DISSERTATION

ON

A study on Evaluation of factors affecting Child immunization

SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTFOR THE AWARD OF THE DEGREE OF

MBA (HEALTH / HOSPITAL MANAGEMENT)

ByNoorussabah

UNDER THE SUPERVISION OFSAKHI JOHN

DEPARTMENT OF MANAGEMENT STUDIESJAMIA HAMDARD

2010-2012

FACULTY OF MANAGEMENT STUDIES, JAMIA HAMDARD

HAMDARD NAGAR NEW DELHI-110062

CONTENTS

Certificate

Acknowledgement

1-Executive summary 5

2- Introduction 6-9

3- Justification 10

4-Review of literature 11-18

5-Research methodology 19-22

4.1Objective of study

4.1.1Primary objective

4.1.2Secondary objective

4.2Scope of study

4.3 Data sources

4.3.1 Secondary data

4.3.2 Primary data

4.4 Type of research

4.5 Research Instruments

4.6 Sampling Design

4.6.1 Population definition

4.6.2 Sampling size

4.6.3 Sampling techniques

5-Data analysis and data Interpretation 23-41

6- Finding 42-43

6- Conclusion 44

7- Recommendation 45

8- Limitation 46

References 47

Bibliography 48 -49

Appendices 50

ACKNOWLEDGEMENT

I express my profound sense of gratitude to H.O.D Sir Prof (Dr) Ravi Chandra for his immense interest, invaluable guidance, moral support and constant encouragement during the tenure of this work. I am indebted for his coordination, encouragement and enlightening discussions at every stage of this project.

I would like to thank respected Sakhi john sir for his inspiring suggestions and positive encouragement in clarifying doubts. He helped me at every step to give this work a final shape, unless it would be impossible to complete this dissertation.

I express my heartfelt gratitude to all my friends for their support and help.

I would like to give special thanks to my parents who are always with me at time of despair difficulties and boosting my morale.

EXECUTIVE SUMMARY

This study is primarily focus on "A study on factor affecting child immunization. Child immunization is a serious and important issue for the society. In India government are doing lots of efforts for achieving the full immunization coverage .lots of free scams and different project start for increasing child immunization

Government of India meek new policy and set different targets but every time government cannot get 100% success because there is some factors affecting for full immunization coverage. Government only makes policy for providing free vaccination .but never make policy how people react to the vaccination.

Child is the feature of any nation and a nation can get success when its young generation becomes disease free. National immunization schedule cover six major

disuse which is help full for decrease child morbidity and mortality. But only formation of policy is not enough it need people get benefits for the government service for that its necessary government remove all the barriers which interfere between chide and immunization then we able to get 100% immunization coverage

.

In this study I try to rule out the barriers which affect the child immunization which interfere between child and immunization these factors related to education, economic status, social condition, medical facilities etc. when we control all these factors successfully then we will be able to get 100% result and then our nation can get a healthy generation who can change the entire world.

• INTRODUCTION Child immunization programmed is one of the most important public health programmed in country delivering effective health service to every child and mother is essential for achieving millennium development goals of the nation. The state is striding to achieve 100% immunization. Immunization is a key intervention under NRHM and activities under the program include intensified pulls polio immunization maintenance of cold chain procedure catch up immunization and special immunization to meet unmet need of the children in different rural areas.

In May 1974 WHO launched a global immunization programmed known as expanded programmed of immunization to protect all citizen of world against six vaccine _ preventive diseases namely – diphtheria, whooping cough, tetanus, polio, tuberculosis and measles by the year 2000.EPI was launched in India in unary 1978.

The programmed is called universal child immunization 1990 that’s the name is given by universal sponsor UNICEF as part of the united nation 40th anniversary in October 1985. It's aimed to adding inputs the global programmed of EPI.

The India version immunization programmed launched in 19 November 1985.anb was dedicated to memory of indri Gandhi. The national health policy aimed at achieving universal

immunization coverage of the eligible population by 1190.

