Effectiveness of planning and management interventions for improving age-appropriate immunization in rural India

• Main Authors: Shankar Prinja (Author), Madhu Gupta (Author), Amarjeet Singh (Author), Rajesh Kumar (Author)
• Format: Book
• Published: The World Health Organization, 2010-02-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 0042-9686
• Keywords: Public aspects of medicine; RA1-1270
• Source: Bulletin of the World Health Organization, Vol 88, Iss 2, Pp 97-103 (2010)

OBJECTIVE: To study the effectiveness of planning and management interventions for ensuring children in India are immunized at the appropriate age. METHODS: The study involved children aged less than 18 months recruited from Haryana, India, in 2005-2006: 4336 in a pre-intervention cohort and 5213 in a post-intervention cohort. In addition, immunization of 814 hospitalized children from outside the study area was also assessed. Operational barriers to age-appropriate immunization with diphtheria, pertussis and tetanus (DPT) vaccine were investigated by monitoring vaccination coverage, observing immunization sessions and interviewing parents and health-care providers. An intervention package was developed, with community volunteers playing a pivotal role. Its effectiveness was assessed by monitoring the ages at which the three DPT doses were administered. FINDINGS: The main reasons for delayed immunization were staff shortages, non-adherence to plans and vaccine being out of stock. In the post-intervention cohort, 70% received a third DPT dose before the age of 6 months, significantly more than in the pre-intervention cohort (62%; P = 0.002). In addition, the mean age at which the first, second and third DPT doses were administered decreased by 17, 21 and 34 days, respectively, in the study area over a period of 18 months (P for trend < 0.0001). No change was observed in hospitalized children from outside the study area. CONCLUSION: An intervention package involving community volunteers significantly improved age-appropriate DPT immunization in India. The Indian Government's intention to recruit village-based volunteers as part of a health sector reform aimed at decentralizing administration could help increase timely immunization.