07/06/20131Assignment Presentation ofPRIMARY HEALTH CARE IN NEPALOnIMMUNIZATIONSAgun PAudelRoll No. 22
Background07/06/20132The National Immunization Programme is a highpriority programme (P1) of Government ofNepal. Immunization is considered as one of themost cost-effective health interventions. It hassignificantly contributed to reduce the burden ofvaccine preventable diseases and childmortality.
07/06/20133Nepal is one of the countries on track to achievethe Millennium Development Goal on ChildMortality reduction. National immunizationServices cover all the districts, municipalitiesand Village Development Committees of thecountry and is provided free of cost.
1. Anon. Routine Immunization and NID Coverage survey report,1998.Child Health Division, Department of Health Service,Kathmandu.07/06/20135Nepal initiated (EPI) in the fiscal year 1978/79. By thenext decade the programme was expanded to all the75 districts of the country. due to various structuralchanges, the programme lagged behind and thenational coverage of immunisation to around 80%could be reached by the year 2000 only.By 2004, some VPD, namely neonataltetanus, diphtheria and poliomyelitis are reported tobe reduced drastically. However, despite goodcoverage, measles and tuberculosis still remainprevalent. it is stated that approximately 18% ofunder-five children’s death in Nepal results fromVaccine Preventable Diseases.
2. EPI vaccination in Nepal07/06/20136(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 ExpandedProgram on Immunization (EPI) vaccines in the Sunsaridistrict of NepalMethodsA number of surveys, small or large, have been undertakenby various agencies for coverage evaluation of immunizationprograms. The most commonly used design is the WHO-30cluster sampling method. Other new methods are the Institutefor Refresh Medical Statistics (IRMS) New Delhi method andthe lot quality assurance sampling method. A total number of3,332 respondents (69.4% females and 30.6% males) wereinterviewed regarding the immunization status of their
07/06/20137ResultsThe children with complete immunization(BCG, measles and three doses of DPT andOPV) were 65.7%. The individual coverage byEPI vaccines (except OPV III and measles)was more than 80%.ConclusionThe result shows that there is positiverelationship between immunization coverageand educational level of the respondents.
3. A cluster survey for determination ofregular vaccination coverage amongchildren07/06/20138Shah, H. (2008). "A cluster survey for determination of regular vaccinationcoverage among children." JNMA J Nepal Med Association 47(170): 91-3.objectiveTo determine the coverage of immunization amongchildren 12-23 months of age in Rautahat District ofNepal.MethodsA cross-sectional method was applied with the 30-cluster sampling method followed by taking a sampleof 210 children. The structured questionnairerequesting information about socio-economiccharacteristics, vaccination, history ofvaccination, doses of vaccines, and vaccinationrecords were used for collecting data.
Results07/06/20139The coverage responses according to historyfrom mothers for BCG, DPTHb-3, Polio3 andMeasles immunizations were96.7%, 90.0%, 97.6% and 78.1% respectively.By analyzing the records of the sampled VillageDevelopment Committees (VDCs), the coveragefor the same vaccines was88.1%, 78.1%, 79.0, 73.8% respectively. Thedrop-out of BCG versus measles was also veryhigh. The District Health Office reports wereremarkably higher than the coverage ofimmunizations obtained by the survey, showingadditional number of the target children.
4. Awareness about a national immunization dayprogramme in the Sunsari district of Nepal.07/06/201310N. Jha, S. Pokhrel & R. Sehgal (1999) “Awareness about a national immunization day programme inthe Sunsari district of Nepal”Bull World Health Organ”.; 77(7): 602–606.The study was carried out during the first NID (6December 1996) to evaluate the local populationsawareness of the programme and the impact of themedia on such awareness.A total of 843 respondents were interviewed, 39% ofwhom were illiterate.Two important aspects of the mass campaign (whether achild previously immunized should be immunized againin the NID, and whether children should be brought tothe next NID) were clearly understood by the majority ofthe people (93.1% and 98.8% of therespondents, respectively).
07/06/201311although only a small proportion (24.4%) ofindividuals understood the purpose of theprogramme. Radio was the single most effectivemeans of providing information, education, andcommunication about NIDs.
5. Rapid Assessment of Perceptions, Knowledge, andPractices Related to Immunization Injection Safety inNepal07/06/201312M. D. Bhattarai,1 P. Adhikari, Dr. M. D. Bhattarai, A. Kane, T. Uprety, S. WittetAimTo study perception, knowledge and practices regarding toimmunization injection safety in NepalMethodsDuring March–May 2001, key informant in-depth interviewsand direct observations were conducted with 78immunization providers and managers. Altogether, 42immunization venues were visited. Twelve focus groupdiscussions (FGDs) also were conducted with 122 mothers.Respondents came from 16 districts across the country andrepresent Nepals ethnic and geographic diversity.
