Utilization Of Immunization Services Research Articles

Assessment of the Level of Utilization of Immunization Services Among Nursing Mothers in Some Local Government Areas of Benue State, Nigeria

The study investigated the level of utilization of immunization services among nursing mothers in some local government areas of Benue state. Descriptive cross sectional research design was adopted and multistage sampling procedure was employed. The questionnaire for the respondents titled assessment of the levels of utilization of immunization services among nursing mothers (ALUISNM). The study population consists of 1,500 nursing mothers in selected LGAs of Benue State. Mean, standard deviation were employed to analyze the data obtained from the respondents, while the null hypothesis was verified using the t-test of ANOVA. It can be deduced that the height of utilization of immunization services amongst the nursing mothers in Benue State is fair. The result that 765 (54.3%) utilized immunization services against 670 (45.7%). The result pointed out that there is high level of utilization of immunization services among women with secondary education (57.6%) followed by those with tertiary education. Based on socio economic status immunization were utilized more by women who are unemployed and self-employed with (56.0%) and (55.3%) respectively. Based on location of immunization services, utilization was more by the urban women (60.0%) than semi urban and rural women. Also based on religion utilization of immunization is higher with those of Islam traditionalist than the Christians. The utilization of immunization services and factors such as socio-economic status [F(2,(1462) = 1.139, p>0.05], location [F(2,(1462) = 2.249, p>0.05]. and religion [F(2,(1462) = 0.528, p>0.05] showed no verifiable significance differences. But there was a significant difference with regards to education [F(3,1461) = 15.773, p<0.05]. Conclusively, there was positive level of utilization of immunization services from the study and therefore recommended that issues like location of health facilities, awareness, education etc should be addressed.

IJCM_226A: Bridging the Gap: Model Immunization Centers in Urban Bihar - A Study on Factors Shaping Community Acceptance and Utilization for Improved Immunization Coverage

Background: Despite significant strides in immunization coverage, Full Immunization coverage in urban areas of India lags behind rural regions, with Urban India recording 75.5% compared to 76.8% in rural areas. Additionally, the prevalence of zero-dose children is higher in Urban India (7.5%) compared to rural counterparts (6.3%). Urbanization introduces a complex dynamic marked by poverty, migration, and growing disparities in health access, social services, and economic resources that necessitate innovative strategies to address immunization inequities in urban settings. In this direction, the Government of Bihar in 2017 introduced the concept of Model Immunization Centers (MICs) to provide high-quality immunization services to urban poor and marginalized to improve coverage and build trust, confidence and motivation for public immunization services. Objectives: The primary objective of the study was to assess and identify the factors that shape the community’s acceptance and utilization of immunization services at MICs in Patna and Siwan. Methodology: A mixed-methods approach was employed, combining quantitative data analysis of immunization records and demographic information with qualitative assessments of community perceptions through in-depth interviews and focus group discussions. The study site i.e., Patna and Siwan Districts of Bihar was purposively selected. Results: The study found that the effectiveness of MICs was significantly influenced by family, community, and social norms. Additionally, MICs played a pivotal role in enhancing people’s trust, confidence, and motivation through the provision of a favourable environment, hygiene maintenance, the availability of free vaccines, reduced waiting times, and courteous staff behaviour. These factors have collectively led to improved immunization coverage, increased footfall, and improved rates of full immunization. Conclusion: The success of MIC in gaining people’s trust and confidence has been a driving force behind the increase in footfall coverage at session sites and high Full Immunization Coverage in Patna and Siwan

Factors Influencing Utilisation of Immunisation Services among Children Under Five Years in Lira Municipality Lira District Northern Uganda

