Mission Indradhanush Research Articles

Getting access to the COVID-19 vaccine: What should be our approach?

As the trials of vaccine development against COVID-19 progress, there is increasing hope of getting an efficacious vaccine soon. There is already a talk of equitable distribution of vaccine once developed. There was need for individual candidate vaccine development as chances of success are low as majority of the candidate vaccine fails in late phases of clinical trials.[1] However, once a safe and efficacious vaccine has been found and its effectiveness is ensured, all the resources should be used for rapid production and equitable distribution so that the pandemic is controlled. India will have an important role to play at this point as its manufacturing capabilities of Serum Institute of India (SII) to produce quality vaccine exceed any other facility worldwide. There is already collaboration between SII to manufacturing companies and international collaborators for equitable distribution of vaccine. One such collaboration is with COVAX, the ACT-accelerator vaccines pillar, which has pledged to donate 150 million dollars through Bill and Melinda Gates Foundation.[2] COVAX, which is co led by Gavi-the vaccine alliance, Coalition for Epidemic Preparedness Innovations and the WHO aims to pool the financial and scientific resources for easy and timely access of vaccine globally especially to countries which cannot afford. There are also pharmaceutical companies such as Astra Zeneca and Novavax which are leveraging on Serum Institute's existing infrastructure for mass production of vaccine for global supply. There is also a need for roadmap for countries to decide that who will get the vaccine first i.e. the distribution will be on the basis of priority or random. There is also question of whether it will be provided free by the government or can also be purchased individually in which case a priority distribution will be difficult. There has been talk in favor of priority distribution in population with increased risk, i.e., healthcare professionals and old age person or person with comorbidities.[3] However, such distribution carries the risk of getting infection from unimmunized population once immunity after vaccination declines. This is especially important if the immunity following vaccination is short lived. Probably, the best possible way of dealing such situation is to immunize a herd of people in and area at once or in short period of time. It will ensure that the virus is not transmitted and dies out in asymptomatic infective person. Thus, block-level immunization can also be a suitable option, especially in our country where other measures for the prevention of virus transmission have been difficult to achieve. This will not be an easy task looking at the sheer number of people which needs to be immunized. However, India already has infrastructure and experience to implement immunization programs according to a roster prepared following the planning process. Recently, an Intensified Mission Indradhanush 2.0 has been launched to ensure reaching the unreached with all available vaccines and accelerate the coverage of children and pregnant women in the identified districts and blocks.[4] This includes planning meetings at district and block levels, and oversight is provided by district task force for immunization. These programs have been the cornerstone of India's fight against infectious diseases. These well-built mechanisms can also be used to drive immunization against COVID-19. There are many options available for policymakers and the one with best scientific evidence and achievability should be opted. However, there should be definite transparent process to follow which should be made well in advance to prevent any confusion. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The evaluation of immunization coverage under mission Indradhanush: a review

The government of India introduced mission Indradhanush (MI) to strengthen the routine immunization planning and delivery mechanism. It was launched on 25th December 2014 with an objective to achieve more than 90% full immunization (FI) coverage in the country. To evaluate universal immunization coverage, barriers encountered for not achieving the target and problem solving in removing the barriers. PubMed and google scholar were used to search the relevant articles. PRISMA tool was used for the review process and for in­clusion of potential articles. The studies conducted in Manipur, Madhya Pradesh, Bihar and south Kerala reported successful achievement of MI goal. The minimum FI percentage was 57% and the maximum was 96.4%. The most common reason for not achievement of the goal was lack of awareness, illiteracy, child illness, fear of adverse effects.

