JOURNAL CLUB by

DR. MOHD NAJMULAQIB KHANJR, DEPTT. OF COMMUNITY MEDICINE

JNMCH

Reasons for failure of immunization: A cross sectional study‑

among 12-23 month old children of Lucknow, India‑ ‑

Rajat Vohra, Anusha Vohra,

Department of Community Medicine, Pharmacology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan,

Pankaj Bhardwaj, Jyoti Prakash Srivastava, Pratibha GuptaCommunity Medicine, Era’s Lucknow Medical College and

Hospital, Lucknow, Uttar Pradesh, India ADVANCED BIOMEDICAL RESEARCH | JULY - SEPTEMBER 2013 | VOL 2 | ISSUE 3

• About the journal• Abstract• Introduction• Rationale• Aim and Objective• Materials and Methods• Results• Discussion • Critical Analysis

Journal club: Objectives

Peer reviewed International journal

Published quarterly by the Wolters Kluwer/Medknow publication

It is indexed/abstracted by he major international indexing systems like index medicus/medline scopus, pubmed, caspur, scolar etc

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About the Journal

ABSTRACTBackground: Roughly 3 million children die every year of vaccine preventable diseases and a significant

number of these children live in developing countries. The present study was conducted to assess thereasons for failure of immunization among 12-23 month old children of Lucknow city in India.‑ ‑

Materials and Methods: Out of all villages in rural areas and mohallas in urban areas of Lucknow district, eightvillages and eight mohallas were selected by simple random sampling. A community based cross sectional‑study was done among 450 children aged 12-23 months. The immunization status of the child was assessedby vaccination card and by mother’s recall. A pre designed and pre tested questionnaire was used to elicit‑ ‑information on reasons for failure of immunization. Data was analysed using statistical package for socialservices (SPSS) version 11.5. Chi square test was 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 major reasons for failure of immunization were postponing it untilanother time, child being ill and hence not brought to the centre for immunization, unaware of the needof immunization, place of immunization being too far, no faith in immunization, unaware of the need toreturn for 2nd and 3rd dose, mother being too busy, fear of side reactions, wrong ideas about immunization,and polio was considered only vaccine, and others.

Conclusion: More awareness should be generated among the people living in rural and urban areas to

immunize their children.

Key Words: 12-23 months children, immunization status, reasons for failure

INTRODUCTION• Immunization is a significant, cost effective, and

important public health intervention.

• Roughly 3 million children die every year of vaccine preventable diseases (VPDs)

• Recent estimates 34 million children are not completely immunized, with almost 98% of them living in developing countries

• National Family Health Survey (NFHS) III cites national coverage against the six expanded programme on immunization (EPI) vaccines in the age group of 12-23 months is only 47.3%.

• In U.P., only 23% children aged 12-23 months have undergone full immunization.

• Study in urban slums of Lucknow district showed that only 44.1% children were fully immunized, while 32% were partially immunized, and 23.9% were unimmunized.

• DLHS III observed that 51.1% of children in Lucknow were ‑fully immunized.

Aims and objectives• Immunization status of the study population.

• Dropout rates and coverage of individual vaccines.

• Reasons for partial and non immunization of ‑the children

• Association between immunization status with the reasons of failure of coverage.

Materials and Methods • STUDY DESIGN: A Cross Sectional Study.

• STUDY PERIOD: Not mentioned

• STUDY AREA: Eight villages and mohollas of lucknow district.

• SAMPLE SIZE 450 children of age group 12 – 23 months

• SAMPLING METHOD Simple random sampling

• STUDY TOOL A pre designed and pre tested questionnaire was used to assess the ‑ ‑reasons for non immunization and partial immunization of the child.‑

• INCLUSION CRITERIA 12 – 23 months child

• EXCLUSION CRITERIA Not mentioned

• DATA ANALYSIS Spss version 11.2

• Sample size of 450 was divided equally into urban and rural areas.

• Households in each area taken by probability proportionate to size technique.

• Help of ANM, AWW, and ASHA taken to build rapport with local people.

• Father , any other adult taken as primary respondent in absence of mother.

• Immunization status of the child was assessed by vaccination card and by mother’s recall

Immunization status of the children wascategorized as• Fully immunized: BCG,3 doses of DPT, 3 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

Discussion• In the present study, overall, 62.7% children were fully

immunized, 24.4% were partially immunized, and 12.9% were unimmunized.

• Singh et al. in a study in different states of India, showed 63.3% were fully immunized, 27.1% partially immunized, and 9.6% unimmunized children.

• Bholanath et al.[2] in a study in urban slums of Lucknow district showed that only 44.1% were fully immunized, while 32% partially immunized, and 23.9% were unimmunized.

Comparison of drop out rate among similar studies:Vaccines PRESENT

STUDYBholanathet al.

Sharma et al.

Yadav et al.

BCG TO MEASLES

28.93% 33.24%. 60.2% --------

DPT-1 TO DPT-3

8.82% 23.16% 31.9% 10.4%

OPV-1 TO OPV-3

8.77% 23.16%, 31.5%, 10.1%,

DPT-3 TO MEASLES

17.88% 13.12%. -------- ---------

• Lack of knowledge and lack of faith came out to be the main reasons for non immunization of the children in the ‑present study compared with

STUDY REASON FOR NON IMMUNIZATION

Bholanathet al.

• lack of faith• lack of knowledge,• considering polio as the only vaccine

Saxena et al. • lack of awareness • side effects of vaccination

Punith et al • unawareness of the need• unawareness of the need to return• lack of information about the place

• In the present study, lack of motivation (postponing) among parents and illness of the child were the main reasons for partial immunization of the child compared with….

STUDY REASON FOR PARTIAL IMMUNIZATION

Bholanath et al. • Parents being busy (17.2%)• Parents migrated to other place

(14.7%)• Child/sibling became ill as a result of

previous vaccination (11.7%)• Carelessness (11.7%)• No knowledge of vaccine or place

(10.4%)• Others

Recommendations• More awareness should be generated among the people

living in rural and urban areas

• Parents education and poverty have a great impact therefore primary education, particularly for girls, is essential as increased education can influence a mother’s understanding of the importance of immunization.

• IEC services should be directed towards improving the immunization status.

• More awareness should be generated among people that there are five other vaccines other than polio vaccine which is overshadowed by repeated PPI rounds.

Criti cal analysis Positive points:1. Abstract is structured2. Table is systematic & informative3. Implications of the study identified4.Discusson relates key findings with the

research.

Negative points:

1. Title is different than study.2. Criteria for taking equal samples from rural and

urban areas not been mentioned.3. Can’t comment on reasons on the basis of chi

square for a particular variant.4. Exclusion criteria not mentioned

• References

• Singh P, Yadav RJ. Immunization status of children in India. Indian Pediatr. 2000;37:1194 9.‑

• 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.‑

• 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 2009;34:152 5.‑

• 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;31:10 12.‑

• Saxena P, Prakash D, Saxena V, Kansal S. Assessment of routine immunization in urban slums of Agra district. Indian J Prev Soc Med 2008;39:60 2.‑

• Punith K, Lalitha K, Suman G, Pradeep BS, Kumar KJ. Evaluation of primary immunization coverage of infants under universal immunization programme in an urban areas of Bangalore city using cluster sampling and lot quality assurance sampling technique. Indian J Community Med 2008;33:151 5.‑

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