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  • Title: Factors affecting immunization coverage levels in a district of India.
    Author: Balraj V, Mukundan S, Samuel R, John TJ.
    Journal: Int J Epidemiol; 1993 Dec; 22(6):1146-53. PubMed ID: 8144298.
    Abstract:
    Immunization coverage is measured to assess the performance of the Expanded Programme on Immunization. In 1988 we conducted a coverage survey among 12-23 month-old children in the North Arcot District (population 5,007,746) in southern India. In each of the 12 towns a 30-cluster sample survey was conducted. In the 35 rural blocks with 1590 panchayats, 159 were selected systematically and all children (n = 7300) were surveyed. In the towns, coverage ranged for measles vaccine from 29 to 53%, BCG from 65 to 91% and OPV and DPT third dose from just over 60% to just over 80%. In the rural areas, coverage ranged for measles vaccine from 10.8 to 19.3%, BCG 25.1-34.1%, DPT third dose 42.2-50.4% and OPV third dose 39.6-48%. In the towns, 25, 66, 67 and 59% of BCG, DPT, OPV and measles vaccines had been provided by private agencies showing that availability of vaccines throughout the week and easy access even in payment terms played an important role in achieving higher levels of coverage compared with rural areas where all vaccines are given by Government agencies, free of charge. In the rural areas, significantly large variations in coverage were seen among panchayats--large and peri-urban panchayats had significantly better coverage than small and more rural panchayats. Within any given block (the population unit consisting of 30-40 panchayats served by a Primary Health Centre), there were large variations in the levels of immunization coverage between panchayats.(ABSTRACT TRUNCATED AT 250 WORDS) The authors report findings from an immunization coverage survey in 1988 among 12-23 month old children in the North Arcot district of southern India conducted to assess the performance of the Expanded Program on Immunization. All 7300 children in 159 of 1590 systematically selected panchayats were surveyed. In the towns, coverages for measles vaccine ranged 29-52%, BCG 65-91%, and OPV and DPT 3rd dose 60-80%. Coverages in the rural areas were the following: measles vaccine, 10.8-19.3%; BCG, 25.1-34.1%; DPT 3rd dose, 42.2-50.4%; and OPV 3rd dose, 39.6-48%. In the towns, 25%, 66%, 67%, and 50% of BCG, DPT, OPV, and measles vaccines, respectively, were provided by private agencies. The higher coverage levels achieved in towns point to the importance of making vaccines available and easily accessible throughout the week. Government agencies provide all vaccines free of charge in rural areas. Further, large and peri-urban panchayats in rural areas had significantly better coverage than small and more rural ones, while large variations were found between panchayats in the levels of immunization coverage within any given block of 30-40 panchayats. The authors argue that variations in coverage levels in urban and rural areas and within rural areas may be due to varying efficiencies of different immunization delivery systems or responsible staff serving each region. In closing, neither the district nor block is a satisfactory unit for coverage surveys. Information should instead be collected from each geographical area served by a health worker to best detect poorly immunized areas. Coverage surveys should also ultimately be replaced with the auditing of immunization and disease surveillance.
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