A Cross-Sectional Study of Immunization Coverage in Children in Urban Slums of Western Maharashtra

Background: Children in urban slums suffer accentuated vulnerability to illnesses, as outbreaks of vaccine-preventable diseases are more common in urban slums. Though the immunization coverage has been steadily increasing, the average level remains far less, which is 62% (NFHS4) than the desired coverage (90%).Objectives: 1) To estimate Immunization coverage in children aged between 12–23 months living in Urban Slum area 2) To study sociodemographic factors influencing immunization coverage & reasons behind missed vaccination.Material and Methods: A community-based cross-sectional study was conducted from September to December 2018. A sample of 210 children aged 12–23 months was selected using WHO 30 cluster sampling technique from urban slum areas. Data were collected by parent interviews using the pretested questionnaire and checking immunization card.Results: Out of a total of 210 children studied, 106 were boys, and 104 were girls. BCG, OPV1/Penta1, OPV3/Penta3 and Measles1 immunization was received by 207 (98.6%), 203 (96.7%), 181 (86.2%) and 154 (73.3%) children respectively. Socio-demographic factors like Religion, Birthplace, socio-economic status, mother’s education, Mother’s Occupation were found significantly associated with full immunization coverage. Common reasons for missed immunization were sick child (35%) and unawareness of missed doses (23%).Conclusion: In urban slum area coverage of full immunization was found only 66.2%, which is though above the national coverage (62%) but still far lower than the expected coverage under Mission Indradhanush (90%). This demands vigorous efforts to improve immunization through IEC, Community Participation and Inter-sectoral coordination.

Evaluating the effect of key performance indicators of vaccine supply chain on sustainable development of mission indradhanush: A structural equation modeling approach

Indradhanush is a health mission, launched by the Government of India in 2014 to ensure that all children up to two years of age and pregnant women are completely immunized with all available vaccines. In this study, a novel framework is presented that demonstrates how the universal immunization program (UIP) India can utilize the key performance indicators (KPIs) of its vaccine supply chain (VSC) towards the goal of sustainable development (SD) of Mission Indradhanush. Based on the expert's opinions and an in-depth review of the literature, 57 performance indicators of VSC and 52 sustainability practices criteria (SPC) were identified. Using the balanced scorecard (BSC), the performance indicators were assessed in four dimensions: learning and growth, internal process, customer, and finance; whereas SPC were evaluated in three dimensions: economic, environmental and social. Further, from the field survey in 3 states of India, 248 valid questionnaires were collected, which were used to conduct exploratory factor analysis (EFA) and structural equation modeling (SEM). The results of the analysis revealed that the learning and growth and internal process KPIs of VSC have a positive and significant effect on the success of Mission Indradhanush sustainable development. In addition, results also revealed that the internal process mediates the relationship of learning and growth and sustainable performance and is the main dimension of VSC to strive towards sustainability. The findings of the present study will be beneficial to the policy-makers for measuring, monitoring, and improving the performance of immunization programs so as to build up the sustainability in Mission Indradhanush.

Coverage evaluation of the universal immunization program in Imphal-East district of Manipur: a cross-sectional study

Background: For the state of Manipur, the evaluated coverage among children as per NFHS-2, NFHS-3 and NFHS-4 were 42.3%, 46.8% and 65.9% respectively. But with the introduction of Mission Indradhanush in December 2014 which aimed in achieving the full immunization coverage to all eligible children over the next five years through special catch-up drives might have helped in improving the coverage. Hence, some improvement is expected by now. To ascertain the current status, the study was taken up. The current study was conducted to evaluate the primary vaccination coverage among children aged 12-23 months. The study also aimed to determine any association between important background characteristics with the vaccination status.Methods: A cross-sectional study was conducted in Imphal East District, Manipur during May 2017 to April 2020 among mothers having 12-23 months old children. 1,309 eligible study-women were selected by using multi-stage sampling technique. Data on their background characteristics, immunization status of the children and vaccination-related details were collected by using a pre-tested interview schedule.Results: The full immunization rate among children was found to be 93%. There was significant association between the immunization status and important background characteristics like place of delivery, order of birth, family income and mother’s educational status.Conclusions: Present study indicated that the full immunization coverage of the district was higher than the national and regional coverage findings. Place of delivery, order of birth, family income and mothers’ low educational status were found to be significantly associated with full immunization coverage.

