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ORIGINAL ARTICLE
Year : 2013  |  Volume : 4  |  Issue : 2  |  Page : 90-95

Immunization coverage and its determinants among 12-23 months old children of Lucknow


1 Department of Community Medicine, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur, Rajasthan, India
2 Department of Community Medicine, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
3 Department of Pharmacology, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur, Rajasthan, India

Date of Web Publication16-Sep-2013

Correspondence Address:
Rajaat Vohra
D-4, Ganesh Marg, Bapu Nagar, Jaipur - 302 015, Rajasthan
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.118235

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  Abstract 

Context:Roughly three million children die each year of vaccine preventable diseases (VPDs) with a significant number of these children residing in developing countries. Aims: The present study was conducted to assess the immunization status of 12-23 months old children and its determinants in Lucknow. Settings and Design: List of all villages in rural area and mohallas in urban area of Lucknow district was procured. Eight villages and eight mohallas were selected by simple random sampling. A community based cross sectional study was done among 450 children aged 12-23 months. Materials and Methods: A pre-designed and pre-tested questionnaire was used to elicit information on family characteristics, bio social characteristics, and housing characteristics. The immunization status of the child was assessed by vaccination card and by mother's recall, where vaccination card was not available. Statistical Analysis: Data were analyzed using statistical package for social services (SPSS) version 11.5. Chi-square test will be used to find out the significant association. Results: Overall, 62.7% children were fully immunized, 24.4% children were partially immunized, and 12.9% children were not immunized. The various determinants of immunization status of the child the place of residence, religion, socio economic status, father's education and father's occupation, source of information regarding immunization, registration of pregnancy, number of ante natal visits, iron and folic acid tablets consumed by the mother, tetanus toxoid received by the mother, place of delivery and the attendant who conducted the delivery. Conclusion: More awareness should be generated among the people living in rural and urban area, to immunize their children and to prevent the morbidity and mortality from six lethal vaccine preventable diseases.

Keywords: Determinants, immunization status, 12-23 months children


How to cite this article:
Vohra R, Bhardwaj P, Srivastava JP, Gupta P, Vohra A. Immunization coverage and its determinants among 12-23 months old children of Lucknow. Muller J Med Sci Res 2013;4:90-5

How to cite this URL:
Vohra R, Bhardwaj P, Srivastava JP, Gupta P, Vohra A. Immunization coverage and its determinants among 12-23 months old children of Lucknow. Muller J Med Sci Res [serial online] 2013 [cited 2021 Jan 26];4:90-5. Available from: https://www.mjmsr.net/text.asp?2013/4/2/90/118235


  Introduction Top


Roughly three million children die each year of vaccine preventable diseases (VPDs) with a significant number of these children residing in developing countries. Recent estimates suggest that approximately 34 million children are not completely immunized, with almost 98% of them residing in developing countries. Immunization is a significant, cost effective, and important public health intervention measure to prevent disease. Effective immunization has reduced the morbidity and mortality of children due to VPD to a great extent worldwide. Eradication of small pox is a glaring example of the success of vaccination.

National Family Health Survey (NFHS) III cites that national full immunization coverage against the six expanded programme on immunization (EPI) vaccines in the age group of 12-23 months old children is only 47.3%., ranges from 13% in Nagaland to 91% in Tamil Nadu. Uttar Pradesh (UP), Bihar, Madhya Pradesh (MP), Rajasthan, and North Eastern states share majority of the non-immunized children in India. In UP, only 23% children aged 12-23 months have undergone full immunization.

The present study was conducted to assess the immunization status of 12-23 months old children in rural and urban areas of Lucknow.


  Materials and Methods Top


List of all villages in rural area and mohallas in urban area of Lucknow district was procured. Eight villages and eight mohallas were selected by simple random sampling. A community based cross sectional study was done among 450 children aged 12-23 months.

Firstly, considering the immunization coverage among 12-23 months old children to be 23%, the sample size was calculated to be 450. Then the sample size was divided equally into urban and rural areas. The number of household to be taken for the survey in each village and mohallas was decided according to Probability Proportionate to Size (PPS) technique. Simple random sampling (using last digit of currency) was used to select the first household for the survey. Then starting from the first household, all the houses, where a child of 12-23 months was available, were surveyed till the desired number of children were met from that village or mohalla.

Help of Auxillary Nurse Midwife (ANM), Anganwadi Worker (AWW), and Accredited Social Health Activist (ASHA) was taken to build a rapport with local people. Mother of the child was preferred as primary respondent. In the absence of mother, father was taken as respondent. In case of the absence of both of them, the adult in the household who remained with the child for most of the time, was taken as respondent. Help of other available adult member of the household or nearby household was also taken.

A pre-designed and pre-tested questionnaire was used to elicit information on family characteristics, bio social characteristics, and housing characteristics. The immunization status of the child was assessed by vaccination card and by mother's recall, where vaccination card was not available.

