Pulse Polio immunization with OPV is being conducted two times each year in all 550 districts in the country since 1995. The Government has launched comprehensive Pulse Polio Program all over India on October 14, 2001 to give polio drop to all children up to five years of age. In Bihar, this program was conducted during October 14-18, 2001. UNICEF requested Institute for Research in Medical Statistics (IRMS), Delhi to evaluate the reach at this program so that the recommendations could be utilized in the second round of Pulse Polio scheduled on December 2, 2001. Accordingly, a quick evaluation has been undertaken in the districts of Champaran (E) and Bhagalpur of Bihar.

A quick evaluation were undertaken with the objectives to assess the coverage of IPPI during October 14-18, 2001, to identify the proportion of zero dose children, to assess the reach and effect of communication efforts of IPPI and to assess the reasons for non-compliance. A forty cluster sampling technique has been used. The allocation was 15 clusters from urban and 25 from rural areas in each district.

All the villages were divided into four sub-groups according to the population of the village as <500, 500-999, 1000-1999 and more than 1999.Numbers of clusters selected from each sub-group are in proportion to the number of villages in that group. Probability Proportion to Size (PPS) technique has been used to select desired number of villages in each sub-group. Primary caretaker of all the children born between Oct. 1996 to Oct. 2001 in each selected cluster has been interviewed using structured questionnaire. In the sub-groups with population <500 and 500-999, all eligible children were covered. But in bigger villages, an effort was made to cover all children belonging to Muslims, Schedule Casts/Schedule Tribes while it was every fifth household in case of other caste.

PPS technique was used to select specified number of Wards from the list of wards using census-91 as frame. All the Mohallas/colonies of the selected ward were listed with the help of ward members and community members. These mohallas/colonies were divided into three sub-groups of upper/Middle Socio Economic Category (SEC), Low SEC and slum. One mohalla/colony from the first group, two (one Muslim and one Hindu) from the second and two from third (one SC/ST and one other) sub-group were selected randomly. Thus, a total of five mohallas /colonies were selected from each urban cluster. So, 100 children (under five of age) from each urban cluster were assessed.

About two third of the households belong to Hindu and remaining were mainly Muslims. About 35% of the households belong to Schedule caste and schedule Tribes were very few. About two third of mothers were illiterate, it being 82% in rural area and 60% in urban area. Only few (2%) were graduates, it being about 5 percent in urban 0.3% in rural areas. Only one percent of the children did not receive Pulse Polio drops, it being 2% in urban area and 1% in rural area. About 91% of the children received the Pulse Polio drop by house- to-house approach followed in the campaign.

It was observed that immunization of children did not depend upon the literacy of mother / Religion / Caste. The main reason for not receiving pulse polio drop have been observed as no body came to the house (42%), not present during home visit (32%), no need of OPV every time (16%) and remaining were others. Muslims in Urban areas and Scheduled Caste in rural areas had lower coverage. By whose decision the pulse polio drop was not given, were mainly Mother (37%) and other family members (60%). Playing of tapes as well as announcements by Mike (30%) and Health worker (27%)were the main sources of information for the Pulse Polio Program. Only date for the Program and to immunize your each of the child were the main messages through Inter-personal Communi-cation (IPC) and Mass media. Most of the people prefer house-to-house approach because of saving of time.

Clustering of un- reached though the un-reached children are spread all over, yet concentrated in clusters, which are at the border with Nepal or in areas with higher concentration of scheduled castes in rural, and Muslims in urban areas.

Timely funding, the banner and poster should be available at least 10 days earlier the actual date of PPI, by increasing the teams, by increasing the frequency of mike and taking cooperation of Mullah for separate announcement from Masjid were suggestions made for improvement of coverage.

R.J. Yadav,
K. Suresh,*
Institute for Research in Medical Statistics,
Indian Council of Medical Research,
New Delhi 110 029, India.
E-mail: [email protected]
* Program Officer, UNICEF, New Delhi.