Immunization Among Infants in an Urban Slum (Part-2)

RESEARCH DATA AND ANALYSIS

The study was conducted in Vashantek Area, Dhaka Cantonment. It is low income generated people living area. Basically it is an urban slum. A cross-sectional study was conducted in Vashantek area to find out the AEFI situation among infants and factors associated with it. In total, 206 respondents of infants were interviewed face to face using a semi-structured questionnaire in Bangla. In addition to 206 respondents, more 7 health personnel were interviewed in the same manner.

The majority of the respondents are female, to be specific, mothers of the infants. Because this is the usual practice that mother are the main caregivers in our country for the babies. For the purpose of survey targeted to the infants, we usually look for the first hand information from the mothers and if not, from the closer one who takes care of them. Where mother was not present father, grandmother, and aunt were interviewed.

For field-data collection, purposive sampling technique was used. Keeping in the mind about the general and specific objectives, semi-open ended questionnaire were formed. The questionnaire was formed mainly on four heading. They are, demographic and socio-economic condition, on immunization, knowledge of health personnel and finally on AEFI.  In demographic and socio-economic condition, the information was gathered regarding household population characteristics, such as age, sex, education, monthly income, sanitation, condition of house of the respondents, profile of the infants etc. Subsequently, data was collected on immunization aspects, knowledge of health personnel and with great emphasis data on AEFI were collected. To get those data, researcher had to visit the area at several occasion with indiscriminate timing.

Data was collected with care and check list was prepared so that the objectives of the research are met. The data from the questionnaire is placed in the data instrument sheet.  Sorting the data and performing the quality control check, the collected data were processed and finally analyzed by using SPSS window.

Research Data.          Data is taken on the following categories:

a.         Data about the Respondents Demographic and Socio-Economic Condition

            b.         Data Regarding Immunization

            c.         Data Collected from Health Personnel

       Data Regarding AEFI

Data about the Respondents Demographic and Socio-Economic Condition

Regarding the Relationship of Respondents with the Infants.

Data. Mothers are the mainly caregivers for baby in our country. To get the actual feedback of infants, mothers were chosen mostly.

Data Table : Table Regarding the Relationship of Respondent with the Infant

Interpretation.

From the graph, it is clear that 91.75% of respondents are female. Out of that,87.87% respondents were chosen infant’s mother. When mother was absent, father,grandmother or aunt were chosen as respondents. From this it can be interpretated that as  mothers were the majority respondents, so it is likely to get correct feedback about the AEFI.

Regarding Age of the Respondents.

Data.   Almost all adult people were interviewed. Their age was ranging from 15 years to 55 years.

Data Table : Table Regarding the Age of the Respondents

Interpretation.

From the above data, it is clear that the majority of the respondent’s (52.90) were from the age group ranging from 15 years to 25 years. 39.81% were from age group 26-35 years. Only 1.46% respondents were from age group 46-55 years.

Regarding Gender of the Respondents.

Data.   Respondents were the mixture of male and female of different age group. Data was collected mostly from infants’ mother. Where mother were not present, respondents were father, aunt or grandmother.

Data Table : Table Regarding the Gender of the Respondents

 Interpretation.           From the above data, it is clear that the majority of the respondent’s, e.g. 91.75% were female and a little percentage (8.25) were male. As female were mostly the infants mother, so exact data regarding the infant was extracted.

Regarding Education of the Respondents

Data.   The Vasantek area is mainly an urban slum based area, so, much educated people do not live here. People live here are very poor. They come from different corners of the country for better livelihood. So they are not that literate due to poverty.

Data Table : Table Regarding the Education of the Respondents

Interpretation.

From the above data, it is clear that a considerable percentage of respondents both male and female could not go to school. But the majority of the respondents both male and female have passed class five. So majority of the respondents are little literate and not much aware about the effect of vaccination.

Regarding Occupation of the Respondents.

Data.   Respondents of the infants were engaged in different forms of jobs. Male normally work as daily labour, rickshaw puller, small business or remain unemployed and female besides garments workers and daily labour, female work as bua (part time servant in other house ) or housewife.

Data Table: Table Regarding the Occupation of the Respondents

Interpretation. We can see from the above data that most male respondents were small businessman (47.06) and majority of female respondents (48.68%) were bua who work as per time servant in other house.  There is no significant association with respondent’s occupation and AEFI.

Regarding Monthly Income of the Respondents.

Data.   Poor and small earning people live here. As the slum is less cost effective, those people were comfortable to live here. Here they are deprived from all modern facilities/amenities.

Data Table  : Table Regarding the Monthly Salary of the Respondents

n= 194, because 12 female respondents are housewives.

Interpretation.

It is observed from the above data that majority of male respondents (47.06%) monthly incomes were varying from 3100 to 4500 taka whereas 66.10% female respondent’s monthly incomes were varying from 1500 to 3000 taka. A small percentage (5.88%) male respondent’s monthly income from 6100 to 7500 taka and 0.53% female respondents income from 4600 to 6000 taka.  There is no significant association with respondent’s monthly salary and AEFI.

Data Regarding Awareness Instruments

Data.

All awareness programs are broadcasted through both radio and TV. So radio and TV have direct impact on awareness. But those poor people do not have the luxury to buy radio or TV where they live hand to mouth.

Data Table : Table Regarding the Awareness Instruments

Interpretation.