WHO EPI Immunization schedule

AGE VACCINE

BIRTH BCG. oral polio vaccine

6 WEEKS DPT, oral polio

10 WEEKS DPT, oral polio

14 WEEKS DPT, oral polio

9 MONTHS M seals

Problem of child immunization

As the vaccine is temperature sensitive we have to maintain the cold chain whiz. There is an associated hazard to immunization which includes allergic hypersencivety reaction and post vaccine neurological manifestation. We have to keep the centre well equipped with the facilities to combat with these problems if need arises. There is regular time period for vaccines which is not strictly followed. No immune response is entirely free of adverse reaction or remote squeals. The adverse reaction that may occur may be grouped under the following.

• Reaction of given overdose vaccination: these may be general reaction. The local reaction may be pain swelling, redness tenderness, and development of small nodules, at earlier abscess at the site of injection. The general reaction may be fever, malaise, headache and other constitutional symptoms.

• Reaction due to given improper techniques: faulty technique may related to faculty production of vaccine ( e.g. in adequate inactivation of microbe, in adequate detoxication ) too many vaccine given in one dose , improper site or route, vaccine reconstituted with incorrect dilute, wrong amount of dilute used, drug substituted for vaccine or diluted, vaccine prepared incorrectly for use( e.g. an adsorbed vaccine not shake properly before use) vaccine or diluents contaminated , vaccine stored incorrectly.

• Tuberculosis

Standard cases definition suspected cough persisting for 2 weeks or more fits of coughing which may be followed by vomiting. Typical whoop in old infants and children expose to a suspect case in the previous 2 weeks or an epidemic of whooping cough in area. A case diagnosed as peruses by a physician or a person cough lasting at least 2 weeks with at least one of the following symptoms. Paroxysm of coughing, inspiratery whoop, post –jussive vomiting.

DIPHTHERIA

STANDARD CASES DEFINE SUSPECT Sore throat, mild fever, and grayish white membrane in throat, exposure to suspected case of diphtheria in the previous one week or a diphtheria epidemic in the area. An illness characterized by laryngitis or pharyingitis or tonsillitis and an adherent membrane of the tonsils, pharynx and nose. Probable case that is lab-confirmed or linked epidemiologically to a lab conformed case i.e. isolation of bacterium diphtheria from throat swab or four fold or greater rise in serum antibody (only if both serum sample are obtained before administration of diphtheria taxied or antitoxin). Diphtheria antitoxin and antibiotic can be suspected. Cases are isolated and contacts are vaccinated with diphtheria oxide to prevent additional cases.

POLIOMYELITISSTANDARD CASES DEFINITION SUSPECT

Sudden onset of weakness and floppiness in any part of the body in a child less than 15 year of age or paralyze in a person of any age in whom polio is suspected.

NEONATAL TETANUS

STANDARD CASE DEFINITION SUSPECT any neonatal death between 3 and 28 days of age in which the case of death is unknown or any neonatal reported as having suffered from neonatal tetanus between 3 and 28 days of age and not investigated. Any neonate with normal ability to suck and cry during the first 2 days of life and who, between 3 and 28 days cannot suck clinical and does not depend upon laboratory confirmation. NT cases reported by physician as considered to be confirmed.

Mile stone in national immunization programs in India.

1978 Expended programmed of immunization(EPI) introduce after eradication of smallpox.BCG,DPT,OPV ,Typhoid limited to mainly urban areas

1985 Universal immunization programmed(UIP)introduced

• Expanded to entire country• Measles added• Close monitoring of <1yr age

group

1986 Technology mission

1990 Vitamin A-supplement

1992 Child survival and safe motherhood program

1995 Polio national immunization days

1997 Reproductive and child health program(rich 1)

2005 RCH-2 AND THE NATIONAL RURAL HEALTH MISSION (NRHM)

• JUSTIFICATION

Full immunization is a basic right which every child should achieve. But there are lots of factors which affecting full for full immunization. Government makes planes and every time planes cannot get 100% success because of some social barrier this barrier is much in slum areas than posh areas.

Head has been removed for the purpose of funding to the state. The matter has been raised with the state government but it will at least take in year.

For development of child immunization is very important issue, when child not get full immunization it leads to improper child health and also create lots of health problem and malnutrition also. Most of the neonatal death occur due to improper immunization , child abuse for many disease like polio, diphtheria, measles, tetanus, tuberculosis etc. when we are able to provide full immunization it will helpful for prevent so many disease.