Assessment of Immunization Coverage in Children Aged 1 Year To 2 Years From Rural, Urban and Tribal Areas After Launching Mission Indradhanush

Assessment of Immunization Coverage in Children Aged 1 Year To 2 Years From Rural, Urban and Tribal Areas After Launching Mission Indradhanush

Addressing health inequity through strategic planning and management

Substantial progress has been made to improve health in India in terms of availability, accessibility, cost-effectiveness, and quality. However, there are major health inequalities between and within the states. Strategic planning of health programs is required to address inequities in health. Need of the hour is to address this using a simplified strategic approach; who is left out, why are they left out, what causes are responsible for it and what are the determinants of inequality. The basic steps of strategic management, including strategic assessment, objectives, strategy formulation, and implementation, can be used to address the health equity. This article cites the examples of Serbia immunization programme, Government of India programme on Mission Indradhanush, and Thailand's universal health coverage to get better understanding to use strategic management to address health inequity. This approach is crucial in achieving sustainable development goals.

Evaluation of infrastructure, implementation and bottlenecks in the Mission Indradhanush program in selected districts of Indore division (Madhya Pradesh)- A Cross sectional study

Evaluation of infrastructure, implementation and bottlenecks in the Mission Indradhanush program in selected districts of Indore division (Madhya Pradesh)- A Cross sectional study

Implementation fidelity of village health and nutrition days in Hardoi District, Uttar Pradesh, India: a cross-sectional survey

BackgroundVillage Health and Nutrition Days (VHNDs) are a cornerstone of the Government of India’s strategy to provide first-contact primary health care to rural areas. Recent government programmes such as the Janani Suraksha Yojana (JSY) and Mission Indradhanush (MI) have catalysed important changes impacting VHNDs. To learn how VHNDs are currently being delivered, we assessed the fidelity of services provided as compared to government norms in a priority district of Uttar Pradesh.MethodsWe fielded a cross-sectional study of VHNDs to provide a snapshot of health services functioning. Process evaluation data were collected via administrative sources, non-participant observation using a standardised form, and structured questionnaires. Questionnaires were designed using a framework to assess implementation fidelity. Key respondents were VHND participants, front-line workers involved in VHND delivery, and VHND non-participants (pregnant women due for antenatal care or children due for vaccination as per administrative records). Results were summarised as counts, frequencies, and proportions.ResultsIn the 30 villages randomly selected for inclusion, 36 VHNDs were scheduled but four (11.1%) were cancelled and one VHND was not surveyed. Vaccination and antenatal care were offered at 96.8% (30/31) and child weighing at 83.9% (26/31) of VHNDs. Other normed services were infrequently provided or completely absent. Health education and promotion were particularly weak; institutional delivery was the only topic discussed in a majority of VHNDs. The true proportion of any serious problem impeding vaccine delivery was 47.2% (17/36), comprising 4 VHND cancellations and 13 VHNDs experiencing vaccine shortages. Of the 13 incidents of vaccine shortage, 11 related to an unexpected global shortage of injectable polio vaccine (IPV). Over the 31 VHNDs, 37.8% (171 of the 452 scheduled beneficiaries) did not participate. Analysis of missed opportunities for vaccination highlighted inaccuracies in beneficiary identification and tracking and demand side-factors.ConclusionsThe transformative potential of VHNDs to improve population health is only partially being met. A core subset of high-priority services for antenatal care, institutional delivery, and vaccination associated with high-priority government programmes (JSY, MI) is now being provided quite successfully. Other basic health promotion and prevention services are largely not provided, constituting a critical missed opportunity.

A cross sectional study to assess the awareness and satisfaction level among the beneficiaries regarding Mission Indradhanush in selected districts of Indore division

Background: Only 62% (NFHS-4) of the infants in India are fully immunized which is much less than the desired goal of achieving 85% coverage. To accelerate the process of immunization by covering 5% and more children every year, the Mission Mode has been adopted to achieve target of full coverage by 2020. Mission Indradhanush will target all children under the age of two years and pregnant women with all available vaccines.Methods: It is a cross sectional study done in 3 randomly selected districts of Indore division. The beneficiaries selected were children <2 years and pregnant women. The selection of beneficiaries was done by exit interview technique. Data collection was done by using pre-designed, semi-structured questionnaire which assess the awareness and satisfaction level of the beneficiaries.Results: About 88% were aware about the immunization. Overall 78% beneficiaries agreed that vaccination is compulsory, 62% agreed that vaccination schedule should be followed, 30% beneficiaries considered that vaccination was harmful. Most of the beneficiaries were satisfied with behaviour of the health provider, with all key messages given by health provider.Conclusions: Most common reasons found for drop out or left out were, fear of side effects due to vaccination followed by lack of awareness regarding session sites. Satisfaction level was found relatively low regarding difficulty in finding the place where vaccination was done and distance of session sites.

