Indian Pediatrics 1999;36: 954-955

Awareness, Utilization and Cost of Newer Childhood Vaccines in a Lower Middle and Middle Class Urban Population of Vellore Town, South India

The Indian Academy of Pediatrics has suggested that the three newer vaccines_MMR (Measles-Mumps-Rubella), Hepatitis B (Hepatitis B) and Hib (Hemophilus influenzae_type b) may be offered as optional vaccines to children, in its newly recommended immunization time-table(1). While coverage estimates for the Expanded Programme on Immunization (EPI) vaccines are widely available, newer vaccine coverage figures are rare.We did a cross-sectional study to assess awareness, utilization and cost of these vaccines in an entire colony of lower-middle and middle class population of Vellore town.

Parents of 133 out of the total 146 children (aged 18-36 months) were interviewed and awareness regarding vaccine availability was 61%, 71% and 47% for MMR, Hepatitis B and Hib, respectively. Knowledge regarding dosage schedule and diseases prevented was higher for Hepatitis B and Hib vaccines as compared to MMR vaccine. Vaccine coverage was 44%, 41% and 15% for MMR, Hepatitis B and Hib, respectively. Total direct (medical and non-medical) expenditure for vaccination was approximately 20% higher in a private clinic as compared to CMCH (Christian Medical College and Hospital), a tertiary-care teaching hospital (Table I). A single visit for vaccination took 40 minutes at a private clinic located within 1 km when compared to 95 minutes at CMCH located 3 km away. Awareness and coverage of these vaccines was similar to that for EPI vaccines prevailing in the urban areas of India during the 1970s(2,3). Hepatitis B vaccine coverage was similar to that seen in a middle and upper-class population of Chennai city(4).

Table I^__Awareness, Utilization and Cost of Newer Childhood Vaccines.

* - amongst those aware of the vaccine only.

NA - Not available.

In conclusion, this study shows a high awareness regarding vaccine availability and moderate coverage with newer childhood vaccines. A sizeable proportion sought vaccination at a private clinic in spite of comparatively higher expenditure, probably because of quicker services and proximity of location. Doctors, including private practitioners, are crucial to any concerted educationsl efforts at improving knowledge and utilization. Know-ledge of type of users will be of interest to policy makers, pediatricians and the pharmaceutical industry. Free or subsidised vaccine may have to be offered to low income groups for equitable coverage.

Immunization Survey Group,
Department of Community Health,
Christian Medical College and
Hospital, Vellore 632 002,
Tamil Nadu, India.
E-mail: abraham@cmc.ernet.in

References

1. Committee on Immunization of the Indian Academy of Pediatrics. IAP Guide Book on Immunization. Mumbai, Indian Academy of Pediatrics, 1996; pp 27-32.

2. Chansoria M, Taluja Rk, Mukherjee B, Kaul KK. A study of immunization status of children in defined urban population. Indian Pediatr 1975; 12: 879-888.

3. Hooja V, Ghosh S, Mittal SK, Verma RK. Immunization status in an urban community. Indian Pediatr 1976; 13: 747-750.

4. Pai M, Sundaram P, Radhakrishnan KK, Thomas K, Muliyil JP. Hepatitis B immunization coverage and awareness in a middle and upper-class population in Chennai city. Indian Pediatr 1998; 35: 922-923.

 
Immunization Survey Group members were Premkumar Mony, Anuradha Bose, Amit Kumar Dutta, Jeyanath Suresh Rose, Harikrishan B, Md. Abrar Alvi, Pallipati Aparajit Paul, Ranjith John Jacob, Stephen Amarjeet Jiwanmal and Vinodh M.P.