Dear Editor,

Health of the migrant population staying in urban slums is very important from public health point of view. Slum population face many health related problems particularly the vulnerable groups like pregnant women, nursing mothers, and children. The access to health care facilities for Ante-natal care (ANC), immunization, counselling and general health check-up is not adequate for the migrant population. The children become susceptible to various vaccine preventable diseases like tuberculosis, measles, polio and tetanus. The reason is mainly due to lack of awareness, poverty, illiteracy and lack of access to health care facilities. Poor nutritional status among children makes them more vulnerable for infections. These factors will lead to increase in infant mortality rate and under-five mortality rate. In a study conducted by Swain et al1 and Yadav et al2 the immunization coverage is inadequate among the urban slum children. The health authority tends to neglect the migrant population as they constitute small numbers compared to the district. It is also difficult for the health system to track the mobile population. To address the issues of migration with respect to health needs, health care utilization and immunization, a collective effort from government, private health sector and non-governmental organisation is required.

A cross-sectional study was conducted among the slum children to assess immunization coverage according to National immunization schedule for Oral polio vaccine (OPV), Bacillus Calmette-Guerin (BCG), Diphtheria, Pertusis, Tetanus (DPT) and Measles in the age group of 0 to 5 years. A predesigned semi-structured questionnaire was used to collect the data. House to house survey was conducted and parents were asked about immunization status of their children. Data were analysed using SPSS version 11.5. The total children in the age group of 0-5 years were 27. Almost 55% of the parents were illiterate. About 67 % of the study group received BCG at birth. The coverage of OPV at birth was good, however the coverage for subsequent dose was very low. Only 29.6% of the children received Measles vaccine. Vitamin A coverage was only 25.9% at 9th month and at 1 and half years the coverage reduced to 22.2%. OPV/DPT booster coverage was 18.5%. About 60 % of the study populations are partially immunized, 14.8% are unimmunized. In a study conducted by Swain et al1 only 59% of the children had received BCG vaccine at birth which is low compared to our study. However in a study conducted by Yadav et al the coverage of BCG vaccination was more than national statistics.2 In Swain et al study the vaccination for measles and Vitamin A was low1 which is similar to study conducted by Yadav et al2 and our study. Ignorance (25.9%) and lack of awareness (29.6%) were the most common cause for low immunization coverage in our study, however in the study conducted by Yadav et al ignorance (80.36%) was the main reason for low coverage.2 As per the World Health Organization (WHO) fact sheet 2008, the national immunization coverage for BCG, OPV3, DPT3 and Measles was 87%, 67%, 66% and 70% respectively.3 This suggest that the Immunization coverage at the national level is much better compared to our study. However, there are few pockets like urban slums which have inadequate coverage especially for measles vaccine. The district health authority should conduct frequent outreach camps in underserved areas and give emphasis on immunization of eligible population. The Information, Education and Communication (IEC) department should educate the parents about importance of immunization. The main limitation of this study was small sample size. However, the study highlights the importance of immunization in slums. The few pockets of un-immunized children are responsible for maintaining infection in the community and sporadic outbreaks.

Sincerely,

Pattanshetty S, Ramachandra Kamath, Sujatha K, Darshan BB

Kasturba Medical College, Manipal University, Manipal - 576104

References

1. Swain KB, Mishra S. Immunization Coverage among Migrant Tribal Children in Slums of Orissa. Indian Pediatrics 2006; 43: 1011-1013

2. Yadav S, Mangal S, Padhiyar N, Mehta JP, Yadav BS. Evaluation of Immunization Coverage in Urban Slums of Jamnagar City. Indian Journal of Community Medicine 2006; 31(4): 300-301

3. India 2008 EPI Fact sheet. Available from URL: http://www.searo.who.int/vaccine/LinkFiles/EPI 2008/India08.pdf. Accessed on 19/12/2010

Author affiliation:

Corresponding Author:

Name: Dr.Sanjay Pattanshetty

Email: sanjay.pattanshetty@gmail.com