This study investigated the factors influencing the utilization of immunization services among children under 5 years in Lira Municipality, Lira district, Northern Uganda. Utilizing a community-based cross-sectional design with quantitative data collection methods, 380 mother-infant pairs were randomly selected from residents of Lira Municipality. Univariate, bivariate, and multivariate logistic regression analyses were conducted using STATA software version 14.0 to identify significant factors affecting immunization service utilization. The study found that 77.63% (295/380) of children under 5 years utilized immunization services, with the highest utilization observed among male children (82.71%). Factors significantly influencing utilization included mothers' education level (aOR 7.46, 95%CI 2.17 – 25.65, P=0.001), religion (Muslims vs. Christians: aOR 0.15, 95%CI 0.07 – 0.32, P<0.001), rudeness of health workers (aOR 3.50, 95%CI 1.73 – 7.06, P<0.001), awareness of subsequent immunization schedules (aOR 0.38, 95%CI 0.20 – 0.70, P=0.002), possession of a child immunization card (aOR 0.34, 95%CI 0.19 – 0.63, P=0.001), and understaffing at health facilities (aOR 2.87, 95%CI 1.43 – 5.78, P=0.003). The study highlights the importance of addressing these factors to improve immunization coverage, which currently falls below the global target recommended by WHO and UNICEF. Keywords: Immunization services, Children, Under-Vaccinated, Unvaccinated, Mothers, No versus Yes.

Effect of Covid pandemic on immunization status of children in tertiary care Hospital of North India: reason for partial and non-immunization a cross-sectional study

BackgroundLow immunization coverage in India attributes to many factors including sociodemographic factors and people’s behavior. COVID-19 pandemic resulted in disruptions in achieving optimum availability and utilization of immunization services. This study was carried out to find out the immunization status of children in the post COVID era and various factors responsible for non-immunization during the pandemic.MethodsThis cross-sectional study included parents of 225 admitted children aged 1–6 years were interviewed using a semi-structured open-ended questionnaire. Children were classified as completely immunized, partially immunized and unimmunized on the basis of vaccines missed given under first year of life. Reasons for non-immunization and delay/missed vaccination during COVID-19 pandemic were recorded.ResultsOf the 225 children, 162 (72%; 95% CI 66–78%) were completely immunized, 55 (24.4%; 95% CI 19–30%) were partially immunized and 8 (3.6%; 95% CI 1–6%) were unimmunized. Parents with hospital deliveries, higher education level and lesser birth order were more likely to have children with better immunization status (p < 0.05). First dose of measles scheduled at 9 months and 3rd dose of pentavalent vaccine/OPV/Rotavirus vaccine scheduled at 14 weeks were most commonly missed vaccines among partially immunized. Lack of awareness (n = 36, 57.1%; 95% CI 45–70%) was the common reason for partial and non-immunization followed by illness of child (n = 21, 33.3%; 95% CI 21–45%) and COVID-19 pandemic (n = 11, 17.4%; 95% CI 8–27%). Pandemic was reason for delay in 50 (22.2%; 95% CI 17–28%) children. Restrictions of movement (64%; 95% CI 50–78%), fear of being exposed to COVID-19 (52%; 95% CI 38–66%) were the most common reasons for delay during the pandemic. Of the 50 children who had delay due to pandemic, 39 children (17.3%; 95% CI 12–22%) received their catch-up immunization after the pandemic. No child remained completely unimmunized due to COVID-19 pandemic.ConclusionsAlthough COVID-19 pandemic resulted in disruptions in routine immunization services, sociodemographic factors such as awareness for immunization, parental education and various beliefs for immunization were responsible for the children remaining unimmunized or partially immunized after the pandemic.

Factors Associated with the Utilization of Tetanus Toxoid Immunization Services among Pregnant Women in Oepoi Health Center, Kupang, East Nusa Tenggara

