Health programme effects upon acceptance of immunisation in northeast Thailand.

Abstract

As every year 5 million children die in developing countries because of infectious diseases, the government of Thailand in 1976 initiated an expanded program for immunization. Although vaccine coverage of the under 1 year of age population with BCG, diphtheria, pertussis, and tetanus is over 80%, the dropout rates are high and over 40% are without complete immunization. The availability and accessibility of immunization and the efficacy of health care delivery is analyzed. Group sessions were carried out with mothers of children under 4, with village health communications (VHCs) and village health volunteers (VHVs). 2 provinces with the highest immunization coverage and 2 with the lowest were selected. 608 women from 16 villages provided the sample as well as a total of 128 VHVs and VHCs. Distance to health center showed a significant relationship with completion of immunization (in contrast to travel time). The rate of complete immunization was higher for those who received regular information from VHVs and VHCs and who themselves contacted this personal than for those who never contacted the VHVs and VHCs. The most important factor of completion of immunization was the VHV/VHC contact. High immunization areas were highly correlated with high level of VHV/VHC knowledge about infectious diseases. The frequency of VHV/VHC reporting to subdistrict health officers also increased immunization coverage. Household visits were utilized by 54.6% of VHVs and VHCs in high immunization areas and by 15/7% only in low average areas. In high coverage areas, 13% of them were not instructed about dissemination of information as compared with 27.4% of them in low immunization areas. The 2nd phase of the study will consist of the measurement of intervention impact on immunization acceptance.