Introduction
Immunization is the process of inducing immunity against a specific disease. It can be done by the vaccines, immunoglobulins, and antisera. Immunity is of two types, active immunity and passive immunity. Active immunity is induced by administering a vaccine or toxoid. It stimulates the immune system to produce a prolonged humoral or cellular immune response.1
Immunization plays an important role in reducing morbidity and mortality. Last week of April (24th to 30th) is celebrated as world immunization week.2 Vaccination is one of the most powerful and cost-effective weapon of modern medicine to control infectious disease. Some infectious diseases whose control is solely based on immunization are polio, diphtheria, tetanus, measles etc. Unfortunately, we do not have a vaccine for every infectious disease like malaria and diarrheal diseases.3
Vaccines are defined as a whole or parts of micro-organism administered to prevent an infectious disease. History of vaccine did not begin with Edward Jenner inventing a vaccine for smallpox. Evidence exists that Chinese used smallpox inoculation as early as 1000 BC 4. After smallpox, many other vaccines like Rabies, plague, cholera, typhoid, tuberculosis came in existence. A good vaccine is easy to administer, induces permanent immunity, free from toxic substances with minimal side effect and stable for a prolongeduse.5
Immunization is primary focus of child health and many programs have been launched by government of India for better coverage as immunization is a primary level prevention.6
When immunization coverage reaches the figure of 80% or more, disease transmission pattern is severely disrupted and provides degree of protection even for remaining children who have not been immunized. This protection is because of “Herd Immunity”.7 Every country has its own immunization schedule. A well thought immunization schedule must be epidemiologically relevant, immunologically effective, operationally feasible and socially acceptable. Choice of vaccines in National immunization schedule is based on consideration of disease burden, vaccine availability and cost effectiveness.8 In May 1974 WHO launched first global immunization initiative EPI (expanded programme of immunization) aim to protect all children of world against 6 vaccine preventable diseases (VPDs)and was adopted by India in 1978.EPI chiefly covered urban areas. 9
Materials and Methods
The Present study was conducted in the Department of Pediatrics of Lala Lajpat Rai & Associated Hospital GSVM Medical College, Kanpur from Feb. 2017 to Oct. 2018. A total of 500 children were studied.
All the children aged between 1-5 years, admitted in Department of Pediatrics were asked to participate in this study. Information regarding vaccination, socio-demographic factors was collected from their parents and care takers. Accuracy and validity of information were confirmed by immunization card in possible situation and inspection for BCG scar.
Data collection
Informed oral written consent was taken from parents of the child.
All children aged 1-5 years admitted in the ward of our Hospital were studied using National immunization schedule and their parents were interviewed regarding awareness of immunization. The information was collected on pre-designed proforma and all the information was tabulated and interpreted through standard statistical methods and causes for partial and un-immunization were studied.
Results
Table 1
Age distribution of the study subjects
|
Age group |
N=500 |
Percentage |
Complete |
% |
|
1-2 year |
274 |
54.8% |
161 |
58.7 |
|
2-3 year |
78 |
15.6% |
33 |
42.3 |
|
3-4 year |
49 |
9.8% |
15 |
30.6 |
|
4-5 year |
99 |
19.8% |
47 |
47.4 |
In our study, 500 children were included for assessment of immunization status. Subjects were distributed according to age group. Maximum subjects belonged to 1-2 years 274 (54.8%) and maximum immunization was found among children between 1 to 2 years of age (58.7%).Table 1
Value <0 001 indicates a significant association between age and immunization status
Table 2
Immunization status in study subjects
|
|
N=500 |
Percent |
|
Completely immunized |
256 |
51.2% |
|
Partially immunized |
228 |
45.6% |
|
Unimmunized |
16 |
3.2% |
Among 500 subjects studied, 256 (51.2%) were completely immunized, 228 (45.6%) were partially immunized and 16 (3.2%) were unimmunized.Table 2
Table 3
Distribution of vaccination card among study subjects.
|
Vaccination Card |
N=500 |
Percent |
|
Available |
423 |
84.6 |
|
Not available |
77 |
15.4 |
Among 500 study subjects, 423 (84.6%) had vaccination card and 77 (15.4%) had no vaccination card.Table 3
Table 4
Distribution of immunization status according to socio-economic status.
|
Class |
Complete |
% |
Partial |
% |
Unimmunized |
% |
|
Upper |
12 |
100 |
0 |
0 |
0 |
0 |
|
Upper Middle |
38 |
80.8 |
9 |
19.1 |
0 |
0 |
|
Lower Middle |
58 |
33.9 |
102 |
59.6 |
11 |
6.4 |
|
Upper Lower |
122 |
55.7 |
92 |
42 |
5 |
2.2 |
|
Lower |
26 |
50.9 |
25 |
49 |
0 |
0 |
In upper class, 100% of children were completely immunized.Table 4
In upper middle class, 80.8% children had complete and 19.1% partial immunization status.
No one remained unimmunized in upper middle class.
In lower middle class, 33.9% of children were completely immunized, 59.6% partially immunized and 6.4% remained unimmunized.
In upper lower class, 55.7% children were completely immunized 42% partially immunized, and 2.2 % were unimmunized.
In lower class, 50.9% were completely immunized, 49% partially immunized and no one was unimmunized.
Value <0 001, indicates significant relation between socio-economic status and immunization status
Table 5
Distribution of immunization status according to birth order.
Children who were 1st in birth order, had maximum immunization coverage (44.8%). Minimum immunization coverage was in birth order >4 (3.2%). P value is <0.001, indicates the significant relation between birth order and immunization status. As birth order increased, immunization coverage decreased.Table 5
Discussion
The Present study was conducted in tertiary care center of Kanpur from Feb. 2017 to Oct. 2018 with study population of 500 children belonging to 1-5 years age group.
Among them, 256 (51.2%) Children were fully immunized. Similar findings were noted in studies of Ashish Awasthi et al. (57.03%).10
Suresh Kumar Verma et al. (48.5%), 11 Anil B. Kurane et al. (65.2%),12 and While Mathew et al. (25%). Nirupam et al (34.5%) 13 noted very low percentage of immunization.
The NFHS - 4 data showed that the percentage of fully immunized children in Kanpur Nagar was 50.9% and for UP (51.1%). Our result for fully immunized children was similar to NFHS 4 survey.
45.6% Children were partially immunized in the study population. Similar findings were seen in study conducted by Kumar et al. (48%),14 Jain et al. (44.5%), Anil B. Kurane et al. (34%).12 In present study, 3.2% children were un-immunized which was similar to Prabhakaran Nair et al. 15 (4.2%)
In this study, 303 (60.6%) children were males and 197 (39.4%) were females whereas in the study of Kumar et al. (58.6%)14 children were male and 41.6% were female. Similar results were shown in study of Deshmukh PR et al. 7 (52% Male and 48% Female).
Conclusion
In this present hospital based descriptive cross –sectional study, we found that 51.2% children were fully immunized, 45.6% were partially immunized and 3.2% children were unimmunized as per National immunization schedule.
Children belonging to upper class were 100% completely immunized. In upper middle class 80.8% children in lower middle class 33.9%, in upper lower class 55.7% and in lower class 50.9% children were completely immunized respectively. In lower class immunization coverage was higher than lower middle class.
Droprate for BCG to pentavalent 1 was 10.64%, similarly dropout from BCG to measles was 12.7%. Dropout rate of pentavalent 1 to pentavalent2 was 1.4%, pentavalent2 to pentavalent3 was 2.6%. It indicates that system is not able to hold the child once registered. Steps for improvement should focus on reducing the drop rate from BCG to pentavalent and measles.
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