Vaccine wastage at primary, secondary, and tertiary level of healthcare system-A study from Northern India.

BACKGROUND: High vaccine wastage results in escalation of budget of immunization program. OBJECTIVE: To analyze vaccine wastage at three levels of service delivery under public sector, such as at district level, community health Centre (CHC), and sub center (SC). STUDY DESIGN: A retrospective cross-sectional record based study in a north Indian state. MATERIALS AND METHODS: The record from January to June 2016 was taken from randomly selected 5 districts of the state at 3 levels; for number of doses of vaccine used and number of children vaccinated for BCG, OPV, Hepatitis B, Pentavalent, DPT, IPV, Measles, and TT (vaccines being given in state in the study year). A total of 67,550 vaccine doses in routine immunization were studied. STATISTICAL ANALYSIS USED: Data were presented in mean ± standard deviation. One-way ANOVA test was used to compare the means among three levels. RESULTS: Vaccine wastage for Pentavalent was remarkably low (4.86% at district level, 8.35% at CHC and 11.50% at SC) in contrast to other similar 10 dose vials of vaccines like DPT, TT, Hep B. For both the lyophilized vaccines, interestingly BCG wastage was not only significant but over the permissible levels at 60.39%, whereas it is not so for measles. Result indicated that mean difference of the vaccine wastage among three levels was significant for the BCG, OPV, Hepatitis B, Pentavalent, and TT (P < 0.05); while insignificant for the DPT, IPV, and Measles (P > 0.05). CONCLUSIONS: Not all vaccine wastage is preventable, but pruning the corners where feasible and allowing where it is desirable should depend on prioritizing stakeholders at the receiving end.

Perceptions and preferences regarding sex and contraception, amongst adolescents.

INTRODUCTION: Conceptually and by the outlook, the reproductive and sexual health needs of adolescents differ from those of adults. Adolescent girls are coerced into unwanted sex or marriage, putting them at risk of unwanted pregnancies, unsafe abortions, sexually transmitted infections (STIs) including HIV, and dangerous childbirth. A majority of young people do not have correct information on the use of contraceptives or the prevention of pregnancy and STIs, and youth-friendly reproductive health services are not readily available. MATERIALS AND METHODS: A community-based cross-sectional study conducted among school-going 500 adolescent girls in the field practice area of Urban Health Training Centre, Tripuri, of Government Medical College, Patiala (Punjab). A survey with semi-structured, self-administered, and pretested questionnaire was conducted to collect the information on demographic characteristics, and knowledge and perceptions about safe sex. RESULTS: Only 39.71% of girls were aware that the legal age of marriage of girls in India is 18 years. About 22% of girls said that they would prefer to have pre-marital sex and majority, out of them, belonged to nuclear families. Around 38.4% of girls knew that condom is the safest contraceptive method but a preferred choice of contraceptive method among the girls for condoms (24.40%), oral pills (20.20%), and emergency pill (19.60%). CONCLUSION: Choice of the method with lower levels of knowledge regarding STIs and 22% preferring premarital sex may expose them to higher risks. Increasing trends of pre-marital sex with lower levels of awareness about contraception and STIs is very detrimental.

Are adolescents ready for future responsibilities? Experience from a cross-sectional study regarding Breastfeeding knowledge and attitude.

BACKGROUND: Breastfeeding plays an important role in the holistic development of a child. Current knowledge and attitude of future parents will significantly influence breastfeeding practices. Therefore, ascertaining current knowledge and attitude of both soon-to-be parents will help to formulate breastfeeding promotion strategies. RESEARCH AIM: To ascertain the knowledge and attitude of adolescents towards breastfeeding and its correlates with socioeconomic and demographic factors. MATERIALS AND METHODS: A cross-sectional institutional based study in which participants were recruited from Punjab, state of India. A total of 392 adolescents from January to June 2017 were evaluated on the basis of a pretested, reliable, and valid instrument. The instrument consisted of questions on knowledge and attitude regarding breastfeeding. RESULTS: One-hundred two (26%) participants had good knowledge and 290 (74%) had poor knowledge regarding breastfeeding. A bothersome fact is that only 25% of the participants knew about the age till which a child should be breastfed. There was a statistically significant (OR = 2.93; 95% CI: [1.45--5.93]) association between high knowledge and positive attitude. CONCLUSION: The level of knowledge amongst adolescents showed variation ranges from 15.82% to 93.11% on various aspects of breastfeeding. Despite this glaring variation, 75% of the participants had a positive attitude towards breastfeeding. Thus, there is a need for implementing modified and improved breastfeeding promotion strategies in India.

Positive impact of rescheduling Bacillus Calmette-Guérin vaccination on vaccinations at birth.

CONTEXT: Inimitable among the trio of recommended immunizations administered to newborns at delivery centers of institutions is hepatitis B. While it is necessary for hepatitis B to be given within 24 hours of birth, the same cannot be said for Bacillus Calmette-Guérin (BCG) and zero-dose oral polio vaccine (OPV). OBJECTIVE: To assess the impact of rescheduling of BCG vaccination from the current twice weekly to daily to cover newborn vaccinations at the Government Medical College, Patiala, India. MATERIALS AND METHODS: Until 2015, the delivery of BCG vaccine was restricted to twice a week, but from the year 2015, the schedule was changed from twice weekly to daily. Records for the 2 years, 2014 and 2015, were obtained, i.e., before and after the change. Data on 7065 babies born from January 2014 to December 2015 were statistically analyzed for the coverage of birth dose of hepatitis B, BCG, and OPV using Microsoft Excel. Chi-square test was applied, and p < 0.05 was considered significant. RESULTS: Rescheduling of BCG dose, from twice weekly to daily, the coverage of BCG and OPV zero dose increased from 54% (in 2014) to 78% (in 2015), and a marked increase from 8.2% to 42.9% was noted for the birth dose of hepatitis B. By rescheduling BCG (twice weekly to daily), the vaccine wastage increased from 21.5% to 26.2%, the difference found to be statistically insignificant. CONCLUSIONS: Modification in the delivery of immunization service from twice a week to daily has had a good impact on the vaccination of newborns though the goal of achieving the ideal 100% coverage is yet to be reached. Apart from the immunization of newborns, improving parental awareness, better coordination between immunization staff and maternal health staff, improved communication, and clear delineation of responsibility and answerability in the immunization service delivery will have a good impact on the vaccination of newborns.

Understanding health seeking behavior.

Leaving conventional "Dai" assisted home delivery to opt for institutional delivery is not unusual followed by shift from rural to urban living. However, this case, in particular, is oddly different. Hence, a deeper insight is warranted leading to a view that is unique. While analyzing the reasons it stands as a pointer in policy formulation, a necessity to understand such cases. Health belief model is applied in arriving at the inferences. It is often not just what is offered that makes bait but how it is perceived by the recipient matters. This can be visualized by this case study.