Exhibition on Family Planning

1. Exhibition on Maternal and Child Health
1. Background
National Immunization Program (NIP) of Nepal (Expanded Program on Immunization) was
started in 2034 BS and is a priority 1 program. It is one of the successful public health
programs of Ministry of Health and Population, and has achieved several milestones
contributing to reduction in morbidity and mortality associated with vaccine preventable
diseases (VPDs) [1]. It is the most cost-effective and efficient way to control and eliminate
the vaccine-preventable diseases that contribute to childhood illness and deaths. All children
in Nepal need to receive the recommended number of doses of BCG, DPT-HepB-Hib, OPV,
PCV, IPV-IM, and measles/rubella vaccines during their first year of life [2].
National immunization cover all the districts, municipalities and wards of the country and is
provided free of cost. NIP under Family welfare Division has a lead role in all immunization
related activities at the National level. The Provincial health directorate acts as a facilitator
between the Central and the local level and monitors the achievement within the province to
improve the NIP. It is the responsibility of the D(P)HO and Health section under municipality
to ensure that a successful immunization programme is implemented at the district and below
local level.
NIP has introduced several new and underutilized vaccines contributing towards achievement
of Global Vaccine Action Plan targets of introducing new and underutilized vaccines in
routine immunization. Currently, the program provides vaccination against 11 vaccine
preventable diseases. Recently, in August 2018, fractional dose of Inactivated Polio Vaccine
was introduced in routine immunization of Nepal. As per comprehensive Multi-year Plan for
Immunization (cMYP) 2017 - 2021, several other vaccines, including rotavirus vaccine, are
planned for introduction in Nepal. Immunization services are delivered through 16,500
service delivery points in health facilities (fixed sessions), outreach sessions, and mobile
clinics [1].
To increase immunization coverage in Nepal, the government has invested in efforts and
resources to improve the service delivery system of the national immunization programme.
The public sector is the primary provider of immunization services, although the private
sector is increasingly providing such services. The government provides all vaccine included
in the programme free-of-charge. Nepal has been implemented to improve coverage and the
health and survival of children through community mobilization of unvaccinated and under-
vaccinated communities to increase coverage. Furthermore, to increase access to vaccination
in geographic areas with low coverage, the government has identified bottlenecks in supply
of services and has mobilized local resources to intensify outreach clinics and mobile clinics
[4].
Since FY 2069/70 (2012/13), Nepal has initiated and implemented a unique initiative known
as ‘full immunization program’. This program addresses issues of social inequity in
immunization as every child regardless of social or geographical aspect within an

2. administrative boundary are meant to be fully immunized under this program. As of end of
FY 2074/75, a total of 80 % palikas, and 56 out of 77 districts have been declared ‘fully
immunized’. Gandaki Province has declared their province as fully immunized province [1].
Overall, the National Immunization Program is considered as the main contributor towards
decline of infant and child mortality, and has contributed significantly in achieving MDG
Goal 4 of reducing child mortality [3].
2. Statement of the Problem
It is already mentioned that EPI is first priority program of Nepal and it is one element of
primary health care. The NDH-2016 shows that the percentage of children age 12-23 months
who received all basic vaccines at any time has increased from 43% in 1996 to 87% in 2011.
However, the percentage who received all basic vaccines fell by 9 percentage points between
2011 and 2016, from 87% to 78%. On the other hand, the percentage of children age 12-23
months who did not receive any vaccinations decreased from 3% in 2006 and 2011 to 1% in
2016.
Vaccination coverage among children age 12-23 months for all basic vaccines varies across
Nepal, ranging from 65% in Province 2 to 93% in Province 4.The percentage of children age
12-23 months who received all basic vaccinations increases with increasing mother’s
educational attainment. Vaccination coverage is lowest among children whose mothers have
no education (68%) and highest among those whose mothers have an SLC or higher (91%)
[2].
3. Literature Review:
Though the immunization program has made significant progress over the years, vaccine
preventable diseases still cause morbidity and child death. Major constraints in the
immunization program have been identified -limited staff at the central level, inadequate
refresher training, less release of funds, weak system for vaccine logistic and cold chain
management, poor supervision, incomplete data and competing priorities like NIDs.
Immunization is a proven, cost-effective intervention to reduce morbidity and mortality from
vaccine-preventable diseases. Each year immunization averts 2.5 million deaths in children
younger than 5 years. Globally in 2011, 103 million (83% of total) children received all three
doses of diphtheria–pertussis–tetanus (DPT3) vaccine, but an estimated 22 million children
did not complete such vaccination. Gaps in immunization coverage exist between and within
countries, and in some places, the gap is increasing. For example, the average DPT3 coverage
in low-income countries was 15 percentage points lower than that of high-income countries
in 2011. [Source: https://www.who.int/bulletin/volumes/95/4/16-178227/en/].
Vaccination coverage is highest in Province 4 (93%), followed by Province 3 (85%) and
Province 7 (83%). Children in the Hill zone have greater vaccination coverage (88%) when
compared to those in the Mountain (74.1%) and Terai zones (71.3%). Children in the Hill
Brahmin/Chhetri castes have the highest coverage (87.9%) of vaccination, followed by those