Results07/06/201313There were sufficient supplies of BCG, DPT, TT, polioand measles vaccines for the expected number ofclients but lack of regular supply of other requiredmaterials for sterilization. Many managers and field-level staff complained of needles being repeatedlyused until blunt, causing pain and distress for clients.A shortage of syringes and needles is seen acrossthe board in EPI. Respondents also reportedproblems maintaining cold-chain equipment;fortunately, polio vaccine vial monitors (VVM) werefound intact in all cases and none of them indicatedexcessive heat exposure.
6. Survey on immunization status in westernNepal07/06/201314Survey on immunization status in western Nepal, with special reference tokaski, gorkha and myagdi. By Dr. Rohit sainju, Kathmandu research center.ObjectiveThe study has been successful in its objective offinding out the immunization coverage of mothers andinfants in the survey sites.Methods:50 mothers (with at least one child under five years ofage) were selected from one ward in each of thethree districts. Questionnaires were used to ascertainthe vaccination status of 150 mothers and 196children under five years of age. Anotherquestionnaire was used for the health post in-chargeto learn about the problem of vaccination services.
Result07/06/201315 Coverage of BCG was found to be higher thanthe national figure (84.5%) in all the surveysites. Coverage of DPT is higher than that of thenational coverage in sardikhola kaski (85.2%vs 76.8%. The coverage of measles vaccine was lowerthan national coverage for the same vaccine inall three survey sites TT coverage for the all three survey sites wasfound to be far better than the national
Immunisation against Japanese Encephalitis in Nepal:Experience of 1152 subjectsMaj A Henderson*,BMedSci, MRCP, RAMCPhysician, British Military Hospital, Dharan07/06/201316
7. Immunization coverage of children in a semi-urbanvillage panchayat in Nepal, 198507/06/201317Ahluwalia, Indu B.Helgerson, Steven D.Bia, Frank J.funded by the Yale International Committee and in cooperationwith UNICEF, Nepal, used a questionnaire to survey and assessthe immunization status of children 3 years or younger in asemi-urban panchayat.Mothers of children ranging in age from less than 1 month to 3years were questioned both about immunization status of theirchildren and their own use of health care and specific sources ofinformation.54% (124/228) of the children had received at least one vaccineand only 4% (10/228) had full coverage with the recommendedvaccines (3 doses of DPT and TOPV, one dose of measles andBCG).Children born at a hospital were more likely than those born athome to have been vaccinated.
07/06/201318More than 70% of the women felt thatvaccinations were good preventive measures.The study results suggest that health educationabout immunization efforts should be focused onwomen and these efforts should be intensified.
8. Determinants of child immunization in Nepal: The role ofwomen’s empowermentShanta Pandey, PhD , Hae nim Lee, MSW07/06/201319Objective: examined if women’s empowermentimproved child immunization using data on1,056 mothers with young children from Nepal.Methods: The study utilized the 2006 NepalDemographic and Health Survey, a nationally-representative sample of 10,793 women from8,707 households across Nepal. We selected allmothers with first child between the ages of 12and 23 months at the time of interview. Thisresulted in a sample of 1,056 mothers.
Results:07/06/201320Among the measures of women’s empowerment, mothers’education was significantly associated with child immunization.The odds of being fully immunized for children of mothers withsecondary education were 5.91 times the odds for children ofmothers without any formal education.Other measures of women’s empowerment – women’s age atbirth of first child, gap in age between spouses, women’sknowledge about sexually-transmitted diseases, their role inintra-household financial, health and mobility decisions, andtheir perceptions toward wife beating – were not associated withchild immunization.Among control variables, mothers who received antenatal carewere 3.31 times as likely to immunize their children as motherswho did not receive any antenatal care. Other such barriers tohealth service use such as cost of care, distance to healthservices, and quality of health services were not significant.
ANNUAL REPORT 2065/66, Department of Health Service07/06/201321The national Immunization coverage of allantigens in the regular EPI programme did notimproved last year. DPT/Hep-3 and Polio3coverage has decreased by 1.0 percent andMeasles immunization has decreased by morethan 3.0 percent compared to last fiscal year. TT-2 to pregnant women has also decreased by 6percentage.
ANNUAL REPORT 2067/68, Department of Health Service07/06/201322The national Immunization coverage of all antigens inthe regular EPI programme was improved compared tolast fiscal year 2065/66 (2008/2009). BCG, DPT-HepB-Hib-3, Polio3 and Measles coverage has increasedby 9, 1, 2 and 11 percent respectively during last fiscalyear. TT-2 to pregnant women has also increased by8.0 percent. Currently NIP provides vaccination againstTB (BCG), diphtheria‐pertussis‐tetanus‐hepatitis Bandhaemophilus influenza(DPT‐HepB‐HiB), poliomyelitis (OPV) and measlesthroughout the country andJE vaccine in high risk postcampaign districts through routine immunization.