Kumar Devendra, Aggarwal Anju, Gomber Sunil
Department of Pediatrics, University College of Medical Science and Guru Teg Bahadur Hospital, Delhi 110 095, India.
J Health Popul Nutr. 2010 Jun;28(3):300-4. doi: 10.3329/jhpn.v28i3.5560.
Reasons for the low coverage of immunization vary from logistic ones to those dependent on human behaviour. The study was planned to find out: (a) the immunization status of children admitted to a paediatric ward of tertiary-care hospital in Delhi, India and (b) reasons for partial immunization and non-immunization. Parents of 325 consecutively-admitted children aged 12-60 months were interviewed using a semi-structured questionnaire. A child who had missed any of the vaccines given under the national immunization programme till one year of age was classified as partially-immunized while those who had not received any vaccine up to 12 months of age or received only pulse polio vaccine were classified as non-immunized. Reasons for partial/non-immunization were recorded using open-ended questions. Of the 325 children (148 males, 177 females), 58 (17.84%) were completely immunized, 156 (48%) were partially immunized, and 111 (34.15%) were non-immunized. Mothers were the primary respondents in 84% of the cases. The immunization card was available with 31.3% of the patients. All 214 partially- or completely-immunized children received BCG, 207 received OPV/DPT1, 182 received OPV/DPT2, 180 received OPV/DPT3, and 115 received measles vaccines. Most (96%) received pulse polio immunization, including 98 of the 111 non-immunized children. The immunization status varied significantly (p<0.05) with sex, education of parents, urban/rural background, route and place of delivery. On logistic regression, place of delivery [odds ratio (OR): 2.3, 95% confidence interval (CI) 1.3-4.1], maternal education (OR=6.94, 95% CI 3.1-15.1), and religion (OR=1.75, 95% CI 1.2-3.1) were significant (p<0.05). The most common reasons for partial or non-immunization were: inadequate knowledge about immunization or subsequent dose (n=140, 52.4%); belief that vaccine has side-effects (n=77, 28.8%); lack of faith in immunization (n=58, 21.7%); or oral polio vaccine is the only vaccine required (n=56, 20.9%. Most (82.5%) children admitted to a tertiary-care hospital were partially immunized or non-immunized. The immunization status needs to be improved by education, increasing awareness, and counselling of parents and caregivers regarding immunizations and associated misconceptions as observed in the study.
免疫接种覆盖率低的原因多种多样，从后勤方面的原因到取决于人类行为的原因都有。该研究旨在查明：(a) 印度德里一家三级护理医院儿科病房收治儿童的免疫接种状况；(b) 部分免疫接种和未免疫接种的原因。使用半结构化问卷对325名年龄在12至60个月之间连续入院的儿童的家长进行了访谈。在国家免疫规划下，一岁前错过任何一剂疫苗接种的儿童被归类为部分免疫接种，而12个月龄前未接种任何疫苗或仅接种了脉冲式脊髓灰质炎疫苗的儿童被归类为未免疫接种。使用开放式问题记录部分/未免疫接种的原因。在这325名儿童（148名男性，177名女性）中，58名（17.84%）完全免疫接种，156名（48%）部分免疫接种，111名（34.15%）未免疫接种。84%的案例中母亲是主要受访者。31.3%的患者持有免疫接种卡。所有214名部分或完全免疫接种的儿童都接种了卡介苗，207名接种了口服脊髓灰质炎疫苗/百白破疫苗1，182名接种了口服脊髓灰质炎疫苗/百白破疫苗2，180名接种了口服脊髓灰质炎疫苗/百白破疫苗3，115名接种了麻疹疫苗。大多数（96%）接受了脉冲式脊髓灰质炎免疫接种，包括111名未免疫接种儿童中的98名。免疫接种状况在性别、父母教育程度、城乡背景、分娩途径和地点方面存在显著差异（p<0.05）。经逻辑回归分析，分娩地点[比值比（OR）：2.3，95%置信区间（CI）1.3 - 4.1]、母亲教育程度（OR = 6.94，95% CI 3.1 - 15.1）和宗教信仰（OR = 1.75，95% CI 1.2 - 3.1）具有显著性（p<0.05）。部分或未免疫接种最常见的原因是：对免疫接种或后续剂量的了解不足（n = 140，52.4%）；认为疫苗有副作用（n = 77，28.8%）；对免疫接种缺乏信心（n = 58，21.7%）；或认为口服脊髓灰质炎疫苗是唯一需要的疫苗（n = 56，20.9%）。大多数（82.5%）入住三级护理医院的儿童部分免疫接种或未免疫接种。如研究中所观察到的，需要通过教育、提高认识以及就免疫接种和相关误解对家长和照料者进行咨询来改善免疫接种状况。
