DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20200947

Not covered enough: inadequate age appropriate immunisation in urban slums of Delhi: a community based cross sectional survey

Sonali Randhawa, Shomik Ray

Abstract


Background: The urban average of childhood immunization coverage rates are partial against children living in slums and mask the disparity within the urban poor. The objective of study was to measure the age appropriate immunization as per India’s Universal Immunization Program (UIP) schedule, explore determinants of coverage and reasons for incomplete immunization in urban slums of New Delhi.

Methods: A cross sectional survey was carried out in selected urban slums of West and South East districts of New Delhi. WHO’s coverage cluster survey sampling methodology was used. Three hundred mothers of under five children were selected. Age appropriate immunization status of the children was recorded on physical examination of the vaccination card.

Results: Fifty eight percent (56% West; 60% South East district) of sample population was age appropriately immunized. The odds of age appropriate immunization were higher for institutional delivery (OR 10.5, 95% CI 4.27-23.6) and among third born children (OR: 1.8, 95% CI: 1.04-3.30). The odds were equal for people from Delhi or migrated from different state (OR: 1.015, 95% CI: 0.62-1.64). Most common reason for incomplete immunization were obstacles (72.8%) and lack of information (23.2%).

Conclusions: There was a consistent drop in coverage among vaccines with more than one dose and by the subsequent dose of vaccine. The difference in coverage estimates among studies emphasise the need for identifying the key reasons of incomplete immunization and finding area specific solutions to improve coverage.

 


Keywords


Age appropriate, Incomplete, India, Immunization, Urban slums, Vaccination

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References


World Health Organization. Global Vaccine Action Plan 2011-2020. 2013.

Vohra R, Vohra A, Bhardwaj P, Srivastava J, Gupta P. Reasons for failure of immunization: A cross-sectional study among 12-23-month-old children of Lucknow, India. Adv Biomed Res. 2013;2(1):71.

GAVI Alliance. Gavi country factsheet. Available at India.https://www.gavi.org/country/india/. Published 2018. Accessed on 12 October 2019.

Feldstein LR, Mariat S, Dobo GM, Diallo MS, Conklin LM, Wallace AS. Morbidity and mortality weekly report global routine vaccination coverage, 2016. Centers Dis Control Prev. 2016;66(45):1252-5.

Kusuma YS, Kumari R, Pandav CS, Gupta SK. Migration and immunization : determinants of childhood immunization uptake among socioeconomically disadvantaged migrants in Delhi, India. Trop Med Int Heal. 2010;15(11):1326-32.

International Institute for Population Sciences. National Family Health Survey (NFHS-3), India, 2005-06: Delhi. 2009.

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey 4-India. 2015.

Joshi V. Directorate of Census operations NCT of D. Census of India 2011. Primary Census Abstract data Highlights NCT of Delhi. Minist Home Aff Gov India. 2012:2-3.

Kesarwani P, Singh N, Keshari SS, Dixit S. Cross sectional study of immunization coverage in urban slum areas of Lucknow region. Int J Community Med Public Heal. 2017;4(9):3310-3.

Sharma V, Singh A, Sharma V. Provider’s and user’s perspective about immunization coverage among migratory and non-migratory population in slums and construction sites of Chandigarh. J Urban Heal Bull New York Acad Med. 2015;92(2):304-12.

Agarwal S, Bhanot A, Goindi G. Understanding and addressing childhood immunization coverage in urban slums. Indian Pediatr. 2005;42(7):653-63.

Mathew JL. Inequity in childhood immunization in India: a systematic review. Indian Pediatr. 2012;49(3):203-23.

Prinja S, Gupta M, Singh A, Kumar R. Effectiveness of planning and management interventions for improving age-appropriate immunization in rural India. Bull World Health Organ. 2010;88(2):97-103.

Clark A, Sanderson C. Timing of children’s vaccinations in 45 low-income and middle-income countries : an analysis of survey data. Lancet. 2005;373(9674):1543-9.

Pramanik S, Muthusamy N, Gera R. Vaccination coverage in India : A small area estimation approach. Vaccine. 2015;33:1731-8.

World Health Organization. The Department of Immunization V and B. Training for mid-level managers. Module 7: The EPI coverage survey. 2008.

Division/MOHFW I. Universal Immunization Program. 2013:20. Available at https:// mohfw. gov.in/sites/default/files/5628564789562315.pdf. Accessed on 12 October 2019.

Government of India. Family Welfare M of H. Mission Indradhanush : Operational Guidelines. 2016.

Singh PK. Trends in child immunization across geographical regions in India: focus on urban-rural and gender differentials. PLoS One. 2013;8(9):55-9.

Vashishtha VM, Kumar P. 50 years of immunization in India: Progress and future. Indian Pediatr. 2013;50(1):111-8.

Indian Institute for Population Sciences. National Family Health Survey 4: State Fact Sheet, NCT Delhi. 2015:1-6.

Devasenapathy N, Jerath SG, Sharma S, Allen E, Shankar AH, Zodpey S. Determinants of childhood immunisation coverage in urban poor settlements of Delhi , India : a cross-sectional study. BMJ Open. 2016;8:22-9.

Sharma S, Kohli C, Sharma N, Mehra D. Incomplete immunization coverage in Delhi : reasons and solutions. Prim Heal Care. 2016;6(4):4-6.

Pramanik S, Agrahari K, Srivastava A, Varanasi V, Setia M, Laxminarayan R. Integrated child health and immunization survey, rounds 1 and 2 Report. immunization technical support unit, Ministry of Health and Family Welfare. Government of India, New Delhi. 2016.

Brenzel L, Laxminarayan R, Haldar P. Variation in cost and performance of routine immunisation service delivery in India. BMJ Glob Heal. 2018;3(3):e000794.