Short Communication

Immunization Coverage Evaluation by Secondary Data Analysis at Rural Health Unit and Training Centre, Singur in Hooghly district of West Bengal

Dan Amitabha*, Chattopadhyay O **, Pasi Achhelal ***, Dasgupta Dipankar ****, Barman Lina*****

* Public Health Specialist, Grade I, RHU& TC, Singur
** Consultant (Public Health), UHU&TC, Chetla
*** Public Health Specialist, Grade II, Airport Health Organisation, Mumbai
**** Sr Medical Officer, RHU& TC, Singur
***** Medical Officer, RHU& TC, Singur

Corresponding Author:
Dr Achhelal R Pasi,
Email - ar123_pasi@yahoo.co.in

Summary

Immunization has beenthe safest, most cost-effective and powerful means of preventing death in under-five children. Immunization data of Reproductive and Child Health (RCH)Programme at Rural Health Unit and Training Centre (RHU&TC), Singurwas analysedto evaluate vaccination coverage against vaccine-preventable diseases.Secondary data analysis was done for the period 2013-14 to 2015-16.Immunization coverage of RHU&TC Singur for year 2015-16 (BCG 100 percent, OPV3 99.9 percent, DPT3/Penta3 99.9 percent and Measles 99.9 percent) was 99.9 per cent.In service area of RHU&TC Singur, one Primary Health Centreand one Sub-centreserves a population of 53,034 and 8,840 respectively.Population covered by RHU&TC Singur was 12-15 percent more than that of the state average.Though there was deficit of manpower by 20-25percent, total immunization coverage at RHU&TC Singur was nearly 100 percent whilesame as per DLHS 4 coverage survey(2012-13) and NFHS – 4(2015-16)were 79 percent and 84.4 percent respectively.

Key words: VPDs, Immunization coverage, RHU&TC Singur, Hooghly District



Introduction:

Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease1.Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert 2-3 million deaths each year1.

During 2016, about 86percent of infant’s worldwide (116.5 million infants) received 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal. By 2016, 130 countries had reached at least 90percent coverage of DTP3 vaccine2.

In India, Smallpox has been eradicated in the year 1977 and Maternal and Neonatal Tetanus has been eliminated in the year 2015. India got the polio-free certification in 2014. Nine million routine immunization (RI) sessions are organized in India each year.This targets 26 million children and 30 million pregnant women.The national average of full immunization is 61 per cent, and for DPT-3 coverage, 72 percent.Rural children are least likely to have complete vaccination, and this inequity is most pronounced in states like Madhya Pradesh, Rajasthan, Chhattisgarh, Jharkhand and Uttar Pradesh3.As per National Family Health Survey - 4 (2015-16) in West Bengal, BCG coverage is 97.5percent, OPV-3 87.9percent, DPT-3/Penta-3 92.7percent, Measles 92.8percent, Hepatitis B/Penta-3 86.4percent and full immunization 84.4percent4.

Rural Health Unit and Training Centre (RHU and TC), Singur is the field practice area of All India Institute of Hygiene and Public Health (AIIH and PH). It is one of the few centres in India, where govt. of India provides primary health care services to community.In this background, the secondary data for the last 3 years (2013-14 to 2015-16) was analysedwith the aim to find the achievement and gaps in the Universal Immunization Programme in the service area of RHU&TC, Singur.Present secondary data analysis was done tostudy the vaccine supply status at RHU&TC, Singur, to evaluate the vaccination coverage against vaccine-preventable diseases in RHU&TC, Singur and to compare the vaccination coverage with state and national level coverage.