Mother's role is also very important in child immunization lots. Mother is the responsible for child we cannot neglect the role in child immunization.

• REVIEW OF LITERATURE

Routine immunization - do people know about it? A study among caretakers of children attending pulse polio immunization in east Delhi.

Rahal Sharma 1,10Sandi K Bhasin 2

1 Department of Community Medicine, VMMC and Safdarjung Hospital, New Delhi, India2 Department of Community Medicine, UCMS and GTB Hospital, Delhi - 110 095, India

The goal of immunizing children against chief diseases responsible for child mortality and morbidity is indeed a noble one. However, it is not an easy task to achieve. In a developing country like India, the sheer logistics of the numbers of the target population that stretches across geographically diverse regions make universal immunization of children a Herculean taps

Study on awareness about Hepatitis B dithered are several reasons to aim for universal coverage. The factors that should be helpful are many. The Indian culture promotes safe nurturing of children. Hardly do we find parents who risk their children to life-threatening diseases, unless they being unaware or misinformed. All vaccines under the routine immunization programmed are provided free-of-charge. However, the figures for the coverage of routine immunization (RI) are lagging. The current level of coverage of 'fully-immunized' children under the national immunization programmed is quite low, as pointed

out by several studiers' infection in coastal

It was a community-based cross-sectional study undertaken in November 2006. The respondents were people who took children under five years to a pulse polio immunization booth in the national capital territory of Delhi on 12 the November. Undergraduate medical students of our institute were deputed at the polio booths for this purpose. Each student was asked to interview 20 people at the booth where s (he) was deputed, it being convenience sampling. The anonymity of the respondents was assured and their verbal consent was taken. The study being a students' project was reviewed and approved by the department experts the time when the respondent came to the center was recorded. Most of the interviews (65.7%) had been conducted within the 3 h of activity by 12 p.m. The age of 682 respondents ranged between 11 and 77 years, the median age being 30 years. Nearly two-thirds (67.0%) of them belonged to the age group of 21-40 years, while 13.3% were below 21 years and 19.6% were above 40 years. There was almost equal representation of both genders (50.4% males and 49.6% females). While 95 (13.9%) persons were illiterate, 15.8% had finished primary school, 39.6% had done middle or high schooling, and 209 (30.6%) were graduates.

A survey conducted in China about KAP towards Vaccine preventable disease the result shows that the level of immunization knowledge among parents was positively associated with attitude and practice of immunization. Immunization coverage was89.3% in the high stratum in 63.8% in the low stratum service area (28).In Africa, a serious 30 cluster immunization coverage survey was undertaken as a survey of KAP among parents result of the survey showed 90% of population begins immunization but 30% drop out. The survey conducted in Ethiopia and the weighted national immunization coverage assessed by card plus history for children aged 12-23 months vaccinated before the age of one year was BCG 83.4%, DPT1 84.3%, DPT366.0%, measles 54.3%, and fully immunized children 49.9%. A community based cross-sectional survey in Sway town eastern show shows 53% of children were fully immunized, 19 % was defaulters and the rest were totally non-immunized. The reasons for defaulters were inconvenience of vaccination time, child sickness and lack of information about the need for repeated vaccination (30).April 1995 in Gander and surrounding villages in West Ethiopia cluster sampling was conducted to assess immunization coverage in area and problem associated with vaccination delivery. Among the sample children