3. in the Janajati/Newar castes (83.3).Education of both mothers and fathers is related to the
vaccination coverage of their children. With higher levels of the education have higher levels
of vaccine coverage.
Vaccination coverage is highest among children of the richer wealth quintile (84.8%),
followed by richest quintile (81.6). The vaccination coverage is lowest in middle wealth
quintile (70.9). Children whose mothers worked in previous 12 months have higher
vaccination coverage (81.3) than children whose mothers did not work (73.2).
Vaccination coverage is lowest for children whose mothers have no media exposure (65.3).
Those children with mothers who were exposed to media less than once a week have higher
vaccination coverage (84.1) than those whose mothers were exposed to media at least once a
week (78.2).
Vaccination coverage varies by place of delivery, with children of those mothers delivering in
facilities having higher vaccination coverage (83.9) than those born outside of facilities
(67.5). Vaccination coverage is also higher among children who had four or more ANC visits
(85.8%). Highest levels of vaccination coverage are seen among children whose mothers
retained their vaccination cards (91%). The lowest level of vaccination coverage is among
children who never received a vaccination card (50%).
The coverage of all antigens increased in 073/74 compare to 072/073. The highest coverage
was of BCG (91%), DPT-HepB-Hib3 (86%), oral polio vaccine 3 (86%), which were all
more than the previous year. The measles rubella fist dose coverage was 84% whereas second
dose coverage in 2073/74 was (57%) however it is more than previous year.
EPI coverage survey reveals that revealed that 47.7% of them dropped out due to lack of
services, 32.2% due to lack of information, 6.5% due to lack of motivation. Research of
Gedlu E, Tesemma T. found 22.8% various obstacles such as child sickness and health
institution related problems. A population-based study of Ardythe L. and et al33 detected
commonly reported problem was clinic waiting time (12%). The second most common
problem was difficulty obtaining a timely appointment (10%). Some of the other problems
reported were taking time away from work, office hours, cost, and transportation, with the
frequency varying by type of usual provider. Research in North India34 found major reasons
for non-immunization of the children were: migration to a native village (26.4%); domestic
problems (9.6%); the immunization center was located too far from their home (9.6%); and
the child was unwell when the vaccination was due (9%).The lack of awareness and fear of
side effects constituted a small minority of reasons for non-immunization.
To reach universal immunization coverage and to increase equity, countries need to focus on
targeted interventions that reach the most disadvantaged populations, rather than only
focusing on increasing coverage at the national level.

4. 4. Objective
a. To prove knowledge and information about the immunization services to the
community people and sensitize them to utilize it.
Activities
Importance of Immunization and Immunization Schedule
Importance of Immunization :
 Different vaccine should provide to protect the child from disease. Children under the
age of two are given vaccines to prevent them from any kind of diseases including
DPT-Hepb-hib, Polio, PCV, measles, rubella.

5.  Vaccination is the ability of the body to fight the disease by giving it vaccine to
prevent the disease.
 Vaccines are used to prevent lifelong illness. Most vaccinations must be completed
within one year of childbirth.
 Regular vaccinations for children can prevent the child from developing physical and
mental well-being and various infectious diseases.
 All vaccine supplements must be supplemented To keep children healthy, prevent
from disability and prevent the risk of death, children should have to complete all
vaccines.
Vaccination sites:
The government provides all types of vaccines free of cost under the National Vaccine
Program from health post, PHCC, district hospital, private facilities and PHCR-ORC
Time Schedule for Vaccination:
 Vaccine against TB should provide immediate after birth
 After 6, 10 and 14 weeks of birth, the child should have to provide DPT-Hepb-hib and
polio and PCV
 After competition of 1 year of birth, the baby should have to provide JE
 At 15 months of age the Children should have to provide Measles and Rubella.
Photos:

7. References
 Annual Report, Department of Health Services, MoHP, 2074/75.
 Nepal Demographic and Health Survey, 2016
 Nepal and the Millennium Development Goals, Final Status Report 20002015,
National Planning Commission
 WHO bulletin, volume 95, issue 4, 2016/17.
 Factors Affecting Vaccination Coverage and Retention of Vaccination Cards in Nepal, DHS
Further Analysis Reports No. 121