CHAPTER-1

INTRODUCTION

Background of the study

Immunization is an investment for today and tomorrow, it is one of the most cost
effective public health interventions to reduce infant mortality rate (IMR) as also the under five
mortality rate and morbidity by protecting the children from vaccine preventable diseases.
Roughly 3.0 million children die each year from vaccine preventable diseases (VPDs) with a
disproportionate number of these children residing in developing countries. India has one of
the lowest routine immunization (RI) rates in the world. In general, covering as many diseases
as possible, ensuring vaccine potency and achieving high immunization coverage are essential
requirements for childhood immunization to have the desired public health impact of
decreasing mortality and morbidity and possibly eliminating some of the vaccine preventable
diseases.

India’s Universal Immunization Programme is the largest in the world. Every year the
programme targets around 26.7 million infants and 29 million pregnant women. Around 9
million sessions are held every year to deliver vaccines to the target population. However, over
the past many years immunization coverage among children aged 12-23 months in the country
has increased at a very slow pace of around 1% each year. Mission Indradhanush intended to
reach out to unvaccinated and partially vaccinated children, with the focus on hard -to- reach
and high-risk population. The first two phases of mission Indradhanush contributed to an
increase of 6.7% points in full immunization coverage according to the Integrated Child Health
and Immunization Survey. Analyzing the coverage trend and progress, it will clearly understood
the mission Indradhanush alone will be inadequate to reach the target of 90% Full
Immunization Coverage by December 2018. An intensified Mission Indradhanush was launchd
by the honorable Prime Minister in October 2017 to accelerate vaccination coverage.

As per Government of India directives, the year 2012 was declared as the year of intensification
of Routine Immunization and ‘Immunization Weeks’ were organized in selected low coverage
areas throughout Chhattisgarh state and continued in 2013 too. It has been observed that
besides these measures, some more strategic interventions are essential to strengthen the
different aspects of immunization services like micro-planning, cold chain and logistics
management, and monitoring/ supportive supervision and community mobilization.
Statement of the problem
A study to assess the prevalence of immunization drop outs among children less
than 5 years in selected village of Chhattisgarh.

Purpose of the study

1. Identify the immunization status of the children.
2. Assess the prevalence of the immunization drop out at the research setting.

Objectives of the study

To assess the prevalence of immunization drop outs among children less than 5
years in selected village of Chhattisgarh.

Variables
KEY VARIABLE:- immunization drop outs .

DEMOGRAPHIC VARIABLE: Age, sex, type of family, educational status of mother,

educational status of father, monthly income of the family, occupation of parents.

Definition of terms
• Assess:- To estimate the number of immunization drop out children as measured by an
immunization checklist.

• Prevalence:- In this study prevalence means number of children who had not
completely immunized according to the age and not having immunization card either
with family members or in health centers.

• Immunization Drop outs:- in this study immunization dropouts are the children who
have not received complete immunization according to the age and not having
immunization card either with family members or in health centers.
Conceptual framework

Delimitations
The study is limited to selected village of Chhattisgarh.

Summary:
The chapter includes study background, problem statement , purpose of study,
objectives of study , variables, operational definition and delimitation of study.

CHAPTER-II

REVIEW OF LITERATURE
 Das Gupta S, Karmakar PR, Mandal NK, Roy RP, Mallik S, Mandal AK . Indian J Public
Health (2005)- Routine primary immunization : status in two district of west Bengal.
This study was conducted at Birbhum and Purba Medinipur district of West Bengal to
assess the routine primary coverage following 40 cluster sampling technique was used
to study 320 children in each of the districts. BCG coverage was found to be 76.9% at
Birbhum and 84.38% at Purba Medinipur. Full primary immunization was observed
53.13% and 61.56% in Birbhum and Purba Medinipur respectively. High drop out rate
was identified as a major deficiency in both the districts. Of the children who received at
least one routine vaccine, more than one third at Birbhum and more than one forth at
Purba Medinipur did not turn up later for completion of their primary vaccine doses. It is
evident that routine immunization coverage was poor in both the districts and it seems
there has been no improvement in situation for last few years.

 Phukan RK ,Barman MP, Mahanta J (2009)- The children of Assam in the North- East
Region of India have consistently evidenced low rates for routine childhood
 immunizations .This study has been conducted to evaluate the factors affecting the
immunization coverage in the first year of life of the children. About 62.2% of the
children were fully immunized. Lack of information among the parents was one of the
major causes of drop out of vaccinations. The children from urban areas and mother’s
education level showed significant role in immunization coverage. Improvement in
female literacy coupled with the reduction in the drop out rate would add to achieve a
higher target of immunization among children in the study area.

