Universal Immunization Coverage Research Articles

Role of the private sector in vaccination service delivery in India: evidence from private-sector vaccine sales data, 2009-12.

India's Universal Immunization Programme (UIP) provides basic vaccines free-of-cost in the public sector, yet national vaccination coverage is poor. The Government of India has urged an expanded role for the private sector to help achieve universal immunization coverage. We conducted a state-by-state analysis of the role of the private sector in vaccinating Indian children against each of the six primary childhood diseases covered under India's UIP. We analyzed IMS Health data on Indian private-sector vaccine sales, 2011 Indian Census data and national household surveys (DHS/NFHS 2005-06 and UNICEF CES 2009) to estimate the percentage of vaccinated children among the 2009-12 birth cohort who received a given vaccine in the private sector in 16 Indian states. We also analyzed the estimated private-sector vaccine shares as function of state-specific socio-economic status. Overall in 16 states, the private sector contributed 4.7% towards tuberculosis (Bacillus Calmette-Guérin (BCG)), 3.5% towards measles, 2.3% towards diphtheria-pertussis-tetanus (DPT3) and 7.6% towards polio (OPV3) overall (both public and private sectors) vaccination coverage. Certain low income states (Uttar Pradesh, Rajasthan, Madhya Pradesh, Orissa, Assam and Bihar) have low private as well as public sector vaccination coverage. The private sector's role has been limited primarily to the high income states as opposed to these low income states where the majority of Indian children live. Urban areas with good access to the private sector and the ability to pay increases the Indian population's willingness to access private-sector vaccination services. In India, the public sector offers vaccination services to the majority of the population but the private sector should not be neglected as it could potentially improve overall vaccination coverage. The government could train and incentivize a wider range of private-sector health professionals to help deliver the vaccines, especially in the low income states with the largest birth cohorts. We recommend future studies to identify strengths and limitations of the public and private health sectors in each Indian state.

Postpartum screening after gestational diabetes mellitus: Aiming for universal coverage.

These rates stand in stark contrast to the success achieved by our colleagues in paediatrics and community health, who target the same population (mothers) to ensure universal immunization coverage of their infants. This editorial focuses on the opportunity provided by postpartum screening, discusses how to achieve universal screening in women with a history of GDM, and the optimize use of this window to help change the natural history of diabetes.

Increasing Immunization Coverage

In 1977, the American Academy of Pediatrics issued a statement calling for universal immunization of all children for whom vaccines are not contraindicated. In 1995, the policy statement "Implementation of the Immunization Policy" was published by the American Academy of Pediatrics, followed in 2003 with publication of the first version of this statement, "Increasing Immunization Coverage." Since 2003, there have continued to be improvements in immunization coverage, with progress toward meeting the goals set forth in Healthy People 2010. Data from the 2007 National Immunization Survey showed that 90% of children 19 to 35 months of age have received recommended doses of each of the following vaccines: inactivated poliovirus (IPV), measles-mumps-rubella (MMR), varicella-zoster virus (VZB), hepatitis B virus (HBV), and Haemophilus influenzae type b (Hib). For diphtheria and tetanus and acellular pertussis (DTaP) vaccine, 84.5% have received the recommended 4 doses by 35 months of age. Nevertheless, the Healthy People 2010 goal of at least 80% coverage for the full series (at least 4 doses of DTaP, 3 doses of IPV, 1 dose of MMR, 3 doses of Hib, 3 doses of HBV, and 1 dose of varicella-zoster virus vaccine) has not yet been met, and immunization coverage of adolescents continues to lag behind the goals set forth in Healthy People 2010. Despite these encouraging data, a vast number of new challenges that threaten continued success toward the goal of universal immunization coverage have emerged. These challenges include an increase in new vaccines and new vaccine combinations as well as a significant number of vaccines currently under development; a dramatic increase in the acquisition cost of vaccines, coupled with a lack of adequate payment to practitioners to buy and administer vaccines; unanticipated manufacturing and delivery problems that have caused significant shortages of various vaccine products; and the rise of a public antivaccination movement that uses the Internet as well as standard media outlets to advance a position, wholly unsupported by any scientific evidence, linking vaccines with various childhood conditions, particularly autism. Much remains to be accomplished by physician organizations; vaccine manufacturers; third-party payers; the media; and local, state, and federal governments to ensure dependable vaccine supply and payments that are sufficient to continue to provide immunizations in public and private settings and to promote effective strategies to combat unjustified misstatements by the antivaccination movement. Pediatricians should work individually and collectively at the local, state, and national levels to ensure that all children without a valid contraindication receive all childhood immunizations on time. Pediatricians and pediatric organizations, in conjunction with government agencies such as the Centers for Disease Control and Prevention, must communicate effectively with parents to maximize their understanding of the overall safety and efficacy of vaccines. Most parents and children have not experienced many of the vaccine-preventable diseases, and the general public is not well informed about the risks and sequelae of these conditions. A number of recommendations are included for pediatricians, individually and collectively, to support further progress toward the goal of universal immunization coverage of all children for whom vaccines are not contraindicated.