Material and Methods:

Secondary data analysis of vaccinationwas done for the period 2013-14 to 2015-16.Study area was RHU and TC,Singur, situated in the Singur Community Development Block of Hooghly district, about 40 km from Kolkata. It has two Primary Health Centres(PHCs) viz. Nasibpur PHC (NPHC) and Anandanagar PHC (APHC). Under each PHC there are 6 sub-centres, total 12 in 64 villages and it covers a population of around 1 lakh. A child was considered fully immunized if he/she has received 1 dose of BCG, 3 doses of OPV, 3 doses of Pentavalent, 2 doses of fractional IPV, Measles -1st dose, JE 1st dose before the age of one year5,6.Data was collected from Immunization register, Management Information and Evaluation System (MIES) maintained by Data Entry Operator (DEO).Study was conducted after taking permissions from appropriate authorities and as it was secondary data analysis waiver frominstitutional ethics committee was requested. Data was entered in Microsoft Excel. Analysis was done in line with the objectives. Data was presented by using rates, ratios and proportions.

Results:

Vaccine supply:There was no shortage of vaccine supply during the period under study.
Trainingand Awareness programme:Several training sessions were conducted for the health personnel’s. A district level Training of Trainers (TOT)for Public Health Nursing Supervisors (PHNS) and Public Health Nurse (PHNs) on Inactivated Polio Vaccine (IPV) introduction was conducted on 05.01.2015. A 2 days (10.3.2016 to 11.3.2016) district level training on Cold Chain Handling was conducted and it was attended by 4 PHNs.A one day Training on introduction of IPV was conducted at RHU&TC Singur and it was attended by Medical Officers (MOs), PHNs, Health Workers Females (HWFs), Health Assistants (Male and Female), Field Workers and DEOs. This was followed by 1 day training of ASHAs.

Immunization data wasanalysed at RHU&TC Singurby Public Health Specialists and feedback was given in the monthly meetings.As per national guidelines, one Cold chain point was maintained at Anandanagar PHC6,7.

Population coverage: RHU&TC, Singur provides services to a population of 53034 per PHCwhile in rest of the area of Singur block and West Bengal population covered by per PHC is 51068 and 32944 respectively7,8. Each sub-centre of RHU&TC,Singur provides services to a population of 8840 while each sub-centre in the rest of the Singur block and West Bengal provides services to a population of 4750 and 5426 respectively7.One Health Worker of RHU&TC,Singur on an average covers a population of 4610 while in the rest of the Singur Block under Government of West Bengal; a health worker covers a population of 2585 respectively7,8.

Vaccination Coverage: In the year 2013-14 and 2014-15,RHU&TC Singur achieved 100 per cent immunization coverage of children less than one year of age. In the year 2015-16, only one child was not immunized due to refusal by the family (Table 1). The Immunization coverage for RHU&TC Singur was 99.9 percent while immunization coverage reported by District Level Household Surveys (DLHS 4; 2012-13) and National Family Health Survey (NFHS 4; 2015-16) for rural area of Hoogly district of West Bengal was 80.8 percent and 84.4 percent respectively8,9,10( Table 2).



Table 1: Immunization status of infants in the service area of RHU&TC Singur

PHC Name No. of Births Infants Died Migrated Children <1 year

Immunization  received

Out In Full B
C
G
3 doses of Measles At least 1 dose of Vit A
DPT /
Penta
OPV

2013-14

APHC 561 7 15 6 545 545 545 545 545 545 545
NPHC 696 9 24 1 664 664 664 664 664 664 664
Total 1257 16 39 7 1209 1209 1209 1209 1209 1209 1209

2014-15

APHC 530 7 10 7 520 520 520 520 520 520 520
NPHC 690 15 35 0 640 640 640 640 640 640 640
Total 1220 22 45 7 1160 1160 1160 1160 1160 1160 1160

2015-16

APHC 521 4 9 7 515 515 515 515 515 515 515
NPHC 634 6 26 2 604 603 604* 603 603 603 603
Total 1155 10 35 9 1119 1118 1119 1118 1118 1118 1118


APHC = Anandanagar PHC, NPHC = Nasibpur PHC
* One infant in NPHC area (DOB-11.12.15) having hydrocephalus received only BCG from outside.

