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ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 560-566

Epidemiological study to assess the status of measles vaccination in under five children and factors associated, in a peri-urban area, Asudgaon village, in Raigad district, Maharashtra, India


Department of Community Medicine, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India

Date of Submission21-Sep-2022
Date of Acceptance05-Dec-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Dr. Neha Riswadkar
Department of Community Medicine, MGM Medical College and Hospital, Kamothe, Navi Mumbai 410209, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_170_22

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  Abstract 

Background: Measles continues to be a major cause of childhood morbidity and mortality in India. Measles is considered one of the leading vaccine-preventable causes of child mortality worldwide. Major reasons for low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization. Materials and Methods: A cross-sectional, descriptive, epidemiological study that aimed to examine the coverage of measles vaccination among under-five children of Asudgaon village. All under-five children residing in every 5th household of the village were included(n = 445). After obtaining consent from the mother, data was collected from her using a pre-designed and pre-tested questionnaire. The data was entered and analyzed in SPSS 23. Results: There was a total of 100 children eligible for the study. Overall, 41% of children were fully immunized against measles, 37% were partially immunized, 5% were immunized to date and 17% were not immunized. The most reasons for partial or non-immunization for measles were inadequate knowledge about immunization (19%), unawareness of days of vaccination(n = 14%), the child being ill at the time of vaccination, husband or mother-in-law against vaccination, fear of effects, and others. The Chi-square test indicates a significant association between mothers’ education and measles vaccination. Conclusion: Immunization status needs to be improved through education, increasing awareness, and counseling of parents regarding immunization and associated misconceptions as observed in the study.

Keywords: Immunization, measles, measles-rubella vaccine, vaccination coverage


How to cite this article:
Riswadkar N, Waingankar PJ, Relwani NR, Sanjeev S. Epidemiological study to assess the status of measles vaccination in under five children and factors associated, in a peri-urban area, Asudgaon village, in Raigad district, Maharashtra, India. MGM J Med Sci 2022;9:560-6

How to cite this URL:
Riswadkar N, Waingankar PJ, Relwani NR, Sanjeev S. Epidemiological study to assess the status of measles vaccination in under five children and factors associated, in a peri-urban area, Asudgaon village, in Raigad district, Maharashtra, India. MGM J Med Sci [serial online] 2022 [cited 2023 Feb 6];9:560-6. Available from: http://www.mgmjms.com/text.asp?2022/9/4/560/365974




  Introduction Top


Measles continues to be a major cause of childhood morbidity and mortality in India. Although the true burden is difficult to quantify, only a small proportion of cases seek treatment in the formal health sector. Measles is considered one of the leading vaccine-preventable causes of child mortality and morbidity worldwide. Measles vaccination also prevents measles outbreaks. The current strategy utilized by World Health Organization (WHO) /United Nations Children’s Fund (UNICEF) to reach the measles reduction goal, includes increasing coverage of the measles vaccine, vitamin A treatment, and supplementation in addition to offering two doses of vaccine to all.[1]

Immunization has been one of the most significant and cost-effective Public-health interventions to decrease childhood morbidity and mortality. The World Health Organization launched the Expanded Programme on Immunization (EPI) in 1974 for the protection of children against the 6 deadly diseases: diphtheria, pertussis, tetanus, tuberculosis, measles, and poliomyelitis. The government of India responded to WHO’s a worldwide effort by starting its EPI in 1978. On 19 November 1985, the Universal Immunization Programme was introduced in India, aiming at covering at least 85% of all infants by 1990. According to the National Family Health Survey NFHS -5, 95 percent of children are at least partially vaccinated; only 5 percent have not received any vaccinations at all. Vaccinations were recorded from a vaccination card for a large majority (84%) of children, which is a substantial increase since NFHS-4 (61%).[2] Reasons for lack of coverage vary from logistic ones to those dependent on human behavior.

