An evaluation of immunization services, using the reaching every district criteria, in two districts of Gujarat, India

Montgomery, JoLynn P.; Ganguly, Parthasarathi; Carlson, Bradley F.; Shrivastwa, Nijika; Boulton, Matthew L.

doi:10.1186/s41256-018-0060-4

Cited by 7 publications

(7 citation statements)

References 4 publications

(2 reference statements)

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“…The findings of this study based on a large-scale survey differ from some of the existing evidence-based on smaller studies. For instance, a few micro studies suggest that the exclusion of marginalised communities such as the migrants, Dalits (the lowest social group in the Indian caste hierarchy) and people in remote areas facing discrimination, resulted in low CFI coverage [27,6] while untouchability practices against the Dalits and lower castes also transcend into poor delivery of healthcare facilities into these communities [27]. However, our study did not find caste-wise differences in CFI coverage in Gujarat.…”

Section: Discussioncontrasting

confidence: 61%

“…Further, the UIP added vitamin-A supplementation in 1990, Polio eradication in 1995-96, Pentavalent 1,2,3 dosage replacing DPT 1,2,3 in 2012-13, among others. To deliver these services UIP was strengthened by recruiting more healthcare personnel, training of the health personnel for immunisation, and extension of the cold chain and logistics infrastructure throughout India [5,6]. These targeted interventions increased CFI coverage in India from 44% in 2005-06 to 62% in 2015-16 [7].…”

Section: Introductionmentioning

confidence: 99%

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Perplexing condition of child full immunisation in economically better off Gujarat in India: An assessment of associated factors

Goli

James

Pallikadavath

et al. 2020

Vaccine

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Background: Despite decent progress in Children Full Immunisation (CFI) in India during the last decade, surprisingly, Gujarat, an economically more developed state, had the second-lowest coverage of CFI (50%) in the country, lower than economically less developed states such as Bihar (62%). Further, the proportion of children with no immunisation in Gujarat has risen from 5% in 2005 to 9% in 2016. This paper investigated factors associated with the low level of CFI coverage in Gujarat. Methods: The study used two types of datasets: (1) the study used information on immunisation from 7,730 children aged 12-23 months and their mothers from the fourth round of the Gujarat chapter of National Family Health Survey (NFHS 2015-16). (2) A macro (district) level data on both supply and demand-side factors of CFI are compiled from multiple sources. Bivariate and multivariate linear and logistic regression techniques were employed to identify the factors associated with CFI coverage.Results: In Gujarat, during 2015-2016, 50% of children aged 12 to 23 months did not receive full immunisation. The odds of receiving CFI was higher among children whose mothers had a Maternal and Child Protection (MCP) card (OR: 1.97, 95% CI 1.48-2.60) and those who received "high" maternal health services utilisation (OR: 1.59, 95% CI 1.10-2.26) compared to their counterparts. The odds of receiving CFI was about three times higher among the richest households (OR: 6.50, 95% CI 3.75-11.55) compared to their counterparts in the poorer households. Macro-level analyses suggest that poverty, maternal health care, and higher-order births are defining factors of CFI coverage in Gujarat. Conclusions:In order of importance, focusing on poverty, economic inequalities, pregnancy registration, and maternal health care services utilisation are likely to improve receiving CFI uptake in Gujarat. The disadvantageous position of urban areas and non-scheduled tribes in CFI coverage needs further investigation.

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Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Perplexing condition of child full immunisation in economically better off Gujarat in India: An assessment of associated factors

Goli

James

Pallikadavath

et al. 2020

Vaccine

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“…In contrast, the Sukkur division has a considerably lower FIC coverage of 33·7% [ 22 ] and the lowest proportion of immunization centers meeting critical criteria (38·0%) as per our analysis. This finding is consistent with the literature as the quality of immunization centers is linked to the availability of vaccination personnel and equipment, where quality deteriorates due to a lack of vaccines and poor storage equipment, which in turn leads to reduced vaccination service utilization and consequently lower coverage rates [ 7 – 9 , 13 , 23 , 24 ]. Moreover, poor cold chain practices have also been associated with reduced coverage and increased disease outbreaks, such as the measles outbreak in Cameroon, due to loss in vaccine efficacy and increased wastage [ 9 , 11 ].…”

Section: Discussionsupporting

confidence: 91%

“…Health facility studies in Cameroon, Ghana, Kenya, and Uganda have noted limited resources for cold-chain management characterized by the limited use of cold boxes and vaccines being stored outside of the recommended temperature range [ 9 , 12 ]. Moreover, in India and Bangladesh, vaccination centers have been shown to commonly face a shortage of vaccine supplies, with only 15% of the facilities in Bangladesh having proper storage capacity for vaccines with widespread shortages of pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV) doses [ 13 , 14 ]. In Pakistan, studies investigating gaps in vaccination service delivery pointed to the need for improved governance, human resource capacity building, better facility-level services, and addressing community perceptions as key areas for improving EPI [ 15 ], while also underscoring barriers to effective supportive supervision [ 16 ] and poor immunization-related knowledge among health workers [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of vaccination service delivery and quality: a cross-sectional survey of over 1300 health facilities from 29 districts in Sindh, Pakistan conducted between 2017–18

