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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 2  |  Page : 82-85

Evaluation of intensive pulse polio immunization in Solapur District


1 Department of Community Medicine, MGIMS, Sevagram, Maharashtra, India
2 Department of Anatomy, JNMC, Wardha, Maharashtra, India

Date of Submission11-Mar-2019
Date of Decision10-Apr-2019
Date of Acceptance14-Aug-2019
Date of Web Publication25-Nov-2019

Correspondence Address:
Dr. Brij Raj Singh
Department of Anatomy, JNMC, Sawangi, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_56_19

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  Abstract 


Background: Mass immunization campaigns are now an established fact for the eradication of poliomyelitis. Intensified pulse polio immunization (IPPI) campaigns using only a booth-based approach have not been sufficient to interrupt wild poliovirus transmission in different areas, where it is most persistent with low immunization coverage. Since 1995, PPI is conducted in India and IPPI was introduced in 1998. When we are progressing toward polio eradication and ever-increasing efforts are being done to administer polio drops to every eligible child, it has been observed subjectively that an element of fatigue is creeping in the health system and community. Aim and Objective: The objective of the study is to assess the operational aspects and knowledge of staff regarding PPI program. Material and Methods: Study design – A community-based cross-sectional study. Setting – Six taluks of Solapur district – Mangalwedha, Sangola, Barshi, Mohol, Pandharpur, and Madha. Study period – October 24–30, 2010, and November 21–27, 2010, i.e., 2 weeks. Sample studied – 174 booths, 359 parents, 1289 houses, and 3162 children under 5 years of age. Result: Out of 174 booths, 94.83% booths were easily accessible and IEC material displayed prominently on 85.06% booths.. Regarding source of information of IPPI, 38.16% parents got information from health workers followed by poster. Placement of teams at transit sites, teams were adequate at 80.77% sites, shifting timing appropriate at 88.46%, deployed member present at site in only 76.92% booths and supervisor cross checking the work of teams at only 50% booths. More than 85% of total booth workers were trained. On post booth day activity, in migrant's population 11.97% children were unimmunized whereas in settled population it was 2.32%. Percentage of unimmunized children in migratory population was more than settled population which is statistically highly significant. Conclusion: Special attention is required toward immunization of migratory populations, including slums with migration, nomads, sugar cane cutters, brick kiln workers, also construction site workers and also on transit sites including bus stand, railway stations, mela sites, and weekly bazaars. The role of local media and mass communication programs should be worked out and organized in a more systemic manner. Use of mass media must be done to motivate people for immunization. Supervisor work needs to improve. Community participation should be view as one of the key component for the success of the program. More voluntary agencies, persons, local leaders, and nongovernmental organizations should be motivated to come forward and work for this noble cause.

Keywords: Intensified pulse polio immunization, poliomyelitis, poliovirus


How to cite this article:
Dhatrak A A, Chaudhary K, Singh BR, Gajbe U. Evaluation of intensive pulse polio immunization in Solapur District. J Datta Meghe Inst Med Sci Univ 2019;14:82-5

How to cite this URL:
Dhatrak A A, Chaudhary K, Singh BR, Gajbe U. Evaluation of intensive pulse polio immunization in Solapur District. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2019 Dec 9];14:82-5. Available from: http://www.journaldmims.com/text.asp?2019/14/2/82/271554




  Introduction Top


Mass immunization campaigns are now an established fact for the eradication of poliomyelitis. Intensified pulse polio immunization (IPPI) campaigns using only a booth based approach have not been sufficient to interrupt wild poliovirus (WPV) transmission in different areas, where it is most persistent with low immunization coverage. There is sustaining transmission of WPV by migrants in Maharashtra. In 2010, a total of five cases of poliomyelitis (WPV 1) were found. Recent confirmed case is a 10-month-old child who stayed in Solapur for 5 months and did not receive oral polio vaccine in January–February 2010 IPPI rounds. On October 6, 2010, decision of mopping up activity was taken.