From the above data it is evident that majority of respondents (48.09%) have neither TV nor radio, so they need to depend on others for information. 40.29% have either TV or radio and only 12.62% respondents have both radio and TV.

Data Regarding the Age of the Infants Mother.

Data.       Normally poor female become mother in early age. Due to poverty or ignorance, they become mother of more children.

Data Table : Table showing the Age of the Infant’s Mother

Interpretation.

From the graph it is very clear that majority of infant’s mother (56.31%) became mother at the age between 15 years to 25 years and 2.43%  are become mother in between 36 to 45 years. As the infants mothers are of tender age and little literate, they are expected to be less aware about health.

Data Regarding the Number of the Member of the Family.

Data.

Normally poor female become mother in early age. Due to poverty or ignorance, they become mother of more children. They think that they will be helping hand or earning member in the later stage of their lives.

Data Table : Table Showing the Number of the Member of the Family

Interpretation.

From the graph, it is seen that more than two third (77.19%) of the respondents are having 5 members family and more. Only 22.81% of respondents are having 4 member family and less. It has two interpretations. One, respondents, having more family members, have more expenditure and less likely to send their children to the school. Two, they are still aware of the negative aspects of more population.

Order of the Infants in the Family

Data.   Generally, poor people normally take more children. Because they think their children will be the earning member in their later stages on life.

Table : Table Showing the Infants in the Family

Interpretation:

From the graph it is distinct that about 93.69% of the infants are not the only child. They have more than one child. Parents’ with more than one child cannot able to provide due care and attention to their children. Only 6.31% infants are the only child.

Regarding Condition of House.

 Data.   Vashan Tek is a slum. So majority of the condition of house is not good as people are poor.

Data Table :Table Showing the Condition of House

Interpretation.

From graph we get 66.50% of the respondents houses were semi-pacca and 23.30% are kacha. Meaning that around 80% of respondents live in semi-pacca and kacha houses. It shows that their financial condition was not at all good.

Regarding Status of Sanitation.

Data.   To know the status of sanitation, following data was collected.

Data Table : Table showing the Status of Sanitation

Interpretation.

From graph it is clear that that nearly all (98.54%) of the household have their own or common sanitary latrines and only 1.46% of the respondents have hanging type of latrines. Despite being poor, almost all people use sanitary latrine which prevents fecal borne diseases, like, polio.

Regarding Sources of Drinking Water.

Data.   People, to be specific, children normally suffer from water borne diseases who are still away from the light of education. Less of awareness, sometimes compelled them to drink impure water. So following data helped to evaluate the correct state of drinking water in an urban slum.

Data Table : Table showing the Sources of Drinking Water

Interpretation.

From graph it is evident that almost 85.92% of the household have water source from tap water. Some respondents have the water connection from WASA water supplied source. But majority collect water from a distance from a tap water source beside the road.  Only 14.08% of the respondents have the drinking source from tube well. This WASA supplied water is not pure to drink without boil. This is a grey area for their better livelihood.

Regarding Type of Family.

Data.   Normally in rural areas, more joint families are found. But in cities, people preferred single family than that of joint family. By following data, actual family types were portrayed.

Data Table : Table showing the Types of Family

Interpretation.

From data and graph it is stated that 88.83% of the respondents have single family whereas only 11.17% have the joint family. From the family types it is clearly depicted that people are having more expenditure in urban areas as such they prefer to have single family.

Data Regarding the Religion.

Data.   To know the respondent’s religion following data was collected. It is to mention that Bangladesh is a muslim country. It was expected that majority of respondents were likely to be muslim.

Data Table : Table showing the Religion of the Respondents

Interpretation.

From the graph, it is evident that more than two-third (84.95%) of respondents were muslim and 12.62% were Hindu. Rest was Christen and other religion followers. This data had no direct association with the research.

Data Regarding Immunization

Data Regarding the Age of Infants.

Data.   Here infants up to one year old were considered as the study of population. For survey requirement, age of the infants was collected in weeks.

Data Table : Table showing the age of the infants

Interpretation.

From the graph it is seen that 32.53% of infants and 40.29% of infants were from 10 to 13 weeks age group and 14-36 age weeks group respectively. So it was found that during the collection of data 14 to 36 age weeks’ group infants participated more than other age groups.

Data Regarding the Gender of Infants.

Data.   Both male and female infants were considered for the study. Here data was collected in months. All infants were maximum 12 months old.

Data Table : Table showing the Gender of the Infants

Interpretation.

From the graph we can see that there are 98 male infants whose percentage was 47.57% and 108 are female infants whose percentage was 52.43% considering the total respondents. For both male and female infants, 4 to 6 months infants were maximum that is, 37.76% and 35.19% are respectively for male and female.

Data Regarding Place of Vaccination.

Data.   Infants received vaccination from government centre, NGO clinic and private clinic.

Data Table : Table showing the Place of Vaccination

Interpretation.

More than half of the respondents replied that they received vaccination from the government centre whose percentage is 60.19%. 21.84% and 17.97% respondent’s infants received vaccination from NGO centre and private clinic respectively.

Data Regarding Vaccination Given by New Syringe.

Data.   New syringes are used so that no blood borne diseases can be transmitted.

Data Table : Table showing the Vaccination Given by New Syringe

 Interpretation.

From graph it is clear that nearly all (90.78%) respondent’s infants were vaccinated by new syringes. Around one tenth (9.22%) respondents were casual about the information of using the new syringes.