47.4% fully immunized while 30% were not immunized at all. The reason given for not immunizing children were lack of knowledge 39.7% social problem 38.7% various obstacles 22% such as child sickness and health institution related problems (31).A cross sectional community based study was carried out in Jimmy town South west Ethiopia to determine reason for defaulting from expanded program of immunization(EPI) using structured questionnaire in March 1997. A total of 376 children aged 12 to23 months and their mothers were covered in study. Out of total 376 children 46.5%were fully immunized, 53.5% were defaulters. The reason given by mothers for not completing vaccination were missed appointments time (48.8%) mothers and no enough time (25.9%) and child was sick (23.4%) maternal age, neonatal care , parity, education knowledge about vaccine preventable disease and immunization. Another study in Jimmy town shows higher acceptance of immunization by mothers who have been educated to above 6 grade and the higher of educational status the higher rate of completing the vaccination schedule and the relation between occupation and child immunization were government employee was the first to fully immunize their child that is i.e. 94% and the least was house made that is 50% the reason for this might be government employee could have access to know the benefit of immunization from their passed education and daily activities but house maids might have lack of education &economy. Also the study had been identified factors associated with non immunization and defaulters was illiteracy, lack of knowledge about EPI target diseases attitude of mothers were 45.6% said very useful, 54.1% said useful and the rest 0.3% said not useful (32).Currently a great consideration have given for immunization, the result have been under expected. The aim of this study will be to assess the obstacles in relation to the mother KAP to child immunization

Awareness of vaccination status and its predictors among working people

A study on factors affecting immunizationChung-Yolk Lee1, Claudine Naguel2, Danielle Gyurech3, Nicole Duvoisin2 andJulian Schilling

Adult vaccination status may be difficult to obtain, often requiring providers to rely on individual patient recall. To determine vaccination status awareness and the sociodemographic Predictors of awareness for tetanus, hepatitis A and B, tick

born encephalitis (TBE) and influenzaVaccination.

Immunization-related knowledge, attitudes and practices of mothers

Mapatano MA, MD, Drip Professor, Department of Nutrition Kayembe K, MD, Drip Professor, Department of Epidemiology and Biostatistics Head of the Division of Research

In 1999, a cross-sectional household survey applied a systematic sampling technique in a sample of eight out of the 22 health zones that then served the population of Kinshasa. These were dichotomized into low- and high-coverage health zones, based on BCG immunization coverage. Mothers of children aged

from zero to four years were the respondents to a standardized questionnaire .

Different factors determine the complete vaccination status, depending on whether the child lives in a zone with low or high routine EPI coverage. For example, the father’s involvement is associated with the child’s vaccination status in the high- coverage zone, but not in the low-coverage zone. Programmers and policy makers should take these factors into account when designing strategies to increase immunization coverage

GENDER AND IMMUNISATION Report for SAGE, November 2010 Adriane Martin Hilbert, Xavier Bosch-Cap blanch, Christian Schindler, Lies Beck,

Florence Secular, Oran McKenzie, Sara Gary, Christina Suckle, Sonja Marten

According to the DHS, in 22 of the 29 Indian states, at least of 80% of children had received at least one dose of vaccine with a national average of 85.6%. Among these states which include Kerala, Several reached more than 90% of children with at least one dose of vaccine. Rajasthan remains. Below the national average. In Rajasthan, a poorer Indian state, the analysis of the DHS-survey revealed a low percentage of children with at least one dose of vaccine (78.4%). Sex discrepancies were not significant. TT-immunization of the mother was the most important predictor variable of infant Vaccination while the partner’s education had no effect. Wealth played a particularly important role in the vaccination status of children whose mothers were less empowered. In Kerala the DHS-survey

showed a vaccination rate of 97% (at least one dose of vaccine). TT-immunization of the mother is the Strongest predictor variable of infant vaccination. Mother’s education was the predominant variableAffecting children’s vaccination status.

Report on Vaccination Coverage Assessment “Indicators of immunization programs” Drain O’Flanagan, Noah Mullins

Factors affecting uptake of childhood immunization: a Bayesian synthesis of qualitative and quantitative evidence

Mary Dixon-Woods Phil -()-a, Prof Ray Fitzpatrick PhD b, Prof Keith R Abrams PhD a, Prof David R Jones PhD

Falls in levels of measles, mumps, and rubella (MMR) immunization in the UK and the continuing debate on how to respond to this situation emphasize the importance of identifying and understanding the factors that affect the uptake of recommended childhood immunizations. Both qualitative and quantitative evidence could be useful in this process. We aimed to explore the feasibility and value of an approach to formal synthesis of qualitative and quantitative evidence in the context of factors affecting the uptake of childhood immunization in developed countries. We used a Bayesian approach to meta-analysis. Evidence from 11 qualitative and 32 quantitative studies of factors affecting uptake of childhood immunization was combined and assessed. We conclude that use of either qualitative or quantitative research alone might not identify all relevant factors, or might result in inappropriate judgments about their importance, and could thus lead to inappropriate formulation of evidence-based policy. Further development of our methods might enable rigorous synthesis of qualitative and

quantitative evidence in this and other contexts.