Since 1995, PPI is conducted in India and IPPI was introduced in 1998. When we are progressing toward polio eradication and ever-increasing efforts are being done to administer polio drops to every eligible child, it has been observed subjectively that an element of fatigue is creeping in the health system and community. There is an increase in the number of national immunization rounds and subnational immunization rounds in the country, followed by intensive inputs in terms of house-to-house immunization activity.[1],[2]

Even after these efforts, few children are missed and coverage of 100% is still not achieved. Hence, there is a need for evaluation.

The global polio eradication initiatives strategic plan for 2010–2012 set two goals for controlling outbreaks:

  • For outbreaks occurring in 2009, transmission should have been stopped by mid-2010
  • For outbreaks occurring in 2010, transmission should have been stopped within 6 months of the first confirmation of the outbreak.


Objective

To assess the operational aspects and knowledge of staff regarding Pulse polio immunization program.


  Materials and Methods Top


Study design

This was a community-based cross-sectional study.

Setting

The study was conducted in six talukas of Solapur district – Mangalwedha, Sangola, Barshi, Mohol, Pandharpur, and Madha.

Study period

The study was carried out during October 24–30, 2010, and November 21–27, 2010, i.e., For two weeks

Sample studied

The sample studied was 174 booths, 359 parents, 1289 houses, and 3162 children under 5 years of age.

Study variables

Immunization status, false P houses, parent's source of information, vaccine vial monitor (VVM), and migratory population were the study variables.

Statistical analysis

Z-test, test of goodness of fit, and percentages were used for statistical analysis.

The present study was conducted during October–November IPPI rounds in 2010. Six talukas were selected purposively for the study, as we were monitoring IPPI activities in these areas. Randomly, 174 booths were selected out of 2054 booths. Evaluation was done on booth activity day and also on the house-to-house activity days.

During the study, randomly 174 booths were visited. All staff members on these booths were interviewed. A total of 359 parents or guardians of children were also interviewed regarding their source of information. House-to-house visits were made to 1289 houses for 5 days after booth activities.


  Results Top


Of 174 booths, 94.83% of booths were easily accessible, and Information Education and Communication material displayed prominently on 85.06% booths. In 70.69% of booths, members were marking children finger correctly, i.e., left little finger with adjacent skin. In 98.28% of booths, tally sheet marking was correct while it tallies with children immunized at 94.25% of booths [Figure 1] and [Table 1].
Figure 1: Booth activity: knowledge and practice of booth members. IEC: Information Education and Communication, VVM: Vaccine vial monitor

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Table 1: Booth activity-knowledge and practice of booth members

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In 75% booths, mobilization of children to booth was done by team member [Figure 1]. Cold chain was well maintained at each booth and melted ice packs were replaced immediately by fully frozen ice packs by one mobile team at every monitoring booth. Vaccines in VVM stage 3 or 4 was not found on any booth. About cold chain, nearly the same finding was given by Rajoura et al. in their study at Delhi.[3]

More than 85% of total booth workers were trained [Table 1]. Similar observation was made by Rajoura et al. in their study at Delhi.[3]

At 98% booths, correct knowledge regarding stages of VVM was found in members [Figure 1]. This finding was in contrast to finding of Puri and Mishra.[4] Participation from community members was seen in 63.79% of booths.

On postbooth day activity, in migrant's population, 11.97% of children were unimmunized whereas in settled population it was 2.32%. Percentage of unimmunized children in migratory population was more than settled population, which is Statistically highly significant [Table 2].
Table 2: Immunization status of children in settled and migratory population

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During house-to-house activity, false P houses were 2.17%. Further, 2.35% unimmunized children were found [Table 3]. Reasons for unimmunized children were – children were not at home at time of visit of health team, parents were not at home, parents were not aware of polio round, or parents were too busy. Similar observations were made by Bandyopadhyay et al. in their study at Delhi.[5]
Table 3: Settled population children immunization status

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In 84.48% booths, team members are same as per micro plan; at the remaining booths, there is replacement of team member [Figure 2].
Figure 2: Team member placement as per micro plan

