REPORT OF AN IMMUNISATION COVERAGE SURVEY IN TAMIL NADU.
MAKKAL NALAVAZHVU IYAKKAM
http://www.scribd.com/doc/58794261
BACKGROUND.
Immunizations are the single most cost- effective public health intervention1. Universal Childhood immunization has been accepted by world public health leaders as both an affordable and cost effective strategy not only for child survival but also for promoting primary health care2.
In India, the UIP was launched in 1985-86 to extend immunization coverage among the eligible children and to improve the quality of services. The target now is to achieve 100 per cent immunization coverage.
The immunization coverage of Tamil Nadu, which bagged the award for the best performing state under NRHM, as per DLHS 3 (2007-2008) is shown in Table 1.
Table 1. Immunization coverage in Tamil Nadu according to DLHS 3(2007-2008).
.
Fully immunized 83.2%
BCG 99.6%
MEASLES 97.6%
DPT3 88.9%
Though this is the picture on paper there are many differences in the field reality in Tamil Nadu. A major change happened when immunizations were moved from the village sub center level to the primary health centre following the untoward incident of death of two children following measles vaccination. This led to reduction in the coverage rates of measles vaccine and also led to increased indirect costs for immunization. The civil society in Tamil Nadu was increasingly concerned about this and also felt a need to evaluate the true immunization scenario in the state at the field level. This study was conducted by a non-governmental organization in association with its network partners.
The objectives of the current study were to evaluate the immunization coverage of children in Tamil Nadu state and to make recommendations regarding strengthening of immunization services based on the study findings.
Ten districts in Tamil Nadu were selected randomly. In each district 30 villages were selected by a random process. In each village 14 children were selected-7 between age group 6months to 11months and another 7 between age group 12 months to 17 months. Field workers received training on the sampling procedure and information collection. Information regarding the receipt of BCG vaccine, three doses of OPV and DPT and one dose of measles vaccine were collected from the mothers of the selected children.
Characteristics of the study population
Among a total of 4096 children, data was incomplete for 589 children. These children were not included in the primary analysis.
Table 2.
NAME OF DISTRICT No. of children aged 6-11 Months No. of children aged 12-17 months Total
Dindikkal 210 190 400
Kanyakumari 113 110 223
Kovai thiruppur 199 206 405
Krishnagiri 170 162 332
Nammakkal 143 115 258
Nilagiri 157 172 329
Perambalore 207 198 405
Theni 213 199 412
Dharmapuri 49 57 106
Thiruchi 109 119 228
Vellore 209 199 408
Total 1780 1727 3507
Data incomplete-589(14.4%)
Table 3. Distribution by gender.
Sex 6-11months old 12-17months old Total
Male 849(50.1%) 791(51.8%) 1640(50.9%)
Female 891(47.7%) 894(45.8%) 1786(46.8%)
Data missing 40(2.4%) 41(2.4%) 81(2.3%)
Total 1780 1727 3507
.
Table 4. Overall immunization coverage in Tamil Nadu from the study
Vaccine 6-11 months 12-17 months Total coverage
BCG 1775(99.7%) 1721(99.7%) 3496(99.7%)
DPT 1 1767(99.3%) 1719(99.5%) 3486(99.4%)
DPT 2 1751(98.4%) 1689(98.3%) 3449(98.3%)
DPT 3 1678(94.3%) 1642(95.1%) 3320(94.7%)
POLIO 1729(97.1%) 1683(97.5%) 3412(97.3%)
MEASLES - 1505(87.1%)
The total BCG immunization coverage according to the current study is 99.70%.The coverage in Tamil Nadu according to the NFHS 3 is 99.5% while according to DLHS 3 the coverage is 99.6%. BCG mark was not present among 1.9% of children among 6-11 months and 3.1% of children among 12-17 months. 92.4% has reported to have got BCG from Government facilities.
Overall DPT 1, DPT 2 and DPT 3 coverage is 99.40%, 98.30% and 94,7% respectively. DPT 3 coverage in NFHS 3 is 95.7% while according to DLHS 3 is only 88.9%
97.3% of children have received 3 doses of OPV. The coverage of measles vaccine among children 12 -17 months in this survey is 87.1%which appears to be much lower than Measles vaccine coverage of Tamil Nadu according to NFHS 3(12-23months) which is 92.5% and DLHS 3 which is 97.6%.
District wise vaccine coverage among children 12-17 months is shown in Table 4.
Table 5. District wise vaccine coverage among children 12-17 months.
District BCG DPT1 DPT2 DPT3 MEASLES
Dindikkal 100% 100% 100% 97.9% 87.7%
Kanyakumari 99.1% 98.2% 97.3% 93.6% 78.2%
Kovai thiruppur 99.5% 99% 98.1% 95.6% 74.3%
Krishnagiri 100% 100% 98.1% 93.2% 83.3%
Nammakkal 100% 100% 98.3% 94.8% 93.9%
Nilagiri 99.4% 100% 99.4% 98.8% 93.6%
Perambalore 99.5% 100% 99.5% 92.9% 86.4%
Theni 100% 100% 100% 100% 99%
Dharmapuri 100% 100% 98.2% 98.2% 87.7%
Thiruchi 100% 98% 96.6% 94.1% 79.8%
Vellore 99% 99.5% 98.3% 87.9% 83.9%
GRAPH1. PROPORTION OF CHILDREN IMMUNISED FROM GOVERNMENT FACILITIES.
Among those immunized, proportion of those immunized from Government facilities appears to be decreasing as they are moving towards DPT3 and Measles.
67.2% of mothers want their children to be immunized at the village itself, while others said that they want their children to be immunized in PHCs. Even though around 5% are getting immunized from private sector, only 0.6% of them want to get immunized from there. It appears that they are forced to get immunized from private sector for various reasons. Qualitative analysis of this issue is needed before commenting more.
COST OF IMMUNISATION
TRAVEL EXPENSES:
30% of them didn’t have any travel expenses for child’s immunization.1 out of 4 spent less than Rs 10, while another 1 out of 4 between Rs 10 and Rs20, while around 2% said that they spent more than Rs 100 towards travel expenses.
WAGES LOST:
44.1% had no major loss of wages, 28% had loss less than Rs.100 and rest of them had loss more than Rs.100 because of child’s immunization.
FOOD EXPENSES:
Around half of the mothers had no expenses towards food, while 30% spent less than Rs 50 and rest reported to have spent more than Rs 50 towards food when they went for immunization.
CONCLUSION.
The immunization coverage of Tamil Nadu obtained from this survey is almost similar to the results obtained from other surveys like NFHS3 and DLHS3 except for low immunization coverage for measles vaccine. Actions are needed for improving DPT3 and measles vaccine coverage in the state. Certain low performing districts needs focused activities. There was no significant difference in the immunization status of children in the age group 6-11 months and 12-17 months. Around 10% of the families depend on the private sector for immunizing children. Two out of three mothers wish to immunize their children in the village level itself. The indirect amount they spent for immunizing children is not at all ignorable