Reasons for failure of immunization: A cross‑sectional studyamong 12-23‑month‑old children of Lucknow, India

1. JOURNAL CLUB
by
DR. MOHD NAJMULAQIB KHAN
JR, DEPTT. OF COMMUNITY MEDICINE
JNMCH

2. Reasons for failure of immunization: A
cross-sectional study
among 12-23-month-old children of Lucknow, India
Rajat Vohra, Anusha Vohra,
Department of Community Medicine, Pharmacology,
Mahatma Gandhi Medical College and Hospital, Jaipur,
Rajasthan,
Pankaj Bhardwaj, Jyoti Prakash Srivastava, Pratibha Gupta
Community Medicine, Era’s Lucknow Medical College and
Hospital, Lucknow, Uttar Pradesh, India
ADVANCED BIOMEDICAL RESEARCH | JULY - SEPTEMBER 2013 | VOL 2 | ISSUE 3

3. • About the journal
• Abstract
• Introduction
• Rationale
• Aim and Objective
• Materials and Methods
• Results
• Discussion
• Critical Analysis
Journal club: Objectives

4. Peer reviewed International journal
Published quarterly by the Wolters
Kluwer/Medknow publication
It is indexed/abstracted by he major
international indexing systems like index
medicus/medline scopus, pubmed, caspur,
scolar etc
Impact factor ---
About the Journal

5. ABSTRACT
Background: Roughly 3 million children die every year of vaccine preventable diseases and a significant
number of these children live in developing countries. The present study was conducted to assess the
reasons for failure of immunization among 12-23-month-old children of Lucknow city in India.
Materials and Methods: Out of all villages in rural areas and mohallas in urban areas of Lucknow district, eight
villages and eight mohallas were selected by simple random sampling. A community based cross-sectional
study was done among 450 children aged 12-23 months. The immunization status of the child was assessed
by vaccination card and by mother’s recall. A pre-designed and pre-tested questionnaire was used to elicit
information on reasons for failure of immunization. Data was analysed using statistical package for social
services (SPSS) version 11.5. Chi square test was used to find out the significant association.
Results: Overall, 62.7% children were fully immunized, 24.4% children were partially immunized, and 12.9%
children were not immunized. The major reasons for failure of immunization were postponing it until
another time, child being ill and hence not brought to the centre for immunization, unaware of the need
of immunization, place of immunization being too far, no faith in immunization, unaware of the need to
return for 2nd and 3rd dose, mother being too busy, fear of side reactions, wrong ideas about immunization,
and polio was considered only vaccine, and others.
Conclusion: More awareness should be generated among the people living in rural and urban areas to
immunize their children.
Key Words: 12-23 months children, immunization status, reasons for failure

6. INTRODUCTION
• Immunization is a significant, cost effective, and
important public health intervention.
• Roughly 3 million children die every year of vaccine
preventable diseases (VPDs)
• Recent estimates 34 million children are not
completely immunized, with almost 98% of them
living in developing countries

7. • National Family Health Survey (NFHS) III cites national
coverage against the six expanded programme on
immunization (EPI) vaccines in the age group of 12-23
months is only 47.3%.
• In U.P., only 23% children aged 12-23 months have
undergone full immunization.
• Study in urban slums of Lucknow district showed that only
44.1% children were fully immunized, while 32% were
partially immunized, and 23.9% were unimmunized.
• DLHS-III observed that 51.1% of children in Lucknow were
fully immunized.

8. Aims and objectives
• Immunization status of the study population.
• Dropout rates and coverage of individual
vaccines.
• Reasons for partial and non-immunization of
the children
• Association between immunization status
with the reasons of failure of coverage.

9. Materials and Methods
• STUDY DESIGN:
A Cross Sectional Study.
• STUDY PERIOD:
Not mentioned
• STUDY AREA:
Eight villages and mohollas of lucknow district.
• SAMPLE SIZE
450 children of age group 12 – 23 months
• SAMPLING METHOD
Simple random sampling

10. • STUDY TOOL
A pre-designed and pre-tested questionnaire was used to assess the
reasons for non-immunization and partial immunization of the child.
• INCLUSION CRITERIA
12 – 23 months child
• EXCLUSION CRITERIA
Not mentioned
• DATA ANALYSIS
Spss version 11.2

