Background: This was a community-based, observational, cross-sectional study to determine the immunization status of children living in slums in the 26 blocks of Sangam Vihar and 4 blocks of Tigri extension area of South Delhi, India. Study Population: A total of 210 children between 12 and 23 months old. Sampling Technique: 30 cluster technique approved by the World Health Organization. Primary Outcome Measures: Immunization coverage by sex, religion, type of family, occupational status of the head of the family, stated average monthly family income, and education status of the mothers. Data collection procedure: Interview technique; principal investigator Dr. Imteyaz Ahmad collected the data using a standardized structured interview schedule with the mother/caregivers of children 12 to 23 months old after permission to conduct the study was taken from the civic authority of the local government. Record analysis of antenatal care for tetanus immunization by antenatal cards and BCG scar survey by observation of scar arm in the deltoid region for scar was also done by him. Results: One hundred and six (50.4%) children in our sample were found to be fully immunized, 88(41.9%) partially immunized and 16 (7.6%) were not immunized. Amongst these associations the difference of coverage by occupation groups and mothers education were found to be statistically significant. Conclusion: There was a discernable bias in favour of male children, Hindu children, children of nuclear family, children of non manual labour occupation parents, children from higher income family and children with mothers having high school or higher level education.
Keywords: Educational status, family, immunization, religion, sex
|How to cite this article:
Imteyaz A, Pal R, Akram M, Ahmad M, Shah H. Correlates of the immunization status of children in an urban slum of Delhi. Ann Trop Med Public Health 2008;1:59-63
|How to cite this URL:
Imteyaz A, Pal R, Akram M, Ahmad M, Shah H. Correlates of the immunization status of children in an urban slum of Delhi. Ann Trop Med Public Health [serial online] 2008 [cited 2020 Aug 9];1:59-63. Available from: https://www.atmph.org/text.asp?2008/1/2/59/50686
Communicable diseases kill more than 14 million people every year mainly in the developing world. In the last 3 to 4 decades, diseases like measles and tetanus continue to be a major cause of mortality and morbidity especially among young children in most of the developing countries like India.  Recent estimates suggest that approximately 24 million children are not completely immunized with almost 98% of them residing in developing countries.  Six children die every minute as a result of infectious diseases that could be prevented by existing vaccines. For measles alone, nearly one million children die each year, so each day, 4000-8000 people, mainly children, die from vaccine-preventable diseases. 
To estimate immunization status of children in an urban slum of Delhi.
|Materials and Methods|
Study design : Community-based, observational, cross-sectional study. Study period: October 2005 to April 2007. Study area: The 26 blocks of Sangam Vihar and 4 blocks of Tigri extension area of south Delhi. Inclusion criteria: Children between the ages of 12 and 23 months of either sex were included in the study for immunization coverage. Sample size: A total of 210 children between 12 and 23 months old. Sampling technique: In the first stage of sampling, the population of the study area had been divided into a set of non overlapping subpopulation by its geographical map. The study area had been divided into 30 blocks: 26 blocks from Sangam Vihar and 4 blocks from Tigri extension. In the second stage of sampling, seven eligible subjects were taken within each block. These blocks were defined as a cluster. Each cluster was a primary sampling unit. 30 cluster technique approved by WHO was used to assess the immunization coverage. Blocks were defined as a cluster; a geographical map of the area was used to select the cluster. From each of these clusters, the immunization status of 7 children between 12 and 23 months old and mothers of children between 1 and 11 months old was collected. The starting point of each cluster was selected by its central point by the coin tossing method. After entering the cluster, the first household was chosen for interview on the basis of the last 4 digits of a randomly chosen currency note and tallying the same with the house number. House-to-house visits and face-to-face interviews were conducted in each of these clusters until 7 children between 12 and 23 months old were found. Technique used: Personal oral interviews of the mothers/caretakers of children between 12 and 23 months old; recording analysis of antenatal care for tetanus immunization by antenatal cards; BCG scar survey by observation of the scar arm in the deltoid region by using a close ended, structured questionnaire in Hindi and Urdu, piloted retranslated before use. Outcome variable: Immunization coverage by sex, religion, type of family, occupational status of the head of the family, stated average monthly family income and education status of the mothers. Statistical analysis: Data were analyzed in the rates and proportion of immunization coverage, Chi-Square (χ2 ) test was applied to calculate the significance.
|Results and Discussions|
The study was conducted in Sangam Vihar area and Tigri Extension area of Delhi. Total of 210 children were assessed for immunization. Seventy percent of these children were Hindus and the rest mainly Muslims. Sixty percent children were male, 74% children belonged to nuclear family, most of the families were from low income categories, and about 90% belonged to lower occupation status. 66% of mothers had an education of primary level or less. In the current study one hundred six (50.4%) of them were found to be fully immunized, 88 (41.9%) partially immunized and 16(7.6%) were not immunized [Table 1] and [Figure 1].