 Ashish awasthi, CM Pandey, Uttam singh, Parvesh Kumar, TB Singh(2014)- A study was
conducted to identify the maternal determinants of complete immunization status
among 12-23 months in urban slums at Varanasi in India. Data on 384 children were
collected using pretesting questionnaire through house to house visit. Only 57.03%
children have received the complete immunization schedule under Universal
immunization program. Mothers education, low parity, maternal age, employment
status of mother are main factors associated with adherence of immunization schedule.

 Sanjeev Singh, Damodar Sahu, Ashish Agarwal, Meeta Dhaval Vashi, Lakshmanan
Jeyaseelan, Ambily Nadaraj(2019)- A cross-sectional cluster survey was conducted on
children of age 12-23 months in slum households of Mumbai, Maharashtra, India.
Parents or caretakers of 550 eligible children were interviewed using structured
interview schedule, out of 550, 73.1% were fully vaccinated, 23.8% were partially
vaccinated and 3.1% were reported unvaccinated. This study revealed higher drop out
rate for BCG –DPT3 (18.3%)and DPT1-DPT3(12.8%) vaccine than target cut off at 10%.
Strategies should be focused on reducing the drop out rate by tracking eligible children
and raising awareness about importance of full vaccination.

 Anjan Datta, Chanda Mog, Shampa Das, Srabani Datta- a cross sectional study has been
conducted among 330 children of 12-23 month age group in Mohanpur area, Tripura. A
pre- designed , pre- tested questionnaire has been used to collect required information
with verification of immunization card, by examination of scar mark or interviewing the
respondent. Out of 330 children 59.7% were male and 40.3% were females . 300 (90.9%)
were fully immunized whereas 29(8.8%) were partially immunized and 0.3% were non-
immunized. This study reveals BCG-DPT3 drop outs to be 2.1%, BCG-measles drop out at
3.9% and DPT3- measles drop out to be 1.8%.

 Rajat Vohra, Amisha vohra- A cross-sectional study has been conducted among 12-23
month old children to assess the reason for failure of immunization of Lucknow city in
India. Out of all villages in rural area and mohallas in urban area of Lucknow district,
 eight villages and eight mohallas were selected by simple random sampling. A
community based cross sectional study was done among 450 children aged 12-23
months. The immunization status of the child was assessed by vaccination card and by
mothers recall. A predesigned and pretested questionnaire was used to elicit
information on reasons for failure of immunization. Overall 62.7% children were fully
immunized, 24.4% children were partially immunized and 12.9% children were not
immunized.

 Jasmeet Singh, S.S. Deepti, Sanjeev Mahajan, Mohan Lal, Tejbeer Singh, N.S. neki- A
cross sectional study to evaluate vaccination coverage and dropout rate among children
of age 0-5 years in slums of Amritsar city. They recognized 64 slum areas which were
divided into 4 sectors depending upon their location and then form each sector one
area was selected randomly by lottery method. Total 1600 houses were surveyed for
study that is 400 houses from each sector. Out of 1131(0-5year) children 45.19% were
fully immunized, 31.12 % were partially immunized and 23.69% were unimmunized.
Fully immunized status among the children of literate mothers was higher than illiterate
mothers. This study revealed higher drop out for BCG-measles (38.5), DPT1-
meales(33.5%).

 Rashmi Sharma, Vikas K Desai, Abhay Kanishvar- a study to assess the immunization
status of children between the age group 12-23 months in the slums of Surat and to
compare it with the MICS from previous years. This was a community based cross
sectional study conducted in 15 clusters. 15 urban slums selected out of a total of 299
slums using the cluster sampling method. The multi indicator cluster sampling(MICS)
method was used for sample selection and the performa designed by UNICEF was used
as a study tool. Only 25% children between the age of 12-23 months were fully
immunized ; coverage was highest for BCG(75%) and lowest for measles (29.9%). As far
as the dropout rate is concerned, it was 60.2%, 31.9% and 31.5% for BCG- measles,
DPT1-DPT3 and OPV1-OPV3 respectively. Vitamin A was taken only 28.9% of the
subjects. Between the two , female children were more disadvantaged in terms of
vaccination. When compared with the coverage of 1997 and 1998 , the current coverage
is poor more so, in relation to DPT and OPV.

 Dhadwal D, Sood R, Gupta AK, Ahluwalia SK, Vatsavan A, Sharma R- A cross sectional
study was carried out to assess coverage among 257 urban and 339 rural children aged
13-36 months who have vaccinated at pulse polio booths in Shimla hills on a national
immunization day in 1995. 286 (84.37%) urban and 148(57.59%) rural children were
fully vaccinated. The dropout rates for oral polio vaccine were 3% among urban children
 and 15% among rural children, for DPT vaccine, there rates were 1% and 8% respectively
and for measles they were 94.1% and 81.3% respectively. Complete immunization was
positively associated with maternal education.

