Report of an immunisation coverage survey in tamil nadu

REPORT OF AN IMMUNISATION COVERAGE SURVEY IN TAMIL NADU

Makkal Nalavazhvu Iyakkam & CHAD, CMC Vellore

• Immunizations are the single most cost- effective public health intervention.

• 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 care.

• 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.

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.

• 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.

• Among a total of 4096 children, data was incomplete for 589 children(14.4%). These children were not included in the primary analysis.

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

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

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%)

Proportion of children immunised from Private

BCG 7.4%

OPV 5.1%

DPT 1 5.9%

DPT 2 6.06%

DPT 3 6.29%

Measles 5.59%

NAME OF DISTRICT Proportion of children immunised from private

Dindikkal 4.72%

Kanyakumari 29.2%

Kovai thiruppur 2.31%

Krishnagiri 2.19%

Nammakkal 1.4%

Nilagiri 3.79%

Perambalore 5.59%

Theni 1.46%

Dharmapuri

Thiruchi 5.14%

Vellore 11.95%

Total 5.59%

Mean(Rs) Confidence interval Median(Rs)

Travel 31.9 26.2-37.6 7

Food 18.58 16.5-20.6 0

Wages lost 56.92 53.6-60.2 0

others 60.6 2.12-119.06 0

total 168.01 108.68-227.45 58

MEAN AMOUNT SPENT(IN Rs)

CONFIDENCE INTERVAL

MEDIAN AMOUNT

DHARMAPURI 52.2 47.3-57.2 55

DHINDIKAL 385.9 245.3-526.4 425

KANIYAKUMARI 179.5 138.8-220.2 30

KOVAI 223.6 211.5-235.6 211

KRISHNAGIRI 76 65.9-86.0 60

NAMAKKAL 184.9 176.7-193.1 170

NILAGIRI 191.2 172.6-211.2 220

PERAMBALORE 67.3 48.4-86.1 7

THENI 2.99 2.47-3.4 0

THIRUCHI 708.6 39-1377.5 55

VELLORE 162.8 143.3-182.3 120

• 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%.

• 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.

• 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.

• Around 5% 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