Vijay Misra 1, 10Chittaranjan Panda1, 10Haribhakti Seba Das1, 10Kinshuk Chandra Nayak 2, 10Shivaram Prasad Singh1

1 Department of Gastroenterology, Sriram Chandra Bhanja Medical College, Cuttack-753007, India2 Institute of Life Sciences, Bhubaneswar - 751 023, India

Hepatitis B is a major health problem in India. To prevent transmission and progression of the disease in the community, proper community awareness about the disease, including prevention, is necessary. Our objective was to study the awareness amongst the general population about hepatitis B virus, including knowledge regarding vaccine the study was conducted in Department of Gastroenterology of SCB Medical College. The patients attending the OPD and their attendants were subjected to a questionnaire about different aspects of hepatitis B. Binary logistic regression analysis (SPSS 16) was employed to assess the statistical importance of the observations.

Only about one-third of the population in coastal Eastern India is aware about hepatitis B and its vaccine. Less than a third of the population is vaccinated for hepatitis B. The educated, especially those who read newspapers and listened to radio, were more aware about the disease/vaccine. The government health agencies and physicians should work together to educate the masses about hepatitis B and its vaccine. The community should be informed that HBV infection can affect any age and can persist for one's whole life despite the best of available therapies and that the infected person may remain asymptomatic and undiagnosed for long periods, and the diseased person may develop chronic complications like liver failure and liver cancer. Emphasis should especially be laid on awareness campaigns to educate the public that hepatitis B is vaccine preventable disease and that it could be easily prevented by three simple, easily

available, inexpensive shots of hepatitis B vaccine. The mass media should act

more conscientiously and come forward to educate the community about this easily preventable infection.

Comparison of my study from other study:

Others studies which already done earlier they also try to evaluates inhabiting factor for child immunization as general which effect the child immunization but I try to evaluate the mothers role in child immunization . no study is give so importance to mother's role for 100% coverage of child immunization. While mother is really a important for children's and immunization is also concern for children so if we want to achieve 100% result we cannot achieve it without mother's .i try to prove that a motivated mother towards immunization can be much beneficial than others still only mother cover two third of whole factors.

4)METHODOLOGY4.1 OBJECTIVE

4 1.1Primary objective

• Identify the factors affecting full immunization coverage which become barrier for full immunization.

4 1.2Secondary objective

Reassessment of mother’s practice towards child vaccination and its associated factors with child vaccination

• To study the role of community participation in supporting immunization services.

• To study the role of education, socio cultural back ground, economic status, religions etc.

4.2 Scope of study

Government of India are much concern on child 100% child immunization lots so planning and money expend for achieving the result but government cannot cover 100% immunization in this study try to rule out the factors which become like barriers for complete immunization .

4.3 Research design;

Using descriptive research design for this research project. To get complete information about child health problems and its influencing factors can be easily judge.

Quantitative research

Having applied quantitative research methodology for monitoring and evaluation facility wise performance of child at state to district level. This research includes

several key parameters likes as statically tool, data analysis and comparison, indicators wise performance evaluation report.

4.4 DATA SOURCES

4 4.1Primary data

: It has been collected by forming a proper questionnaire. Questionnaire is a systematic and

structured manner of collecting data for conducting experiment. The nature of the

questionnaire is very inductive and fundamental. It has been kept in a proper framework to

make it clear to the retailers. A sample questionnaire has been attached in the report. Primary

data can be collected in five main ways:

I. Observation

ii. Focus groups

iii. Surveys

iv. Behavioral data

v. Experiments

44.2 Secondary data :

Secondary data were collected from different websites, magazines, clinics..

4.5 TYPE OF RESEARCH

As far as this project is concern, it is a descriptive type of research work. The study was presented as a “depth interview”. This is an unstructured, direct, personal interview in which a single respondent is probed by a highly skilled interviewer to uncover underlying motivation, beliefs, attitudes, and feeling on the topic.