Data Regarding Vaccination given by New Syringe to Other Infants

Data.   Syringes are the important media to push injection to human body. As through it blood borne diseases can be transmitted, so everybody must be aware of its uses

Data Table : Table Showing Vaccination Given by New Syringe to Other Infants

Interpretation. From graph it is clear that nearly all (82.52%) respondent’s replied that other infants were vaccinated by new syringes. Around one tenth respondents (12.62%) were confused about the use the new syringes to other infants and a small percentage (4.85%) respondent’s informed that other infants were not vaccinated by the new syringes. It means that if those 4.85% were possessed any blood borne diseases, other infants were likely to be infected.

Data Regarding the Same Vaccinator Push Vaccination to all Infants

Data.   Vaccinator plays a vital role. Again, there is an acute shortage of health personnel in health care centre. So data was collected whether same person pushed the vaccination to all infants or not.

Data Table : Table Showing Same Vaccinator Push Vaccination to all Infants

Interpretation.

From the graph, it is stated that majority (88.83%) of respondents were confessed that same person who was usually doing the job of vaccination did the immunization. Around 8.74% were not sure and small percentage (2.43%) respondents replied negatively on the question.

Data Collected from Health Personnel

Here total health personnel were 7.

 Data Regarding the Last Training Attended by Health Personnel

Data.   Training is the one of the steps to acquire knowledge. It makes the health personnel confident on their job.

Data Table : Table Sowing the Last Training Attended by Health Personnel

 Interpretation.

In response to the question regarding last training received it was found that more than one tenth (14.29%) of the respondents had one week training before 18 months before. Among 85.71% respondents, few were   trained for 1-2 days, and few were trained for one week. All training was conducted through EPI service.

Data Regarding the Requirement of Refresher Training to Health Personnel

 Data.

Refresher training makes the personnel to regain their confidence on the specific field.

Data Table : Table Showing the Requirement of Refresher Training to Health Personnel

Interpretation.

From the graph, it is clear that 85.71% health personnel were desired to have specific refresher training before any national immunization programme. On the other hand, 14.29% respondents felt that refresher training is not required.

Data Regarding the Adequate Manpower at Vaccination Centre

Data.   In the government machinery, everywhere there is a shortage of manpower. Sometimes, it hampers the operation.

Data Table : Table Showing the Adequate Manpower at Vaccination Centre

Interpretation.

85.71% respondents agreed that there is an acute shortage of manpower in vaccine centre on national immunization day, while a small percentage (14.29%) argued that there is enough manpower. It has negative interpretation, that is, if there is not an adequate and trained manpower, it would likely to affect the immunization programme.

Data Regarding the Topic to be Imparted in Training to Health Personnel

Data 

Training, mainly practical oriented training has immense value in learning.

Data Table : Table Showing the Topic to be Imparted in Training to Health Personnel

Interpretation.

Main areas identified for immunization training from health personnel were techniques of vaccine administration; cold chain logistics; use of AD syringes; details learning on route, site, schedule, dose and finally IPC and counseling etc. Among those topics, 43% respondents wanted to have training on details learning on route, site, schedule and dose. It is required practical oriented training.

Data Regarding the Improvement of Immunization Coverage

Data.   To make the successful campaign, immunization coverage should to reach to all people in the country.

Data Table : Table Showing the Improvement of Immunization Coverage

Interpretation.

It is conspicuous from the above graph that approximately 43% suggested the greater community participation was one of the effective means for improvement of immunization coverage. Others suggested for involving more human resources, improved mobility, better management of supplies and logistics, more supervision and training which percentage is equal to approximately 14%.

Data Regarding AEFI

Data Regarding Fully Immunization Status of Infants

Data.  

Children are the future leader. So they should grow up taking all preventive measures. It will help them to be health in future life.

Data Table : Table Showing the Fully Immunization Status of Infants

Interpretation.

From the graph, it is perceived that the majority (88.83%) of infants were given immunization as per schedule applicable to them till date. But still 11.17% of infants were not fully immunized.

Regarding Any Serious Reaction after Vaccination.

Data.   Normally vaccine manufacturers produce vaccine strictly following safety norms and ensure effectiveness with current technology available. Vaccines used in the national immunization programs are extremely safe and effective. But no vaccine is perfectly safe and adverse events can occur following immunization.

Data Table : Table Showing the Serious Reaction after Vaccination

Interpretation.

From the graph, it is clearly stated that absolutely 100% infants neither faced serious reaction nor any big problem following the vaccination.

Data Regarding the Knowledge on AEFI

Data.

As no vaccine is safe or perfect, there should be knowledge that after vaccination, AEFI may develop. Otherwise general mass may lose confidence on vaccination.

Data Table : Table Showing the Knowledge on AEFI

Interpretation.

From the graph it is evident that around 62.14% respondents do not have the knowledge on AEFI and remaining respondents (37.86%) have knowledge on AEFI.

Data Regarding Sources of Knowledge on AEFI

 Data.Sources of knowledge on AEFI are important. Normally, poor people have less access to this kind of sources.

Data Table : Table Showing the Sources of Knowledge on AEFI

Interpretation.

From graph it is seen that majority of respondents (62.62%) have their AEFI knowledge source as health workers. One third of respondents gained knowledge about AEFI from relatives and small percentage gained knowledge from other reliable sources.

Regarding Infants with Different Types of AEFI

Data.   After vaccination, infants may suffer fever, pain, swelling, irritability, abscess, crying, drowsiness etc. due to different factors.