Background: The tetanus toxoid (TT) immunization program is a process of building immunity as an effort to prevent tetanus infection. TT immunization is important to form tetanus antibodies that will prevent neonatal tetanus. The coverage of TT immunization in Oepoi Community Health Center Working Area in 2020 is classified as very low, which was only 37.06%. The low coverage of TT Immunization indicated a lack of utilization of immunization services by pregnant women. This study aimed to determine the factors associated with the utilization of Tetanus Toxoid immu­ni­zation services for pregnant women in the working area of the Oepoi Health Center. Subjects and Method: This cross-sectional study was conducted in the working area of the Oepoi Health Center, Kupang, East Nusa Tenggara from March to October 2022. A total of 46 third trimester pregnant women were selected by simple random sampling. The dependent variable was the TT immunization service. The independent variables were knowledge, the role of health workers, husband's support, and parity. Data was collected by using a questionnaire and analyzed by using the chi-square test. Results: There is a relationship between knowledge (OR= 48.00; 95%CI= 7.84 to 293.71; p&lt;0.001), the role of health workers (OR= 22.16; 95%CI= 2.57 to 190.99; p&lt;0.001) husband’s support (OR=10.85; 95%CI= 2.68 to 43.89; p&lt;0.001), parity (OR= 3.73; 95%CI= 1.08 to 12.90; p= 0.033) and the utilization of the TT immunization service in the Oepoi Health Center working area. Conclusion: Knowledge, the role of health workers, husband's support, parity are related with the utilization of TT immunization services in the working area of the Oepoi Health Center. Keywords: immunization, tetanus toxoid, pregnant women. Correspondence: Chintya Leba Leo. Faculty of Public Health, Universitas Nusa Cendana Kupang. Jl. Adisucipto Number 1 Penfui Kotak Pos 104 Kupang 85001, East Nusa Tenggara. Email: chintya­leba­leo@gmail.com. Mobile: +62 813-3855-7740. Journal of Health Promotion and Behavior (2023), 08(01): 58-64 DOi: https://doi.org/10.26911/thejhpb.2023.08.01.08

Impact of COVID-19 on routine immunization at immunoprophylaxis clinic of tertiary care center of central India: a cross-sectional study

Background: The global COVID-19 pandemic is overstretching existing health systems. The COVID-19 pandemic has prompted the world to implement drastic prevention methods based on limiting population movements that have an impact on public health policies such as vaccination. This study aimed to assess the impact of COVID-19 on routine immunization at an immunoprophylaxis clinic of the tertiary care centre.Methods: a record-based cross-sectional study was carried out during the 4 months, (February to May) 2020 in the Immunization Clinic of Tertiary Care Center of central India. Vaccines included in the study were OPV, IPV, ROTA, PENTA, MR, and DPT. Data analysis was done by using software open EPI, p&lt;0.05 was considered to be statistically significant.Results: The study showed a prominent decline in the percentage of children who came for immunization during the period of lockdown due to the COVID-19 Pandemic. This downward trend continued from the month of February, as the months progressed and till May arrived, the fraction of children vaccinated in 2020 as compared to 2019 saw a very significant reduction, (p&lt;0.000). individual vaccine-wise immunization status of under 5 children also shows a downward trend in the year 2020 as compared to the year 2019.Conclusions: There was a sharp decline in the utilization of immunization services in a tertiary care center in central India.

Tetanus Toxoid Vaccination Status of Women in Baghdad

Background: Immunization remains one of the paramount public health interventions and a cost effective method to reduce both the ailment and death associated with infectious diseases. Uptake of vaccination is dependent not only on providing of the vaccination services but also on other influences including awareness and practice of women. Objectives: To assess tetanus toxoid immunization status of mother’s. In addition, to address the factors influencing their immunization status. Method: Cross sectional study conducted in ten primary health care centers in Baghdad for the period from February until the end of October 2020. Convenient sample of mothers, who had delivered a live baby within the previous 12 months from the study and attended the selected primary health care centers in Baghdad were recruited. An interview questionnaire used to collect data regarding history of tetanus toxoid vaccine up take of the mothers during their last pregnancy. Results: The total number of mothers enrolled in the study was 400, 214(53.5%) of them were received tetanus toxoid vaccine (TTV) during their last pregnancy. 127(59.3%) of the mothers were uptake two doses of TTV. Among the study group, 31.75% of mothers were considered as immunized according to WHO classification. Age of mother, education, and respondents’ working status; alongside with antenatal care attendance and place of delivery all had insignificant impact on the immunization status. Lack of time was the main reason for not vaccination (22.6%). Conclusion: Tetanus toxoid immunization coverage was inadequate. For that reason, immunization campaigns targeting enhanced utilization of immunization services by mothers and women of childbearing age are highly recommended.

