally around 20% of children remain unimmunized5. Those who receive vaccination have no guarantee against protection from diseases due to lack of quality services. Present study shows higher vaccination coverage (87.5%) as compared to National data (63.3%) and studies conducted in Madhya Pradesh5 and in Rajasthan7 who found 60.8% and 67.3% coverage rate of vaccination respectively. While comparing the findings with other surveys, the proportion of fully immunized children may differ because of selection of different areas and methods of evaluation. Although overall coverage is good, the quality of services are not acceptable in some subgroups of population in the present study.

Right age at initiation of vaccination is an important factor for successful immunization. The proportion of children who started vaccination at right age was found to be higher (77% to 95% for different vaccines) in present study as compared to study by Afifa Zafer7 (17% to 40%) which may be due to the fact that the quality of services through Medical College Centre were better in the study area.

However, despite light and better services, study points out that immunisation service in lot B were poor, and should be rejected. thus lot quality technique should be used especialy in areas with high immunisations coverage to detect pockets/ areas/lots of poor coverage and quality and to take correction action.

References

  1. Reproductive and Child Health, Module for Medical Officer, National Institute of Health and Family Welfare, New Delhi, May 2000.
  2. Evaluate Vaccination Coverage, National Immunization Programme, Ministry of Health and Family Welfare, Govt. of India, New Delhi, 1989.
  3. S. P. Gupta, Statistical Methods, 25th Edition, Sultan Chand and Sons, New Delhi, 1990.
  4. Lot Quality Technique, RCH Module of Immunization Strengthening Project, GOI, Ministry of Health and Family Welfare, New Delhi, 2001.
  5. Update, Expanded Programme on Immunization, World Health Organization, November 1997.
  6. R. J. Yadav, P. Singh. Immunization status of children and mother in the state of Madhya Pradesh. Indian J Comm Med, 2004; 29: 147-148.
  7. Zafer A., Tamboli B L, Bhatnagar R., K. D. Ameta. Immunization Coverage- A comparison between tribal, non-tribal and urban areas of Udaipur district. Indian J Comm. Med, 1996; 21: 47-52.

Deptt. of Preventive & Social Medicine, Govt. Medical College,
Miraj.Distt: Sangli, Maharashtra State. PIN – 416410.
E-mail:[email protected]

Access free medical resources from Wiley-Blackwell now!

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

Copyright © 2005 Indmedica