Data Table : Table Showing the Different Types of AEFI

Note :  n=274,because same infant suffered from multiple AEFI

Interpretation.           Above graph shows the different types of AEFI, the infants had experienced. Majority of them (62.77%) have had fever as per parents statements, 18.99% suffered from mild local reaction and 4.74% have had irritability.

Regarding Category of AEFI to Individual Vaccine

Data.

Individual vaccine may offer different types of AEFI. Pentavalent is a newly introduced vaccine comprised of DPT, HepB and Hib. It is popularly known as “Five-in-one”.

Data Table :           Table Showing the AEFI to Individual Vaccine

Note :  n=274,because same infant suffered from multiple AEFI

Graph : Graph showing the age of the infant’s mother.

Interpretation.           From the graph it is seen that majority of infants (62.77%) have had fever and 18.99% have had local reaction. Besides those, 7.30%, 0.73%, 1.10%, 2.55%, 1.82% was persisting crying, irritability, abscess, loss of appetite, drowsiness and others respectively. From above data it can be deduced that there is no major reactions, but there was mild reactions which was cured automatically with few days.

Data Regarding Infants by Individual Vaccine dose and AEFI

Data.   From different vaccine doses, AEFI may develop.

Data Table : Table Showing the Infants by Individual Vaccine Dose and AEFI

n= 1240, as same infants suffered from multiple AEFI

 Interpretation.Table shows that 206 infants received 1240 dose of different vaccine. Graph 34 shows 176 infants received pentavalent dose-1 and among them 72.16% developed AEFI, among 139 infants in pentavalent dose-2, 67.63% developed AEFI and among 115 infants in pentavalent dose-3, 55.65% developed AEFI. Graph 35 shows the different percentage of developed AEFI of different types of doses. Among 206 and 136 infants, there developed 64.56% and 37.5% AEFI for BCG and Measles respectively in graph 36.

Data regarding infants by types and duration of AEFI

Data.   AEFI may be serious or minor. It may develop since after receiving vaccination and may continue from several hours to several days.

Data Table : Table Showing the Infants by Types and Duration of AEFI

Interpretation.

The above data shows that 147 study subjects suffered from AEFI for 1 day, 62 subjects suffered from AEFI for 2 days, 10 subjects suffered from AEFI for 3 days and 3 subjects suffered from AEFI more than 30 days. . From above data it can be said that without any major reactions, majority of infants suffered from mild reactions mainly fever which subside automatically within few days

Data Regarding the Infants by Drug Allergy

Data.   After receiving vaccination, infants may have previous drug allergy. If so, it needs be taken in cognizance.

Data Table :  Table Showing the Infants by Drug Allergy

Interpretation.

Above table and graph shows that 81.55% respondents were unknown about their infant’s drug allergy and rest 18.45% had no drug allergy.

Data Regarding the Infants by Pre-existing Neurological Illness

Data.   After receiving vaccination, infants may have pre-existing neurological illness. If so, it needs be taken in to consideration.

Data Table : Table Showing the Infants by Pre-existing Neurological Illness

Interpretation.

From the graph it is observed that 41.75% respondents did not know about their infant’s pre-existing neurological illness and 58.25% replied that their infants did not have.

Data Regarding the Infants by Coincidental Incident

Data.   Infants may suffer ARI, diarrehea, may have rash or oedema on whole body before or after the vaccination. If so, it will not be considered as AEFI.

Data Table : Table Showing the Infants by Coincidental Incident

Note:One infant suffered from both diarrhea and ARI.

Rash categorized as coincidental as because in all cases rash appear after 24 hours.

Interpretation.

The above graph shows that among 206 infants only 3.88% developed coincidental incidents. Therefore, it can be revealed that the above percentage was coincidental which was not occurred due to vaccination.

Data Regarding the Infants by Category of Reportable AEFI

Data.   Categories of reportable AEFI are highlighted in this data.

Data Table :  Table Showing the Infants by Category of Reportable AEFI

Note: Local reactions which had pain, redness and swelling of more than 3 days were categorized as severe.

Graph : Graph showing the infants by category of reportable AEFI

 Interpretation.

From the graph, it was seen that 16.50% had reportable AEFI and the rest 83.5% had non reportable AEFI. So it can be said 16.5% was the reportable AEFI, but not serious.

Data Regarding the Reportable AEFI According to Age and Sex

Data.   Reportable AEFI according to age and sex are highlighted in this data.

Data Table : Table Showing the Reportable AEFI According to Age and Sex

 Interpretation.

The above graph shows that among reportable cases of AEFI 52.94% were male and the rest 47.06% were female. Among them, most are in age group 10-13 whose percentage were 23.53% were female. There were no infants with reportable AEFI in age group 37-52. There was no association between reportable AEFI with age and sex.

Data Regarding the Infants by Treatment Seeking Behavior

Data.   For any infections, normally parents seek doctors advice for child. There is no exception for AEFI after vaccination.

Data Table : Table Showing the Infants by Treatment Seeking Behavior

Interpretation.

From the above graph, it was revealed that approximately two-third respondents (66.50%) wait for recovery of their infants from AEFI that means they took no treatment for the problems of AEFI. 17.96% treated their infants with antipyretic without consulting physician. Only 2.92% contacted with doctor for recovery of their infants. Here, they also conveyed that they would continue the vaccination.

Data Regarding the Infants by Outcome of Treatment

Data.

After taking the physician treatment, some infants are get cured and some are not.