Strategies to overcome vaccine hesitancy: a systematic review

BackgroundVaccination, albeit a necessity in the prevention of infectious diseases, requires appropriate strategies for addressing vaccine hesitancy at an individual and community level. However, there remains a glaring scarcity of available literature in that regard. Therefore, this review aims to scrutinize globally tested interventions to increase the vaccination uptake by addressing vaccine hesitancy at various stages of these interventions across the globe and help policy makers in implementing appropriate strategies to address the issue.MethodsA systematic review of descriptive and analytic studies was conducted using specific key word searches to identify literature containing information about interventions directed at vaccine hesitancy. The search was done using PubMed, Global Health, and Science Direct databases. Data extraction was based on study characteristics such as author details; study design; and type, duration, and outcome of an intervention.ResultsA total of 105 studies were identified of which 33 studies were included in the final review. Community-based interventions, monetary incentives, and technology-based health literacy demonstrated significant improvement in the utilization of immunization services. On the other hand, media-based intervention studies did not bring about a desired change in overcoming vaccine hesitancy.ConclusionThis study indicates that the strategies should be based on the need and reasons for vaccine hesitancy for the targeted population. A multidimensional approach involving community members, families, and individuals is required to address this challenging issue.

A Cross Sectional Study to identify managerial issues in the Implementation of vaccination of under-five Children for effective management of Immunization Center

The benefits of vaccination are clearly demonstrated by the eradication or enormous decline of the incidence of many vaccine-preventable diseases, Yet the coverage against VPDs remains close to complete but there is a large gap between target and achievement of child immunisation in the country and the coverage of many highly recommended vaccines is still frequently inadequate and children still suffer from diseases that would are prevented. The main aim of this study was to discuss the recognized barriers to the vaccination of children confronting immunization achievement, providers and parents, and the ways in which they can be overcome. Most of the issues underlying limited vaccination coverage among children are because of a scarcity of understanding among healthcare providers and attendants, which underlines the necessity for educational programmes specifically addressed to each of these groups. However, it will take the combined efforts of healthcare systems and providers to pull down all of the barriers. The study was conducted to identify managerial barriers to vaccination of under five children. There is scope for improvement by focusing on the factors which are influencing utilization of immunization services. However, it'll take the combined efforts of healthcare systems and providers to tug down all of the barriers. The study was conducted to identify managerial barriers to vaccination of under five children. There is scope for improvement by focusing on the factors which are influencing utilization of immunization services.

Determinants of Poor Utilization and Accessibility of Immunization Services: A Qualitative Study in Selected Counties in South Sudan

BACKGROUND: Reducing vaccine-preventable diseases mortality and morbidity in non-industrialized countries requires the enforcement of robust immunization strategies aimed at increasing coverage and reducing dropouts and missed immunization opportunities. Attaining high (&amp;gt;80%) immunization coverage with a low drop-out rate in South Sudan has been challenging because of the program&amp;rsquo;s high defaulting rates. This study aimed to determine the reasons for poor accessibility and utilization of immunization services in counties earmarked for Fragility, Emergency and Refugees (FER) in South Sudan.&#x0D; &#x0D; METHODS: A descriptive phenomenological study design was conducted across four counties of Northern Bahr El Ghazal, South Sudan, between May 2019 and December 2020 in which 42 focused group discussions and key-informant interviews involving the community and primary healthcare centers and units were conducted. Relevant EPI (Expanded program on immunization) tools were reviewed and data were analyzed using thematic analysis. &#x0D; &#x0D; RESULTS: The main reasons identified were negative attitudes towards healthcare workers and immunization services, competing priorities of the caregivers, delayed opening of the immunization sessions, insufficient cold chain facilities, inadequate knowledge and information about immunization services, and non-availability of vaccines at the health facility.&#x0D; &#x0D; CONCLUSIONS: A plan to supply adequate vaccines and related supplies to the counties by identifying stock levels in time must be a priority. Health facility micro-plan development and implementation should be supported by increased funding for the implementation of outreach and mobile sessions to reach missed children, intensified door-to-door health awareness, and regular community meetings to increase vaccine uptake.

