Assessing Providers' Vaccination-Related Practices in India Open Access

Abstract

Background: Significant progress has been made toward improving routine immunization coverage in India, but universal coverage has yet to be achieved. Substantial variation in vaccination coverage exists across the country and little is known about how providers' vaccination practices affect coverage rates.

Aims: To identify barriers to achieving optimal vaccination coverage and to investigate factors influencing missed opportunities to vaccinate in two Indian states with low routine vaccination coverage.

Methods: We conducted an observational, cross-sectional study of Auxiliary Nurse Midwife (ANM) and Public Health Centre (PHC) physician vaccination practices during clinic visits for children under 3 years of age in Bihar and Uttar Pradesh. Information on provider behaviors was collected through parent-report and direct-observation. Information on clinic visit purpose was collected from parent reports only.

Results: Both ANMs and PHC physicians were more likely to adhere to recommended immunization-related clinical practices during vaccination-specific visits compared to illness visits. Adjusting for state and healthcare worker type, providers were 8 times more likely to verify child vaccination status during vaccination visits compared to illness visits (p<0.001) and 3.4 times more likely to counsel parents on vaccination (p=0.022).

Conclusions: Rigorous training of all vaccination practitioners should focus on the necessity of verifying the vaccination status regardless of type of visit. It is also important to emphasize the difference between true and falsely perceived contraindications to vaccination. Improved counseling will help improve vaccination rates and reinforce the importance of completing the vaccination schedule to parents.

Table of Contents

Table of Contents

Introduction...........................1 Methods................................3 Participants............................3 Procedures.............................3 Instrument.............................4 Data Variables.........................4 Data Analysis..........................5 Results..................................5 Unadjusted Analyses................5 Multivariable Analyses...............7 Discussion..............................9 Conclusions............................13 References.............................14 Tables...................................18 Supplementary Tables...............24 List of Tables

Table 1. Crude association between provider practices and healthcare worker type (ANM vs. PHC physician).........................................................................18

Table 2. Parent-reported differences in provider vaccination practices for illness compared to vaccination visits stratified by healthcare worker type....................19

Table 3. Parent-reported differences in healthcare worker vaccination practices, stratified by visit purpose...........................................................................20

Table 4. Association of vaccination practices and predictor variables, adjusting for state, healthcare worker type, visit purpose, and clinic.................................21

Table 5. Association of vaccination practices and predictor variables, adjusting for state, healthcare worker type, purpose, number of children in clinic, and clinic..22

Table 6. Predictors of verification of vaccination status as assessed by multiple regression, stratified by number of children in clinic..........................................23

Table 7. Crude association between provider practices (ANM and PHC physician aggregated) and state................................................................................24

Table 8. Crude association between provider practices and number of children in clinic (1-4 vs. ≥5).....................................................................................25

Table 9. Crude association between vaccination practices and healthcare worker type in Bihar............................................................................................26

Table 10. Crude association between vaccination practices and healthcare worker type in Uttar Pradesh..............................................................................27

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Uttar Pradesh routine immunization Bihar
Committee Chair / Thesis Advisor	Goodman, Michael, Emory University
Committee Members	Hughes, James M, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti)

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