Data Table : Table Showing the Infants by Outcome of Treatment

Interpretation.

From the graph it can be deduced that 90.71% infants recovered from their suffering and 8.29% infants have residual effects of AEFI.

Data Regarding the Infants According to Types of AEFI and Age at Time of Vaccination

Data   

Data highlighted about at what age infants are affected by what the category of AEFI.

Data Table : Table Showing the Infants According to Types of AEFI and Age at Time of Vaccination

Graph : Graph showing the infants according to types of AEFI and age at time of vaccination

Interpretation.

The above graph shows that highest percentage of study subjects belongs to age group 6-9 weeks suffered more AEFI than the other age group except for abscess.

Data Regarding the Infants by Number of AEFI they Experienced

Data.   The data below portrays the number of AEFI the infants are experienced with.

Data Table : Table Showing the Infants by Number of AEFI They Experienced

Graph : Graph showing the infants by number of AEFI they experienced

 Interpretation.

From the above graph it is observed that 35.92% infants suffered from single AEFI, 51.46% suffered from two types of AEFI and 1.45% suffered from four types of AEFI.

Data Regarding the Infants having Different Types of AEFI and Gender

Data.   The below data shows the percentage of boys and girls are experienced with different kind of AEFI.

Data Table : Table Showing the Infants having Different types of AEFI and Gender

Graph : Graph showing the infants having different types of AEFI and Gender

Interpretation.                      From the graph it is seen that 52.91% male and 47.09 female developed fever after vaccination. 48.08% boys and girls developed local reaction after vaccination. Regarding persisting crying, girls suffered more (60.00%) than boys (40.00%) from that illness.

Data Regarding the Continuation of Vaccination if there is Minor AEFI

Data.   Parents may lose confidence or may get afraid of AEFI after immunization. Some parents may not continue further about the remaining vaccination.

Data Table : Table Showing the Continuation of Vaccination if there is Minor AEFI

 Graph : Graph showing the continuation of vaccination if there is minor AEFI

Interpretation.

From the graph it is revealed that 85.92% of the respondents had been willing to continue the vaccination even there would be minor AEFI. But a small percentage (14.08%) denied continuing further vaccination.

Data Regarding the Discouragement of Relatives and Neighbor if there is Minor AEFI of Respondents

Data.   When infants are affected with AEFI, some or all parents may discourage to continue the vaccine.

Data Table : Table Showing the Discouragement of Relatives and Neighbor if there is  Minor AEFI of Respondents

Graph: Graph showing the discouragement of relatives and neighbor if there is minor AEFI of respondents

Interpretation.

From the above graph it is observed that 90.78% of respondents were willing to encourage their relatives and neighbors if there would be minor AEFI, but 9.22% respondents replied that they would like to discourage their relatives and neighbor if there would be minor AEFI.

ata Regarding the Hearing the Occurrence of Minor AEFI Develop in the Same day

Data.   There may have instances that infants may suffer AEFI in the same day.

Data Table : Table Showing the Hearing the Occurrence of Minor AEFI Develops in the Same Day

Interpretation.

From the table it is observed that 78.64% of respondents heard the occurrence of minor AEFI develop in the same day whereas only 21.36% respondents did not hear. So it can be deduced that minor reactions were very common after vaccination.

Data Regarding Taking Vaccine on NIDs

Data.

Same infants may be vaccinated more than one. Following data shows how many have received more than one vaccine on NIDs.

Data Table : Table Showing the Vaccine Taken on NIDs

Interpretation.

From the above graph it can be seen that nearly three fifth (59.71%) respondents replied positively but one fifth were confused and another one fifth denied to reply.

Findings on the Survey of the Respondents Demographic and Socio-Economic Characteristics:

a. From the survey, it was seen that 91.75% respondents were female and out of that 87.87% were mother of infants (Ref: Data Table 1, Data Table 3). Out of the respondents, majority (52.90%) were from 15 to 25 age group which was followed by 26 to 35 age group (39.81%) (Ref: Data Table 2). Regarding the respondents’ education, for both male (64.71%) and female (59.79%), maximum respondents have passed class five (Ref: Data Table 4). About the occupation maximum 47.06% male respondents were small businessmen whereas maximum 48.68% of female respondents were serving as Bua (Temporary maidservant) in other house. Small business refers to vegetables seller, shopkeeper, chatpati & Fuska (a kind of food) seller, different seasonal fruits juice seller, cake (traditional winter) seller etc. It is to be noted that 6.35% of female respondents were only housewife (Ref: Data Table 5). Maximum 47.06% male monthly income were varying from 3100 to 4500 taka  and maximum 66.10% of female respondents monthly income were varying from 1500 to 3000 taka (Ref: Data Table 6). Majority of respondents (48.09%) did not posses neither TV nor radio (Ref: Data Table 7). Regarding the age of infants’ mother, maximum 56.31% were varying from 15 years to 25 years of age (Ref: Data Table 8). Though people were poor, even then they were mostly (44.18%) 5 members family which was followed by 6 members family (30.10%)(Ref: Data Table 9). And 93.69% infants were not the only child (Ref: Data Table 10). 66.50% of the houses of the respondents were semi-pacca and around one fifth (23.30%) were having kacha house (Ref: Data Table 11). Nearly all respondents (98.54%) were possessing sanitary latrines and only 1.46% were with hanging latrines (Ref: Data Table 12).  Majority (85.92%) of respondents was drinking running tap water which was collected from a distance (Ref: Data Table 13). Majority (88.83%) of respondents preferred to have single family rather than joint family (Ref: Data Table 14). It was seen in earlier data that maximum respondents had 5 and 6 members’ family, but they were not in joint family rather single family due to more number of children. Bangladesh is a muslim country. Therefore it was expected to have more muslim (84.95%) respondents (Ref: Data Table 15).