4.6 RESEARCH INSTRUMENTS

I. Questionnaire ii. Personal interview

‘Personal interview’ method was chosen for this project. According to the requirement it would be most appropriate to get data from community. Personal interview was taken. Questions were asked according to the situation to get the data as early as possible because only 5 to 6minutes people give for infraction personal interview is taken from clinks patients.

4.7 SAMPLING DESIGN

Sampling design is a conductive approach, which gives the research work a factual as well as conclusive framework. It contains sample size, which is basically a true representation of the target population. Sample size was 200 respondents.

Any sampling process starts from defining the problem and ends with final selection of the sample.

47.1 Population definition

The population comprises the children's parents come to the hospital and clinics for their child immunization:

4 7.2Sampling size: The total sample size is 100

4 7.3 Sampling techniques:

Here the ‘non probability’ technique was selected. Mainly through ‘judgment sampling’ process.

4 7.4 STUDY AREA

This study is conduct in three different areas of Delhi areas is named as:

Sangumvihar area in south Delhi for estimation of slum population

Greater Kailash area for estimation of high class area population.

5) DATA ANALYSIS AND INTERPRETATIONTable-1 According to area child immunization status

HIGH-CLASS ARESLUM AREA

89%55%

Graph-1

DATA INTERPRETATION according to different area immunization status change we did our study in different areas and we found that children who live in slum areas are less immunize than those children who live in posh areas. Posh areas child immunization status is 30% high than slum areas peoples.

AGE OF MOTHER Table-2 immunization status of children according to mother's age

15-29 YEAR OF AGE 29-45 YEAR OF AGE

77% 68%

Graph-2

DATA INTERPRETATION we take the data from different hospital and we found that child immunization statue is much higher their mothers are young than those children which mothers are after 30 child immunization status is lower.

MOTHER'S EDUCATION

Table-3 Immunization status in slum area according to mother's education.

NON SCHOOLING

PRIMARY

HEIGH SCHOOL

INTER MEDIATE

GRADUATION

POST GRADUATION

30% 35% 48% 55% 67% 80%

Immunization status in high-class area according to mother's education.

NON SCHOOLING

PRIMARY

HEIGH SCHOOL

INTER MEDIATE

GRADUATION

POST GRADUATION

45% 52% 60% 69% 78% 89%

Graph -3

DATA INTRPRETATION education is important factors for child immunization child immunization status is much higher in educated mother than less educated or UN educated. Educated mother understand the importance of immunization. We make comparison between slum area and high class area we see child belong high class are much immunize than slum area. Child which mother is highly educated are much immunize less educated.

MOTHER AWARENESS

Table -4 immunization status according to mother's awareness in slum area.

AWARE FOR FULL IMMUNIZATION

UNAWARE FOR FULL IMMUNIZATION

70% 30%

Immunization status according to mother's awareness in high-class area.

AWARE FOR FULL IMMUNIZATION

UNAWARE FOR FULL IMMUNIZATION

93% 45%

Graph-4

DATA INTERPRETATION 70% mothers are aware about full immunization including booster doses age but 30% mothers are not aware about full immunization they know only partial immunization most of the women who donor know the immunization belong to slum areas and they are un educated.

If we compare to high-class are then we found immunization status are much better than slum areas even posh areas women's who is un aware still higher immunization status than slum areas.

ECONOMIC STATUS

Table- 5LOW ECONOMIC STATUS

MEDIUM ECONOMIC STATUS

HEIGH ECONOMIC STATUS

45% 67% 89%

Graph-5

DATA INTERPRETATION children belong to high socio economies status are much immunized than those children who belong to less socio economic background.

WALK TIMETable-6 immunization status in children according to availability of health center distance.LESS THAN 30 MINUTES MORETHAN 30MINUTES

89% 65%

Graph-6

DATA INTERPRETATION distance from clinic or health center is also affect the immunization status area where health centers are much near children much

immunize than those areas where health centers is some distance.

