ESTIMATED IMMUNISATION COVERAGE IN CHILDREN

ATTENDING MODILON GENERAL HOSPITAL, MADANG DISTRICT,

MADANG PROVINCE, PAPUA NEW GUINEA.

INVESTIGATOR

DR TINA YARONG, MBBS, MODILON GENERAL HOSPITAL

CO-INVESTIGATORS

DR JIMMY AIPIT,DCH/MMED MODILON GENERAL HOSPITAL

A RESEARCH REQUIREMENT FOR DIPLOMA IN CHILD HEALTH (DCH)

Vaccination

Most effective

primary intervention

to reduce the burden

of disease and

enhance health.

Averts over between

2 and 3 million

deaths each year.

Vaccination

• 1974 - EPI established by WHO

• 1977 - EPI began in PNG

• 2000 - PNG certified polio free

- MDGs agreed upon by

Globally

• 2012 - Global Vaccine Action Plan

endorsed

Immunisation Coverage

Assess need to introduce vaccines

Guide Strategies

Monitor performance

Identify areas of need

DTP3 /MCV1 indicators for

funding

Measles Coverage –

track progress towards MDG 4

2012 Estimated Global DTP3 Coverage in Infants <12 months

Figures based on WHO and UNICEF estimates of vaccination coverage

83%

72%

97%

0%

20%

40%

60%

80%

100%

120%

Global coverage WHO African

region

Western Pacific

Region

Figures based on WHO and UNICEF estimates of vaccination coverage

2012 Estimated Global Coverage for BCG, Polio3 and MCV1

89%

84% 84%

81%

82%

83%

84%

85%

86%

87%

88%

89%

90%

BCG Polio3 MCV 1

Papua New Guinea – National coverage

WHO EPI country poster

Estimated Vaccination Coverage for Madang

Province between 2009 & 2012

Figures based on Madang PHO estimates of vaccination coverage

2009 2010 2011 2012

DTP-HepB-HiB3 51.6% 37.4% 51.7% 30.8%

BCG 74.4% 56.5% 74.6% 63.2%

Sabin 3 54.6% 38.2% 53.1% 52.4%

MCV 9-11 38.4% 33.1% 42.7% 48.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

%

Estimated Madang District Vaccination Coverage

2009-2012

Figures based on Madang PHO estimates of vaccination coverage

2009 2010 2011 2012

DTP-HepB-HiB-3 91.4% 79.3% 85.3% 42.5%

BCG 128.1% 118.6% 118.1% 96.5%

Sabin 3 89.8% 73.7% 85.2% 68.6%

MCV 9 -11 58.0% 58.8% 57.2% 49.2%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

140.0%

%

Aim

To determine the immunization coverage of children

under 5 years of age attending Modilon General Hospital

residing in Madang District.

Objective

Evaluate the immunization status for children < 5 years

presenting to the Paediatric unit at MGH.

Determine the factors contributing to delayed or

incomplete vaccination status.

Methodology

Type : Cross Sectional study.

Duration : February 2014 to August 2014.

Study Site : Children’s Outpatient’s Department and

Ward 4

Information was collected by way of a designed

questionnaire.

Data analysed with Microsoft Excel and Stata Version

7

Inclusion Criteria ;

Signed consent from parent or caregiver

Factors Assessed

• Age, residence, proximity(cost) to clinic, marital status of parents, socioeconomic status(employment status), level of education of parent.

Sociodemographic characteristics

• Place of delivery, supervised delivery, awareness of immunisation. Maternal History

Other factors

• Immunisation status, adoption, number of siblings, reason for clinic visit.

Child History

• Presence of MCH team, reason for delayed vaccination.

RESULTS

Median age: 12.4 months

95%CI (10.1 -13.4mnths)

Male : 56.25% Biological :

94.49%

Proximity to health facility : 90.07%

within 30 mins - 52.50% walked.

83 % were sick on attendance

Hospital deliveries 75%

Home/village 19% Health centres

6%

Recruite

d n=294

Excluded

n=22

272

assessed

COPD

n= 215

WARD 4

n= 57

10%

53%

31%

5% 1%

Educational level of parent

Not attended

Primary Level

Secondary Level

Tertiary Level

Unknown

30%

12% 12%

46%

Place of Residence

Urban

Urban settlement

Peri-urban

Rural

9%

46% 17%

28%

Rec'vd verbal hx

Rec'vd & rec'd

Unknown

Not rec'vd

Hep B Birth Vaccine Status

14%

67%

10% 9%

Not recv'd

Recv'd & rec'd

Verbal hx recv'd

Unknown

BCG Vaccine Status

Sabin Vaccine Coverage

%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Not recv'd Rec'vd within 12 months

Rec'vd >12 mnths

Unknown/not due

19.1

58.8

4.0

18.0

41.2 37.1

4.4

17.3

47.1

21.0

5.9

26.1

OPV1 OPV2 OPV3

DTP-HepB-HiB Vaccine Status

%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Not recv'd Rec'vd within a year

Rec'vd >12 mnths

Unknown/Not due

25.7

60.7

4.0

9.6

34.9

44.9

2.9

17.3

40.4

29.4

4.8

25.4

Penta 1 Penta 2 Penta 3

Measles Vaccine Status

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Not recv'd Rec'vd within 1 year

Rec'vd >1 year Unknown/not due

17.7

33.5

10.3

38.6

20.6

11.8 14.3

53.3

MCV1 MCV2

%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

HBV BCG Sabin 3 Penta 3 MCV 1 MCV2

61.69%

82.35%

28.36%

39.41%

57.78%

25.20%

Estimated Vaccination Coverage < 12 months

Estimated Vaccination Coverage < 5 years

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

HBV BCG Sabin 3 Penta 3 MCV 1 MCV2

61.69%

82.35%

36.32%

45.81%

73.34%

55.91%

Factors that influence coverage

Vaccine Factors P value Multivariate

BCG Brought to clinic within a week post

home/village delivery.