b. We know mothers were the care giver for baby in our country. So female (91.75%) specially mothers (87.87%) were chosen as maximum respondents. Where mother was absent, grandmother, aunt or father was chosen as respondents who took care of the infants. Therefore, it was very much useful to get the first hand information about the infants. Most respondents were muslims (84.95%) with educational background up to class five for both male (64.71%) and female (59.79%) and used to drink WASA supplied tap water (85.92%). It was learnt that they could not continue study due to poverty. Leaving the study, they had to earn for the family. Due to less educational background, respondents (female) were not aware of not only health aspects but also drinking water. Only few people boil their tap water for drinking. Further, mother of the infants age were maximum 56.31% from 15 years to 25 years of age. At times, they become mother before the age of the maturity. So both mother and infants sometimes suffered in malnutrition. Though 88.83% respondents preferred single family even then 44.18% had 5 members and 30.10% had 6 members family. The size of the family appeared to be big as they think that more family members would help the family in the later stage by earning. The maximum respondents (44.18+30.10=74.48%) had 5 and 6 members family, but maximum 47.06% male’s monthly income were varying from 3100 to 4500 taka  and maximum 66.10% of female respondents monthly income were varying from 1500 to 3000 taka. With those small monthly income and more family members, it would be very difficult to run their livelihood in expensive city like Dhaka. So the maximum 66.50% had been living in semi-pacca house and around one fifth (23.30%) had been living in kacha house due to poverty. But surprisingly nearly all respondents (98.54%) were possessing sanitary latrines. Here it was required to mention that everybody did not possess separate sanitary latrines individually, but they used to share the common sanitary latrines in a group in a particular area.

Findings on the Survey on Immunization Characteristics:

a. 32.53% of infants and 40.29% of infants were from 10 to 13 weeks age group and 14-36 age weeks group respectively. So it was found that during the collection of data 14 to 36 age weeks group infants participated more than other age groups (Ref: Data table 16). There are 98 male infants (percentage was 47.57%) and 108 are female infants (percentage was 52.43%) considering the total respondents (Ref: Data table 17). More than half of the respondents received vaccination from the government centre whose percentage is 60.19%. 21.84% and 17.97% respondent’s infants received vaccination from NGO centre and private clinic respectively (Ref: Data table 18).

b. Regarding the use of new syringes, nearly all (90.78%) respondent’s infants were vaccinated by new syringes. Around one tenth (9.22%) respondents were casual about the information of using the new syringes (Ref: Data table 19). Nearly all (82.52%) respondents informed that other infants were vaccinated by new syringes. Around one tenth respondents (12.62%) were confused about the use the new syringes to other infants and a small percentage (4.85%) respondent’s informed that other infants were not vaccinated by the new syringes. It means that if those 4.85% were possessed any blood borne diseases, other infants were likely to be infected. For this programmatic error, adverse reaction might occur. (Ref: Data table 20). Majority (88.83%) of respondents were confessed that same person who was usually doing the job of vaccination did the immunization. Around 8.74% were not sure and small percentage (2.43%) respondents replied negatively on the question. Normally same vaccinator vaccinates most of the infants who are regarded as experienced. But due to shortage of adequate manpower, a small percentage of infants might be vaccinated with untrained health personnel whose knowledge on route and dose of vaccination might be shallow. It might be the cause of adverse reaction (Ref: Data table 21).

Findings on the Survey of the Knowledge of Health Personnel Characteristics:

a.Besides providing the questionnaire to health personnel, a comprehensive discussion took place where different aspects were discussed. Training makes someone confident about a particular matter. Moreover, it is conspicuous from the data that training is very essential. At first, regarding the last training received it was seen that majority (85.71%) of health personnel had their training 18 months before where 57.14% were trained for 1-2 days and 28.57% were trained for one week (Ref: Data table 22). 85.71% health personnel were desired to have specific refresher training. After regular interval, the training should be imparted (Ref: Data table 23). 85.71% respondents agreed about the acute shortage of manpower in health centre. Shortage of manpower always hinders the mission to achieve. So recruitment of new personnel would a solution to achieve the goal. In addition to those, logistics support is also necessary (Ref: Data table 24).

b.Main areas identified for immunization training for health personnel were techniques of vaccine administration; cold chain logistics; use of AD syringes; details learning on route, site, schedule, dose and finally IPC and counseling etc. Among those topics, 43% respondents suggested to have training on details learning on route, site, schedule and dose (Ref: Data table 25). It is required practical oriented training. Approximately 43% suggested the greater community participation was one of the effective means for improvement of immunization coverage. Others suggested for involving more human resources, improved mobility, better management of supplies and logistics, more supervision and training which percentage is equal to approximately 14% (Ref: Data table 26).  