 Pandey S, Ranjan A, Kumar P, Agrawal N, Ahmad S- A cross sectional study was

conducted in rural area of Bhojpur district during January to may 2015. The aim of this
study is to assess the immunization coverage among children in rural area of Bhojpur
district and identify socio- demographic factors associated with it. A total of 360 children
of age 12-36 months were included in the study of which 65% of children were fully
immunized, 33.9% were partially immunized and 1.1% were not immunized at all.
Mothers education {ADR 2.28(1.28-4.05), P value=0.005}, place of birth {ADR 29.04
(10.75-78.43), P value=0.0001} and availability of immunization card {ADR 20.04(15.82-
916.47) P value- 0.0001} were significantly associated with immunization status.

 Mehra M, Dewan S, Aggarawal S, Garg S- A study to assess the immunization coverage

evaluation survey in rural Narela zone and city zone areas of Delhi.the major purpose of
this study is to document the vaccination status of the target population and to identify
areas which need strengthening. Survey were carried out for a 2.4 lakh rural and 2.2
lakh urban population of Delhi by the cluster sampling method. A total of 210 and 212
children respectively aged 12-23 months were included in the study in 30 randomly
selected clusters in each zones, respectively while those immunized with
DPT3/OPV3/BCG was 70.0 and 73.1 in the two zones. Dropout rate for DPT and OPV1-
OPV3 was 16-18%. The dropout rate between DPT and OPV2-OPV3 was higher than that
between DPT and OPV2. Percentage of non-immunized children was a significantly
higher than in rural as compared to urban areas.

CHAPTER-III
METHODOLOGY
According to Polit and Beck, “methodology means the steps, procedure and strategies
for gathering and analysis in the research investigation”.

Research approach:
Quantitative research approach will be used to assess the
prevalence of immunization drop outs among children less than 5 year in selected
village area of Chhattisgarh.

Research design:
 A descriptive survey research design will be employed among
children less than 5 years in selected village area of Chhattisgarh which is designed to
assess the prevalence of immunization drop outs.

Research setting:
The setting for the present study is the selected village area of
Chhattisgarh.

Population:
Population is the children less than five years.

Sample and sample size:

The sample of the study consists of 200 children less
than 5 years in selected villages of Chhattisgarh ( data will be collected from the care
givers)

Sampling criteria:
a) Inclusion criteria:
• Children age less than five years.
• Caregivers willing to participate and available at the time of data collection.
• Caregivers who are interested to participate in research study.
• Caregivers who are able to understand either Hindi or English language.
b) Exclusion criteria:
• Care givers not available during data collection period.
• Care givers who are not able to communicate either in Hindi/English .

Sampling technique:
A non-probability purposive sampling method will be
adopted for the study . In this type of sampling , subjects are chosen to be part of the sample
with specific purpose in mind.

Data collection technique and instruments:

Tool
 A demographic proforma and self-structured checklist related to immunization
schedule.

Description of tool
1. DEMOGRAPHIC PROFORMA:-

It includes code no, age, sex, type of family, educational status of mother, educational
status of father, monthly income of the family , occupation of parents.

2. CHECKLIST:-

• Checklist will be developed by researchers for the study. In checklist the name of the
vaccines according to National immunization schedule will be listed with two options:
given and not given

• Items will be added to the tool regarding the presence of immunization card with care
givers or in health centre and whether it is complete or in complete according to the
age.

Validity –content validity of tool will be obtained from 5 experts from different fields

Pre-testing-pre testing of the tool will be done from 10 mothers of under five children.

Language validity : will be ensured by translating and retranslating the tool and by
experts opinion.

Reliability-The reliability of the checklist is obtained by administering it to children of

age less than five years. The internal consistency of the checklist will be established by test and
re-test method.

Pilot study:
A pilot study is referred to a small scale preliminary try out of the method to be
used in an actually large scale study, which acquaints the researcher with problems that can be
corrected in proportion for the large research study or is done to provide the researcher with
an opportunity to try out the procedure, methods and tools of data collection.

After obtaining the formal administrative approval a pilot study will be conducted among 20
children of age less than five years of selected village area of Chhattisgarh, the tools and study
design will be checked for feasibility.
Procedure for data collection:
Data will be collected after obtaining permission from the
caregivers of the subjects by explaining purposes of the study. The researcher introduce self
and objectives of the study will be explained to the participants. Confidentiality will be assured
of all the participants. An informed consent will be taken from the participants. Anonymity of
the subjects will be maintained. Then, the investigators will collect the data from caregivers of
under five children by using demographic Proforma and Check list from a selected village of
Chhattisgarh.

Plan for analysis:

The plan of data analysis will include descriptive statistics. Descriptive
statistics will be used to describe sample characteristics in frequency and percentage,
mean and standard deviation .

Summary:
The chapter includes the research approach in design , setting of the study
population, sample and sampling techniques, sampling criteria, data collection techniques and
instruments and data analysis .