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Missed opportunities for immunization in children under 2 years attending an urban teaching hospital
N Deivanayagam1, K Nedunchelian, N Mala
1Advanced Centre for Clinical Epidemiological Research and Training (ACCERT), Madras Medical college.
Insights
Missed opportunities for immunization (MOI) in young children were reduced through health worker education and providing immunization schedules with outpatient forms. These interventions significantly lowered MOI rates across various pediatric clinics.
Area of Science:
- Pediatrics
- Public Health
- Preventive Medicine
Background:
- Missed opportunities for immunization (MOI) represent a significant gap in achieving full childhood vaccination coverage.
- Identifying and addressing MOI in diverse healthcare settings is crucial for improving public health outcomes.
- Pediatric outpatient and follow-up services are key touchpoints for potential immunization interventions.
Purpose of the Study:
- To assess the prevalence of missed opportunities for immunization (MOI) in children under two years old.
- To evaluate the effectiveness of two interventions aimed at reducing MOI in pediatric healthcare settings.
- To analyze the impact of health personnel education and integrated immunization schedules on vaccination rates.
Main Methods:
- A cross-sectional survey was conducted in Medical Outpatient, Newborn Follow-up, and Immunization Clinics.
- Two interventions were implemented sequentially: health worker education and attaching immunization slips to outpatient forms.
- Data analysis compared MOI rates before and after each intervention phase.
Main Results:
- Baseline MOI rates were 35.5% (Medical Outpatient), 23.1% (Newborn Follow-up), and 9.7% (Immunization Clinic).
- Following the first intervention (education), MOI decreased to 24.5% and 12.2% in Medical Outpatient and Newborn Follow-up services, respectively.
- The second intervention (immunization slips) further improved immunization rates by 18.4%, 30.4%, and 16.0% across the clinics, with significant reductions in MOI (p < 0.001).
Conclusions:
- Periodic awareness campaigns for healthcare personnel are effective in reducing missed opportunities for immunization.
- Integrating immunization schedules with outpatient forms is a highly effective strategy for minimizing MOI.
- Targeted interventions can significantly enhance childhood immunization coverage and prevent vaccine-preventable diseases.
Abstract:
A cross-sectional survey was done to assess the missed opportunity for immunization (MOI) in children under two years of age attending Medical Outpatient, Newborn Follow-up Service and Immunization Clinic of Institute of Child Health and to evaluate interventions. Baseline survey phase-I was done and two interventions: (i) education and awareness of immunization among health personnel; and (ii) attaching immunization slip to the outpatient form were done. After each intervention phase-II and phase-III surveys were carried out. The data from the different phases were analyzed for the effect of interventions. The total number of children surveyed were 634; 423 from Medical Outpatients, 108 from Newborn Follow-up Service and 103 from immunization Clinic. MOI was 35.5%, 23.1% and 9.7% in the above health facilities, respectively. After intervention I, the MOI was 24.5% and 12.2% in Medical Outpatient and Newborn Follow-up Service and none in Immunization Clinic. After intervention-II there was an improvement in immunization of 18.4%, 30.4% and 16.0% in the three health facilities mentioned above. MOI was avoided because the medical officers advised immunization in the above children. The difference in the MOI among Medical Outpatient and Immunization Clinic between baseline, phase-I and phase-II were significant (p < 0.001). It is concluded that MOI can be brought down by creating awareness periodically and that attaching an immunization schedule to the outpatient forms is an effective method of reducing MOI.