Vaccination coverage and factors associated with routine childhood vaccination uptake in rural Vellore, southern India, 2017

BackgroundVellore district in southern India was selected for intensified immunization efforts through India’s Mission Indradhanush campaign based on 74% coverage in the National Family Health Survey in 2015. As rural households rely almost entirely on the Universal Immunization Program (UIP), we assessed routine immunization coverage and factors associated with vaccination status of children in rural Vellore. MethodsWe conducted a cross-sectional household survey among parents or primary caretakers of children aged 12–23 months during August–September 2017 using two-stage, EPI cluster sampling. We verified vaccination histories from vaccination cards and collected data on sociodemographic and non-socio-demographic characteristics by using mobile data capture. Associations with vaccination status were examined with univariate and multivariate logistic regression models. ResultsA total of 643 children were included. Coverage of BCG, third dose pentavalent/DPT, measles/MR vaccines and full vaccination (BCG, three doses of polio and pentavalent/DPT and measles/MR vaccines) among children with vaccination cards (n = 606) was 94%, 96%, 93% and 84%, respectively. Of children with vaccination cards, 70.8% had received all recommended doses according to the UIP schedule. No socio-demographic differences were identified, but parents’ familiarity with the schedule (Adjusted Prevalence Odds Ratio (aPOR): 2.06, 95%CI = 1.26–3.38) and receiving information on recommended vaccinations during antenatal visits (aPOR: 2.16, 95% CI = 1.13–4.12) were significantly associated with full vaccination status of the children. ConclusionsWe found higher UIP antigen coverage and proportion of fully vaccinated children than previously reported from rural Vellore. However, adherence to the recommended schedule was still not optimal. Our study highlights the potential of improving parental awareness of vaccination schedule and targeting health education interventions at pregnant women during antenatal visits to sustain and improve routine immunization coverage.

National Immunization Programme - Mission Indradhanush Programme: Newer Approaches and Interventions.

Vaccines are globally accepted as instrumental in drastically bringing down vaccine preventable diseases (VPDs) related mortality and morbidity. Despite global relentless efforts, about 19.3 million children still go missing for full immunization and are at risk for VPDs. Government of India has tried to rejuvenate its four decades old Universal Immunization Programme (UIP) by recently launching Mission Indradhanush in 2014, followed by Intensified Mission Indradhanush in 2017 to boost up immunization coverage. UIP have also brought in newer vaccines, changed dose schedules, open vial policy and a robust surveillance system. Even then, country's average immunization coverage is much below par. Thus, there is a pressing need for transforming immunization program from simple vaccine delivery platform to a comprehensive disease control programme. Country should introduce newer vaccines through evidence-based policies and increase access to immunization services through system strengthening.

Process evaluation of mission Indradhanush immunization program in urban and rural communities of Ahmedabad district of Gujarat

Background: Mission Indradhanush has been launched in December 2014 as a special drive to vaccinate all unvaccinated and partially vaccinated children. This study was conducted with an aim to evaluate process of mission Indradhanush immunization program in urban and rural communities of Ahmedabad district, Gujarat.Methods: Community based cross-sectional study carried out at places such as urban slums with migration, nomadic sites, brick kilns, construction sites, underserved and hard to reach areas from July 2015 to July 2017. Cluster sampling method has been used, adapted from WHO 30-cluster sampling. Thirty (30) clusters were selected using probability proportional to the population size (PPS). Each PHC/UHC was taken as one cluster.Results: All the planned session being held as per micro plan (100%). Due lists of beneficiaries were present at all sites but not updated at 6 (10%) session sites. Mobilizers were present at 58 (96.67%) session sites. ANMs were giving all 4 key messages at 86.67% of session sites. 115 (95.8%) caregivers told source of information was home visits of ASHA/AWW. 66(55.00%) mothers were aware about when to come for next visit and 70 (58.33%) aware about which vaccines were given on MI session day.Conclusions: All the session sites had micro plan and due list, which is major achievement and positive sign of successful implementation of mission Indradhanush. Availability of vaccines and other logistics were also up to the mark. Over all implementation process was satisfactory and according to operational guidelines of MI.