The immunization status of the children was categorized as

  • Fully Immunized: When the child had received BCG, three doses of DPT and three doses of OPV and Measles vaccine.
  • Partially Immunized: When the child had received some but not all vaccines.
  • Not Immunized: When the child had not received any of the vaccine.

  Results Top


[Table 1] shows that overall 282 (62.7%) children were fully immunized, 110 (24.4%) children were partially immunized, and 58 (12.9%) children were not immunized. In urban area, 127 (56.4%) children were fully immunized while 56 (24.9%) children were partially immunized, and 42 (18.7%) children were not immunized. In rural area, 155 (68.9%) children were fully immunized while 54 (24%) children were partially immunized and 16 (7.1%) were not immunized.

Overall BCG vaccination coverage was 87.6% of which coverage was 82.7% in urban area while 92.4% in rural area. Overall DPT 1, DPT 2, and DPT 3 vaccination coverage was 83.1%, 81.1%, and 75.8%, respectively. In urban area, DPT 1, DPT 2, and DPT 3 vaccination coverage was 75.1, 72.4, and 67.1%, respectively. In rural area, DPT 1, DPT 2, and DPT 3 vaccination coverage was 91.1, 89.7, and 84.4%, respectively [Table 2].
Table 1: Immunization status of the study population

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Table 2: BCG, DPT 1, DPT 2, DPT 3 vaccination coverage

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Overall OPV zero dose, OPV 1, OPV 2, OPV 3 vaccination coverage was 78.7, 83.5, 81.1, 76%, respectively. In urban area, OPV zero dose, OPV 1, OPV 2, and OPV 3 vaccination coverage was 75.1, 76, 72.4, and 67.6%, respectively. In rural area, OPV zero dose, OPV 1, OPV 2, and OPV 3 vaccination coverage was 82.2, 91.1, 89.7, and 84.5%, respectively. The overall coverage of Measles vaccine was 62.2%. The measles vaccination coverage was 56.4% and 68% in urban and rural area, respectively [Table 3].
Table 3: OPV zero dose, OPV 1, OPV 2, OPV 3, and measles vaccination coverage

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[Table 4] showed the various determinants of immunization status of the child were the place of residence, religion, father's education, and father's occupation. Hindu children of rural area with well educated father had better immunization status.
Table 4: Determinants of immunization status of the child: Family characteristics

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Children of mother's, who were given health education by ANM, AWW, ASHA, and doctor, were found to be better immunized. A total of 88.9% of the children who were immunized in the private health facility were fully immunized in comparison to only 61% of the children who were immunized in the government health facility. Though 67.7% male children were fully immunized as compared to 57.5% female children, sex did not had a statistically significant association with the immunization status. A total of 71.1% children, whose vaccination card was available at the time of interview, were found to be fully immunized in comparison to 56.3% children whose vaccination card was not available [Table 5].
Table 5: Determinants of immunization status of the child

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Mothers who had received ante natal care, their children were found to be better immunized compared to mothers who had not received ante natal care. Registration of pregnancy, number of antenatal visits, iron and folic acid tablet consumption by the mother, tetanus toxoid received, and attendant who conducted the delivery were found to be significant determinants of the immunization status of the child [Table 6].
Table 6: Determinants of immunization status: Mother's antenatal characteristics

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  Discussion Top


In the present study, overall, 62.7% children were fully immunized, 24.4% children were partially immunized, and 12.9% children were not immunized. Similar results were shown by Padam Singh, et al.[1] in a study in different states of India where 63.3% children were fully immunized, 27.1% children were partially immunized, and 9.6% children were unimmunized. DLHS-III observed that 51.1 % of children in Lucknow were fully immunized. Bholanath, et al.[2] in a study in urban slums of Lucknow district showed that only 44.1% children are fully immunized while 32% children are partially immunized and 23.9% children are unimmunized.

Overall, the BCG vaccination coverage in the present study was 87.6%. Similar results were found in the studies conducted by SIHFW, Jaipur [3] in the sampled districts, S.K. Pradhan [4] in Orissa, Pragti Chhabra, et al. [5] in urbanized villages of Delhi which showed the BCG vaccination coverage to be 84.09, 84.7, and 82.7%, respectively.

Overall, DPT 1, DPT 2, and DPT 3 vaccination coverage in the present study was 83.1, 81.1, and 75.8%, respectively. Similar results were showed by studies conducted by Pragti Chhabra, et al.[5] in urbanized villages of Delhi and Padam Singh et al.[1] in different states of India. Another study by Rashmi Sharma, et al.[6] in the Slums of Surat showed DPT 1 coverage of 70.4%, DPT 2 coverage of 60.8% and DPT 3 coverage of 48.6%. Praveer Saxena, et al. [7] in a study in urban slums of Agra district stated that DPT 1 coverage in urban slums of Agra district was 56.6%.

