Infectious diseases are major cause of morbidity and mortality in children. One of the most cost effective and easy method for child survival is immunization. In May 1974, the World Health Organization (WHO) officially launched a global immunization programme known as Expanded Programme of Immunization (EPI) to protect all the children of the world against six vaccine preventable diseases by the year 2000. EPI, launched in India in January 1978 was redesignated as Universal Immunization Programme (UIP) since 1985. UIP has been able to avert many deaths because of the six childhood diseases. Present study is an attempt to evaluate immunization coverage of children as well as mothers under UIP in urban slums of Jamnagar city (Gujarat).
A cross sectional study was conducted in January 2005. A sample of 210 children aged between 1 to 2 years and mothers with children upto one year of age was selected using WHO, 30 cluster sampling technique from urban slums of Jamnagar city. Immunization coverage of child and mother was assessed through checking of immunization card, presence of BCG scar and interview. If immunization card was not available, then information was sought from the mother of that child. Reasons for partial or no immunization were also asked from mothers.
Following criteria for full immunization, partial immunization and no immunization of children between 1-2 years and mothers was used1.
Full immunization: Child, 1 to 2 years age, who received 3 doses of DPT and OPV each, 1 dose of BCG and measles each. Mothers who received two doses or 1 booster dose of prenatal tetanus toxoid during her last pregnancy.
Partial immunization: Child, who missed any one or more of above doses and for mother who received just one dose of primary prenatal tetanus toxoid during her last pregnancy.
No immunization: Child or mother who did not receive even a single dose of vaccine.
Drop out rate was calculated as per standard formula.
Of the 210 surveyed children, 130 were males and 80 were females. Immunization card was available for 74.28% of children. Coverage with BCG vaccine was maximum (94.7%) followed by OPV3 (84.7%), DPT3 (81.4%), and that of measles was least (75.7%). This indicates higher coverage as compared to National coverage2 [BCG (85.9%), DPT (80.8%), OPV (81%) and measles (66.5%)] and NE states3 [BCG (84.1%), DPT (67.6%), OPV (67.7%) and measles (54.3%). Coverage was better in case of children who had their immunization cards available.
|Reasons||Children (n=56)||Mother (n=35)|
|Schedule not as planned||1||1.79||0||-|
| Problem of relation between
health worker & community
Drop out rates, for DPT, OPV were found to be 10.4% and 10.1% respectively, which are higher than the drop out rates at the National level3 (DPT-7.7%, OPV-7.6%). Although the drop out rates for full immunization were low in the present study (20.1%) compared to that at National level2 (22.5%). Drop out rate in present study is more than the figure of 15%, considered to be the indicator for defaulter as a problem4. Percentage for fully immunized children was 73.3% being more for male than female children (75.3% and 70.0% respectively) (Table-I). Above rates were higher than National level2 (63.0%). Percentage for partially immunized children was 23.8% and for unimmunized was 2.8%. Both these figures were higher in females than in males. Also the percentage of fully immunized mothers was 83.3%, which is higher than 78.0% of National average2, this figure was 61.0% for NE states3.
Main reasons for dropout or unimmunization of children and mothers were ignorance in about 80% and inconvenience in the rest (Table – II). In Madhya Pradesh lack of information was found to be the leading cause in a study by Yadav and Singh5.
All the above observations are a pointer to a better immunization coverage services in Jamnagar city but also indicates a scope for further improvement in immunization coverage through rectifying reasons for nonimmunization.
Deptt. of Community Medicine M.P. Shah Medical College,