Findings on the Survey on AEFI Characteristics:

a. The majority (88.83%) of infants were given immunization as per schedule applicable to them till date. But still 11.17% of infants were not fully immunized. It was due to lack of awareness or to mange appropriate time for vaccination (Ref: Data table 27). All (100%) caretakers replied that they faced neither serious reaction nor any major problem after the vaccination. There was no complaint of any major AEFI (Ref: Data table 28). 62.14% respondents do not have the knowledge on AEFI whereas remaining 37.86% have the knowledge on AEFI (Ref: Data table 29). The majority of respondents (62.62%) confected that health personnel were the main source of AEFI knowledge. One third of respondents gained knowledge about AEFI from relatives and small percentage gained knowledge from other reliable sources (Ref: Data table 30). Minor reactions, i.e. pain, swelling and redness were very common. Fever was most likely to occur within six hours post immunization. Majority of infants (62.77%) have had fever and 18.99% have had local reaction. Persisting crying last for less than 3 hours was observed in 7.30% of infants in the study. In most cases, parents linked the character of cry to that of cry due to pain. Infants refused to be comfortable and neither slept nor ate during this time. There was an interesting survey regarding persisting crying, that is, girls suffered more (60.00%) than boys (40.00%) from that illness. Besides those, 4.74%, 0.73%, 1.10%, 2.55%, 1.82% was irritability, abscess, loss of appetite, drowsiness and others respectively (Ref: Data table 32). From above data it can be deduced that there is no major reactions, but there was mild reactions which was cured automatically with few day (Ref: Data table 32).

b.206 infants received 1240 dose of different vaccines. 176 infants received pentavalent dose-1 and among them 72.16% developed AEFI, among 139 infants in pentavalent dose-2, 67.63% developed AEFI and among 115 infants in pentavalent dose-3, 55.65% developed AEFI. Besides the pentavalent, there developed 64.56% and 37.5% AEFI for BCG and Measles out of 206 and 136 infants respectively. (Ref: Data table 33). Among the above developed AEFI, 147 infants suffered from AEFI for 1 day, 62 infants suffered from AEFI for 2 days, 10 infants suffered from AEFI for 3 days and 3 infants suffered from AEFI more than 30 days. From above data it can be said that without any major reactions, majority of infants suffered from mild reactions mainly fever which subside automatically within few days (Ref: Data table 34).  81.55% respondents were unknown about their infant’s drug allergy and rest 18.45% had no drug allergy (Ref: Data table 35). Among 206 infants only 3.88% developed coincidental incidents. Therefore, it can be revealed that the above percentage was coincidental which was not occurred due to vaccination (Ref: Data table 36). 16.50% had reportable AEFI and the rest 83.5% had non reportable AEFI. So it can be said 16.5% was the reportable AEFI, but not serious. Local reactions which had pain, redness and swelling of more than 3 days were categorized as severe.  (Ref: Data table 37). Among reportable cases of AEFI 52.94% were male and the rest 47.06% were female. Among them, most are in age group 10-13 whose percentage was 23.53% were female. There were no infants with reportable AEFI in age group 37-52. There was no association between reportable AEFI with age and sex (Ref: Data table 37).  Two-third respondents (66.50%) wait for recovery of their infants from AEFI that means they took no treatment for the problems of AEFI as because they think that AEFI was self limiting. 17.96% treated their infants with antipyretic without consulting physician. Only 2.92% contacted with doctor for recovery of their infants. Here, they also conveyed that they would continue the vaccination (Ref: Data table 39). 90.71% infants recovered from their suffering and 8.29% infants have residual effects of AEFI (Ref: Data table 40). The highest percentage of study subjects belongs to age group 6-9 weeks suffered more AEFI than the other age group except for abscess(Ref: Data table 41). 35.92% infants suffered from single AEFI, 51.46% suffered from two types of AEFI and 1.45% suffered from four types of AEFI (Ref: Data table 42). 52.91% male and 47.09 female developed fever after vaccination. 48.08% boys and girls developed local reaction after vaccination. Regarding persisting crying, girls suffered more (60.00%) than boys (40.00%) from that illness (Ref: Data table 43).

c. 85.92% of the respondents had been willing to continue the vaccination even there would be minor AEFI. But a small percentage (14.08%) denied continuing further vaccination. Despite of sufferings, majority was determined to continue the next dose. That suggests that due to AEFI, there was no negative impact on immunization. But a small percentage (14.08%) denied continuing further vaccination because of vaccine related adverse behavioral events (sleepiness, fretfulness, eating lass, prolong crying, high pitched)  (Ref: Data table 44). 90.78% of respondents were willing to encourage their relatives and neighbors if there would be minor AEFI, but 9.22% respondents replied that they would like to discourage their relatives and neighbor if there would be minor AEFI (Ref: Data table 45). 78.64% of respondents heard the occurrence of minor AEFI develop in the same day whereas only 21.36% respondents did not hear. So it can be deduced that minor reactions were very common after vaccination (Ref: Data table 46). Nearly three fifth (59.71%) respondents replied positively but one fifth was confused and another one fifth denied replying (Ref: Data table 47). At nutshell, there was no complaint of any episode of convulsion or unconsciousness, floppiness of the limbs, any severe reaction in 24 hours following the vaccination, nor any shivering of the body. Again, there was neither complaint of lymphadenitis nor any boil at the site of vaccination. There was no event of paralysis of the limbs or any episode of diarrhoea. The problems that came out as ill events after the vaccination were minor and, in some cases, just a common inflammatory reaction.

 The study was conducted in urban area, name Vasantek near Dhaka Cantonment. Though it is an urban area, but it does not possess any facility like urban town. The area is less developed and low income people live here. The respondents were not only the parents of the infants, but also the health personnel.

