Improving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy

Gurnani, Vandana; Haldar, Pradeep; Aggarwal, Mahesh Kumar; Das, Manoj; Chauhan, Ashish; Murray, John; Arora, Narendra K.; Jhalani, Manoj; Sudan, Preeti

doi:10.1136/bmj.k4782

Cited by 103 publications

(176 citation statements)

References 5 publications

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“…2 Various studies have reported reasons for nonvaccination as lack of awareness, apprehension about adverse events, vaccine resistance (reluctance to receive the vaccine for reasons other than fear of adverse events), child travelling, parents busy and programme related gap. 22 Our study also showed similar reasons for not immunizing their children.…”

Section: Resultssupporting

confidence: 76%

Assessment of immunization coverage and associated factors among children in Paravur Taluk of Ernakulam district, Kerala

Kizhatil

Reshma

Hariharan

et al. 2019

Int J Community Med Public Health

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Background: Immunization is one of the most cost-effective interventions averting countless childhood deaths and protecting millions of children from disability and illness. The objective of the current study was to assess the immunization coverage and associated factors among children aged 12-23 months and 5-7 years in Paravur Taluk of Ernakulam district, Kerala.Methods: A community based cross sectional study was done. Cluster sampling method of WHO was used for evaluation of immunization coverage.300 children in the age group of 12–23 months and 300 children in the age group 5-7 years were selected from each of the 30 clusters. Crude coverage details for each vaccine were estimated using percentages. Bivariate analysis was conducted to identify independent predictors of immunization coverage.Results: Among the children 12-23 months old, eleven (3.7%) children were partially immunized, while everybody had received at least one vaccine. The proportion of children fully immunized was 96.3%. Among the children 5-7 years old 55 (18.3%) were partially immunized. Belonging to Muslim religion, fathers’ occupation i.e. who were labourers/unskilled workers, mother’s education less than 12th standard and not possessing the mother and child protection card were found to be factors associated with partial immunization.Conclusions: This study shows that full immunization has not reached all children.

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Section: Resultssupporting

confidence: 76%

Assessment of immunization coverage and associated factors among children in Paravur Taluk of Ernakulam district, Kerala

Kizhatil

Reshma

Hariharan

et al. 2019

Int J Community Med Public Health

View full text Add to dashboard Cite

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“…A recent survey during Intensified Mission Indradhanush in 2017-18 revealed that lack of awareness (45%), apprehension about adverse events (24%), vaccine resistance (reluctance to receive the vaccine for reasons other than fear of adverse events) (11%) were the common reasons for non-vaccination among under-5 children. 5 Building upon the proposed dimensions of vaccine hesitancy, namely, awareness, accessibility, and acceptability, we studied their applicability in the rural settings of Odisha. While narrowing down from the wide scale of possible determinants of the vaccination coverage gap, these three dimensions have the possibility of ambiguity and overlap.…”

Section: Discussionmentioning

confidence: 99%

“…4 The government of India started a program, named as Intensified Mission Indradhanush in 2017 with a rigorous implementation strategy to target underserved, vulnerable, resistant, and inaccessible populations. 5 Amidst the tremendous progress achieved in immunization, there are increasing public concerns related to vaccine safety or efficacy. Public decision-making related to the acceptance of vaccine is driven by a mix of scientific, psychological, sociocultural, and political reasons.…”

Section: Introductionmentioning

confidence: 99%

Understanding the three As (Awareness, Access, and Acceptability) dimensions of vaccine hesitancy in Odisha, India