The National Family Health survey 1998-99 found that 58% of children aged 12 to 23 months were fully immunized.  A study conducted in an urban slum of Delhi showed that 69.3% of the children were fully immunized, 15.7% of the children were partially immunized, and 15.1% of the children were not immunized.  Another study in Madhya Pradesh showed that 60.8% of the children were fully immunized, 27.7% of the children were partially immunized, and 11.5% of the children were not immunized.  An Indian study found that 63.3% of children were fully immunized, 27.1% of the children were partially immunized, and 9.6% of the children were not immunized. 
There was a discernable bias in favor of male children, Hindu children, children of nuclear families, children of non manual labor occupation parents, children from higher income families, and children with mothers having a high school or higher level education.
In our study population the coverage of full immunization was more in male children, higher in Hindu than Muslims, more of the children belong to nuclear family and higher income group [Table 2],[Table 3],[Table 4] & [Table 6] and [Figure 2],[Figure 3],[Figure 4] & [Figure 6]. But this difference was not significant. ( P >0.05)
In the current study, significant associations between the coverage levels of immunization of the children with mother’s level of education (χ2 =7.98, P<0.005) and occupational status of head of the family (χ2 =10.88, P <0.005) was observed. In the occupational status I & II there 80% of the children were fully immunized, while in status IV & V these figures were less than 25%. In those children, whose mothers were educated to primary levels or less, 43.6% were fully, and 47.1 % partially immunized, while 9.3% were not immunized at all. Of the children whose mothers were educated to the high school level, 59.0% were fully immunized, 36.0% were partially immunized, and 4.9% were not immunized. Of the children whose mothers were educated above high school levels, 100% of children were fully immunized [Table 5],[Table 6],[Table 7] and [Figure 5],[Figure 6],[Figure 7].
Researchers also observed that maternal literacy and education are significant in determining the complete immunization of the children.  Another study in Madhya Pradesh showed that 70.3% of children with literate mothers were fully immunized, a significant difference has been observed among the fully immunized children of literate parents especially for the literate mothers as compared with illiterate parents.  A study revealed that the quantity and quality of coverage was significantly better with literacy of mothers, as 46.5%, 39.6%, 13.8% children were found to be fully, partially, and not immunized, respectively in the group of literate mothers while in the illiterate groups these figures were 15.3%, 23.8%, and 61.54%, respectively.  A study in urban slums of south Delhi also showed that of children with illiterate mothers, 71.3% were fully immunized and 88.7% were partially/not immunized, while for children with literate mothers, 60% were fully immunized and 40% were partially/not immunized. The literacy status of the mothers was found to have a significant effect on the coverage.  In the current study, 70% of the participants were Hindus and the rest were mainly Muslims. A total of 60% percent of the children were male, 74% of the children belonged to nuclear families, most of them were from low income categories, about 90% belonged to a lower occupation status, and 66% of mothers had an education of primary level or less. The current study observed that non immunized rates in Hindus were 6.8% compared with 9.6% in Muslims. A study in Vikas Nagar North India also observed a lower immunization rate in Muslim families (65.4%) compared with Hindus (85.2%).  A study in Delhi showed that Muslims contributed significantly more cases of diphtheria than Hindus.  Another study showed a significant difference in immunization by religion: Muslim children were significantly less likely to be immunized. 
The current study reveals a representative picture of immunization coverage and the proximate factors determining the same in urban slums of Delhi. The finding of the research indicates that in developing countries we shall have to organize systematic studies to generate positive change in the attitude of health planners for optimum quality of life for our future generations.
We acknowledge the co-operation of the Department of Preventive and Social Medicine, Faculty of Medicine (Unani) Jamia Hamdard (Hamdard University) New Delhi, to give permission for the study as part of an MD dissertation. The authors also acknowledge the civic authority (M.L.A/and Councilor) of the study area.
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Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]