Factors Influencing Utilization of Child Immunization Services in a Tertiary Health Institution in Sokoto North-West Nigeria

Despite our hygiene and safety some infections can still spread hence the need for vaccination and immunization of people especially during childhood. The high effectiveness of immunization in preventing diseases and death as made immunization one of public health’s most cost-effective intervention. When parents fail or do not complete their child’s vaccination, diseases that are long gone might re-appear. This study aimed at determining the knowledge, attitude and practice of mothers/guide towards immunization and the factors affecting utilization of immunization services in a tertiary institution in North-West Nigeria. One hundred and thirty-eight mothers/guides participated in this cross-sectional study. Respondents were recruited using a purposive sampling technique. A 47-item questionnaire on the self-reported knowledge, attitudes and practices towards utilization of immunization services was formulated and used for data collection. A focus group discussion which involved three vaccination health workers working in the health facility was also carried out in the study. A large proportion of the participants are within the age group of 21-30 (60.14%). Those who had no formal education, 53 (38.41%) were the majority. This study revealed that 93% have poor knowledge while 7% have good knowledge about immunization. 57.97% have good attitudes and 42.03% have poor attitude towards immunization. 52.90% have good practices while 47.10% have poor practices towards immunization. Level of education was revealed to have statistical significant relationship with mothers/guides knowledge, attitude and practice towards immunization. Factors such as lack of husbands’ consent, absence from town, sick child, travel cost and travel distance were reported to affect utilization of immunization services. According to the outcome of this study, it implies that a high proportion of mothers/guides have poor knowledge about immunization. Efforts should be made to appropriately educate mothers/guides on various vaccine preventable diseases and appropriate immunization schedules to ensure better compliance. Lack of husband’s consent is a major factor that affects the utilization of child immunization services by mothers/guides. Therefore, efforts should be targeted at educating men and employ necessary campaigns to change gender discrimination in relationships and households in this part of Nigeria.

Impact of Training of Primary Health Care Centers' Vaccinators on Immunization Session Practices in Wasit Governorate, Iraq: Interventional Study.

BackgroundImmunization averts more than 2.5 million deaths of children annually. The World Health Organization (WHO) and the United Nations Children’s Fund estimates of immunization coverage in Iraq in 2015 revealed a 58% coverage for the third dose of the diphtheria-tetanus-pertussis vaccine and a 57% coverage for the measles vaccine. High-quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates.ObjectiveThe goal of this study was to assess the impact of training of primary health care centers’ (PHCs) vaccinators on the quality of ISPs.MethodsThis was an interventional study conducted on 10 (18%) PHCs in Wasit Governorate. Two PHCs were randomly selected from each health district. ISPs were assessed by direct on-job observation, using modified WHO immunization session checklists. Findings were grouped into seven domains: vaccine and diluent management, cold chain management, session equipment, registration, communication, vaccine preparation and administration, and waste management. The vaccinators were enrolled in a one-day training session using the WHO module, “Managing an Immunization Session”, and one month later a second assessment was conducted using the same tools and techniques. We then calculated the median differences of the domains' scores.ResultsA total of 42 vaccinators were trained, with 25 (60%) of them having graduated from technical health institutes, but only 15 (36%) having had previous training on standard ISPs. Following training, a significant improvement was noticed in three domains: vaccines and diluents management (P=.01), cold chain management (P=.01) and vaccine preparation and administration (P=.02).ConclusionsThe training of the PHCs' vaccinators for a single day was effective in improving some ISPs. We would recommend using this training module, or a more in-depth one, for other PHCs to improve utilization of immunization services.

Operationalizing Integrated Immunization and Family Planning Services in Rural Liberia: Lessons Learned From Evaluating Service Quality and Utilization.