The DHLS-3 data showed 69% full immunization coverage in Maharashtra.[3] However further analysis of the survey showed that there are big regional variations within the state regarding child immunization coverage.[4] Measles vaccination coverage (MCV1) in India improved significantly from 51% to 81% in 2016.

Major reasons for the low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization and fails to take advantage of many opportunities to provide vaccines to children. Ideally, immunizations should be given as part of a comprehensive child health care program. The nation experienced a marked increase in measles cases between 1989 and 1990. Almost one-half of all cases have occurred in unvaccinated preschool children, mostly minorities. The measles epidemic may be a warning flag of problems with our system of primary health care.[5]To control and eliminate vaccine-preventable diseases it is important to know the vaccination coverage and reasons for non-vaccination. Because of this, the study aims to identify the status of Measles Vaccination in under-5 children and factors associated with it in peri-urban areas, Asudgaon Village in Raigad District in Maharashtra. Between NFHS - 4 and NFHS - 5 measles vaccination showed an increase in vaccination coverage in Maharashtra from 83% to 85%, and in Raigad district up to 97.8%.[2] But the catchment area for a tertiary care hospital, Asudgaon village, in Raigad district has lower coverage of measles vaccination. So, this study was carried out to examine the coverage of measles vaccination in Asudgaon and also identify the reasons for partial and non-vaccination of measles.


  Materials and methods Top


A cross-sectional, descriptive, epidemiological study that aimed to examine the coverage of measles vaccination among under five (U5) children of Asudgaon village. The study was conducted in April-June 2019. We included all the U5 children residing in the selected households of the village (n = 100). First, we listed all households having at least one U5 child, and then we selected every 5th household (n = 445). After obtaining informed consent from the mother of the child, we collected the data from her using a pre-designed, pre-tested questionnaire. The questionnaire included socio-demographic and personal and family characteristics like age, sex, level of education of parents, per capita income using the Modified BG Prasad scale,[6] occupation of parents, etc. The reasons for partial or non-vaccination were assessed. After data collection, 2 faculty members reviewed them independently and data entry was done. The immunization status of the child was assessed by vaccination card and my mother recalled where the vaccination card was not available. We entered data in SPSS 23 and performed applicable statistical tests including the chi-square test.

The immunization status of the children was categorized as follows:

Non-Vaccination

- Children who had not received the measles vaccine up to 12 months of age vaccine were classified as non-immunized.

Partial Vaccination

- A child who has missed the second dose of the Measles vaccine after 2 years. (age group for 2nd dose 16–24 months)

Immunized till date

- A child who has received 1st dose of the measles vaccine at 12 months but is less than 16 months, hence not eligible for measles 2nd dose.

Fully immunized

- A child who has received both doses of measles vaccine at 9 months and 16–24 months respectively, with or without additional MR vaccine received during the campaign.


  Results Top


The study population included 100 children aged between 9–59 months, of whom, 59% of children were boys. 1/3rd of the children were 3 years old. One-third (31%) had a birth order of 3. Only 36% were urban births. Most of the households were Hindu (95%). Three-quarters (75%) had the Marathi language as their mother tongue. The average age of the mothers is 26 years, and for the father is 30 years. The multitude of the mothers was educated till only high school (High school:43%),34% were educated up to middle school and only 23% were educated above high school. Half of the fathers were educated above High school and 28% and 23% were educated only up to high school and Middle school respectively. The type of family they lived in showed that 90% were part of a nuclear family, and 10% were part of three generations family.

