Health seeking behavior of the mothers for the special care new-born unit discharged children: a comparative study.

Establishment of special care new-born units (SCNU) in hospitals not only serves to provide the intensive care to sick neonates, but presents with opportunities to enhance knowledge and modify attitude and practices of their parents through behavior change communication (BCC). A cross-sectional study was conducted in Dibrugarh District, Assam from January to June, 2011 to assess differences in health-care seeking behavior of these mothers from mothers of newborns who were born at home and mothers who had normal uneventful institutional deliveries. Mothers of 29 SCNU discharged, 34 institutions delivered and 26 home delivered children were interviewed using a semi-structured interview schedule and a knowledge, attitude and practice (KAP) survey tool. Mothers of children admitted to SCNU scored better in questions related to vaccination, contraception, protection of child from infections and cold and perceptions about traditional healers, but overall KAP scores in the three groups were not found significantly different.

Contribution of Immunization Weeks toward improving coverage, access to services, and completion of recommended childhood vaccinations in Assam, India.

Recommended childhood vaccines have typically been provided through routine immunization programs. Recently, implementation of strategies that use campaign-like features for providing all the recommended childhood immunizations have been utilized to increase vaccination coverage. Between January 2006 and January 2008, Assam, India, conducted Immunization Weeks (IWs), a periodic campaign-like approach for providing the recommended childhood vaccines generally administered through the routine Universal Immunization Program (UIP). Using data from a household vaccination coverage survey conducted in 5 districts of Assam in late-2007/early-2008 among children 12-28 months of age, a secondary analysis was conducted for a subset of children with vaccination cards to assess the impacts of implementing the IW-strategy. Sixty-five percent of the 3310 surveyed children received at least one vaccine dose through an IW. Without IWs, coverage would likely have been lower for all vaccines (e.g., 75% measles vaccine coverage including IWs doses and an estimated 61% without IWs). The proportion of children receiving at least one IW dose was significantly different depending on the child's residence; 72% in hard-to-reach char areas, 66% in rural areas and 53% in urban areas (p=0.01). Overall, 2085 (63%) of children were fully vaccinated; of these 60% received a combination of IW and UIP doses, 35% received doses only through the UIP, and 5% received doses only through IWs. A delay in administration later than the recommended ages was found for both UIP doses and for IW doses (e.g., for measles vaccine, UIP doses were 6.9 weeks delayed and IW doses 13.6 weeks delayed). Among this sample of vaccinated children, IWs appeared to increase vaccination coverage and improve access to services in hard-to-reach areas. However, the UIP appeared to be a better system for ensuring that children received all doses in the recommended vaccination series.

Implementation and evaluation of the Reaching Every District (RED) strategy in Assam, India, 2005-2008.

In 2005, UNICEF and the Centers for Disease Control and Prevention implemented and evaluated the Reaching Every District (RED) approach, an intervention designed to improve key components of immunization services including planning, outreach, community mobilization, supervision, and monitoring, in select districts of Assam, India. Two intervention and 3 comparison districts were selected for a 2-year evaluation trial. In intervention districts, immunization staff received comprehensive training and ongoing supervision by a fulltime consultant, and regular monitoring of progress was conducted. Population-based vaccination coverage surveys were conducted at baseline and 2 years after the start of implementation in the 5 districts. Post-intervention process indicators were systematically collected and focus group discussions were held. At follow-up, children in both the intervention and comparison districts were twice as likely to be fully vaccinated as they were at baseline. However, sites that received intervention training were better performing than those that did not, as measured by process indicators, including a higher number of outreach visits planned and held (p=0.02), having a monitoring chart (p<0.01), and correctly calculating dropout (p<0.01). The number of supervisory visits was significantly and positively associated with other key process indicators. Although coverage did not differ significantly between intervention and comparison districts, among individual districts, process data indicate significant improvements in program quality in the intervention districts. Further studies are needed to determine if the improved process indicators have sustainable impact on maintaining improvements in coverage.