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Regarding source of information of IPPI, 38.16% parents got information from health workers followed by poster (18.66%), miking (18.11%), relative (9.75%), banner (6.41%), TV (2.79%), and newspaper (1.67%) [Figure 3]. From this, we can say that health care worker was mainly responsible for immunization of children (χ2 = 464.7, df = 9, P < 0.001, test of goodness of fit). Similar observation made by Nandan et al. in their study.[6]
Figure 3: Parent's source of information of intensified pulse polio immunization

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At transit site, out of total child passed through site, 84% of children were checked by team members for immunization (finger marking) and 16% children were missed [Figure 4]. Out of missed children, 13% were unimmunized which was later on immunized by monitors. Agrawal AK et al and Biswas AB et al has shown mentioned similar Observation.[7],[8]
Figure 4: Work of teams at transit site

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Regarding placement of teams at transit sites, teams were adequate at 80.77% sites, shifting timing appropriate at 88.46%, deployed member present at site in only 76.92% booths, and supervisor cross-checking the work of teams at only 50% booths [Figure 5].
Figure 5: Placement of teams at transit sites

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  Conclusion Top


Special attention is required toward immunization of migratory populations including slums with migration, nomads, sugar cane cutters, brick kiln workers, and construction site workers and also on transit sites including bus stand, railway stations, mela sites, and weekly bazaars. The role of local media and mass communication programs should be worked out and organized in a more systemic manner. Use of mass media must be done to motivate people for immunization. Supervisor work needs to improve. Community participation should be view as one of the key components for the success of the program. More voluntary agencies, persons, local leaders, and nongovernmental organizations should be motivated to come forward and work for this noble cause. More efforts needed to generate awareness among the general population regarding pulse polio to achieve 100% coverage. More stress needs to be placed on using mass media as an effective tool for behavioral change. It has been observed that there is always a shortage of trained volunteers for carrying out IPPI activities. The motivation level among the volunteers and health workers is at its lowest ebb. The reasons could be the increasing workload on health workers or inadequacy of honorarium. House-to-house activity following booth activity appears to be counterproductive, with attendance at the booth showing a decline. Some parents find it more convenient to vaccinate a child at home rather than to take them to the booth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
National Polio Surveillance Project India and Government of India. Pulse Polio Immunization Programme Operational Guidelines; 2004.  Back to cited text no. 1
    
2.
Chaudhary A, Sharma S, Girdhar S. Polio eradication Time for introspection, letter to the editor. Indian J Community Med 2007;32:151-2.  Back to cited text no. 2
  [Full text]  
3.
Rajoura OP, Bhasin SK, Chhabra P, Aggarwal OP. Pulse polio immunization in National Capital of Delhi: A process evaluation. Indian J Community Med 2002;27:181-4.  Back to cited text no. 3
  [Full text]  
4.
Puri A, Mishra M. Awareness of oral polio vaccine vial monitor: Among the polio booth staff. Indian J Community Med 2004;29:178.  Back to cited text no. 4
    
5.
Bandyopadhyay S, Banerjee K, Datta KK, Atwood SJ, Langmire CM, Andrus JK, et al. Evaluation of mass pulse immunization with oral polio vaccine in Delhi: Is pre-registration of children necessary? Indian J Pediatr 1996;63:133-7.  Back to cited text no. 5
    
6.
Nandan D, Mishra SK, Gupta GK, Gupta S, Maheshwari BB. Pulse polio immunization coverage evaluation in rural area of Agra district. Indian J Community Med 1996;21:34-6.  Back to cited text no. 6
  [Full text]  
7.
Aggarwal AK, Lakshmi PV, Grover A. Evaluation of house-to-house strategy for intensive pulse polio immunization in rural area of Haryana. Indian J Community Med 2006;31:33-4.  Back to cited text no. 7
  [Full text]  
8.
Biswas AB, Nandy S, Mishra R, Mondal PK, Mitra K, Mitra J. Involvement of junior doctors and students in IPPI some experiences. Indian J Community Med 2004;29:99-100.  Back to cited text no. 8
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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