11. • Sample size of 450 was divided equally into urban and
rural areas.
• Households in each area taken by probability proportionate
to size technique.
• Help of ANM, AWW, and ASHA taken to build rapport with
local people.
• Father , any other adult taken as primary respondent in
absence of mother.
• Immunization status of the child was assessed by
vaccination card and by mother’s recall

12. Immunization status of the children was
categorized as
• Fully immunized: BCG,3 doses of DPT, 3 doses
of OPV and measles vaccine.
• Partially immunized: When the child had
received some but not all vaccines
• Not immunized: When the child had not
received any of the vaccine

13. Results

18. Discussion
• In the present study, overall, 62.7% children were fully
immunized, 24.4% were partially immunized, and 12.9%
were unimmunized.
• Singh et al. in a study in different states of India, showed
63.3% were fully immunized, 27.1% partially immunized,
and 9.6% unimmunized children.
• Bholanath et al.[2] in a study in urban slums of Lucknow
district showed that only 44.1% were fully immunized,
while 32% partially immunized, and 23.9% were
unimmunized.

19. Comparison of drop out rate among similar studies:
Vaccines PRESENT
STUDY
Bholanath
et al.
Sharma et
al.
Yadav et al.
BCG TO
MEASLES
28.93% 33.24%. 60.2% --------
DPT-1 TO
DPT-3
8.82% 23.16% 31.9% 10.4%
OPV-1 TO
OPV-3
8.77% 23.16%, 31.5%, 10.1%,
DPT-3 TO
MEASLES
17.88% 13.12%. -------- ---------

20. • Lack of knowledge and lack of faith came out to be the
main reasons for non-immunization of the children in the
present study compared with
STUDY REASON FOR NON IMMUNIZATION
Bholanath
et al.
• lack of faith
• lack of knowledge,
• considering polio as the only vaccine
Saxena et al. • lack of awareness
• side effects of vaccination
Punith et al • unawareness of the need
• unawareness of the need to return
• lack of information about the place

21. • In the present study, lack of motivation (postponing)
among parents and illness of the child were the main
reasons for partial immunization of the child compared
with….
STUDY REASON FOR PARTIAL IMMUNIZATION
Bholanath et al. • Parents being busy (17.2%)
• Parents migrated to other place
(14.7%)
• Child/sibling became ill as a result of
previous vaccination (11.7%)
• Carelessness (11.7%)
• No knowledge of vaccine or place
(10.4%)
• Others

22. Recommendations
• More awareness should be generated among the people
living in rural and urban areas
• Parents education and poverty have a great impact
therefore primary education, particularly for girls, is
essential as increased education can influence a mother’s
understanding of the importance of immunization.
• IEC services should be directed towards improving the
immunization status.
• More awareness should be generated among people that
there are five other vaccines other than polio vaccine which
is overshadowed by repeated PPI rounds.

23. Critical analysis
Positive points:
1. Abstract is structured
2. Table is systematic & informative
3. Implications of the study identified
4.Discusson relates key findings with the
research.

24. Negative points:
1. Title is different than study.
2. Criteria for taking equal samples from rural and
urban areas not been mentioned.
3. Can’t comment on reasons on the basis of chi
square for a particular variant.
4. Exclusion criteria not mentioned

25. • References
• Singh P, Yadav RJ. Immunization status of children in India. Indian Pediatr.
2000;37:1194-9.
• Nath B, Singh JV, Awasthi S, Bhushan V, Kumar V, Singh SK. A study on
determinants of immunization coverage among 12-23 months old children
in urban slums of Lucknow district, India. Indian J Med Sci 2007;61:598-606.
• Sharma R, Desai VK, Kavishvar A. Assessment of immunization status in the
slums of Surat by 15 clusters multi indicators cluster survey technique.
Indian J Community Med 2009;34:152-5.
• Yadav S, Mangal S, Padhiyar N, Mehta JP, Yadav BS. Evaluation of
immunization coverage in urban slums of Jamnagar city. Indian J
Community Med 2006;31:10-12.
• Saxena P, Prakash D, Saxena V, Kansal S. Assessment of routine
immunization in urban slums of Agra district. Indian J Prev Soc Med
2008;39:60-2.
• Punith K, Lalitha K, Suman G, Pradeep BS, Kumar KJ. Evaluation of primary
immunization coverage of infants under universal immunization programme
in an urban areas of Bangalore city using cluster sampling and lot quality
assurance sampling technique. Indian J Community Med 2008;33:151-5.

26. Thank you