Reported high immunization coverage achieved in Nepal over the last ten years is expected to reduce child mortality in the country. The present study, carried out in a hill district in mid-west Nepal, aimed to assess ...
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Reported high immunization coverage achieved in Nepal over the last ten years is expected to reduce child mortality in the country. The present study, carried out in a hill district in mid-west Nepal, aimed to assess the quality of immunization data in Nepal. The number of children who received different vaccines during one year was obtained from three sources: 1) the Immunization Register of three Primary Health Care Service Outlets (PHCSOs) where each immunized child is recorded;2) monthly PHC Reports, which are based on the Immunization Register;3) monthly DHO Reports, which are based on the above PHC Reports (the DHO reports are the source of official statistics). The number of children in the PHC Reports was higher than the number in the Immunization Registers for all vaccines. The number of immunizations in the DHO Reports was higher than the number in the PHC Reports for BCG, DPT, and measles;the number was lower for poliomyelitis. The overall number of immunizations was higher in the DHO Reports than in the Immunization Registers, by 31% for BCG, 44% for DPT, 155% for polio, and 71% for measles. We conclude that the official report overestimates the immunization coverage in the district. The immunization programme, therefore, might not result in the expected reduction of morbidity and mortality despite the investment in the programme and reported high coverage.
Objective: Recommendations by most national advisory committees on immunization include evaluating all pregnant women for chronic hepatitis B virus infection and immunity to rubella. It is recommended that all pregnan...
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Objective: Recommendations by most national advisory committees on immunization include evaluating all pregnant women for chronic hepatitis B virus infection and immunity to rubella. It is recommended that all pregnant women be screened for hepatitis B surface antigen during an early prenatal visit and that rubella vaccine be administered in the postpartum period to women not known to be immune. This study determined the extent to which hospitals with labor and delivery services adhere to these recommendations. Methods: We conducted a mail survey of a stratified random sample of all US medical-surgical hospitals to (1) determine the proportion of hospitals with hepatitis B screening policies and rubella immunization programs and (2) identify significant factors associated with the presence of these policies and programs. Hospitals were stratified by number of beds (<100, 100-499, and greater than or equal to 500) and affiliation with a medical school. Results: Of 986 institutions surveyed, 858 (87%) responded. Of these, 635 (74%) were labor and delivery hospitals. Approximately half of these (51%) had hospital policies related to screening pregnant women for the hepatitis B surface antigen. Twenty-one percent had rubella immunization programs for postpartum women. Only 14% of labor and delivery hospital!;were in full compliance with published recommendations for hepatitis B surface antigen screening and rubella postpartum vaccination. Hospitals wee more likely to be compliant if they had more than 100 beds, were private rather than public institutions, were affiliated with a medical school, and were in states with laws regarding hepatitis B surface antigen screening of pregnant women. Conclusions: Almost half, and more than three quarters, of hospitals were not in compliance with hepatitis B screening and rubella postpartum immunization recommendations, respectively. Hospitals should develop and implement policies for these preventive services.
This study evaluated an intervention to improve immunization rates in a high poverty, medically underserved rural area employing a pretest-posttest design. The intervention expanded immunization availability, establis...
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This study evaluated an intervention to improve immunization rates in a high poverty, medically underserved rural area employing a pretest-posttest design. The intervention expanded immunization availability, established walk-in appointment policies, and introduced intensified parent education. Formative evaluation indicated specific messages with high salience to parents. As a result, the susceptibility and severity of childhood infectious disease, the outcome efficacy of vaccines, and methods to reduce barriers to immunization were emphasized in communications with parents. Data on DTP1-4, OPV1-3, and MMR were obtained from preschools, local health departments and private medical practices before (n = 567) and after the intervention (n = 331). Following adjustment for birth order and demographics, at post-intervention a significantly greater proportion of children received 6 of 8 vaccines on time. Effect sizes were large. For example, post MMR rates were at least 2X greater than pre rates. Time-series analysis of vend data on local newspaper coverage of child health topics suggested history was not a major threat to the internal validity of this pre-post only design. The findings indicate that comprehensive intervention, targeting improvements in the availability of pediatric care, health system policies and parent behavior, can improve immunization.
This study was conducted to determine whether implementing a program aimed at providing a variety of incentives to physicians who provide immunizations to preschool-aged children would help to improve immunization rat...
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This study was conducted to determine whether implementing a program aimed at providing a variety of incentives to physicians who provide immunizations to preschool-aged children would help to improve immunization rates and reduce fragmented care for patients. Twenty physicians from 14 private practices that provide care to preschool-aged children from low income families in suburban Cook County, Illinois participated in the project. A randomly selected subset of patient case records from the physicians' offices were audited after the implementation of the project to determine the immunization status of children in the practices and the nature of services provided. These 310 records of children under three years of age who were treated between 1991-1994 (the intervention sample) were compared to 310 charts from a 1988-1990 cohort of records (baseline sample). The groups did not differ on race or gender;however, significantly more families in the 1988 through 1990 cohort of children under 3 years of age were insured privately when compared to the 1991 through 1994 cohort Seventy percent (218) of the records in the intervention sample were up to date for age on immunizations compared to 45% (141) of the baseline records, reflecting a statistically significant difference (p<.00001). The intervention sample showed significantly more well child visits where immunizations were given and follow up visits where immunizations were given when compared to the baseline sample. Physicians completed surveys before and after implementation of the project. They were questioned about their knowledge and practices regarding immunizations as well as their opinion of specific project components. All of the physicians viewed the project as an effective means to improve immunization services to low income children. The project demonstrates a potential means of enhancing immunization levels and continuity of care among preschool-aged children. It also highlights the workable nature of the
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