Siddiqi

Abdullah

Dharma

et al. 2022

BMC Health Serv Res

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Background Routine childhood immunization coverage in Pakistan remains sub-par, in part, due to suboptimal utilization of existing vaccination services. Quality of vaccine delivery can affect both supply and demand for immunization, but data for immunization center quality in Pakistan is sparse and in Sindh province in Southern Pakistan, no comprehensive health facility assessment has ever been conducted at a provincial level. We assessed health facilities, specifically immunization centers, and their associated health workers throughout the province to summarize quality of immunization centers. Methods An exhaustive list of health facilities obtained from Sindh’s provincial government was included in our analysis, comprising a total of 1396 public, private, and public-private health facilities. We adapted a health facility and health worker assessment survey developed by BASICS and EPI-Sindh to record indicators pertaining to health facility infrastructure, processes and human resources. Using expert panel ranking, we developed critical criteria (the presence of a cold box/refrigerator, vaccinator and vaccination equipment at the immunization center) to indicate the bare minimum items required by immunization centers to vaccinate children. We also categorized other infrastructure, process, and human resource items to determine high, low and moderate function requirements to ascertain quality. We evaluated presence of critical criteria, calculated scores for high, moderate and low function requirements, and displayed frequencies of infrastructure, process and human resource indicators for all immunization centers across Sindh. We analyzed results at the division level and utilized a two-sample independent clustered t-test to test differences in average function requirement scores between facilities that met critical criteria and those that did not. Results Out of the 1396 health facilities assessed across Sindh province from October 2017 to January 2018, 1236 (88.5%) were operational while 1209 (86.6%) offered vaccination services (immunization centers). Only 793 (65.6%; 793/1209) immunization centers met the critical criteria of having all the following items: vaccinator, a cold box or refrigerator and vaccine supplies. Of the 416 (34.4%; 416/1209) immunization centers that did not meet the critical criteria, most of the centers did not have a cold box or refrigerator (28.3%; 342/1209), followed by lack of vaccines (19.9%; 240/1209), and a vaccinator (13.0%; 157/1209). Of the 2153 healthcare workers interviewed, 1875 (87.1%) were vaccinators, of which 1745 (81.0%; 1745/2153) were male, and had an average of 12.4 years of schooling. A total of 1805 (96.3%; 1805/1875), 1655 (88.3%; 1655/1875) and 1387 (74.0%; 1387/1875) of the vaccinators were trained in vaccination, cold chain and inventory management respectively. Conclusion One out of three immunization centers in Sindh lack the critical components essential for quality vaccination services. While the majority of health workers (>80%) were trained on vaccination and cold chain management, the proportion trained on inventory management was comparatively low. Our findings therefore suggest that suboptimal immunization center quality is partly due to inadequate infrastructure and inefficient processes contributed to an extent, by low levels of inventory management training among vaccinators. Our study presents critical research findings with high-impact policy implications for identifying and addressing gaps to improve vaccination uptake within a low-middle income country setting.

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“…Community leaders can be tremendously useful to health care providers, especially when it comes to improving vaccination coverage (22). Pertaining to community engagement component of the RED strategies, there was a statistically significant improvement in the intervention group in having planned meetings with the local leaders to discuss routine immunization activities after the introduction of the CBMPI program.…”

Section: Assessment Of Skills and Practice Of Health Workers During Cmentioning

confidence: 99%

Effectiveness and Feasibility of Using Local Medical University for Capacity Building to Improve Immunization Program in Ethiopia. Implementation Science Study

Amare¹,

Toni

Mekonnen

et al. 2019

Preprint

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Background: Supportive supervision is one of five essential components of the WHO’s Reaching Every District strategy, an operational approach to reach 90%, immunization coverage. However, it is not mostly practiced based on the standard schedule because of capacity and low number of staffs in the health system. When it is practiced after long interval, it focuses more on inspection and finding lacunas. Taking into account the 54 universities in Ethiopia, the fundamental idea in this implementation science research is to test the feasibility and effectiveness of a Capacity Building and Mentorship Program in Immunization (CBMPI) by medical and health science colleges aimed at supplementing the current approach. Methods: This study applied a pre-post quasi experimental research design. The study included health workers of 30 health facilities (15 intervention and 15 control) followed for six months. To assess effectiveness on immunization coverage and a change in reaching every district strategy implementation difference in difference analysis was used to estimate the effect of the intervention implementation over time. Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used to evaluate the implementation process. Results: The findings of the study indicated that the intervention package has a statistically significant effect (P=0.0001) in the overall implementation of Reaching Every District (RED) outcomes. The difference in difference analysis also indicated that health facilities in the intervention district have shown a higher Penta III coverage (17.4%) and complete vaccination coverage (16.6%) that is attributable to the intervention package. Similarly, knowledge and skills of health workers improved significantly (P<0.05) after the intervention in most of the performance measures. During the qualitative evaluation, the key informants mentioned that the CBMPI program was effective and the new approach was acceptable by health workers for integration in the routine EPI program. Conclusions: In conclusion, capacity building and mentorship by well-trained personnel with the appropriate knowledge and skills have positive effects on immunization program indicators. Thus, it is recommended to do implementation study within the framework of national immunization program to facilitate policy adoption and readiness for routine use in large scale. This work was supported by the Bill & Melinda Gates Foundation, Grant Number OPP1191298

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An evaluation of immunization services, using the reaching every district criteria, in two districts of Gujarat, India

Cited by 7 publications

References 4 publications

Perplexing condition of child full immunisation in economically better off Gujarat in India: An assessment of associated factors

Perplexing condition of child full immunisation in economically better off Gujarat in India: An assessment of associated factors

Assessment of vaccination service delivery and quality: a cross-sectional survey of over 1300 health facilities from 29 districts in Sindh, Pakistan conducted between 2017–18

Effectiveness and Feasibility of Using Local Medical University for Capacity Building to Improve Immunization Program in Ethiopia. Implementation Science Study

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