0.021 OR 17.9

HBV birth Brought to clinic within a week post

home/village delivery.

0.03 OR 20.96 95% CI(1.33-329.3)

Sabin 2nd dose Brought to clinic at one month of age 0.02 OR 3.70, 95% CI(1.23 – 11.10)

Sabin 3rd dose Brought to clinic at one month of age 0.008 OR 3.18, 95% CI(1.35 – 7.45)

Dtp/Hib 2nd dose Brought to clinic at one month of age 0.023 OR 4.47, 95% CI(1.23 – 16.24)

MCV1 Number of siblings 0.02 OR 1.52, 95% CI (1.1-2.1)

MCV2 Level of education 0.033 OR 1.14 95% CI( 1.05-3.60)

Place of residence 0.042 OR 0.74

Factors that influence timing Vaccine Univariate P value Multivariate

BCG Brought to clinic within a week post

home/village delivery.

0.000 AOR 2.361 95% CI(1.500-3.716)

HBV birth Were birth vaccines given for hospital or

Health center deliveries?

0.002 AOR 3.17 95% CI(1.79 – 12.01)

Brought to clinic within a week post

home/village delivery.

0.000 AOR 14.91 95% CI(5.55 – 40.06)

Dtp/Hib 3rd dose Residence 0.009 AOR 0.745 95% CI ( 0.596-0.93)

Brought to clinic at one month of age 0.014 AOR 2.084 95% CI(1.163 – 3.736)

Sabin 3rd dose Brought to clinic at one month of age 0.008 AOR 2.270, 95% CI (1.39-17.82)

Biological or adopted child 0.014 AOR4.975, 95%CI (1.39-17.82)

MCV2 Level of education 0.044 AOR 1.806, 95% CI( 1.016-3.213)

Residence 0.042 AOR 0.741, 95% CI(0.55-0.99)

Discussion

Other studies with similar findings;

• Barriers to measles immunization: the beliefs and attitudes of caregivers

in Goroka, Eastern Highlands Province, Papua New Guinea. (Namuigi

P(1), P N G Med J. 2005 Sep-Dec;48(3-4):183-7.)

• Are hard-to-reach populations being reached with immunization

services? Findings from the 2005 Papua New Guinea national

immunization coverage survey. (Toikilik S(1) Vaccine. 2010 Jun

23;28(29):4673-9. doi: 10.1016/j.vaccine.2010.04.063. Epub 2010 May

6.)

• Socio-demographic factors associated with childhood immunization

uptake in Akinyele Local Government Area, Oyo State, Nigeria. (Brown

VB(1), Oluwatosin OA., Afr J Med Med Sci. 2012 Jun;41(2):161-7).

• Does improving maternal knowledge of vaccines impact infant

immunization rates? (Owais A, et al, BMC Public Health. 2011 Apr

17;11:239. doi: 10.1186/1471-2458-11-239.)

Limitations

Missing records

Timing

Data Collection

Conclusion and Recommendation

Poor vaccination.

In order to move forward in achieving our National health coverage of 80% vaccination and reaching our Millennium Development Goals (MDGs) and containing outbreaks, we need to improve factors like;

Immunise at every opportunity

Women’s literacy rate

Encourage antenatal visits during pregnancy

Advocating for supervised or hospital deliveries

Proper recording of birth vaccines

Promoting family planning

Encourage mobile MCH clinics

Acknowledgements

The Participants

Paediatric SMOs : Dr Aipit, Professor Vince.

Paediatric Team of MGH including Registrars,

Health Extension officers, nursing staff and

residents.

Data Collectors

IMR officers, especially Dr Wangnapi

Madang Provincial Health Officers

Reference

1. PAPUA NEW GUINEA CHILD HEALTH POLICY AND PLAN 2009-2020

2. WHO, UNICEF, World Bank. State of the world’s vaccines and immunization, 3rd

ed. Geneva, World Health Organization, 2009.

3. Global Routine Vaccination Coverage – 2012, Weekly, November 1, 2013/62(430;

858-861.

4. Global Immunization Data 2012, WHO & UNICEF.

5. Freeman PA(1), Thomason JA, Bukenya GB. Factors affecting the use of

immunization among urban settlement dwellers in Papua New Guinea. P N G

Med J. 1992 Sep;35(3):179-85.

6. National Health Plan 2011-2020. Volume 1 Policies and Strategies.

7. National Health Plan 2011- 2020. Volume 2 (Part B) Reference Data and National

Health Profile.

8. Report of Reaching Every Child initiative in Papua New Guinea, An Initiative to

reach the unimmunized children in identified low-performing districts using

Reaching Every District (RED) strategy.