Evaluation of vaccine storage and cold chain management practices during intensified mission Indradhanush in community health centers of Tikamgarh district of Madhya Pradesh

Background: Vaccination is one of the most effective disease prevention strategies and potency of vaccine is dependent on effective management of cold chain at all levels of vaccine handling. An effective cold chain maintenance system is the backbone of success of any immunization program. This study was done to assess the cold chain management and vaccine storage practices in Tikamgarh district of Madhya Pradesh.Methods: Cross-sectional study was carried out using a structured questionnaire.Results: Dedicated room/space for dry storage not available in any of 03 CHCs. Dedicated table for conditioning of icepacks, dedicated clean clothes for wiping of icepacks after conditioning and power back up was available, ILR and DF were connected to separate functional voltage stabilizer and thermometers were placed correctly only in 66.6% CHCs. ILRs and DFs were properly placed, cabinet temperature of ILR and DFs was maintained in normal range in all the three (100%) CHCs. Record of power failure, records of defrosting/cleaning was maintained in temperature log book and cold chain handlers had knowledge of shake test in only 33.3% CHC.Conclusions: Proper vaccine storage and management of cold chain system is essential for immunization. In order to improve quality of immunization services there is a need of space, temperature monitoring and regular defrosting with record keeping and regular training of cold chain handlers to keep their knowledge and skills updated. Monitoring and supervision of cold chain points by DIO should be on regular basis.

Assess the knowledge of under five mother regarding mission indradhanush

Mission Indradhanush is a health mission of the government of India. Mission Indradhanush's objective is to fully immunize more than 89 lakhs children who are either unvaccinated or partially vaccinated.

Editorial.

Editorial.

Socio-demographic profile and reasons for previous partial and unimmunization among children attending Mission Indradhanush session: a cross sectional study

Background: In December 2014, Ministry of Health and Family Welfare of India launched Mission Indradhanush with the aim to ensure that all children are fully vaccinated against seven vaccine-preventable diseases before they reach an age of two years.Methods: A cross sectional, community based study was conducted among parents attending Indradhanush Vaccination Centre (IVC) along with their partial and unimmunized children aged 0-23 months. Study was conducted during Mission Indradhanush (MI) 2nd Phase from November 2015 to January 2016. Data consisting of information regarding the various demographic variables, immunization history, and reasons for partial and unimmunization was collected by interviewing the parents through a pre-tested, structured questionnaire.Results: A total of 153 children were studied involving 63 session sites. 50 (32.7%) children were residing in low coverage areas, 4 (2.6%) children in villages with migratory population, 4(2.6%) children in areas with missed session and 87(56.9%) children residing in village with vacant sub centre. Common reasons for not vaccination were, child was sick on the day of vaccination (32%), child migrated to other place (27.5%), Fear of AEFI (11.8%), ignorance (11.1%). Only 92 (60.1%) children were having MCP card.Conclusions: The reasons for partial and un immunization were mainly lack of awareness of parents, sickness of children, fear of AEFI and migration to other places which would be solved by taking all efforts to raise the awareness of community about need of immunization along with providing complete information about the immunization services being provided to them.