About their order of birth, 31% stood in the third order, while 22% were in the second order. Nearly 93% of children had institutional births, and 7% of them were at home. According to the household income, their SES has been shown in [Table 1]. One-third of households belonged to the Lower class, nearly half were middle class (43%), and only 22% belonged to the upper class. The status of the administration of the vaccine against Measles is shown in [Figure 1].
Table 1: Sample distribution of the study population. (n = 100)

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Figure 1: Coverage of measles vaccination doses

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As regards possession of immunization cards and status of vaccination,75% of children’s mothers had cards showing various vaccinations administered to their children. 41% of them were fully immunized against measles, 37% were partially immunized, 5% were immunized to date and 17% were not immunized against measles. [Figure 1] indicates that 79% of children received the first dose of the measles vaccine, 44% received the second dose and about three-fifth were vaccinated during the MR campaign. [Figure 2] reported that 41% of children were fully vaccinated against measles, 37% were partially vaccinated and 17% did not receive any single dose.
Figure 2: Coverage of measles vaccination status

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A Chi-square test was applied between demographic factors and measles vaccine coverage. [Table 2]. The upshot showed that there were no statistically significant associations between the sex of the child and measles vaccination status (χ2 value = 1.17 (p-value >0.05). An approximately equal number (40%) of male and female children were fully immunized against measles,35.6% of male children were partially vaccinated and 39% of female children, with regards to non-vaccination, 20.3% of male children and 12.2% of female children were non-vaccinated, and around 5% of both male and female children were immunized till date. P value >0.05 indicates there is no statistically significant association between the sex of the child and measles vaccination status.
Table 2: Association with the sex of the child

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[Table 3] shows that the measles vaccination status and fathers’ education did not have a statistically significant association as suggested by χ2 value = 9.01 and p-value <0.05.
Table 3: Association with father’s education

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For fathers who were educated up to middle school, 26.1% of their children were fully immunized, 34.8% were partially immunized, 34.8% were non-immunized, and 4.3% were immunized to date. In fathers who were educated till high school, 39.3% of their children were fully immunized, 35.7% of children were partially vaccinated, 17.9% were non-immunized and 7.1% were immunized to date.

Similarly, the chi-square test was applied to find out the association between a mother’s education [Table 4]. In mothers who were educated up to middle school, 20.6% of their children were fully immunized, 47.1% of children were partially immunized, 26.5% were non-immunized, and 5.9% were immunized to date. In mothers who were educated till high school, 58.1% of their children were fully immunized, 23.3% were partially vaccinated,11.6% were non-vaccinated and 7% were immunized to date. In mothers who were educated above high school, 39.1% of children were fully immunized, 47.8% were partially immunized, and 13% were non-immunized. The significant p-value<0.05 indicates there is a significant association between mothers’ education and measles vaccination.
Table 4: Association with mothers’ education

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Household income status and measles vaccination status were having statistically significant associations as well [Table 5]. According to household income status, for children who belonged to the lower class,25.7% were fully immunized, 42.9% were partially immunized, 20% were non-immunized, and 11.4% were immunized to date. Of the children who belonged to middle-class families, 44.2% were fully immunized, 32.6% were partially immunized, 23.3% were non-immunized, and 4.5% were immunized to date. For children who belonged to upper-class families, 59.1% were fully immunized, 36.4% were partially immunized, and none were non-immunized,4.5% were immunized to date. The p value<0.05 is statistically significant
Table 5: Association with household income

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Regarding factors associated with non-immunization, below [Table 6] gives a snippet of information on them, The most common reasons for partial or non-immunization for measles were: inadequate knowledge about immunization (n = 100, 19%); unaware of days of vaccination(n = 100,14%); Child was ill at the time of vaccination(n = 100,9.5%); The husband or mother in law against vaccination (n = 100,9.5%); Mother was busy with work(n = 100,9.5%)belief that vaccine has side-effects (n = 100, 9.1%); lack of faith in immunization (n = 100, 4.5%); Most (82.5%). Whereas the major reason for missing the second dose of the measles vaccine was found to be non-information about subsequent vaccination. The immunization status needs to be improved through education, increasing awareness, and counseling of parents and caregivers regarding immunizations and associated misconceptions as observed in the study.
Table 6: Reasons for partial or non-vaccination

