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|Year : 1986 | Volume
| Issue : 3 | Page : 131-3
Impact of community-based immunization services.
Sing KK, Mathew MM, Bhalerao VR
The knowledge, attitude and practice of mothers toward childhood immunization was surveyed in 2 neighborhoods in greater Bombay, India. The areas were a slum of 75,000 called Malavani, and a nearby area called Kharodi. Measles and triple (DPT or DPV) vaccines were available at local health centers, 1.5 km away at the most; oral polio vaccines were given by field workers to the Malavani community to children in their homes, but only in the center for those in Kharodi. BCG tuberculosis vaccinations were available to all, but from a center 5 km away. Malavani mothers had significantly better knowledge of triple and measles vaccines, but knowledge about BCG was similar in the 2 groups. Slightly more women from Kharodi expressed negative attitudes toward immunization. Coverage of children, established from clinic records, was significantly better in the Malavani area: 91% vs. 58% for polio; 71% vs 61% for BCG (n.s.); 85% vs. 55% for triple vaccine; and 21% vs 1% for measles. Evidently, visitation by field teams with polio vaccinations affected mothers' knowledge and practice for other immunizations available only at the center.
|How to cite this article:|
Sing K K, Mathew M M, Bhalerao V R. Impact of community-based immunization services. J Postgrad Med 1986;32:131
Immunization is a timely step for prevention of mortality and morbidity due to communicable diseases in 0-5 year age group. Delivery system of immunization has many inherent problems to which an addition may be made by the people themselves with their prejudices, carelessness and apathy. The present study was aimed to find out the difference in the outcome in terms of education and coverage of two types of immunization services viz., (a) community-oriented (b) centre-based.
Malavani is a slum community of 75,000 population adopted by Seth G. S. Medical College of Municipal Corporation of Greater Bombay for comprehensive health care programme which has already been described. Maharashtra Housing Board Colony (MHBC) is a community located near Malavani Health Centre and is a part of the Malavani slums. The farthest house in the MHBC is 1.5 km away from the centre. Oral polio vaccine is delivered to pre-school children of Malavani in their houses at regular intervals whereas triple and measles vaccines are given at the centre.
A neighbouring community, Kharodi, with 1500 population is served by a dispensary of the Public Health Department of the Municipal Corporation of Greater Bombay. The staff of the dispensary consists of a medical officer, a compounder, a record assistant and a servant. The dispensary offers oral polio, triple and measles vaccination strictly in a centre-based fashion as there is no paramedical staff available for the field work.
For BCG vaccination, the children from both the communities are referred by the. respective health centre/dispensary to the nearest municipal maternity home, about 4-5 km away from both the communities. The same immunization schedule as recommended by W.H.O. is followed in both the communities. Systematic random samples of 150 mothers from M.H.B.C., Malavani and 75 mothers from Kharodi village respectively were selected from within the two communities by visiting their houses. Only those mothers were included in the staid! who had at least one, under five, baby and were residents of their respective areas for a minimum period of 3 years. The study was carried out in 3 months' period from October 1984 till December 1984.
A structured interview schedule was prepared and the mothers were asked questions to assess their knowledge, attitude and practices of individual childhood vaccine. Knowledge responses obtained were quantified according to predetermined scores and were then classified into good (score> 60%), fair (score-40-59%) and poor (score< 40%). Responses to attitude were classified into positive, negative and indifferent according to the answers obtained. Practice of immunization was expressed as the percentage of children who had been immunized with particular vaccines. This was assessed by checking immunization cards, and by looking for BCG scats on the arms of the children of the mothers under study. Thus, the number of eligible children below 5 years of age was 272 in the M.H.B.C. Malavani group and 122 in the Kharodi group.
There was no difference in the age, religion or socio-economic status of the mothers between the two groups.
[Table - 1] shows the number of mothers in two groups having good knowledge of the different vaccines.
[Table - 2] shows that there is a significant. difference in the attitude towards childhood immunization programme between the two groups.
[Table - 3] shows that there is a significant difference between the two groups regarding coverage of polio, triple and measles vaccination but the differences in the B.C.G. vaccination coverage is not statistically significant.
The main difference between immunizational services in the two communities was that oral polio vaccine had been made available to the children in Malavani at their doorstep. Because of the regular visits of vaccination team with oral polio vaccine in Malavani, the mothers were educated about not only polio vaccine but also about other vaccines. This resulted in more coverage of eligible children with triple and measles vaccines as well.
Though there was a significant difference in the knowledge about BCG vaccination between the two communities, there was no significant difference in the coverage of BCG vaccination among them. This is due to the fact that for both the communities, the source of BCG vaccination was not in the vicinity.
In order to immunize all the children below 5 years of age by 1990 (which is one of strategies to attain the goal of Health for All by 2000 A.D.), we have to adopt a community-based vaccination programme. Oral polio vaccine can be most easily administered by any paramedical worker at the peripheral level and along with it the message can be sent to the people to take other vaccines.
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