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Assignment Presentation of

PRIMARY HEALTH CARE IN NEPAL

On

IMMUNIZATION

SAgun PAudelRoll No. 22

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Background

The National Immunization Programme is a high priority programme (P1) of Government of Nepal. Immunization is considered as one of the most cost-effective health interventions. It has significantly contributed to reduce the burden of vaccine preventable diseases and child mortality.

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Nepal is one of the countries on track to achieve the Millennium Development Goal on Child Mortality reduction. National immunization Services cover all the districts, municipalities and Village Development Committees of the country and is provided free of cost.

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1. Anon. Routine Immunization and NID Coverage survey report,1998. Child Health Division, Department of Health Service,Kathmandu.

Nepal initiated (EPI) in the fiscal year 1978/79. By the next decade the programme was expanded to all the 75 districts of the country. due to various structural changes, the programme lagged behind and the national coverage of immunisation to around 80% could be reached by the year 2000 only. By 2004, some VPD, namely neonatal tetanus, diphtheria and poliomyelitis are reported to be reduced drastically. However, despite good coverage, measles and tuberculosis still remain prevalent. it is stated that approximately 18% of under-five children’s death in Nepal results from Vaccine Preventable Diseases.

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2. EPI vaccination in Nepal

(Jha, Kannan et al. 2001)Jha, N., A. T. Kannan, et al. (2001). "EPI vaccination in Nepal." Southeast Asian J Trop Med Public Health 32(3): 547-52.

Objective:

To evaluate the immunization coverage of the Expanded Program on Immunization (EPI) vaccines in the Sunsari district of Nepal

Methods

A number of surveys, small or large, have been undertaken by various agencies for coverage evaluation of immunization programs. The most commonly used design is the WHO-30 cluster sampling method. Other new methods are the Institute for Refresh Medical Statistics (IRMS) New Delhi method and the lot quality assurance sampling method. A total number of 3,332 respondents (69.4% females and 30.6% males) were interviewed regarding the immunization status of their children during NID.

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ResultsThe children with complete immunization (BCG, measles and three doses of DPT and OPV) were 65.7%. The individual coverage by EPI vaccines (except OPV III and measles) was more than 80%. ConclusionThe result shows that there is positive relationship between immunization coverage and educational level of the respondents.

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3. A cluster survey for determination of regular vaccination coverage among children Shah, H. (2008). "A cluster survey for determination of regular vaccination coverage among children." JNMA J Nepal Med Association 47(170): 91-3.

objectiveTo determine the coverage of immunization among children 12-23 months of age in Rautahat District of Nepal.MethodsA cross-sectional method was applied with the 30-cluster sampling method followed by taking a sample of 210 children. The structured questionnaire requesting information about socio-economic characteristics, vaccination, history of vaccination, doses of vaccines, and vaccination records were used for collecting data.

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Results

The coverage responses according to history from mothers for BCG, DPTHb-3, Polio3 and Measles immunizations were 96.7%, 90.0%, 97.6% and 78.1% respectively. By analyzing the records of the sampled Village Development Committees (VDCs), the coverage for the same vaccines was 88.1%, 78.1%, 79.0, 73.8% respectively. The drop-out of BCG versus measles was also very high. The District Health Office reports were remarkably higher than the coverage of immunizations obtained by the survey, showing additional number of the target children.

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4. Awareness about a national immunization day programme in the Sunsari district of Nepal.

N. Jha, S. Pokhrel & R. Sehgal (1999) “Awareness about a national immunization day programme in the Sunsari district of Nepal”Bull World Health Organ”.; 77(7): 602–606.

The study was carried out during the first NID (6 December 1996) to evaluate the local population's awareness of the programme and the impact of the media on such awareness. A total of 843 respondents were interviewed, 39% of whom were illiterate. Two important aspects of the mass campaign (whether a child previously immunized should be immunized again in the NID, and whether children should be brought to the next NID) were clearly understood by the majority of the people (93.1% and 98.8% of the respondents, respectively).

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although only a small proportion (24.4%) of individuals understood the purpose of the programme. Radio was the single most effective means of providing information, education, and communication about NIDs.

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5. Rapid Assessment of Perceptions, Knowledge, and Practices Related to Immunization Injection Safety in Nepal

M. D. Bhattarai,1 P. Adhikari, Dr. M. D. Bhattarai, A. Kane, T. Uprety, S. Wittet

Aim

To study perception, knowledge and practices regarding to immunization injection safety in Nepal 

Methods

During March–May 2001, key informant in-depth interviews and direct observations were conducted with 78 immunization providers and managers. Altogether, 42 immunization venues were visited. Twelve focus group discussions (FGDs) also were conducted with 122 mothers. Respondents came from 16 districts across the country and represent Nepal's ethnic and geographic diversity.

