Bangalore, karnataka proforma for registration of subject for dissertation



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1

1


NAME OF THE CANDIDATE

AND ADDRESS

Mrs. SREEMATHI

Koshys college of Nursing

Sy.No. 31/1, Hennur-Bagalur road,

Kadusonnappanahalli,

Kannur post, Bengaluru.


2

NAME OF THE INSTITUTION

Koshys College Of Nursing

3

COURSE OF THE STUDY AND SUBJECT

Ist Year Msc Nursing

Paediatric Nursing.





4

DATE OF ADMISSION

09.06.2010

5

TITLE OF THE STUDY

A study to assess the knowledge and utilization of universal Immunization Programme among mothers of under five children in a selected hospitals of Bangalore in a view to prepare a self instructional module.

BRIEF RESUME OF THE INTENDED WORK

Introduction.

Shots may hurt a little. but the diseases they can prevent can hurt a lot more! Immunization shots, or vaccinations, are essential. They protect against measles, mumps, rubella, hepatitis B, polio, diphtheria, tetanus and pertussis (whooping cough). Immunizations are important for adults as well as for children.

Infectious diseases are a major cause of morbidity and mortality in children. One of the most cost effective and easy methods for child survival is immunization. In May 1974, the World Health Organization (*WHO) officially launched a global immunization programme known as Expanded Programme of Immunization (EPI) to protect all the children of the world against six vaccine preventable diseases by the year 2000.1

Immune system helps our body fight germs by producing substances to combat them. Once it does, the immune system "remembers" the germ and can fight it again. Vaccines contain germs that have been killed or weakened. When given to a healthy person, the vaccine triggers the immune system to respond and thus build immunity. Before vaccines, people became immune only by actually getting a disease and surviving it. Immunizations are an easier and less risky way to become immune.2

The vaccination of children against six serious but preventable diseases (tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, and measles) has been a cornerstone of the child health care system in India. As part of the National Health Policy, the National Immunization Programme is being implemented on a priority basis. The Expanded Programme on Immunization (EPI) was initiated by the Government of India in 1978 with the objective of reducing morbidity, mortality, and disabilities from these six diseases by making free vaccination services easily available to all eligible children. Immunization against poliomyelitis was introduced in 1979-80, and tetanus toxoid for school children was added in 1980-81. Immunization against tuberculosis was brought under the *EPI in 1981-82. In 1985-86, immunization against measles was added to the programme.3

.

*WHO – World Health Organization.



EPI – Expanded Programme on Immunization.

BCG – Bacillus Calmette Guerin

Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen).When this system is exposed to molecules that are foreign to the body (non-self), it will orchestrate an immune response, but it can also develop the ability to quickly respond to a subsequent encounter through immunological memory. This is a function of the adaptive immune system. Therefore, by exposing an animal to an immunogen in a controlled way, its body can learn to protect itself: this is called active immunization.1

The most important elements of the immune system that are improved by immunization are the B cells (and the antibodies they produce) and T cells. Memory B cell and memory T cells are responsible for a swift response to a second encounter with a foreign molecule. Passive immunization is when these elements are introduced directly into the body, instead of when the body itself has to make these elements.5

Immunization is the process of strengthening the internal system of the body to fight against the diseases and other harmful external agents that are capable of affecting the human body. The internal system of the body is known as immune system and a weak immune system may result in the body falling prey to the diseases. Immunization can be done through various techniques, most commonly vaccination. Vaccines against microorganisms that cause diseases can prepare the body's immune system, thus helping to fight or prevent an infection. Immunization program is run on a large scale in all the countries to strengthen the immune system of the child. Influenza, Pneumonia, Hepatitis, Polio and Chickenpox are the major threats to the life of infants and young child. Immunization vaccines are provided at the different age periods and the dosage of these vaccines is very important to safeguard the immune system of the human beings.4

Immunization is usually done in two stages: Active and Passive Immunization. Active Immunization means the injection of a foreign particle that initiates the internal system to produce antibodies to fight against the diseases. The body develops a natural resistance against the first instance of a microbe and next time when the same microbe enters the body, body recognizes it and does not allow it to affect the body. Artificial active immunization is where the microbe, or parts of it, is injected into the person before they are able to take it in naturally. If whole microbes are used, they are pre-treated, attenuated vaccine. Passive immunization includes transferring the pre-synthesized elements of the immune system so that the body does not need to produce these elements itself. Passive immunization occurs physiologically, when antibodies are transferred from mother to fetus during pregnancy, to protect the fetus before and shortly after birth.

