Academic journal article Bulletin of the World Health Organization

Estimation of Child Vaccination Coverage at State and National Levels in India/ Estimation De la Couverture Vaccinale Des Enfants Aux Niveaux Etatique et National En Inde/ Estimacion De la Cobertura De Vacunacion Infantil a Nivel Estatal Y Nacional En la India

Academic journal article Bulletin of the World Health Organization

Estimation of Child Vaccination Coverage at State and National Levels in India/ Estimation De la Couverture Vaccinale Des Enfants Aux Niveaux Etatique et National En Inde/ Estimacion De la Cobertura De Vacunacion Infantil a Nivel Estatal Y Nacional En la India

Article excerpt

Introduction

The landscape of routine child immunization in India is changing rapidly. (1-3) The national government declared 2012-2013 to be a period of intensification in child immunization, with a focus on remote and often inaccessible rural areas, urban slums and migrant and mobile communities. (4) Subsequently, in December 2014, India's Ministry of Health and Family Welfare launched Mission Indradhanush. The aims of this initiative were to vaccinate at least 90% of pregnant women against tetanus and ensure that all children are fully vaccinated against seven vaccine-preventable diseases before they reach an age of two years. (5,6) General improvements in the delivery of routine immunization services were also critical in the successful efforts to interrupt polio transmission in India and remain a key component in attempts to eliminate measles from the country by 2020. (7)

The monitoring of trends in vaccine coverage is complicated by the multiple sources of relevant data and the varied quality of those sources. Although there are data available on administrative coverage--i.e. data on the immunization services delivered by health providers--potentially useful information on vaccination coverage is also collected in coverage evaluation surveys, process and community monitoring, surveillance on vaccine-preventable diseases, integrated disease surveillance and the management of the cold chains used in the storage and transport of vaccines.

In India, as elsewhere, the accuracy of estimates of administrative coverage depends on the accurate recording of the numbers of administered doses, accurate information on the size of the target population, regular and robust reporting by the health workers who administer the vaccines and the prompt and accurate transfer of the relevant data through all of the levels between the health subcentres and the national government. The numerators and/or denominators needed to calculate percentage coverage values are often only available as rough estimates.

As nationally representative surveys of vaccination coverage are expensive and time-consuming, they tend to be infrequent and poor at providing rapid information on the trends in a system's or programme's performance. In India, the last survey of this type was conducted in 2008. Since then, administrative coverage data have served as the primary vehicle for the annual monitoring of vaccination coverage and programme performance at national level. To provide timely feedback, house-to-house rapid monitoring and modified session monitoring have also been implemented --mainly in support of polio-related efforts to strengthen community-based routine immunization. The value of data collected by rapid monitoring is, however, often reduced by selection bias--e.g. as a result of the monitoring being confined to communities that are considered to be at relatively high risk of vaccine-preventable disease--and the challenges posed by determining the size of the target population accurately.

In an attempt to improve our knowledge of recent trends in child vaccination coverage in India, we recently collected relevant data from multiple information sources and used them to derive estimates of the annual levels of such coverage, at both state and national level, for the years 1999-2013.

Methods

As part of a workshop held on 30 April -1 May 2015, with state representatives, we--i.e. the members of a review team that included staff from India's national immunization programme and their counterparts from the India-based offices of the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) and WHO's Regional Office for South-East Asia--reviewed data obtained after 1998 on child vaccination coverage. We investigated data --on bacille Calmette-Guerin vaccine, the first and third doses of diphtheriatetanus-pertussis (DTP1 and DTP3) vaccine, the third dose of oral polio vaccine and the first dose of vaccine against measles--from state-specific administrative reports, coverage surveys (Table 1) and rapid monitoring. …

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