Leaving conventional “Dai” assisted home delivery to opt for institutional delivery is not unusual followed by shift from rural to urban living. However, this case, in particular, is oddly different. Hence, a deeper insight is warranted leading to a view that is unique. While analyzing the reasons it stands as a pointer in policy formulation, a necessity to understand such cases. Health belief model is applied in arriving at the inferences. It is often not just what is offered that makes bait but how it is perceived by the recipient matters. This can be visualized by this case study.
CONTEXT:Inimitable among the trio of recommended immunizations administered to newborns at delivery centers of institutions is hepatitis B. While it is necessary for hepatitis B to be given within 24 hours of birth, the same cannot be said for Bacillus Calmette–Guérin (BCG) and zero-dose oral polio vaccine (OPV).OBJECTIVE:To assess the impact of rescheduling of BCG vaccination from the current twice weekly to daily to cover newborn vaccinations at the Government Medical College, Patiala, India.MATERIALS AND METHODS:Until 2015, the delivery of BCG vaccine was restricted to twice a week, but from the year 2015, the schedule was changed from twice weekly to daily. Records for the 2 years, 2014 and 2015, were obtained, i.e., before and after the change. Data on 7065 babies born from January 2014 to December 2015 were statistically analyzed for the coverage of birth dose of hepatitis B, BCG, and OPV using Microsoft Excel. Chi-square test was applied, and p < 0.05 was considered significant.RESULTS:Rescheduling of BCG dose, from twice weekly to daily, the coverage of BCG and OPV zero dose increased from 54% (in 2014) to 78% (in 2015), and a marked increase from 8.2% to 42.9% was noted for the birth dose of hepatitis B. By rescheduling BCG (twice weekly to daily), the vaccine wastage increased from 21.5% to 26.2%, the difference found to be statistically insignificant.CONCLUSIONS:Modification in the delivery of immunization service from twice a week to daily has had a good impact on the vaccination of newborns though the goal of achieving the ideal 100% coverage is yet to be reached. Apart from the immunization of newborns, improving parental awareness, better coordination between immunization staff and maternal health staff, improved communication, and clear delineation of responsibility and answerability in the immunization service delivery will have a good impact on the vaccination of newborns.
Background: High vaccine wastage results in escalation of budget of immunization program. Objective: To analyze vaccine wastage at three levels of service delivery under public sector, such as at district level, community health Centre (CHC), and sub center (SC). Study Design: A retrospective cross-sectional record based study in a north Indian state. Materials and Methods: The record from January to June 2016 was taken from randomly selected 5 districts of the state at 3 levels; for number of doses of vaccine used and number of children vaccinated for BCG, OPV, Hepatitis B, Pentavalent, DPT, IPV, Measles, and TT (vaccines being given in state in the study year). A total of 67,550 vaccine doses in routine immunization were studied. Statistical analysis used: Data were presented in mean ± standard deviation. One-way ANOVA test was used to compare the means among three levels. Results: Vaccine wastage for Pentavalent was remarkably low (4.86% at district level, 8.35% at CHC and 11.50% at SC) in contrast to other similar 10 dose vials of vaccines like DPT, TT, Hep B. For both the lyophilized vaccines, interestingly BCG wastage was not only significant but over the permissible levels at 60.39%, whereas it is not so for measles. Result indicated that mean difference of the vaccine wastage among three levels was significant for the BCG, OPV, Hepatitis B, Pentavalent, and TT ( P < 0.05); while insignificant for the DPT, IPV, and Measles ( P > 0.05). Conclusions: Not all vaccine wastage is preventable, but pruning the corners where feasible and allowing where it is desirable should depend on prioritizing stakeholders at the receiving end.
Introduction: Maternal mortality is an index of reproductive health of the society. In India illiteracy, late referrals, low socio-economic status of the community and direct causes are responsible for high incidence of maternal deaths which contributes to one-fifth of the global burden. Aim: To evaluate the causes of maternal death in rural areas of Punjab. Materials and Methods: The present retrospective cross-sectional study was conducted in 10 districts of Punjab, India chosen from five different zones i.e., east, west, north, south and central zone for a period of one year from 2016 to 2017. Information of all the deaths was taken from the civil surgeon office of the chosen district and then data of maternal deaths occurring within 42 days of delivery was collected by visiting patient’s residence and verbal autopsy was conducted. The data was collected and entered in predesigned proforma and percentages were calculated in Microsoft Excel version 2016. Results: A total of 67 maternal deaths were noted from above five zones, out of total rural population of 94,59,553. Maximum (n=51) maternal deaths were between age range of 20-30 years. Of these 67, majority 29 (43.28%) were illiterate, 66 (98.5%) women belonged to middle and low socio-economic status, 55 (82.1%) deaths occurred in the postnatal period, 33 (49.25%) occurred at more than 37 weeks period of gestation and 51 (76.12%) were due to direct causes. Out of 67 deaths, haemorrhage (n=29) was the most common cause. Anaemia contributed to 16.7% (11) as an indirect cause of maternal death. Conclusion: The maximum maternal deaths were contributed by illiterate women from middle and low socio-economic status. The most common cause was postpartum haemorrhage followed by pre-eclampsia/eclampsia.
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