Artificial passive immunization is normally administered by injection and is used if there has been a recent outbreak of a particular disease or as an emergency treatment for toxicity example, for tetanus. The antibodies can be produced in animals (serum therapy) although there is a high chance of anaphylactic shock because of immunity against animal serum itself. Thus, humanized antibodies produced in vitro by cell culture are used instead if available. This basically means 87 different are being affected. Currently, antibodies can be used for passive immunization. The process is fast but short lived and is used for experimental purposes only.2

So the vaccines are the 20th century's most successful and cost-effective public health tool for preventing disease, disability and death, the utilization of this free services is hampered by the lack of knowledge of the antenatal women and post -natal mothers, about it. There is a great deal of evidences about the effectiveness of the vaccines and its inexpensiveness and they do not only prevent a vaccinated individual from developing a potentially serious disease, vaccines routinely recommended for children, also help protect the entire community by reducing the spread of infectious agents, but tragically the utilization of this services are low among the antenatal mothers, especially those who had no contact with antenatal care services, when compared with those mothers who had utilized the services of the antenatal care services.6

The Universal Immunization Programme (UIP) was introduced in 1985-86 with the following objectives: to cover at least 85 percent of all infants against the six vaccine preventable diseases by 1990 and to achieve self-sufficiency in vaccine production and the manufacture of cold-chain equipment. This scheme has been introduced in every district of the country, and the target now is to achieve 100 percent immunization coverage. Pulse Polio Immunization Campaigns began in December, 1995, as part of a major national effort to eliminate polio. The standard immunization schedule developed for the child immunization programme specifies the age at which each vaccine is to be administered, the number of doses to be given, and the route of vaccination (intramuscular, oral, or subcutaneous). Routine vaccinations received by infants and children are usually recorded on a vaccination card that is issued for the child. Study.7

At birth, infants have protection against certain diseases because antibodies have passed through the placenta from the mother to the unborn child. After birth, breastfed babies get the continued benefits of additional antibodies in breast milk. But in both cases, the protection is temporary. Some parents may hesitate to have their children vaccinated because they're worried that the children will have serious reactions or may get the illness the vaccine is supposed to prevent. Because the components of vaccines are weakened or killed and in some cases, only parts of the microorganism are used they’re unlikely to cause any serious illness. Some vaccines may cause mild reactions, such as soreness where the shot was given or fever, but serious reactions are rare.9

A proven tool for controlling and even eradicating infectious diseases is the immunization. The immunization campaign carried out by the WHO from 1967 to 1977 resulted in the eradication of small pox. When the programme began, the disease still threatened 60% of the world’s population and killed every fourth victim. Now the eradication of poliomyelitis is within reach. Since the launch the infection has fallen by 99% and some 5 million people have sapped the paralysis. The measles dropped worldwide by over 74% between 2000 and 2007, maternal and neonatal tetanus has been eliminated in 12 of the 58 high-risk countries.2

Child immunization components are BCG and OPV at birth, DPT and OPV at 6 ,10,14 weeks, Measles at 9 months, DPT and OPV booster at 18 months of age, DT between 4.5 and 5.5 years of age ,TT to school going children. Antenatal component for pregnant women is TT two doses. Each year, 1.7 million children die from diseases that could have been prevented with readily available vaccines. Children who are immunized are protected from these dangerous diseases, which often lead to disability or death. All children have the right to this protection. Every girl and boy needs to be immunized. And pregnant women need to be immunized to protect themselves and their infants from Tetanus.

Hib vaccines were introduced; the number of new cases of invasive Hib infections—both drug-sensitive and resistant—in infants and children in the U.S. has decreased by 99%. vaccination against pneumococci is now routinely recommended for infants and young children so that children will not get serious pneumococcal infections such as meningitis or bloodstream infection. The children’s vaccine, PCV7, was approved in the United States in February 2000 and contains the 7 most common pneumococcal serotypes causing invasive (serious) infections in children in North America. Thus the PCV7 vaccine only protects against infection.

A recent study states that a decrease of Invasive Pneumococcal Infections in Children among 8 Children’s Hospitals in the United States after the Introduction of the 7-Valent Pneumococcal Conjugate Vaccine. Pediatrics showed that PCV7 has been successful in preventing invasive pneumococcal disease in children and has resulted in the added benefit of a decrease in penicillin resistance among pneumococcal isolates from children with infection……. Kaplan SL, Mason EO, Wald ER, et al. (2004). 113: 443-449.10

Children with varicella (chickenpox) frequently develop skin infections with S. aureus or group A streptococci, both of which may invade the blood stream. By being protected against varicella with the vaccine, children are protected against an infection with these bacteria, including those that are antibiotic-resistant. Reduction in pediatric hospitalizations for varicella-related invasive group, a streptococcal infections in the varicella vaccine era.

Immunisaton is an important vehicle for health promotion and therefore is a true national investment. As per NFHS data, full immunization coverage in Orissa was 52 percent and no immunization was 9 percent. Evaluated coverage by UNICEF in the last 3 years indicates that there is a decline in coverage of all antigens. Proportion of districts achieving 80 percent of DPT3 coverage has also decreased.

