Immunisation status and its predictors among children of HIV-infected people in Kolkata

Abstract

World Health Organization and United Nations International Children's Emergency Fund have strongly recommended a sustained coverage of universal immunisation among all children against tuberculosis, polio, diphtheria, pertussis, tetanus and measles. In India, these vaccines under the universal immunisation programme are made available absolutely free of cost to all children through the public health system. Information regarding immunisation coverage among HIV exposed children in India is still very limited. The objective of this study was to estimate the proportion of children of people living with HIV who had been completely immunised by the age of 12 months and to find predictors of complete immunisation. A community-based cross-sectional survey was conducted in the Kolkata Metropolitan Area between 15 June and 14 September 2009 using a pre-structured interview schedule. Data were analysed from 256 care-givers of children (85.5% response rate) whose parents were randomly selected from the Bengal Network of HIV-positive people. Multiple logistic regression was used to estimate and test associations of predictors with complete immunisation. The percentage of children of people living with HIV completely immunised at the age of 12 months was 73.0% (67.3% to 78.1%), which was not significantly different from that for all children at 12 months. Mothers having received antenatal care [OR (odds ratio): 7.29; 95% confidence intervals (CI): 2.39-22.25], mothers having postprimary education (OR: 3.37; 95% CI: 1.45-7.81), children of Hindu and Christian religion (OR: 3.74; 95% CI: 1.63-8.62), children not belonging to scheduled castes, tribes and 'other backward classes' (OR: 2.08; 95% CI: 1.02-4.25) were significant independent predictors of complete immunisation status of these children. This emphasises the imperative need for up-scaling of antenatal care among the pregnant mothers to ensure complete immunisation among their children. A special focus on girl child education should also be implemented to empower future mothers for a sustained improvement of child immunisation in the long-run. The current national immunisation programme should focus on the children from the Muslim community and those belonging to scheduled castes, tribes and other backward classes to improve coverage.

Partition and Poliomyelitis: An Investigation of the Polio Disparity Affecting Muslims during India's Eradication Program

“…The Sachar Committee Report was the first of its kind to analyze the systematic deprivation of Muslims across multiple social indicators, and few studies have examined health disparities among these groups. It has been documented that Muslims experience lower rates of child immunization [ 74 ] and higher scores of child health inequality measures related to immunization coverage, stunted growth, and being underweight [ 13 , 75 ]. Lower utilization of safe maternity care services have also been documented among Muslims in India [ 76 ], and long term mistrust of government has been cited as a factor in understanding this resistance to new policy initiatives.…”

Barriers to Immunization Among Children of HIV-Infected Mothers in Kolkata, India

“…9,10 Two separate interview guides were prepared for the caregivers and the service providers based on review of the existing literature and the researchers’ experience in the area. 6,8-13 The interview guide for the caregivers explored the decision-making process, the perceived barriers to immunization in their children, obstacles from the family, obstacles from the health system, and the enabling factors to access the services. The interview guide for the service providers explored the perceived level of immunization among HIV-exposed children, the barriers to their immunization, obstacles from the family, obstacles from the health system, advice on vaccination, and the factors enabling them to follow the advice.…”

“…5 It has been estimated that only 73% of the children with HIV-positive parents in Kolkata are completely immunized at 12 months of age. 6…”