In the present study, overall OPV 1, OPV 2, OPV 3 vaccination coverage was 83.5, 81.1, and 76%, respectively. Similar studies conducted by SIHFW, Jaipur [3] in sampled districts, Pradhan, et al. in Orissa [4] and Yadav, et al.[8] in urban slums of Jamnagar city showed the OPV vaccination coverage to be 97.6, 53.90, 65.1, and 84.7%, respectively. In the present study, overall OPV zero dose vaccination coverage was 78.7%. A study by Pragti Chhabra, et al.[5] in urbanized villages of Delhi showed the OPV zero dose coverage to be 13%. The reason behind such a high coverage of OPV zero doses in the present study could be because of higher number of institutional deliveries in the urban and rural area.

In the present study, overall vaccination coverage for Measles was 62.2%. Similar results were shown by studies conducted by Padam Singh, et al.[1] in different states of India, SIHFW, Jaipur [3] in the sampled districts, Pragti Chhabra, et al.[5] in urbanized villages of Delhi, Pradhan, et al.[4] in Orissa where the Measles vaccination coverage was 66.5, 62.18, 65.3, and 66.5%, respectively.

In the present study, the determinants which showed statistically significant association with the immunization status of the children were the place of residence, religion, socio economic status, father's education and father's occupation, source of information regarding immunization, registration of pregnancy, number of ante natal visits, iron and folic acid tablets consumed by the mother, tetanus toxoid received by the mother, place of delivery and the attendant who conducted the delivery. The place of immunization and availability of vaccination card also had a statistically significant association with the immunization status. Similar study conducted by Pragti Chabbra, et al.[5] in urbanized villages of Delhi showed that mother's education, place of birth, and immunization card were found to be statistically significant determinants of higher immunization status. Padam, et al. [1] in a study in India showed that immunization coverage was higher in urban areas for male children (marginally) and literate mother. The coverage level was the lowest among scheduled tribes followed by scheduled castes as compared to others. Padam, et al. [9] in a study in Bihar showed significant differences in coverage levels by sex in rural areas with males having better immunization coverage than females. Significant difference was also observed in coverage level of SC/ST and rest of the population. Both parents literacy status also had a significant influence on immunization level of the children. Bholanath, et al. [2] in their study urban slums of Lucknow showed that significant independent predictors of partial immunization of the child are illiterate mothers, Muslim religion, belonging to scheduled caste or tribes and higher birth order. Significant independent predictors of unimmunized status of the child are low socioeconomic status, Muslim religion, higher birth order, delivery at home, and belonging to joint family.


  Conclusion Top


The immunization coverage amongst 12-23 months old children of Lucknow was found to be 62.7%. Hindu children belonging to urban area, with educated father were found to have better immunization coverage. Children who were delivered in private hospitals, availing immunization services in private clinics and hospitals were having higher immunization coverage than their counterparts.

The following are the suggestions for improving the immunization coverage in the area:

  • More awareness should be generated among the people living in rural and urban area, to immunize their children and to prevent the morbidity and mortality from six lethal VPDs.
  • Parents education and poverty, as assessed by the household indicators, have a great impact on immunization coverage. In order to improve the vaccination coverage, investments in basic services, such as primary education, particularly for girls, is essential as increased education can influence the mother's understanding of the importance of immunization in child health. Educated mothers also have opportunity of being employed in better paying jobs and thus can help in raising the socio economic status of the family.
  • Information, education and communication (IEC) services should be directed toward improving the immunization status of the children in the community.
  • Reasons for poor utilization of health care services should be inquired and should be dealt with.


 
  References Top

1.Singh P, Yadav RJ. Immunization status of children in India. Indian Pediatr 2000;37:1194-9.  Back to cited text no. 1
[PUBMED]    
2.Nath B, Singh JV, Awasthi S, Bhushan V, Kumar V, Singh SK. A study on determinants of immunization coverage among 12-23 months old children in urban slums of Lucknow district, India. Indian J Med Sci 2007;61:598-606.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Rapid assessment of routine immunization efforts of NYK (Nehru Yuva Kendra) for UNICEF by State Institute of Health and Family Welfare, Jaipur. (An ISO 9001: 2008 certified institution). February 2009.  Back to cited text no. 3
    
4.Pradhan SK. Routine immunization in Orissa: An overview. J Community Med 2008;4.   Back to cited text no. 4
    
5.Chhabra P, Nair P, Gupta A, Sandhir M, Kannan AT. Immunization in urbanized villages of Delhi. Indian J Paediatr 2007;74:131-4.  Back to cited text no. 5
    
6.Sharma R, Desai VK, Kavishvar A. Assessment of immunization status in the slums of Surat by 15 clusters multi indicators cluster survey technique. Indian J Community Med April 2009;34:152-5.  Back to cited text no. 6
    
7.Saxena P, Prakash D, Saxena V, Kansal S. Assessment of routine immunization in urban slums of Agra district. Indian J Prev Soc Med 2008;39.  Back to cited text no. 7
    
8.Yadav S, Mangal S, Padhiyar N, Mehta JP, Yadav BS. Evaluation of immunization coverage in urban slums of Jamnagar City. Indian J Community Med 2006;31:4.  Back to cited text no. 8
    
9.Singh P, Yadav RJ. Immunization coverage in Bihar. Indian Paediatr 1998;35:156-60.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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