^1,2Associate Professor, ³Junior Resident, Department of Community Medicine, Rama Medical College & Research Centre, Mandhana, Kanpur, INDIA.

Email: anupam.sharma1@gmail.com

Table 1: Total Population of (RHTC)Shivrajpur

Tools of study:

Predesigned and pretested schedule. Child coverage form, Reasons for not receiving vaccination form

Methods of data collection:

Table 2

In the present study, ≥12 months to 24 months children were assessed, their date of birth range from 16/11/2018 to 15/11/2019. Total population of shivrajpur village were 20815 (Source- Field practice area of Shivrajpur). According to National House Hold Survey –IV,^[5] up to 24 months children was 1.94% to 2.0 % in total population. So our estimated children’s aged ≥12 months to 24 months were 410 i.e 1.96% in RHTC field practice area of shivrajpur with a population of 20815. Village wise children were shown in the above table. From each village children aged ≥12 months to 24 months were listed beforehand by the help of health workers of RHTC. Two health volunteers were engaged in each cluster to finish the coverage in one day. It was taken two months to complete the whole logistics. 1^st cluster was located in Dubiana village (Total population of Dubiana village is 776) about 14 children expected to be available in the said village. Accordingly 30 clusters were selected within the village listed above. In the 1^st cluster 7 children were assessed using predesigned and pretested child coverage form. Information was collected regarding newer vaccines along with availability of Immunization card (Mother and child protection card), gender wise distribution children in each cluster with sibling interval as well as source of vaccines. From the listed houses, 7 consecutive houses were visited for data collection, if any house was locked, next listed house was visited to collect the required information. In each cluster information of 7 children were collected. It was also noted that if more than one children aged 12-24 months were available in any house, they were also included. So, in 30 clusters 213 children were covered for evaluation of newer vaccines. Information was also collected from mother regarding reasons for not receiving routine immunization as well as newer vaccines. Data thus gathered was compiled and coverage of each newer vaccines in percent (%). After having the coverage report, the mothers meetings were arranged twice in a week about the utility of Routine Immunization (RI) along with newer vaccines and their availability. 8 meetings per months continued for 3 months with a total of 24 meetings for 24 villages.

Data analysis:

The obtained data were analyzed by using statistical package for social sciences (SPSS-Vertion19) software and Microsoft Excel and the appropriate statistical test was applied.

RESULTS

A total of 213 children were assessed on newer vaccines through 30 cluster evaluation survey.

Table 1: Gender wise distribution of study population ( n=213)

In table no 1. Distribution of study population according to gender we have found out of 213 cases 102(48%) were male and 111(52%) were female children.

Table 2: Distribution of study population according to sibling interval (n=211)

Sibling interval was 62.10% for more than 24 months followed by 36.50% for 12-24 months

Table 3: Gender distribution among study population according to recipient of RVV(n=149) and IPV (n=148)

 RVV-3 coverage was 69% (147) with a total of 213 children. Hospital was the main source of vaccination which was about 59.80 %, followed by health centre/sub-centre 26.80 %, Outreach centre 6.70 % and Private clinic 6.70%. IPV-1 and 2 coverage was 69.40%, Hospital is the main source 62.90% followed by HC/SC 16.30% PCV coverage was 69.00 %. Hospital was the main source of vaccine 64.10% followed by Outreach 14.90% and HC/SC 14.20%. MR-2 and JE-2 coverage was 63.80% (136) out of 213 children. Hospital was the main source of vaccination 65.50% followed by Outreach 14.40 and lowest was private hospital 7.20%.

Table 4: Distribution of study population according to reasons for coverage failure (n=64)

Table 4 presents the various reasons for coverage failure among study population. The most common reason was place and time not known involving 28.2% of the total respondents followed by time inconvenient (17%) and ill mother or family problem (15.5%). The other reasons observed were need not aware (7%), fear of reactions (5.7%), contraindications not clear (4.2%), vaccinator absent (4.2%), child ill or not brought (4.2%). The least common reasons were need to return not known (2.8%), rumours (2.8%), place to far (2.8%) and others (2.8%).

Table 5: Coverage of children on newer vaccines (n=213)

In a total of 213 children evaluated, 63.85% received all the newer vaccines, 30.05% received at least one vaccine and only 6.10% received more than one vaccine but not received all newer vaccines.

