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Effectiveness of planning and management interventions for improving age-appropriate immunization in rural India
Shankar Prinja1, Madhu Gupta, Amarjeet Singh
1School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Insights
Community volunteers improved timely diphtheria, pertussis, and tetanus (DPT) immunization in India. This intervention reduced delays in vaccine administration for children under 18 months.
Area of Science:
- Public Health
- Pediatric Vaccinology
- Health Management
Background:
- Timely immunization is crucial for child health, yet India faces challenges with age-appropriate vaccine delivery.
- Operational barriers such as staff shortages and stockouts contribute to delayed immunization schedules.
Purpose of the Study:
- To evaluate the effectiveness of planning and management interventions in improving age-appropriate immunization for children in India.
- To assess the impact of a community volunteer-driven intervention on diphtheria, pertussis, and tetanus (DPT) vaccination timeliness.
Main Methods:
- A pre- and post-intervention cohort study in Haryana, India (2005-2006) involving over 9,000 children under 18 months.
- Investigated operational barriers through coverage monitoring, session observation, and interviews with parents and providers.
- Assessed intervention effectiveness by tracking the age of DPT dose administration.
Main Results:
- The intervention significantly increased the proportion of children receiving the third DPT dose before six months (70% vs. 62%).
- Mean ages for all three DPT doses decreased significantly over 18 months in the intervention area.
- No improvements were noted in a control group of hospitalized children from outside the study area.
Conclusions:
- An intervention package utilizing community volunteers substantially enhanced age-appropriate DPT immunization rates in India.
- Findings support India's health sector reforms aimed at decentralizing administration and leveraging village-based volunteers for improved immunization coverage.
Objective:
To study the effectiveness of planning and management interventions for ensuring children in India are immunized at the appropriate age.
Methods:
The study involved children aged less than 18 months recruited from Haryana, India, in 2005-2006: 4336 in a pre-intervention cohort and 5213 in a post-intervention cohort. In addition, immunization of 814 hospitalized children from outside the study area was also assessed. Operational barriers to age-appropriate immunization with diphtheria, pertussis and tetanus (DPT) vaccine were investigated by monitoring vaccination coverage, observing immunization sessions and interviewing parents and health-care providers. An intervention package was developed, with community volunteers playing a pivotal role. Its effectiveness was assessed by monitoring the ages at which the three DPT doses were administered.
Findings:
The main reasons for delayed immunization were staff shortages, non-adherence to plans and vaccine being out of stock. In the post-intervention cohort, 70% received a third DPT dose before the age of 6 months, significantly more than in the pre-intervention cohort (62%; P = 0.002). In addition, the mean age at which the first, second and third DPT doses were administered decreased by 17, 21 and 34 days, respectively, in the study area over a period of 18 months (P for trend < 0.0001). No change was observed in hospitalized children from outside the study area.
Conclusion:
An intervention package involving community volunteers significantly improved age-appropriate DPT immunization in India. The Indian Government's intention to recruit village-based volunteers as part of a health sector reform aimed at decentralizing administration could help increase timely immunization.
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