TY - JOUR
T1 - Predictors of optional immunization uptake in an urban south Indian population
AU - Manthiram, Kalpana
AU - Blood, Emily A.
AU - Kuppuswamy, Vasanthan
AU - Martins, Yolanda
AU - Narayan, Athi
AU - Burmeister, Kelly
AU - Parvathy, K.
AU - Hassan, Areej
N1 - Funding Information:
The authors would like to thank the Pallavapuram community for participating in this study. Funding was provided from the Leadership Education in Adolescent Health training grant #T71MC00009 from the Maternal and Child Health Bureau at the Health Resources and Services Administration and the Schiesman Traveling Fellowship from Boston Children's Hospital . Dr. S. Swarnalakshmi, PhD, Ms. Geetha, and Dr. Suniti Solomon, MD, at YRG-CARE kindly reviewed the ethical aspects of the project in India. Mr. and Mrs. Kuppuswamy, Ms. Mary, Ms. Anjali, Ms. Dhanam, Ms. Pilomina, Mr. Vignesh, Mr. Rajendran Venkattareddy, Mr. Ravikumar, Ms. Uma Ganapathi, Mr. Shankar Kumar, Mr. Kolandavel Ramasamy, and Ms. Rajeswari Manthiram were graciously helpful in data collection and translation. Drs. Kathryn Edwards, MD, Elizabeth Woods, MD, Heather Corliss, PhD, Atsuko Koyama, MD, and Kathryn Brigham, MD provided helpful input on study design and/or manuscript review.
PY - 2014/6/5
Y1 - 2014/6/5
N2 - Background: In Tamil Nadu, India, bacille Calmette-Guérin, diphtheria-tetanus-pertussis, oral poliomyelitis, hepatitis B, and measles vaccines are part of the routine immunization schedule and are available free from government health centers. All other vaccines are optional and available in the private sector at a cost to families. This study assesses immunization rates of routine and optional vaccines and examines parental attitudes toward vaccines in Pallavapuram, Tamil Nadu. Methods: The cluster sampling method was used to estimate immunization coverage. Seven children 18 to 36 months old were selected from 30 clusters for a total sample of 210 children. Demographics and vaccination data were collected from interviews and immunization records. Predictors of vaccination status were identified with logistic regression models. In addition, 21 parents participated in semi-structured interviews regarding their attitudes toward vaccination. Interviews were analyzed qualitatively for themes. Results: Eighty one percent of children were fully immunized with routine vaccines. However, only 21% received all "major" optional vaccines, defined as 3 doses of Haemophilus influenzae type b vaccine, one dose of measles, mumps, rubella vaccine, and one dose of varicella zoster virus vaccine. Birth in a private hospital (OR 5.6, 95% CI 1.3 to 22.9, P< 0.01), higher income (P= 0.03), and maternal completion of high school (OR 6.4, 95% CI 1.5 to 27.6, P< 0.01) were significant predictors of receiving all major optional vaccines. Elucidated themes from interviews included (1) strong parental support for immunizations, (2) low concern for side effects, and (3) low uptake of optional vaccines due to high cost and lack of awareness. Conclusions: Coverage of optional vaccines is low despite positive attitudes toward immunizations. Efforts to reduce cost and increase awareness of these vaccines particularly among low-income families or to include these vaccines in the routine schedule may increase uptake and reduce morbidity and mortality from vaccine-preventable diseases.
AB - Background: In Tamil Nadu, India, bacille Calmette-Guérin, diphtheria-tetanus-pertussis, oral poliomyelitis, hepatitis B, and measles vaccines are part of the routine immunization schedule and are available free from government health centers. All other vaccines are optional and available in the private sector at a cost to families. This study assesses immunization rates of routine and optional vaccines and examines parental attitudes toward vaccines in Pallavapuram, Tamil Nadu. Methods: The cluster sampling method was used to estimate immunization coverage. Seven children 18 to 36 months old were selected from 30 clusters for a total sample of 210 children. Demographics and vaccination data were collected from interviews and immunization records. Predictors of vaccination status were identified with logistic regression models. In addition, 21 parents participated in semi-structured interviews regarding their attitudes toward vaccination. Interviews were analyzed qualitatively for themes. Results: Eighty one percent of children were fully immunized with routine vaccines. However, only 21% received all "major" optional vaccines, defined as 3 doses of Haemophilus influenzae type b vaccine, one dose of measles, mumps, rubella vaccine, and one dose of varicella zoster virus vaccine. Birth in a private hospital (OR 5.6, 95% CI 1.3 to 22.9, P< 0.01), higher income (P= 0.03), and maternal completion of high school (OR 6.4, 95% CI 1.5 to 27.6, P< 0.01) were significant predictors of receiving all major optional vaccines. Elucidated themes from interviews included (1) strong parental support for immunizations, (2) low concern for side effects, and (3) low uptake of optional vaccines due to high cost and lack of awareness. Conclusions: Coverage of optional vaccines is low despite positive attitudes toward immunizations. Efforts to reduce cost and increase awareness of these vaccines particularly among low-income families or to include these vaccines in the routine schedule may increase uptake and reduce morbidity and mortality from vaccine-preventable diseases.
KW - Immunization coverage
KW - Optional immunizations
KW - Parental attitudes
UR - http://www.scopus.com/inward/record.url?scp=84901013810&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2014.04.012
DO - 10.1016/j.vaccine.2014.04.012
M3 - Article
C2 - 24736005
AN - SCOPUS:84901013810
SN - 0264-410X
VL - 32
SP - 3417
EP - 3423
JO - Vaccine
JF - Vaccine
IS - 27
ER -