Immunization is the most cost-effective intervention in child health. There is an impending risk of outbreak of vaccine-preventable diseases due to increasing urbanization, migration, increasing slums, high density of population, continuous influx of a new pool of infective agents, and poor coverage of primary immunization. Attempts to improve the coverage have been going on for years. The results of our study showed that only 58 (17.8%) children were immunized till one year of age, 48% were partially immunized, and 34.15% were non-immunized. Contrary to the results of previous studies on immunization which were conducted on outpatient children, the present study was carried out on admitted patients. A similar observation was reported by Mathew et al.
who found that 25% of children were fully immunized (9
) and Saxena et al.
found that 30% were completely immunized (5
). The higher coverage of immunization varying from 50% to 70% was observed in other studies (6
). Results of our study indicate a poor immunization status compared to the national average according to the NFHS 3 (2005–2006) which showed that 43.8% of children were fully immunized (4
). Most previous studies included children from slums or rural districts, or were carried out among children attending the outpatient department. In this study, patients admitted to the paediatric ward were only included. This could be the reason for the lower coverage as non-immunized children are more likely to get infections and require admission in the paediatric ward. They have an increased level of morbidity and mortality. In the study in Delhi, the rate of immunized children was 71.7%, partially immunized 19.8%, and non-immunized 8.5% (7
The immunization cards were available with 72.5% of them (7
). Kar et al.
found complete immunization in 69.3% of children in a slum area of Delhi (11
). In our study, the coverage of complete immunization was 17.84%. This may be because of the fact that most of our study children were from slum areas of the nearby states where the immunization coverage is lower than Delhi.
The immunization cards were available with only 31.38% of the patients in this study compared to 74.4% in a study by Saxena et al.
). The immunization cards were found in a higher percentage of the completely-immunized children compared to the partially-immunized and non-immunized children. This highlights the need for emphasizing the importance of record-keeping during immunization visits. All the partially-immunized and 83.78% of the non-immunized patients received OPV during the pulse polio immunization campaign. Many of them thought that pulse polio was the only immunization to be given or that the health workers would come to their home and immunize them. These issues need to be addressed to increase the coverage of immunization.
In our study, the fully-immunized children were predominantly male. The female children were less likely to receive complete immunization and more likely to remain in the non-immunized or partially-immunized group. These findings were also supported by the findings of other studies (5
). Of the children (n=104) from Delhi, 37.5% were completely immunized compared to 8.55% of the completely-immunized children in those from outside Delhi, signifying a better immunization coverage in Delhi. We observed a low coverage of complete immunization among Muslim patients as has been found by other authors (8
Deliveries in the hospital, including those born by caesarean section, were more likely to be completely immunized (p<0.001). This may be because vaccination was started at birth, and parents were educated regarding subsequent vaccinations. Therefore, institutional deliveries should be promoted to increase the coverage of immunization. Education of fathers and mothers was also related to the low coverage of immunization in our study. Such findings were also observed by others (10
). On logistic regression, three most common demographic factors affecting the immunization status were maternal education, religion, and place of delivery; hence, there is a need for maternal education.
The common reasons for partial immunization and non-immunization were: lack of knowledge about vaccination (30.3%); vaccination has side-effects (28.8%); lack of knowledge about subsequent doses (22.1%); lack of faith in the effectiveness of immunization (21.7%); OPV was thought to be the only vaccination (20.9%); vaccine should not be given if the child is suffering from minor illnesses, such as mild diarrhoea with no dehydration or acute respiratory infections (12.7%); child was sick on the scheduled date (12.7%); and minor reactions during previous vaccination (11.9%). Similar reasons have been reported in a study among urban slums of Lucknow district (8
The single most common reason for partial vaccination was lack of knowledge about subsequent doses (22.09%); this highlights the need for training of medical officers and health workers about effective communication after vaccination regarding possible side-effects, their treatment, and the schedule for the next visit. The fact that minor illnesses, such as cough and diarrhoea, are not a contra-indication to vaccination needs to be told to the parents. Recently, it has been emphasized that satisfaction of clients, in terms of behaviour of health workers and information given by them, and easy accessibility are factors significantly different in completely-immunized and partially-immunized group (14
). For non-immunization, the commonest reason was the lack of knowledge about vaccination.
The present study highlights that the immunization status of children admitted to atertiary-care hospital is low—reasons being low educational status of parents, lack of awareness, ineffective communication by healthcare providers, and misconceptions associated with immunization. These issues need to be addressed at the tertiary level to improve the coverage of immunization.