Integration of family planning and immunization services provides an opportunity to meet women's need for postpartum family planning and infants' vaccination needs through client-centered care, while reducing financial and opportunity costs for families. The United States Agency for International Development's Maternal and Child Survival Program (MCSP) supported the Liberia Ministry of Health to scale up integrated family planning and immunization services as part of a broader service delivery and health systems recovery program after the Ebola epidemic. We conducted a mixed-methods program evaluation in 22 health facilities in Grand Bassa and Lofa counties. Family planning uptake and immunization dropout rates at project sites were compared to rates at 18 matched health facilities in the same counties. We conducted 34 focus group discussions with community members and 43 key informant interviews with health care providers and managers to explore quality of care and contextual factors affecting provision and use of integrated services including postpartum family planning. From November 2016 to July 2017, 1,066 women accepted referrals from immunization to family planning counseling (10% of all vaccinator-caregiver interactions); the majority of women who were referred (75%) accepted a family planning method the same day. Trends indicated slightly higher family planning uptake in intervention over nonintervention facilities, but differences were not statistically significant. Pentavalent vaccine dropout rates did not increase in intervention compared to nonintervention facilities indicating no negative impact on utilization of immunization services. Clients and providers expressed that the integrated services reduced costs and time for the clients, educated mothers about postpartum family planning, and ensured infants were completing their vaccinations. Providers expressed the need for increased human resources to meet the elevated demand for family planning counseling services and additional focus on community-level social and behavior change activities. Both groups emphasized that social stigma and norms about postpartum sexual abstinence prevented many women from seeking postpartum family planning services. Although scaling up integrated family planning-immunization services may be programmatically feasible and acceptable to clients and providers, the intervention's success and ability to understand and quantify impact are driven by the effect of contextual factors and fidelity to the intervention approach. Contextual factors need to be understood before implementation, measured during implementation, and addressed throughout implementation to maximize the approach's impact on service utilization and health outcomes.

Door \u2013 to \u2013 door immunization strategy for improving access and utilization of immunization Services in Hard-to-Reach Areas: a case of Migori County, Kenya

BackgroundAccess to quality essential healthcare services and vaccines for all is key to achieving universal health coverage. Inequities driven by differences in place of residence and socio-economic status persist among different communities hindering the achievement of sustained performance on immunization indicators. Innovative community-based Reach Every Child (REC) interventions at the sub-county and county level can reduce these local inequities. This study determines the effect of an enhanced door-to-door immunization strategy on improving immunization coverage in hard-to-reach areas of Migori.MethodsThis was a cross-sectional review of District Health Information System 2 immunization data for July and August 2018 for Migori County. During the presidential immunization rapid results initiative (RRI) in July 2018, poorly performing wards/facilities were mapped using the Quantum Geographic Information Systems methodology, and unreached rural-urban populations identified. Through review of facility level Kenya Expanded Programme on Immunization data, 64 health facilities with over 100 unimmunized children each between January 2017 and June 2018 in all sub-counties were prioritized. In August 2018, intensified fixed-point immunization services were offered within the prioritized facilities. Further, a 3-day door-to-door defaulter tracing by community health volunteers and household level immunization by nurses was conducted. Immunization coverage performance for access and utilization for the two periods were compared using z-tests/t-tests.ResultsCumulatively, a total of 10,744 and 14,809 children were reached with immunization in July and August respectively for the 64 facilities. There were significant increases in the immunization coverage for BCG (74.4% vs 89.9%, P = 0.0001), Penta 1(96.2% vs 102%, P = 0.0649), Penta 3 (92.3% vs 112.1%, P = 0.0001), MR1 (81.7% vs 111.5%, P < 0.0001) and the fully immunized children at 1 year (78.6% vs 103.9%, P < 0.0001). Penta 3 and MR1 drop-out rates (3.99% vs − 9.86%, P = 0.0007; 15.06% vs − 9.27%, P = 0.0001 respectively) decreased significantly. Similar significant effects were observed at the subcounty levels (P < 0.05).ConclusionHard-to-reach populations require multiple REC strategies to reach every child with immunization. Health facilities should actively analyze and use routine immunization data and invest in community health strengthening systems to identify hard-to-reach areas to be targeted with outreaches to improve immunization coverage.