Sharma

Akhtar

Singh

et al. 2020

Clinical Epidemiology and Global Health

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Background: A considerable proportion of the population remain unvaccinated due to multiple reasons including vaccine hesitancy. To study the factors responsible for the incomplete immunization of under-5 children from the perspectives of the communities, a vaccine hesitancy survey was done in two districts of Odisha. In addition, the survey aimed to elucidate the reasons for differential vaccine hesitancy. Methods: This community-based cross-sectional study was conducted in the rural areas of Balangir and Nuapada districts in Odisha. We adapted the vaccine hesitancy survey questionnaire (core closed questions) developed by SAGE working group. We used this questionnaire in a sample of 260 households, selected from 30 clusters. The questions were categorized into three main dimensions, namely, awareness about vaccine efficacy, accessibility to obtain vaccine, and acceptability of the vaccines at the individual and community level. We used bivariate and multivariate regression analysis to determine the predictors for refusal or hesitancy of the vaccine. Results: Long distances and time are the two prime factors of accessibility linked with the refusal or hesitancy of the vaccine. We found that there is a high level of acceptance of vaccines at the level of parents and more than three-fourths took their children for vaccination despite hearing negative information about them. Pentavalent and measles were more commonly refused or hesitated vaccines by the parents compared to BCG or polio. Conclusion: In the current scenario of increasing immunization coverage in India, vaccine hesitancy acts as a missing link in action for the policymakers to achieve cent percent target.

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“…Vaccine studies also indicate the need to embed CE within India's immunization programs [19,21,22]. This growing sensitization about CE among Indian vaccine decisionmakers has been bolstered by the Supreme Court advisory which recommends meaningful dialogue with communities to accelerate vaccination uptake [21]. CE is also perceived to be an important step in addressing communities' vaccine resistance, which leads to delays that inhibit timely vaccination.…”

Section: Introductionmentioning

confidence: 99%

A qualitative analysis of vaccine decision-makers’ conceptualization and fostering of ‘community engagement’ in India

Dutta

Meyerson

Agley

et al. 2020

Preprint

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Background: Globally, and in India, research has highlighted the importance of community engagement in achieving national vaccination goals and in promoting health equity. However, community engagement is not well-defined and remains an underutilized approach. There is also paucity of literature on community engagement’s effectiveness in achieving vaccination outcomes. To address that gap, this study interviewed Indian vaccination decisionmakers to derive a shared understanding of the evolving conceptualization of community engagement, and how it has been fostered during India’s Decade of Vaccines (2010-2020).Methods: Semi-structured interviews were conducted with 25 purposefully sampled national-level vaccine decisionmakers in India, including policymakers, immunization program heads, and vaccine technical committee leads. Participants were identified by their ‘elite’ status among decisionmakers in the Indian vaccination space. Schutz’ Social Phenomenological Theory guided development of an a priori framework derived from the Social Ecological Model. The framework helped organize participants’ conceptualizations of communities, community engagement, and related themes. Inter-rater reliability was computed for a subsample of coded interviews, and findings were validated in a one-day member check-in meeting with study participants and teams. Results: The interviews successfully elucidated participants’ understanding of key terminology (“community”) and approaches to community engagement propagated by the vaccine decisionmakers. Participants conceptualized ‘communities’ as vaccine-eligible children, their parents, frontline healthcare workers, and vaccination influencers. Engagement with those communities was understood to mean vaccine outreach, capacity-building of healthcare workers, and information dissemination. However, participants indicated that there were neither explicit policy guidelines defining community engagement nor pertinent evaluation metrics, despite awareness that community engagement is complex and under-researched. Examples of different approaches to community engagement ranged from vaccine imposition to empowered community vaccination decision-making. Finally, participants proposed an operational definition of community engagement and discussed concerns related to implementing it.Conclusions: Although decisionmakers had different perceptions about what constitutes a community, and how community engagement should optimally function, the combined group articulated its importance to ensure vaccination equity and reiterated the need for concerted political will to build trust with communities. At the same time, work remains to be done both in terms of research on community engagement as well as development of appropriate implementation and outcome metrics.

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Improving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy

Abstract: Vandana Gurnani and colleagues report an analysis from the Intensified Mission Indradhanush strategy in India, showing that cross-sectoral participation can contribute to improved vaccination coverage of children at high risk

Cited by 103 publications

References 5 publications

Assessment of immunization coverage and associated factors among children in Paravur Taluk of Ernakulam district, Kerala

Assessment of immunization coverage and associated factors among children in Paravur Taluk of Ernakulam district, Kerala

Understanding the three As (Awareness, Access, and Acceptability) dimensions of vaccine hesitancy in Odisha, India

A qualitative analysis of vaccine decision-makers’ conceptualization and fostering of ‘community engagement’ in India

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