 The purpose of this study to find out the AEFI situation among infants in a selected urban slum and factors associated with it. Finally put forward some suggestions to overcome those. That may be taken cognizance by the policy makers in time of crisis. So it demanded in depth study. It was lone member team. Nobody assisted me in respect of survey in the field. So for detailed study, one man member team was not really enough.

Further, besides my all other jobs, I had to manage time to visit the location number of times. Even then, I did not get the parents, mainly mother as they work in houses as extra. So time was another constraint. Moreso, parents are hesitant to respond on this occasion. They had to make the situation understand in every case. They thought as I would be getting financial assistance from government so they are expecting financial support for interview or reply. So to make this situation in favor of the researcher, it entails time. As for survey researcher had to go to the respondents time and again, they were not very positive to receive as they think it will not have any dividend to their earning hoods. So sometimes, they did not hesitate to refuse the researcher. Besides the above mention constraints, financial aspects are also a barrier which cannot be ignored. Because, the respondents would be eager to support the researcher, if there would be financial support.

Researcher had to go several times to respondents. Every time she did not meet the same person. In addition, some of the interviewee was other than mothers. This may have hampered in the homogeneity of responses that were asked to them. This might have reflected in the study findings. Sometimes, parents did not mark properly the actual reaction. Only minor vaccine reactions like local reaction, fever, irritability etc, few serious vaccine reactions like persistent crying and little program error like abscess, severe local reaction were assessed. But other vaccine reactions could not be detected because of their very low occurrence rate and small sample size. Here it is to be noted that the respondents are not that educated to mark those reactions which is another barrier for the study.

Finally, finding of the study not necessarily represent the actual total of the vaccinated infants in the country as a small portion of the urban area was projected. Here finding depends on also the workers knowledge about vaccination, its care, handling and preservation.

CONCLUSION

Immunization a child not only protects that child but also other children by increasing the general level of immunity and minimizing the spread of infection. Immunizations are one of the major public health success stories of the past century. Universal immunizations have led to dramatic decreases in the incidence of smallpox, paralytic polio, tetanus, diphtheria, measles, mumps, rubella, congenital rubella, and Haemophilus influenzae type b infections. Smallpox has been eliminated from the world. In fact, immunizations have been so successful that most parents and many young pediatricians have never seen the natural infections. It is wonderful to live in a time when the “usual infections of childhood” no longer occur.

 We know mothers were the care giver for baby in our country. So female (91.75%) specially mothers (87.87%) were chosen as maximum respondents. Mother of the infant’s age was maximum 56.31% from 15 years to 25 years of age. At times, they become mother before the age of the maturity. All (100%) caretakers replied that they faced neither serious reaction nor any major problem after the vaccination. There was no complaint of any major AEFI. Majority of infants (62.77%) have had fever and 18.99% have had local reaction. Besides those, 7.30%, 0.73%, 1.10%, 2.55%, 1.82% was persisting crying, irritability, abscess, loss of appetite, drowsiness and others respectively. More than half of the studied infants developed AEFI. Fever is the most common type of AEFI but of short duration. Next common AEFI was local reactions which persist for long duration. 206 infants received 1240 dose of different vaccines. 176 infants received pentavalent dose-1 and among them 72.16% developed AEFI, among 139 infants in pentavalent dose-2, 67.63% developed AEFI and among 115 infants in pentavalent dose-3, 55.65% developed AEFI. Besides the pentavalent, there developed 64.56% and 37.5% AEFI for BCG and Measles out of 206 and 136 infants respectively. ). Among the above developed AEFI, 147 infants suffered from AEFI for 1 day, 62 infants suffered from AEFI for 2 days, 10 infants suffered from AEFI for 3 days and 3 infants suffered from AEFI more than 30 days. From above data it can be said that without any major reactions, majority of infants suffered from mild reactions mainly fever which subside automatically within few days

 No statistical association exits between AEFI and parent’s education, occupation, sex of infants and house size. But significant association exists between age and the dose of vaccine. Significant association was observed between fever and local reaction, fever and behavioral effects. In our study, we found lower level of knowledge of AEFI among the mass and general people had no idea about the issue. So there should be regular campaign and awareness program in the remote places. Considering the positive impact of immunization in preventing the vaccine preventable diseases and reportable but negligible serious AEFI observed in this study, we should favor routine immunization.

Less injection reaction, programmatic error, coincidental and socio-economic and demographic had direct relation about the development of AEFI. AEFI is a potent threat to the regular vaccination in the mass people. It is important to strengthened monitoring and surveillance system in the country for AEFI. Prompt reporting of events is critical in the successful management of AEFI system. Follow up and corrective actions are essential for AEFI. Proper training should be imparted to health personnel and refresher training should be given time to time when there appears new technological change.

RECOMMENDATIONS

Following are recommended for AEFI:

a.       Proper training should be imparted with the advancement of technology and refresher training to be planned also.  It will build confidence on health personnel. It is also important to remove programmatic error by improving vaccine handling and administration. Strengthen Vaccine and personnel management for vaccination cannot be ignored.

b.      Monitoring and surveillance system should be strength. Reporting and surveillance system of AEFI should be prompt to restore public confidence.

c.      Service providers should carefully assess a child’s reaction following immunization and always be prepared to provide the proper management needed. At the same time, they should always report the events which are reportable.

First Part of the post:

Immunization Among Infants in an Urban Slum (Part-1)