Urban immunization: a story of meticulous policy implementation

Background: Vaccination of under 5 children is a crucial process for making child disease free against vaccine preventable diseases. Intensified mission Indradhanush focus on improving immunization coverage to ensure full immunization to more than 90% by December 2018 instead of earlier set target of 2020.Methods: This cross sectional study aimed to assess the full immunization and reasons for partial or no immunization in children less than two years of age in a metropolitan overcrowded area. Total 246 children were enrolled after applying complete enumeration method of sampling. Parents were interviewed by home to home visit and data recorded through immunization card/recall method.Results: 142 (87.65%) children were found fully immunized. The vaccine wise coverage was 100% for BCG, 95.1% for pentavalent and OPV third dose and 91.1% for measles vaccines. Father’s education was significantly associated with partial immunization. Fear, unawareness, H/O AEFI, inconvenient timings are the major reasons for partial immunization.Conclusions: The target of mission Indradhanush is to achieve 90% by December 2018 is on the verge of fulfillment in this study area. As the age of the child gets increases the adherence for subsequent vaccination decreases. Emphasis should be given on Fathers education and community awareness regarding importance of Vaccination.

A study on awareness and utilization of Mission Indradhanush in an urban slum of Bhubaneswar.

Background:India records 5 lakh child-deaths annually due to vaccine preventable diseases. As a strategic endeavor, the Ministry of Health and Family Welfare, Government of India, launched Mission Indradhanush in December 2014 to achieve more than 90% full immunization coverage by the year 2020.Objectives:To assess the awareness of the respondents about Mission Indradhanush, to assess their attitude and practices regarding childhood immunization, and to determine the association between knowledge and practice with selected variables.Materials and Methods:A cross-sectional study was undertaken from June to September 2017 among mothers with children aged 12–23 months in urban slums under field practice area of Community Medicine Department, Kalinga Institute of Medical Sciences, Bhubaneswar.Results:Mean age of the children was 17.23 ± 3.43 months; 65% were males and 35% females. Mean age of the respondents was 24.48 ± 3.97 years; 68% were literate and 94% were Hindus. Majority (76%) belonged to upper-lower Kuppuswamy socio-economic status scale. Only 10% had heard about Mission Indradhanush; health worker (90%) being the most common source of information. A total of 91% believed that vaccination prevented disease. A total of 96% believed that immunization was important for their children. A total of 73% had the maternal and child protection card with them. A total of 72% of children were fully immunized. Of the 28% partially vaccinated children, only 12.5% had heard about Mission Indradhanush. Reasons stated for partial immunization were mother too busy, child illness, and lack of information.Conclusion:Very few participants had heard about Mission Indradhanush in this study although most of them were aware of immunization services. Strengthening of Information, Education, Communication (IEC) activities regarding the program—Mission Indradhanush—needs attention. The immunization coverage was satisfactory.

District Level Analysis of Routine Immunization in Haryana State: Implications for Mission Indradhanush under Universal Immunization Programme.

Background:The immunization coverage in India is far away from satisfactory with full immunization coverage being only 62% at national level. Targeting the intensive efforts to poor performing areas and addressing the determinants of nonimmunization and dropouts offers a quick solution. In this paper, we assess the inter-district variations in Haryana state, and the association of social determinants with partial and no immunization.Methodology:This analysis is based on data collected as part of a large household survey undertaken in the state of Haryana to measure the extent of Universal Health Coverage. A multistage stratified random sampling design was used to select primary sampling units (i.e., subcenters), villages, and households. A total of 11,594 mothers with a child between 12 and 23 months were interviewed on receipt of immunization services. Determinants of nonimmunization and partial immunization were assessed using multiple logistic regression.Results:About 21% of children aged 12–23 months were partially immunized, while 4.3% children aged 12–23 months had received “no immunization.” While the coverage of full immunization was 74.7% at the state level, it varied from 95% in best performing district to 38% in poorest performing district. Odds of a partially immunized child were significantly higher in urban area (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.1–1.38), among Muslim household (OR = 3.52; 95% CI = 3.03–4.11), children of illiterate parents (OR = 1.58; 95% CI = 1.22–2.05), and poorest quintile (OR = 1.61; 95% CI = 1.36–1.89).Conclusions:Wide interdistrict variations call for a need to consider changes in resource allocation and strengthening of the government initiatives to improve routine immunization in these districts.