Immunization is one of the most cost effective interventions for disease prevention. Traditionally, the major thrust of immunization services has been the reduction of infant and child mortality. The Immunisation era has actually begun at the turn of 18th century with the introduction of protective vaccination. Since then, the phenominal progress in the domain of microbiological and immunological sciences has made over 25 vaccines available against some of the dreaded diseases. Today Diptheria, Pertusis, Tetanus, Typhoid, TB, Polio, Measles and a number of other diseases can be effectively controlled by vaccinations.2

The Governments realized that population explosion made it obligatory to adopt a policy of Family Planning, which, for it success, requires maximum attention to be paid to the preservation, proper growth and development of infant, cutting down the existing infant mortality rate. In order to achieve this, there can be no better measures than the introduction of practicable routine immunisation and nutrition programme. Immunization is one of the most cost effective interventions for disease prevention. Traditionally, the major thrust of immunization services has been the reduction of infant and child mortality.

A study need to be conducted at this stage to understand the knowledge and service utilization which helps in understanding the strength of the present system which need to be continued; implementation on Universal Immunization Program. The quality reach, understanding, the awareness and knowledge levels of mothers about the program services should be the essential aspects. Utilization status and understand the key determinants influencing the utilization behaviour.
6.1 NEED FOR THE STUDY.

There is a great need to scale up immunization of children. Life-saving measles vaccinations are only 33 cents per dose. Pneumococcal and rotavirus vaccines are now available to GAVI-eligible countries and prevent the leading cause of the two main child-killers - pneumonia and diarrhoea. Despite significant progress in immunizing children, 24 million children - almost 20 percent of all children born in 2007 - did not receive the complete regimen of vaccinations for their first year global action for children.The reasons for low immunization coverage are dropouts by beneficiaries who receive one or more vaccination but do not return for subsequent doses due to ignorance about immunization sessions as well as benefits, fear of side effects or socio-economic barriers to utilize services, etc.

Government of India centrally procures and supplies vaccines and cold chain equipments for immunization programme to the states as per their requirements. The states are provided support to improve efficiency in service delivery through following interventions: Support for alternate vaccine delivery from the last cold chain point at PHC/CHC to session site saving time & effort of ANM and bring about efficiency. Where ANM is not available as in the urban slums and underserved areas, hiring of vaccinators have been allowed for providing immunization. Use of Auto-disabled syringes for injection safety and improve service quality. The measles 2nd dose and Hepatitis B vaccination has also been incorporated in the Universal Immunization Programme. Further, all states have been asked to ensure tracking of pregnant women and children for improving coverage of immunization. Programme implementation is monitored and reviewed at the Central level also from time to time.

In developing country each year 30 lakh infants and children will die and another 30 lakh will become crippled, deaf, blind or Mental retarded because of six vaccine preventable diseases Namely; Diphtheria, Pertussis, Neonatal tetanus, polio, Measles and TB. The vaccination or immunization is one of most powerful and cost effective means of preventing diseases but tragically it is underutilized. The immunization is most cost effective and easy way to prevent the disease in the society. It is seen that the children who received BCG, measles, and three dose each of DPT and polio are considered to be fully vaccinated, it showed that 42 percent of children age 12-23 months are Fully vaccinated and 14 percent have not received any vaccinations.6

A survey was done to asses the effectiveness of the Universal Immunization Programme in Assam and West Bengal , India. Immunization coverage rates varied as low as 59.5% for measles in Assam and 69.63% in West Bengal to as high as 80.13% for BCG and 104.73% respectively. All primary health centers provided immunizations on Mondays in Assam and on Wednesdays in West Bengal. Eventually district and block health officials extended these fixed days to subcenter and village levels. Further major hospitals provided them daily. Moreover health workers from various agencies conducted 2 special immunization sessions in the month of October, November, and December at 1 month intervals in areas with a large uncovered child population so as to fully immunize children against certain diseases. Obstacles were prevented for adequate immunization coverage of DPT3 which was only 29% and that of measles 13%., laborer groups helped launch a campaign in West Bengal. The leaders of Calcutta encouraged all communities in West Bengal to become immunized. Organizations including the Ministry of Social Welfare and Lions and Rotary Clubs joined the Ministry of Health in immunization efforts. The UIP used folk media and the mass media to disseminate information and educate the public about immunizations. The Project Officer for UNICEF covered UIP sustainability issues such as political commitment and maintenance of the cold chain.10