VACCINATION CARDTable -7 immunization status in children according to vaccination card.HAVE VACCINATION CARD NOT HAVE VACCINATION CARD

92% 8%

Graph-7

DATA INTERPRETATION peoples who have vaccination card are much immunize vaccination card is aloe important factors people who donor understand the immunization value lost their vaccination cars.

PLACE OF DELIVERYTable-8 immunization status according to place of birth in slum

area.

GOVERN T HOSPITAL PRIVATE HOSPITALS HOME DELIVERY95% 87% 55%

immunization status according to place of birth in high-class area.

GOVERN T HOSPITAL PRIVATE HOSPITALS HOME DELIVERY80 93% 67%

Table-8

INTERPRETATION- immunization is also affect by place of delivery we found most of the children who born in hospital got maximum immunization than the children who born in home.

MOTHERS OCCUPATIONTable-9 Immunization status among children according to mother's education in slum area.

WORKING NON-WORKING

78% 65%

Immunization statue among children according to mother's education in slum area.WORKING NON-WORKING

98% 79%

Graph-9

DATA INTERPETATION working women's children are much immunized than nonworking women's.

FATHER EDUCATIONTable- 10 immunization status among children according to father's education in slum area.

NON-SCHOLLING

PRIMARY

HEIGHSCHOOL

INTERMEDIATE

GRADUATION

POST GRADUATION

32% 40% 55% 67% 75% 89%

Immunization status among children according to father's education in high-class area.

NON-SCHOLLING

PRIMARY

HEIGHSCHOOL

INTERMEDIATE

GRADUATION

POST GRADUATION

34% 48% 59% 73% 82% 93%

Graph -10DATA INTERPRETATION father's education is also important immunization status in children also direct proportion to the education of father.

GENDER OF CHILDTable-11 immunization status according to gender of child.MALE CHILD FEMALE CHILD

78% 77%

Graph-11

INTERPRETATION gender child is not affected for immunization means there is no discrimination in gender for immunization coverage there is very little difference between male and female immunization.

IMPORTANT OF FULL VACCINATION COVERAGETable-12 Immunization status according to full vaccination coverage.GIVE FULL IMPORTANCE NOT GIVE FULL IMMUNIZATION75% 25%

Graph-12

INTERPRETATION most of the people give importance full immunization coverage but it also become a barrier for achieving 100% immunization.

RELIGIONTable -13 immunization status according to religion.SAMPLE SIZE =100

MUSLIM HINDU OTHER RELIGION 67% 78% 70%

Graph - 13

INTERPRETATION In Muslim community immunization status is less than Hindus or other community there is lots of myths and believe which affect the immunization status in Muslim community and these myths also become barrier for immunization status.

Table 14 who in the family make the decision to take the child for vaccination

Mothers FATHER BOTH TOGETHAR

OTHERS

15% 15% 60% 10%

Graph-14

INTERPRETATION regarding immunization status most of the decision is taken by parents in some cases decision is taken by father or month.

• FINDINGS During our study I found socio economic factors are affect on immunization like people who belong to high social back ground are much immunize low socio economic back ground and award nests about immunization is also very less in poor people's the donor give much attention on immunization .

Most of the people give attention on half immunization not full coverage specially for booster dosage .most of the people donor include booster dosage as full immunization include it's as extra dose while immunization is not complete with it booster dose.

During study I found mothers education is also an important factors for full coverage off immunization because we found immunization level is increase as education of mother or father increase like if father or mother is post graduate then child immunization status is much higher than a graduate parent same as graduate immunization status is also much higher than inter mediate parents.

Religion is also an important factors like Muslim community immunization status is lower than Hindu community because lots of myths and miss believe runs in Muslim society specially for polio vaccine this is the rezone Muslim community immunization status is lower than Hindu community.

We also try to rule out the gender factor on immunization but it is not much important because we donor see any much difference between gender of children in immunization.

Government is much concern for instructional delivery we see child who born in government hospital or private hospitals their immunization level is much higher

than those children who born at home.

Occupation mother is also an important factor for child immunization children of working women's immunization status is much higher than non working women.

Family income is also direct proportion to the immunization children which parent's family income is higher are highly immunized than those which family income is lower.