Utilization of immunization services among children aged under five in Kirinyaga County, Kenya

Background: Immunization is the key strategy to curb communicable diseases which are the number one killer of children under five years of age. Immunization prevents mortalities of approximating three million children under five years annually. This study aimed to assess utilization of immunization services among children aged under five in Kirinyaga County, Kenya.Methods: This was a descriptive cross-sectional study conducted among 388 participants in the five sub-counties of Kirinyaga County through systematic random sampling. Data was collected using a structured interview and review of recorded data from the Children immunization record card. Data was analyzed using SPSS and chi-square tests used to measure the association between independent and dependent variables. Statistical significance was set at p≤0.05.Results: Immunization at birth and at 6 weeks was highly utilized at 91%. However, there was a decline during the subsequent visits. Age, gender, profession and level of income were significant factors that affected timely immunization. Health service barriers to utilization included long ques and waiting time, stock out of vaccine and rescheduling of vaccination and clinic return dates. Other identified factors were myths and misconception, side effects, parity and lack of information.Conclusions: The results showed that utilization of immunization services was not in compliance with the expanded programme on immunization schedule. There is therefore need for health education programs to be carried out to improve utilization of immunization services and a door to door campaign to trace and immunize defaulters.

Immunization status of 12-23 months children of urban Jamnagar

Background: Immunization is one of most cost effective public health intervention. Aims: (1) To assess immunization status among children of 12-23 months age group (2) To find out left out/dropout rate (3) To check association of socio demographic factors with immunization status. Material & Methods: A cross sectional study of sample 240 children aged between 12 to 23 months (using 30 cluster sampling technique) from Jamnagar municipal corporation area. Immunization of child was assessed through immunization card, presence of BCG scar & interview. Results: Out of 240 children, Coverage of BCG-99.58%, OPV0-94.58%, DPT1-98.33%, DPT2-96.67%, DPT395.42%, OPV1-96.67%, OPV2-95.83%, OPV3-4.58%. Coverage of HepB1, HepB2, and HepB3 were 73.33%, 70.42%, 68.75% respectively. Coverage of measles was 87.75%. Fully immunized children were 65%. Vaccine dropout of BCG-Measles was highest 11.34%, followed by DPT1-measles 10.58%. For BCG-DPT3 4.17%, DPT1DPT3 2.96% & for HEP1-HEP3 6.25%. Fully immunized status was higher among male child as compare to female child which was statistically significant. Fully immunized children were more in Hindu religion compared to others which was statistically significant. No association found between educations of mother & immunization status of child. Socioeconomic class had no association with immunization status. Conclusion: Vaccination coverage shows gradual improvement in last decade (Fully immunized 65%) but at the same time reflects incomplete utilization (dropout rate is around 11%). Coverage was higher among male children as compared to female children which indicate the existence of gender difference in utilization of immunization services in our study areas. Utilization of immunization services was higher in Hindu community as compared to other community. Keywords: Immunization status, Vaccine, dropout rate

Rural–urban comparison of routine immunization utilization and its determinants in communities in Anambra States, Nigeria

Objectives:The study determined the levels of geographic differences in the utilization of routine immunization between households in an urban and a rural community. It also identified and compared the determinants of utilization of routine immunization in the two geographic areas.Method:The study was undertaken in two randomly selected communities (one rural and one urban) in Anambra State, Nigeria. Interviewer-administered questionnaires were used to collect information on utilization of immunization services from households. Data were analyzed using descriptive and multiple logistic regression analyses.Result:Households in the urban community had a higher level of utilization of routine immunization (95.5%) than those in the rural community (75.3%) and the difference was statistically significant (p < 0.05). It was also found that more rural dwellers (83.3%) received immunization services from public health facilities compared to the urban dwellers (42%; p < 0.05). Health facilities were nearer to households in the urban community than the rural community (p < 0.05). Mean cost of service per visit was higher in the urban community (p < 0.05), but the difference in the mean cost of transportation per visit was not significant (p = 0.125). Regression analysis shows that place of residence was highly significant for utilization of routine immunization services (p < 0.05).Conclusion:Urban–rural differences exist in utilization of routine immunization services. Health facilities are more proximal to consumers in the urban community than the rural community, with higher travel costs among rural dwellers. Ensuring that there is a functional primary healthcare center in every ward and provision of routine immunization services in market places on local market days can help to increase utilization and reduce rural–urban differences in utilization of immunization services.

Comparison of Health-care Utilization Pattern and its Correlates among the Tribal and NonTribal Population of Kerala.