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  Discussion Top


Routine immunization is the cornerstone for achieving and sustaining measles elimination and Rubella control. The challenges that must be overcome are significant and in various stages of being addressed. Grass root level challenges in vaccine coverage have to be identified and corrected to make 100% coverage which is the crucial step for the elimination of measles in India. The present study shows that 41% of the children aged 9–60 months in Ausdgaon village have been fully immunized for measles, 37% are partially immunized, 17% are non-immunized, and 5% were immunized to date. But the study by M. Mathiarasu et al. shows 81.4% full immunization and 18.6% partial vaccination in the Kanyakumari district.[7] A study conducted by Meena et al. found the coverage for MCV1 to be high (92%),[8] Sivasankaran et al. in Tamil Nadu also found high coverage(97.7%) in contrast to our study.[9] Kadri et al.[10] in Ahmedabad and Sharma et al[11] in Mumbai found 71.1% and 87.6% measles vaccine first dose respectively was more than our study findings.

Our study showed 79% coverage for 1st dose of the measles vaccine, and 44% coverage for 2nd dose of the measles vaccine, in contrast, NFHS4 data[12] in 2015–16, for India for 1st dose of measles vaccine showed 81% coverage, for Maharashtra for 1st dose 82.8%, and in Raigad district is 92.9%. So, this study was carried out to examine the coverage of measles vaccination in Asudgaon and identify the reasons for partial and non-vaccination.

We found the most common reasons for partial or non-immunization for measles 1 were: inadequate knowledge about immunization (n = 100, 19%); unawareness of days of vaccination (n = 100,14%); the Child was ill at the time of vaccination(n = 100,9.5%); The husband or mother in law against vaccination(n = 100,9.5%); Mother was busy with work(n = 100,9.5%)belief that vaccine has side-effects (n = 100, 9.1%); lack of faith in immunization (n = 100, 4.5%); Most (82.5%). A similar study was conducted in Surat city, by Desai VK et al[13] wherein 12.9% of the parents stated that it was their ignorance due to which measles vaccination was not administered to their children. Studies conducted by Kar et al[14] in New Delhi and Nath et[15] al in Lucknow showed that the major causes for incomplete immunization were the illness of the child, and unawareness of vaccination, similar to our findings. Studies by Mathew et al. in New Delhi and Karinganavar et al. in Kerala, reported that the distance of the session site from home was the main reason for the non-immune station.

Regarding the immunization coverage with gender, our study indicates there is no statistical association, in contrast, to the study conducted by Mathiarasu et al. and Rashmi Sharma et al.[16] The immunization status needs to be improved through education, increasing awareness, and counseling of parents and caregivers regarding immunizations and associated misconceptions as observed in the study.


  Conclusion Top


Routine immunization is the cornerstone for achieving and sustaining measles elimination and Rubella control. Grass root level challenges in vaccine coverage have to be identified and corrected to make 100% coverage which is the crucial step for the elimination of measles in India. The present study shows that 41% of the children aged 9–60 months in Ausdgaon village have been fully immunized for measles, 37% are partially immunized, 17% are non-immunized, and 5% were immunized to date.

We found the most common reasons for partial or non-immunization for measles1 were: (n = 100) inadequate knowledge about immunization (19%); unaware of days of vaccination (14%); Child was ill at the time of vaccination (9.5%); The family members against vaccination (9.5%); Mother was busy with work (9.5%)belief that vaccine has side-effects (9.1%); lack of faith in vaccination (4.5%), did not know the center of vaccination after migrating (4.5%), vaccinator was not present (4.5%). The a significant association between a mother’s education, household income, and measles vaccination status. No significant association between the sex of the child and measles vaccination.

