ObjectivesTo assess the immunization status of children in the age group 12-23 months and to know the reasons for nonimmunization of children.
Materials and MethodsA cross-sectional survey was conducted using WHO's thirty cluster sampling technique in rural and urban areas of Bareilly district from August 2008 to January 2009. Rural areas were divided into blocks and blocks were divided into villages. Urban areas were divided into wards. Villages and wards were taken as clusters. During the house-to-house survey, a total of 240 children of age 12-23 months were included in the present study.
ResultsOnly around 50% of children were fully immunized while 27.5% were partially and 22.5 % were not immunized at all. Immunization coverage was highest for BCG (62.5%) and lowest for measles (39.2%). Dropout rates were 37.3%, 19.7% and 18.2% for BCG to measles, DPT1 to DPT3 and OPV1 to OPV3 respectively. Vitamin A prophylaxis showed a decline from 38.3 % to 16.7%. Amongst the various reasons for not immunizing the child, the most common in both rural (78.7%) and urban areas (28.6%) was lack of awareness for the need of vaccination. However in rural areas lack of availability of services (87.2%) was the major cause for not immunizing the child.
ConclusionThe present study shows a low coverage of immunization and Vitamin A prophylaxis in both rural and urban areas. Important reasons for non-immunization were lack of awareness about vaccination and availability of immunization services in rural areas and urban areas.
Key WordsImmunization coverage, Children between 12-23months, Vitamin A Prophylaxis.
BackgroundThe current scenario depicts that immunization coverage has been steadily increasing but the average levels remain far less than desired. Still only 44% of infants in India are fully immunized (NFHS III), which is much less than the desired goal of achieving 85% coverage
INTRODUCTION: There is considerable uncertainty with respect to predicting the liver disease status of African American (AA) patients with Hepatitis C seen in the current era of highly effective direct acting anti-virals (DAA). This uncertainty is due to the complex interplay between the identification of patients early in their disease progression by screening, the fact that many AA patients failed earlier interferon based therapy, duration of the HCV viremia in AA patients, the possible variation In disease course in AA as compared to other races, and potential early mortality of AA patients due to liver disease. Understanding the evolution of HCV infection as defined by comparing previous and current patient populations provides information relevant to both therapeutic and health costs decisions. METHODS: We selected patients from a 24 month period between 2002 and 2003 (Epoch 1; n = 414) to compare with patients seen in the same GI clinic between 2012 and 2013 (Epoch 2; n=405). Epoch 1 was the beginning of the peg-interferon and ribavirin treatment era and Epoch 2 reflects the patient population seen when DAA therapy was first available. RESULTS: Epoch 2 patients were older (59.7 vs 50.3 years) with a similar gender distribution (55% vs 59% male). Consistent with the change in clinic demographics, more AA patients were seen in Epoch 2 (89%) as compared to Epoch 1 (77%). There was no significant difference between hepatic fibrosis as assessed by APRI (1.1 vs 0.9) or FIB-4 (2.4 vs 2.6) but there was an increase in intermediate degree of fibrosis as defined by liver biopsy. The majority of Epoch 2 patients were still naïve to treatment (96% Epoch 1 vs 61% Epoch 2) and a similar proportion had cirrhosis (15% Epoch 1 vs 17% Epoch 2) at the time of first visit in the different time periods. CONCLUSIONS: The patients in Epoch 2 from this urban GI referral clinic are older and the majority of them had not been treated or had not responded to treatment. This age demographic continues to reflect patients who were likely infected during the 1960's-1980's which is when HCV infection became widespread. Epoch 2 patients also do not have more advanced liver disease as defined either by significant fibrosis or cirrhosis as compared to Epoch 1. Possible explanations include that Epoch 2 patients' disease was detected earlier by surveillance, progressed very slowly to advanced liver disease, or had a high mortality that resulted in a decline in patients with advanced disease. The role of access to therapy in patients not treated remains to be determined and the increased effectiveness of DAA are predicted to increase the number of AA patients seeking and accepting treatment.
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