Factors affecting immunization coverage levels in a district of India.

ABSTRACT

PIP: The authors report findings from an immunization coverage survey in 1988 among 12-23 month old children in the North Arcot district of southern India conducted to assess the performance of the Expanded Program on Immunization. All 7300 children in 159 of 1590 systematically selected panchayats were surveyed. In the towns, coverages for measles vaccine ranged 29-52%, BCG 65-91%, and OPV and DPT 3rd dose 60-80%. Coverages in the rural areas were the following: measles vaccine, 10.8-19.3%; BCG, 25.1-34.1%; DPT 3rd dose, 42.2-50.4%; and OPV 3rd dose, 39.6-48%. In the towns, 25%, 66%, 67%, and 50% of BCG, DPT, OPV, and measles vaccines, respectively, were provided by private agencies. The higher coverage levels achieved in towns point to the importance of making vaccines available and easily accessible throughout the week. Government agencies provide all vaccines free of charge in rural areas. Further, large and peri-urban panchayats in rural areas had significantly better coverage than small and more rural ones, while large variations were found between panchayats in the levels of immunization coverage within any given block of 30-40 panchayats. The authors argue that variations in coverage levels in urban and rural areas and within rural areas may be due to varying efficiencies of different immunization delivery systems or responsible staff serving each region. In closing, neither the district nor block is a satisfactory unit for coverage surveys. Information should instead be collected from each geographical area served by a health worker to best detect poorly immunized areas. Coverage surveys should also ultimately be replaced with the auditing of immunization and disease surveillance.