• CONCLUSION

For full coverage of immunization we need to increase the awareness in the

community and try to understand the people's importance of immunization. Government should show more attention in that areas where is low socioeconomic status peoples live, low family income, low education level.

People of heir class go itself to hospital or health centers for immunization because they know the importance of immunization and they also ready to pay for immunization. But the people of low socioeconomic background not understand the importance of immunization specially the slum areas people where the medical facilities are not available much easily.

There is some insecurity and miss believe also run in the community government should give attention to remove for these miss believe and misconception. There should be organized much awareness programmed in the community which will help full for motivation of poor community for immunization.

• SUGGESTIONS

• Government should give more attention those areas and community where immunization status is low.

• Try to give mere attention on that factors which affect which become barrier for child immunization.

• Try to remove myths and believe which runs me the community and become barrier for full vaccination coverage.

• More awareness programmed should start in low immunize community.

• Give more attention on mothers education because an educated mother will be helpful for immunization coverage.

LIMITATIONS

1). 100 medicine counters and 100 customers were considered because of time constraint. An assumption is made that the sample represents the whole population. It will not carry the total reflection of the copier market. Total sample size is comparatively less to represent the entire population.

2) A time period of only 8 weeks was allowed for the completion of this project. So considering all the population for the study was not possible.

3). the data were of primary nature. So the degree biases were relatively high as the sample was randomly selected.

REFERANCES

1 -www.cci.in/pdf/surveys_reports/ indias _ health _ industry .pdf

2 -www.in.kpmg.com/pdf/ indian %20 health %20outlook.pdf

3 -www.medicinenet.com.›

4 -www. immunization .net.in /

5 -www.medicalnewstoday.com/info/

6 -www.breathefree.com/ immunization -in-children.html

7 -www.cdc.gov/

8 -www.ncbi.nlm.nih.gov

9 -www.epa.gov/

10 -emedicine.medscape.com/article/296301-overview

11 -http://www.scribbed.com/

13 -www.nlm.nih.gov/medlineplus.html

14 -http://www.imm.com

15-http://immunizenow.org/about/memberresources/default.aspx

16- http: //www.mohfw.nic.in

BIBLOGRAPHY

• Registrar general of India. Child mortality in India 1997-2003 trend causes and risk factors.

• Immunization hand book a hand book of immunization for medical officer. MOHFW go. of India 2011

• Parks text book of preventive medicine.

• Mavalankar DV singh baht r desai a patel srs Indian public private partnership for skill birth attendant

• Ministry of health and family welfare a hand book on child immunization status.

• Wong hockennberry Wilson and perry lower milk Child immunization and child health care 3 edition 11 health problem of children.

7) Immunization and Other Child Health IOCH Vaccination Coverage SurveyBy UNICEF & IOCH

• . CDC. Vaccination coverage by race/ethnicity and poverty level among children aged 19–

35 months—United States,

9(- Beri G.C, Marketing Research. Fourth Reprint, Tata McGraw Hill Private Limited, 2009 .

• Kotlar Philip, Marketing Management. Eleventh Edition, Pearsons Education, 2004

11) N.K Malhotra, Marketing Research. Fifth Edition, Pearsons Education, 2007

APPENDICES

QUESTIONAIRE

Personal questions

1) Name of parents

2) Age of parents

3) Religion of parents

4) Name of child

5) Age of child

6) Sex of child

7) Father occupation IM

8) Mother occupation

9) Where you live?

• Slum area • posh area

10) mother's education

Un

educated

Primary

education

Height

school

intermediate graduation Post

graduation

11 (Education of father

Un

educated

Primary

education

Height

school

intermediate graduation Post

graduation

12) Economic status of family

Height medium low

IMMUNIZATION RELATED QUESTION

13) Aware about immunization

Yes no

14) Distance from health center or clinic

Within 30 minutes After 30 minutes

15) Have you vaccination card

Yes no

16) Where is child born?

Home Private hospital Gov. hospital

17) Have you understood full vaccination is important or not??

Yes no

18) When child get vaccine first time??

Just after birth One hour after birth

12 hour after birth

7 days after birth

19) From where child get immunize??

Bid corporate hospitals

Government hospital

Small clinics At home