An Appraisal of Immunisation in Nigeria: Towards Improving Coverage

Nigeria has achieved modest progress in immunization coverage particularly in the 1980-1990 periods. However, coverage has declined since the achievement of this peak. One factor important in sustainability of coverage is routine immunization and increased awareness to increase the knowledge of mothers on immunization. Within the country also there’s a wide interstate variation in coverage figures with a generally greater percentage of full immunization Coverage obtained in the southern zones than in the Northern zones. Even though the Nigeria’s universal child immunization coverage is said to have improved in the last two years much is still needed to bring the coverage target to at least 75% throughout the nation for effective control of all Vaccine Preventable Diseases. Targeted “mop-up” campaigns should be intensified for the wild polio virus transmission as found limited to a specific focal area, as found presently in some northern parts of Nigeria. As for the control of measles, experience globally also shows that routine immunization together with supplemental measles immunization can reduce measles deaths. Key words: Immunization coverage; appraisal; routine immunization; mop-up campaigns

Nutrition scenario in Karnataka, a state in southern India

India is an agricultural country and the majority of India's population live in rural areas. This is so in Karnataka, a state in southern India. The present report consists of a detailed nutrition situation analysis. Karnataka has a population of 45 million, which is approximately 3-5% of India's population. One in every two women are agricultural labourers, reflecting women's predominance in the field of agriculture. The state has a literacy rate of 56%. The food consumption patterns reveal that cereals and millets are the main food items. However, protective foods (i.e. foods that are rich in proteins, vitamins and minerals) are consumed in lesser amounts. When compared with the average Indian recommended dietary intake (RDI), the intake of energy in adults was found to be higher, as was protein. The average intake of vitamins, however, was 50% less than the RDI. Unlike adults, energy deficiency is a problem in the diets of preschool children. Growth retardation has been observed in a vast majority of children in Karnataka. An improvement in the nutritional status of rural adults has been observed in recent years. Protein energy malnutrition, vitamin A deficiency and B-complex deficiencies are the major nutritional deficiencies among preschool children, while anaemia remains a major health problem in women. Improvement in the healthcare system has brought a decline in the infant mortality rate in Karnataka and the state attained universal immunization coverage in 1990. The National Nutrition Programme - Integrated Child Development Scheme provides an integrated package of services to residents of Karnataka.

Prospects for universal immunization: strategies for achievement.

The technology, experience, management abilities, and international organization now exist for universal immunization coverage in most areas of the world. Unprecedented improvements in immunization coverage have been achieved in recent years because of the collaborative efforts of the international agencies and individual countries. The major barriers still existing can potentially be solved by providing for long-term external support for some countries, by improving the training available to health workers, by enlisting the involvement of political leaders, and by mobilizing all segments of society to improve the health of their children so that immunization does not become the responsibility of the health departments alone.