A study based on the primary data, collected using cluster sampling of sample size of 433 reproductive women who have given at least one live birth prior to the survey to examine utilization of immunization services available to the children in slums of Mumbai was studied. The study area was the vaccination programme implemented by taking Pulse Polio camps. The community volunteers visited the house of the eligible Childs mother and brought them to the camp with the eligible child. The immunization began by asking the question whether mother has an immunization card for the youngest child. The questionnaire also had the same question and investigators questioned study mothers in both the slum areas about the status of the vaccination of the eligible child. If a card was available, the interviewer was required to copy carefully the dates when the child received vaccinations against each disease. For vaccinations not recorded on the card, the mother's report that the vaccination was or was not given was accepted. If the mother could not show a vaccination card, she was asked whether the child had received any vaccinations. If any vaccination had been received, the mother was asked whether the child had received a vaccination against tuberculosis (BCG); diphtheria, whooping cough (pertussis), and tetanus (DPT); poliomyelitis (polio); and measles. For DPT and polio, information was obtained on the number of doses of the vaccine given to the child. The findings revealed a shocking low level of vaccination among the children of 12-23 months old from the Rafi Nagar slum. Primary vaccination was just 48 percent. Even Logistic regression reveals that the children from low category and of illiterate women were not availing themselves of child care services. Thus this study suggested that the measles vaccination programme has to focus not only its coverage but also its timing to include awareness about immunization programmes especially among the illiterate women.11

According to the statistics available from NFHS the survey showed that 70% in rural areas were not immunized and close to 40% not even taken single vaccination, in urban areas. The picture is not so encouraging only 50% of children had fully got immunization and 20% had not received any Immunization at all. In this survey in which sex, birth order, education of parents, cast, religion, Geographical demography and income were taken to consideration showed that the Presentation of children getting immunization is higher among boys 34% comparing to girls 33%. The birth order also plays big roles as it is seen the more likely of the first child to get vaccination is very high comparing with that of second and third child. The immunization is also high among children of literate mother (73%) than children of illiterate mother (28%). On economic basis, low income only 30% fully got immunized compared to children of high income of 65%. Various studies have revealed that the children of literate mothers are more likely to be immunized comparing to children of illiterate mothers. It is clear that the female literacy plays pivotal role. It is also seen that the immunization among the pregnant women increases with education level of the women and considerably high in urban areas 86% than in rural 73%.5

On a paper discussion states that the prevalence and treatment was Eighty-three percent of children in slum area aged less than 12 months who suffered from illness were taken to the Government health facility for medical advice or treatment. 40 percent of children aged 24-35 months from both areas were taken to the Government facility including immunization services. It indicates that mothers from slum area are not that attentive towards seeking treatment for illness from a Government health facility when the child was less than 12 months old. A small percentage of mothers had taken their child to the private health facility and this percent is 10 when the child was 12-23 months old, in slum. The author reports that mass communication for Universal Immunization Programme has no doubt helped to create claim for immunization services.

A prospective study was conducted to finds that the extent of utilization of services pertaining to child immunization and child care among mothers of under five children in rural areas of Bangalore. The result was found to be very low 52% utilized the services among the children of illiterate women, low category36 % of standard of living women. The role of socio-economic factors in service utilization is clearly evident in this study area. Logistic regression shows that the socio-economic background conditions have a strong impact on the utilization of child care services. The odds ratio differed significantly by standard of living category and is very high with respect to child care.12.

The mothers are not availing themselves of child care services; which clearly indicates that there is a concentration of women amongst the poorest of the economic stratum who go without adequate child care. Thus the reproductive health condition of study women and their children living remains poor.

Thus the researcher concluded that - the effective awareness campaign to the mothers of children in the urban areas through health centers, committed community health workers, are needed by easy access to services, better health care delivery system, quality health care, follow-up care could be encouraged. awareness of every stage of vaccinations is suggested and treatment of child when suffering from child killer diseases are needed for the betterment of reproductive and child health in community areas, particularly to illiterate women and their children.

Therefore the researcher felt that there is a need to conduct this study to highlight the possibility of improving the knowledge and utilization of Universal Immunization Programme services among the mothers of under five children, keeping the six vaccine preventable disease at focus. The investigator felt that there is great role for health service providers to achieve full immunization among the mothers by means of educating them.

There is an necessary to take up this study and contribute by finding the knowledge and ways to get best use of utilizing the universal Immunization Programme services for the well being of the their babies. It is crystal clear from the above literature and studies that the major obstacle for under utilization of Universal Immunization Programme services is lack of information about the universal Immunization Programme services among the mothers.

On accounts of above stated matters the immunization is very much important for preventing of deadly diseases and the health of their children. So the researchers understood that and it is necessary to , assess the knowledge and utilization of the universal programme among mothers regarding universal immunization programme, as the future generation comes from the lap of the mothers, so if we wish to have a healthy society we must take care of the their children by simple way of routine vaccinations.


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