Immunization status of hospitalized preschool children: risk factors associated with inadequate immunization.

OBJECTIVES: The purposes of this study were to determine the accuracy of the immunization histories of hospitalized preschool children, assess the sociodemographic factors associated with delayed immunizations, and interview parents or guardians concerning their views on ways of improving immunization delivery. METHODS: The immunization status of 215 preschool children admitted to a pediatric hospital was determined by interviewing parents or guardians regarding their children's immunization histories. The patient's immunization records were subsequently reviewed for confirmation. The admitting physician's history also was reviewed to determine whether the patient's immunization status had been noted. Finally, parents or guardians of all children studied were interviewed to assess their views on ways of improving the delivery of immunization services. RESULTS: Only 44% of the 215 preschoolers evaluated were adequately immunized. Among those between 2 and 5 years of age, 52% were fully immunized. Only 17% of those who were inadequately immunized could have been completely updated if given an immunization at discharge. The admitting physician failed to document the immunization status of 22% of the patients. Thirty percent of the parents gave inaccurate information concerning the immunization status of their children. Most parents felt that the provision of transport (30%) or formal remainders (21%) would enhance immunization rates. Multiple regression analysis showed that a history of missed opportunity to immunize, male gender, lack of transportation, and lack of day care attendance were significant predictors of delayed immunization. CONCLUSIONS: Resident physicians should be more stringent in documenting the immunization status of all admitted preschoolers so that those found to be delayed could be updated before discharge. A hospital policy of updating underimmunized children at discharge and reporting the immunization status of all discharged patients to their primary care provider could help improve the immunization coverage in this population. Transportation for routine health maintenance and telephone or mailed remainders might further improve the immunization status of inner-city children.

Reducing the incidence of sudden infant death syndrome in the Delta region of Mississippi: a three-pronged approach.

Since the "Back to Sleep" campaign in 1994, which encouraged positioning infants on their backs for sleeping, the incidence of sudden infant death syndrome (SIDS) has decreased dramatically in the United states but remains high in some rural Mississippi communities. We discuss some of the hypotheses and etiologic factors of SIDS. The high incidence of SIDS in the Delta region of Mississippi could be dramatically reduced, primarily through an intensified Back to Sleep campaign. Furthermore, the importance of health education in increasing breast-feeding rates and reducing passive smoke exposure rates in this community is emphasized.

Breast-feeding initiation: predictors, attitudes, and practices among blacks and whites in rural Mississippi.

OBJECTIVES: We attempted to determine the incidence, predictors, attitudes, and practices of breast-feeding initiation among women in a low-income rural Mississippi community. METHODS: We interviewed 420 new mothers regarding breast-feeding. RESULTS: Ninety-six women (24%) initiated breast-feeding. More whites (44%) than blacks (20%) initiated breast-feeding. Of those 96, 59% planned to breast-feed for <6 months and 38% for 6 to 12 months. Among women who breast-fed, 78% said they did so because it was healthier. Among those not breast-feeding, most (48%) specifically stated, "I have no reason," while 20% hated the idea and 19% lacked time. About 73% of all women had been encouraged to breast-feed by nonphysicians (83%). For both races, the most significant predictor was a breast-feeding friend or relative. CONCLUSION: Breast-feeding rates in the Mississippi Delta are low, especially among blacks. Effective education programs are needed to increase these rates, and such programs should include friends, spouses, relatives, and significant others.