Background:The isolation from mainstream development activities, together with poverty and inaccessibility to health facilities made the tribal communities specifically vulnerable to various health problems.Objectives:This study aimed to compare the utilization of antenatal care, immunization, and supplementary nutrition services by tribal and nontribal mothers and its correlates in the selected districts.Materials and Methods:The study was a comparative cross-sectional study. The study population comprised tribal and nontribal mothers utilizing antenatal care, immunization, and supplementary nutrition services. A multi-stage cluster sampling strategy was employed for the study. The Chi-square test was used to assess the association between antenatal care services utilization, utilization of immunization services, supplementary nutrition services utilization and sociodemographic variables, and other service characteristics.Results:Effective utilization of antenatal care services was not seen in 5.6% of tribal mothers. The incidence of low-birth weight (≤2500) was significantly more among tribal mothers (31%) when compared to nontribal mothers (15%). The proportion of tribal children receiving complete immunization without delay was 74%, and among nontribal children, it was 78%. Effective immunization coverage was significantly lower among children of tribal mothers with education below high school level. Receipt of take-home ration was reported by nearly 90% of tribal and nontribal mothers. 90% of tribal mothers felt that quality of take-home ration that they received was of good quality.Conclusions:The comparison of health-care utilization restricted to the domains of antenatal care, immunization services, and supplementary nutrition suggests that the tribal mothers and children had a relatively comparable utilization pattern in most of the indicators measured.

A comparative study on vaccination default rates among children aged 9-24 months attending a static immunization clinic in urban and rural area of Bangalore

Background: Immunization contributes significantly to the achievement of millennium development goal number 4 and is one of the eight elements of primary health care. Effective utilization of immunization services is associated with reduced infections in young children with immature immune system and improved child health outcome. The objectives of the study were to compare the default rates for vaccine doses in immunization schedule; to study the factors responsible for default; to describe the socio-demographic profile of study subjects.Methods: An observational study was conducted in the urban and rural Primary health centre on immunization days for 3 months. The study subjects were children aged (9-24) months attending immunization clinics. Their care givers were interviewed regarding socio-demographic profile and causes for default. Sample size calculated was 184 (92) each from urban and rural clinic).Results: Among 184 care givers interviewed, mean age of study subjects was 14.9±4.6 months in urban &amp; 14.6±4.9 months in rural clinic. Default rates for vaccination were 5.4% (birth dose), 7.6% (6th wk.) both in urban &amp; rural clinic. However, for further doses i.e., 10th week, 14th week, 9 months and 18 months the default rates were slightly higher in rural compared to urban clinic. Commonest reason for default was mother not aware that child had missed dose (urban 52.2% and rural 42.3%) followed by child being sick (urban 26.6% and rural 30.4%).Conclusions: The overall default rate was found to be very high which is a serious concern and need to be addressed in order to prevent eventual dropouts.

Payments and Utilization of Immunization Services Among Children Enrolled in Fee-for-Service Medicaid.

To examine the association between state Medicaid vaccine administration fees and children's receipt of immunization services. The study used the 2008-2012 Medicaid Analytic eXtract data and included children aged 0-17 years and continuously enrolled in a Medicaid fee-for-service plan in each study year. Analyses were restricted to 8 states with a Medicaid managed-care penetration rate <75%. Linear regressions were used to estimate the probability of children making ≥1 vaccination visit and the numbers of vaccination visits in the year as a function of state Medicaid vaccine administration fees, age group, sex, race/ethnicity, state unemployment rate, state managed-care penetration rate, and state and year-fixed effects. A total of 1,678,288 children were included. In 2008-2012, the average proportion of children making ≥1 vaccination visit per year was 31% and the mean number of vaccination visits was 0.9. State Medicaid reimbursements for vaccine administration was positively associated with immunization service utilization; for every $1 increase in the payment amount, the probability of children making ≥1 vaccination visit increased by 0.72 percentage point (95% confidence interval, 0.23-1.21; P=0.01), representing a 2% increase from the mean and the number of vaccination visits increased by 0.03 (95% confidence interval, -0.00 to 0.06; P<0.1). The estimated effect was greater among younger children. Higher Medicaid reimbursements for vaccine administration were associated with increased proportion of children receiving immunization services.