DISCUSSION

This study was cover the children aged ≥12 months to 24 months, in the rural field practice areas of the Department of Community Medicine, RMCH and RC, Mandhana, Kanpur, Bihar. The study was conducted over a period of 1 year from 1^st June 2019 to 31^st May 2020. Total population of Shivrajpur was 20815. Coverage of newer vaccines were calculated by using 30 cluster sampling technique. In the present study, 13 to 24 months children were assessed their date of birth range from 16/11/2018 to 15/11/2019 within the study period. A total of 213 children were assessed on newer vaccines through 30 cluster evaluation survey. In our study, the corrected percentage of newer vaccine immunization is found to be RVVand PCV-69%, IPV-69.4%, and MR and JE- 63.8 % respectively. However, above coverage was more than that of the NFHS-4 report (coverage) of Bihar.⁶ This increase possibly could be the active involvement of all stakeholders at survey level area in increasing awareness generation.⁷ The full immunization coverage of children in other studies across the country revealed a similar pattern. Research conducted by Naveen et al. in tribal area of Parol, Thane district Maharashtra FIC was found to be 71.1%,⁸ Murhekar et al. from Tamil Nadu reported FIC to be 79.9%,⁹ Datta et al. in rural area of Tripura had highlighted it as 91.67%.¹⁰ Another focal study from Surajgarha Block, Lakhisarai district by Kumar et al. in Bihar was 55.2%,¹¹ and in rural Uttar Pradesh it was 50% as per Ahmad et al.¹² The full immunization coverage is much lower in the studies from Bihar and Uttar Pradesh and this may be attributed by the lower awareness level and less health services utilization in both the territories. In this study, the valid immunization coverage was 63.8% which is comparable to the study by Murhekar et al. in Tamil Nadu, where it was 78.8% ⁹ and 79.4% as per the study by M. Joy et al. in Kochi, Kerala.¹³ In Bihar, almost 63.8% and 55.4% of the deliveries are institutional as per NFHS4 and DLHS4, respectively.¹⁴ whereas institutional delivery rate is more than 90% in southern states of India. In present study, 70% children have received one or more than one vaccines but did not complete their immunization till the time of survey and 30% children were unimmunized. Other studies conducted by Vohra et al. in Lucknow district¹⁵ and Nath B in urban slums of Lucknow district¹⁶ showed that lack of awareness was the major contributor for the higher dropout rate. In present study, the main reason cited by most of the respondents was unavailability of child on the day of vaccination followed by place and time not kown. Madhvi et al. from Kakinada, Andhra Pradesh showed that the most common reasons for partial/no immunization are ill child (27.5%), lack of knowledge about vaccination (25.12%), migration to other places with no knowledge of place and time of vaccination (17.5%).¹⁷ In our study RVV-3 coverage was 69% (147) with a total of 213 children. In this study we have found IPV-2 coverage was 69.40%. Indian government has also made efforts to rapidly increase immunization coverage through special immunization drives under the Mission Indradhanush programme, whose aim was to achieve full immunization coverage (i.e. greater than 90%) by December 2018. This programme, which focuses on children younger than 2 years and pregnant women, has helped strengthen the overall immunization system and increase coverage. The close tracking and immunization of eligible recipients of inactivated poliovirus vaccine combined with the more appropriate distribution of vaccine has contributed to a rapid increase in the coverage of fractional-dose inactivated poliovirus vaccine, which reached 73.8% by June 2017.¹⁸ In our study, PCV coverage was 69.00 %. It has been estimated that in India incidence of pneumonia among under-fives is 0.37 episodes/year, resulting in 43 million new cases. Of all pneumonia cases, 7-13% are severe enough to require hospitalization. Pneumonia causes an estimated 408,000 deaths among under-fives contributing to 19% of child mortality in India.¹⁹ Several types of JE vaccines have been developed since the 1950s, and 3 have been widely used for immunizations. The inactivated MBDV needs to be administered in multiple doses, can cause serious hypersensitivity in some vaccinees, and can potentially cause neurological side effects.^[20] Moreover, its manufacturing process is less stringent than that for cell culture–derived vaccines. The live attenuated SA-14-14-2 vaccine²¹ is efficacious but produced in primary cells, which are less preferred than continuous cell lines for vaccine production. In this study of 213 children, 63.85% received all of the newer vaccines, 30.05% received at least one vaccine, and only 6.10% received more than one vaccine but not all of the newer vaccines. Immunization are components of primary care, and the current report, which was conducted at the grassroots level in 59 low-performing blocks in Bihar, found that factors such as population indifference, poor supply chain, and logistic are some of the barriers that need to be tackled at the primary care level in order to achieve better FIC. Community preparedness may be measured and compared at a glance.

CONCLUSION

To meet its global commitment of achieving the sustainable development goal three, recently four new vaccines have been introduced in the India's Universal Immunization Program (UIP), including rotavirus vaccine (RV), pneumococcal conjugate vaccine (PCV), measles-rubella (MR) vaccine, and human papillomavirus (HPV), by reducing the mortality and morbidity due to diarrhea, pneumonia, measles, rubella among under-five children, and cervical cancer among adults. A among the total of 213 children RVV-3, IPV and PCV-B coverage was 69.00 % and MR-2 and JE-2 coverage was 63.80%. Hospital is the main source of vaccination which was about 60.00 %. About 30 percent (64) children received at one vaccine like RVV/IPV/PCV. Main reasons for not received vaccine were not aware of time and place and inconvenient time and mothers illness.

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