240826 Important barriers to routine immunization and correlates of missed opportunities to vaccinate among pediatricians and primary health center physicians in India

Tuesday, November 1, 2011: 12:48 PM

Lisa Gargano, PhD , Division of Infectious Diseases, Emory University, Atlanta, GA
Naveen Thacker, MBBS, MD , Indian Academy of Pediatrics, Indian Academy of Pediatrics, Mumbai, India
Panna Choudhury, MBBS, MD , Indian Academy of Pediatrics, Indian Academy of Pediatrics, Mumbai, India
Karen Pazol, PhD, MPH , Maternal and Infant Health Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
Paul Weiss, MS , Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
Sunil Bahl, MBBS, MD , National Polio Surveillance Project, WHO, New Delhi, India
Hamid Jafari, MBBS , National Polio Surveillance Project, WHO, New Delhi, India
Walter Orenstein, MD , Bill and Melinda Gates Foundation, Seattle, WA
James Hughes, MD , School of Medicine, Emory University, Atlanta, GA
Saad Omer, MPH PhD , Rollins School of Public Health, Global Health, Emory University, Atlanta, GA
     
Background: India has low immunization rates by global standards. This study focuses on barriers to vaccination identified by private pediatricians (IAP) and medical officers (MOs) working in primary health centers (PHCs) and correlates of missed opportunities to vaccinate children.

Methods: In the polio high risk districts of Bihar and Uttar Pradesh (UP), we selected a random sample of IAP members to complete surveys by phone or mail and a sample of PHCs was selected for in-person surveys. Multiple logistic regression was used to assess correlates of missed opportunities to vaccinate children.

Results: 398 of 785 IAP members (51%) and 719 of 773 PHC MOs (93%) completed the survey. IAP members identified: parents' lack of awareness of the importance of vaccines (96%), parents' inability to pay for vaccines (79%), and parents' beliefs that children are fully vaccinated through receiving OPV during mass campaigns (77%) as barriers to immunization. PHC MOs identified: parents' lack of awareness of the importance of vaccines (95%), parents' lack of confidence in vaccination (87%), and parents' fear of side-effects (84%) as barriers to immunization. Forty-nine percent of IAP members reported keeping clinic-based vaccination records compared to 93% of PHC MOs. Compared to IAP members, missed opportunities to vaccinate among PHC MOs were associated with beliefs that ASHA workers were primarily responsible for ensuring children are vaccinated (OR=2.0, 95% CI=1.26, 3.22).

Conclusions: These barriers should be considered in prioritizing future immunization strategies. To minimize missed opportunities to vaccinate, future interventions should address the role of healthcare workers.

Learning Areas:
Public health or related research

Learning Objectives:
1.Describe the barriers to vaccination identified by physicians in India. 2.Discuss the implications for designing effective vaccination interventions geared toward decreasing missed opportunities.

Keywords: Immunizations, India

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee programs such as immunization interventions and health education projects
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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