Table 2: Comparison of Immunization Coverage in RHU& TC with DLHS 4 and NFHS 4

Vaccine

Immunization Coverage (Percentage)

RHU&TC Singur (2015-16) DLHS  4 (2012-13) NFHS 4 (2015-16)
 

 

Rural

Rural

Fully Immunized

99.9

 

80.8

84.4

BCG

100

 

96.3

97.5

OPV3

99.9

 

87.8

87.9

DPT3/ Penta-3

99.9

 

92.6

92.7

Measles

99.9

 

89.5

92.8



Discussion:

India has the largest number of births in the world – more than 26 million a year – and also accounts for more than 20 per cent of child mortality worldwide5. Immunization is today one of the safest, most cost-effective and powerful means of preventing death and improving life.Two monumental public health milestones have been achieved recently with India completing five years of being Polio free and the WHO certification of India having eliminated Maternal and Neonatal Tetanus6.

RHU&TC Singurhave shown better performance in immunization coverage. The total coverage was nearly 100percent and it was far above the DLHS 4 (2012-13) and NFHS – 4 (2015-16)8,9,10.

The population covered by RHU&TC Singur was almost 12-15percent more than the West Bengal average. Though there was a deficit of manpower by 20-25percent (against sanctioned post), the performance was better. Performance status was far better than the state and national statistics.

The better performance at RHU&TC Singur may be due to highly skilled, competent and motivated health workers. They had received several hands-on-trainings. A constant monitoring and surveillance system was in operation6,7. Regarding community, the general awareness was very high as AIIH&PH was giving services since more than 50 years. Moreover this being the field practice area of postgraduate public health students, health education was given by the students as well. Almost every session of vaccination was coupled with community awareness programme. Public health specialists and public health nurses regularly conduct awareness programmes on relevant and upcoming issues7. On an average every month 2-3 community awareness programmes were conducted. In case of any default, Health workers and ASHAs take prompt action e.g. family visit, involvement of panchayat members etc.

Limitations:

In present study, analysis of secondary (existing) data was done so the reasons for child not getting vaccinated could not be ascertained.

Conclusion and Recommendations:

In spite of manpower constraints, the immunization coverage in field practice area of RHU&TC, Singur was nearly 100 percent. For long-term sustainable achievement, vacant posts need to be filled up.

Financial Support: Nil

Conflict of interest: Nil


Acknowledgement:

We sincerely acknowledge the help extended to us by the Officer-in-charge, RHU&TC Singur regarding data collection and logistics. We gratefully acknowledge the guidance and inspiration by the Dean and the Director of A.I.I.H.and P.H., Kolkata.We are very much grateful to Public Health Nursing Supervisor, RHUand TC Singur for technical inputs.

References:

  1. World Health Organization . Health topics: Immunization. Available from: http://www.who.int/topics/immunization/en/ last accessed on 18.08.2017.

  2. World Health Organization. Immunization coverage Fact sheet Available from http://www.who.int/mediacentre/factsheets/fs378/en/ last accessed on 18.08.2017

  3. UNICEF. Immunization. Available from: https://www.unicef.org/immunization/ last accessed on 18.08.2017

  4. Govt. of India. Ministry of Health and Family Welfare. Annual Report 2016-17. Chapter 4. Child Health Programme.

  5. UNICEF. Available from:http://unicef.in/Whatwedo/3/Immunization, last accessed on 18.08.2017

  6. Immunization Handbook for Medical Officers. 2016. Ministry of Health and Family Welfare. Government of India, p 39-41.

  7. Govt of West Bengal. SBHI. Directorate of Health Services. Health on the March. 2015-16. Health Information Statistics, p 119 - 123.

  8. Park Textbook of Preventive and Social Medicine; 21st Edition (2011), p 837.

  9. J. Kishore’s National Health Programmes of India; National Policies and Legislations Related to Health. 12th edition (2016), p 159 - 163.

  10. Govt. of India, MOHFW Statistics Division, Rural Health Statistics, 2014-15, p 56 - 76.