Childhood Immunization Coverage in India
Added on 2020-03-16
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Running head: MASTER OF PUBLIC HEALTHName of the student:Name of the University:Author’s note
1MASTER OF PUBLIC HEALTHIntroduction: The rate of full immunization coverage for children has not been achieved equally in lowdeveloped countries compared to developing countries. According to the WHO report forachieving target immunization coverage for vaccine like DTP, countries like Africa and SouthEast Asia are still short of the target of 90%. Many barriers to achieving vaccination target hasbeen found to contribute to the trend in low developing countries. Some of these barriers includepoor parent education, low income and poor access to health care facilities (World HealthOrganization, 2017). As a staff working in health department of Maharashtra, India, I have beengiven the task of evaluating the effectiveness of various interventions to determine whetherinvestment should be done to improve vaccination rate according to new policy directive or not.Hence, this report mainly review the findings from the Cochrane review of the article on‘Interventions for improving coverage of childhood immunization in low and middle-incomecountries’ and evaluates the applicability of the Cochrane review findings on improvingvaccinate rates in India particularly Maharashtra. The structured assessment is likely to influencethe decision regarding investing for vaccination efforts in the chosen country. Childhood vaccination issues in India: The Government of India focused on intensification of childhood immunization in remoteand inaccessible rural areas in the year 2012-2013 and their target was also to eradicate poliotransmission and measles from the country by 2010 (Bhatnagar et al., 2016). According tonational immunization coverage for 2015, 87% vaccination rate was achieved for BCG, DTP3and MCV1. The government was involved in 39% spending on vaccines and 42% spending onroutine immunization programme (EPI Fact Sheet, 2017).This reflects that advances in
2MASTER OF PUBLIC HEALTHimmunization coverage rates has been achieved, however still India has fallen short of coveragefor all children because of many management challenges. Some of the reasons for poor vaccinecoverage back in the 1990s included extreme focus on polio eradication at the expense of othervaccines, insufficient investment of government in vaccination coverage, presence anti-vaccineadvocates as well as poor education in people. The quality of supply chain and infrastructure wasalso found to affect the vaccination coverage because 25% of vaccines did reached health careclinics and doctors and they were wasted (Centre for Public Impact, 2017). The evaluation of more recent statistics on coverage for DPT vaccine revealed that 19.3million infants in 2010 remain unimmunized globally and India achieved only 61%immunization coverage in 2011. The investigation regarding the reason for such trend revealedthat dropout rates was higher in migrant groups because of poor service utilization and inabilityto complete full course of vaccination (Progress Towards Global Immunization Goals, 2017).As2012 became the year of intensification of routine vaccination particularly in remote andbackward areas, Nath, Kaur, & Tripathi, (2015) investigated about the challenges in vaccinationrate among migrant population in Uttarakhand, India. The main findings from the study was thatgap in immunization coverage was seen because of inadequate cold chain maintenance, poortracking of dropouts and poor training in staffs regarding maintaining the temperature ofvaccines. In case of mothers, the main reason for non-immunization included the preference forvaccinating child in resident district only and lack of awareness about session site location.Review of these challenges in achieving vaccination rates in India mainly suggest that tailoredstrategies as intervention were not taken to specifically target immunization coverage in peopleliving in rural and remote areas particularly with low education. It also points out to weakness incounseling efforts to change the attitude of parents towards the immunization process.
3MASTER OF PUBLIC HEALTHAs this report is mainly focused on evaluating applicability of Cochrane review findingsparticularly for Maharashtra, analyzing the challenges in vaccination coverage in the state is alsonecessary. The study by Gatchell, Thind, & Hagigi, (2008) pointed that for children inMaharashtra, education in parents increased the likelihood of completing immunization inchildren compared to uneducated parents. Receipt of antenatal care and exposure to TV was astrong predictor of complete immunization however household standard of living also affectedthe immunization status of children. One unique finding for Maharashtra was that children inrural areas were more likely to be completely immunized compared to those in urban areas. Thisis an indication that rural infrastructure is strong in Maharashtra and more efforts is required inimproving coverage in urban areas. Scheduled caste related biasness in coverage was also seensuggesting more interventions targeting this group. Hence, consideration of state leveldeterminant of immunization is crucial to improving overall immunization rates in India. Summary of the findings of the Cochrane review: The Cochrane review of the article on ‘Interventions for improving coverage ofchildhood immunization in low and middle income countries’ revealed about types ofinterventions implemented in countries like Ghana, India, Nepal, Pakistan and many other lowdeveloping countries. Some of the relevant interventions implemented for improving childhoodimmunization coverage included providing community based health education, facility basedhealth education and redesigned reminder cards, monetary incentives, home visits, immunizationoutreach with and without incentives and integration of immunization with other health services.In terms of effectiveness, moderate evidence was found for communication regardingvaccination in parents and other community members (Oyo‐Ita et al., 2012). However, for otherinterventions like use of reminder card, regular immunization outreach home visits and
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