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Results

There were sufficient supplies of BCG, DPT, TT, polio and measles vaccines for the expected number of clients but lack of regular supply of other required materials for sterilization. Many managers and field-level staff complained of needles being repeatedly used until blunt, causing pain and distress for clients. A shortage of syringes and needles is seen across the board in EPI. Respondents also reported problems maintaining cold-chain equipment; fortunately, polio vaccine vial monitors (VVM) were found intact in all cases and none of them indicated excessive heat exposure.

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6. Survey on immunization status in western Nepal

Survey on immunization status in western Nepal, with special reference to kaski, gorkha and myagdi. By Dr. Rohit sainju, Kathmandu research center.

ObjectiveThe study has been successful in its objective of finding out the immunization coverage of mothers and infants in the survey sites.Methods:50 mothers (with at least one child under five years of age) were selected from one ward in each of the three districts. Questionnaires were used to ascertain the vaccination status of 150 mothers and 196 children under five years of age. Another questionnaire was used for the health post in-charge to learn about the problem of vaccination services.

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Result

Coverage of BCG was found to be higher than the national figure (84.5%) in all the survey sites.

Coverage of DPT is higher than that of the national coverage in sardikhola kaski (85.2% vs 76.8%.

The coverage of measles vaccine was lower than national coverage for the same vaccine in all three survey sites

TT coverage for the all three survey sites was found to be far better than the national coverage.

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Immunisation against Japanese Encephalitis in Nepal:Experience of 1152 subjectsMaj A Henderson*,BMedSci, MRCP, RAMCPhysician, British Military Hospital, Dharan

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7. Immunization coverage of children in a semi-urban village panchayat in Nepal, 1985

Ahluwalia, Indu B.

Helgerson, Steven D.

Bia, Frank J.

funded by the Yale International Committee and in cooperation with UNICEF, Nepal, used a questionnaire to survey and assess the immunization status of children 3 years or younger in a semi-urban panchayat. Mothers of children ranging in age from less than 1 month to 3 years were questioned both about immunization status of their children and their own use of health care and specific sources of information. 54% (124/228) of the children had received at least one vaccine and only 4% (10/228) had full coverage with the recommended vaccines (3 doses of DPT and TOPV, one dose of measles and BCG). Children born at a hospital were more likely than those born at home to have been vaccinated.

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More than 70% of the women felt that vaccinations were good preventive measures. The study results suggest that health education about immunization efforts should be focused on women and these efforts should be intensified.

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8. Determinants of child immunization in Nepal: The role of women’s empowerment Shanta Pandey, PhD , Hae nim Lee, MSW

Objective:  examined if women’s empowerment improved child immunization using data on 1,056 mothers with young children from Nepal.Methods: The study utilized the 2006 Nepal Demographic and Health Survey, a nationally-representative sample of 10,793 women from 8,707 households across Nepal. We selected all mothers with first child between the ages of 12 and 23 months at the time of interview. This resulted in a sample of 1,056 mothers.

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Results:

 Among the measures of women’s empowerment, mothers’ education was significantly associated with child immunization. The odds of being fully immunized for children of mothers with secondary education were 5.91 times the odds for children of mothers without any formal education. Other measures of women’s empowerment – women’s age at birth of first child, gap in age between spouses, women’s knowledge about sexually-transmitted diseases, their role in intra-household financial, health and mobility decisions, and their perceptions toward wife beating – were not associated with child immunization. Among control variables, mothers who received antenatal care were 3.31 times as likely to immunize their children as mothers who did not receive any antenatal care. Other such barriers to health service use such as cost of care, distance to health services, and quality of health services were not significant.

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ANNUAL REPORT 2065/66, Department of Health Service

The national Immunization coverage of all antigens in the regular EPI programme did not improved last year. DPT/Hep-3 and Polio3 coverage has decreased by 1.0 percent and Measles immunization has decreased by more than 3.0 percent compared to last fiscal year. TT-2 to pregnant women has also decreased by 6 percentage.

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ANNUAL REPORT 2067/68, Department of Health Service

The national Immunization coverage of all antigens in the regular EPI programme was improved compared to last fiscal year 2065/66 (2008/2009). BCG, DPT-Hep B-Hib-3, Polio3 and Measles coverage has increased by 9, 1, 2 and 11 percent respectively during last fiscal year. TT-2 to pregnant women has also increased by 8.0 percent. Currently NIP provides vaccination against TB (BCG), diphtheria‐pertussis‐tetanus‐hepatitis B andhaemophilus influenza (DPT‐HepB‐HiB), poliomyelitis (OPV) and measles throughout the country andJE vaccine in high risk post campaign districts through routine immunization.

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THANKYOU!