Ethical consideration/patients consent form

The Institutional Ethics Committee of MGM Medical College, Navi Mumbai, Maharashtra, India had reviewed the research project and approved undertaking the study protocol vide their letter no. 2018/8/40 dated 16th August 2018.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sudfeld CR, Navar AM, Halsey NA Effectiveness of measles vaccination and vitamin A treatment. Int J Epidemiol 2010;39 Suppl 1:i48-55.  Back to cited text no. 1
    
2.
Maharashtra State Report NFHS-5. Available at: https://dhsprogram.com/pubs/pdf/FR374/ FR374_Maharashtra.pdf [Last accessed on 03 Dec 2022].  Back to cited text no. 2
    
3.
Fact sheet Maharashtra. District Level Household and Facility Survey. Available from: http://rchiips.org/pdf/rch3/state/Maharashtra.pdf [Last accessed on 23 Feb 2022].  Back to cited text no. 3
    
4.
Wankhede D Regional variation in child immunization in Maharashtra, India [extended abstract]. Germany: LAP LAMBERT Academic Publishing. Available from: http:// iussp.org/sites/default/files/event_call_for_papers/ Regional%20Variation%20in%20child%20immunization%20in%20Maharashtra,%20India%20(Dronacharya%20 Wankhede).pdf. [Last accessed on 23 Feb 2022].  Back to cited text no. 4
    
5.
The measles epidemic. The problems, barriers, and recommendations. The National Vaccine Advisory Committee. JAMA 1991;266:1547-52.  Back to cited text no. 5
    
6.
Majumder S Socioeconomic status scales: revised kuppuswamy, BG prasad, and udai pareekh’s scale updated for 2021. J Family Med Prim Care 2021;10:3964-7.  Back to cited text no. 6
    
7.
Mathiarasu AM, Devadason P, Karunakaran UD Prevalence of Drop out and associated factors in Measles immunization among children in Kanyakumari District, Tamilnadu, India. South Am J Public Health2016:2-11. DOI: 10.21522/TIJPH.2013.04.02.Art059.  Back to cited text no. 7
    
8.
Meena S, Saxena D, Bankwar V, Meena P Evaluation of measles immunization coverage in a rural area of central India using WHO EPI 30 cluster survey method. Int J Community Med Public Health 2017;4:1668-73.  Back to cited text no. 8
    
9.
Gomber S, Arora SK, Das S, Ramachandran VG Immune response to second dose of MMR vaccine in indian children. Indian J Med Res 2011;134:302-6.  Back to cited text no. 9
    
10.
Gadhavi R, Nayak H, Arjunkumar J, Kumar Modi A An epidemiological study of measles incidence and vaccination coverage in urban slums of Ahmedabad, India. Int J Med Public Health 2018;8:58-61.  Back to cited text no. 10
    
11.
Sharma B, Mahajan H, Velhal GD Immunization coverage: role of sociodemographic variables. Adv Prev Med 2013;2013:607935.  Back to cited text no. 11
    
12.
India: Ministry of Health and Family Welfare (MoHFW), Government of India. National Family Health Survey (NFHS-4), India, 2015–16: Maharashtra. Mumbai: International Institue of Population Sciences (IIPS); 2018. p. 171. Available from: http://rchiips.org/nfhs/NFHS-4Reports/Maharashtra.pdf. [Last accessed on 23 Feb 2022].  Back to cited text no. 12
    
13.
Desai VK, Kapadia SJ, Kumar P, Nirupam S A study of measles incidence and vaccination coverage in slums of Surat city. Indian J Community Med 2003;28:10-4.  Back to cited text no. 13
    
14.
Karinagannanavar A, Khan W, Raghavendra B, Sameena ARB Goud TG A study of measles vaccination coverage by lot quality assurance sampling technique and factors related to non-vaccination in Bellary District. Indian J Community Health 2013;25:244-50.  Back to cited text no. 14
    
15.
Vohra R, Vohra A, Bhardwaj P, Srivastava JP, Gupta P Reasons for failure of immunization: A cross-sectional study among 12-23-month-old children of Lucknow, India. Adv Biomed Res 2013;2:71.  Back to cited text no. 15
    
16.
Sharma R, Desai VK, Kavishvar A Assessment of immunization status in the slums of surat by 15 clusters multi indicators cluster survey technique. Indian J Community Med 2009;34:152-5.  Back to cited text no. 16
    


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