Perceptions and Opinions of people living in periurban Amritsar about ongoing Intensified Pulse Polio Immunization rounds.

Devgun P*, Ahuja SS**, Kaur H**, Kaur H***

* Associate Professor, ** Assistant Professor, *** Lecturer Department of Community Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar.

Correspondence Dr. Priyanka Devgun Email pd1843@gmail.com

Abstract Research Question: What are the perceptions and opinions of people residing in periurban Amritsar about the IPPI campaign? Setting: Periurban Amritsar city abutting 27.5 kilometres of the bye pass. Period of study: Feb 10-19, 2010. Study design: Cross- sectional Sample size: 210 (30 clusters of 7 each) Methodology: 210 households were selected for the study by the technique of cluster sampling. A pretested proforma was administered to the respondents to know their perceptions. Results: A total of 162 children were found in 210 households visited. Opinions of the respondents were noted. Key words: polio camp, booth, immunisation, children.

Introduction The world health community is gearing to achieve the same kind of success story in polio eradication as it had with the eradication of smallpox. With the exception of India, Pakistan, Afghanistan and Nigeria, their efforts have borne fruit in rest of the world.1 In India, the impetus for polio eradication is being given in the form of National Immunisation Days (NIDs) which have been a regular feature in health scenario countrywide ever since 1995.2 Much effort is expended in covering the urban and the rural populations. However of late, the periurban areas and slums have gained importance as far as immunisation coverage is concerned. These places are potential hotbeds for spread of polio on account of conducive conditions thus causing the failure of all efforts to eradicate the same. The following study was conducted following the February 7-9, 2010 round in periurban Amritsar to know the perceptions and opinions of people towards the current round. Materials and Method A total of 6853 under five children were immunised by 70 teams of volunteer MBBS student vaccinators of Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. 210 households were selected by cluster sampling technique for the purpose of the study. A pretested proforma was administered to the respondents in the household and the results noted. Observations and Discussion Table I: Distribution of beneficiaries by age and sex Males Females Total <1 year 25 (67.5%) 12 (32.5%) 37 1-5 years 88 (70.4%) 37 (29.6 %) 125 113(69.7%) 49 (30.3%) 162 There were 162 under five children in 210 households visited. Out of them, 69.7% were males and 30.3% were females. In a study conducted in Chandigarh, the males were found to be 56% while the females were 44%.3 This is yet another pointer to the skewed sex ratios in India particularly Punjab. The current all-India sex ratio in the 0-6 age group, also called the child sex ratio is 927:1000. 4

Table II: Knowledge Age Less than 5 Less than 10 Any age Do not know Total

about the age of immunisation Number Percentage 186 88.5 % 12 5.7 % 4 1.9 % 3 1.4 % 210 100 %

88.5% of the respondents could correctly tell the age targeted in the pulse polio campaigns as less than five years while only 1.4% did not know the age. Table III: Correctly identifying the day of NID and location of the nearest booth Awareness about Present Absent Total NID on Sunday 208 (99%) 2 (1%) 210 Location of nearest 194 (92.4%) 16 (7.6%) 210 booth An overwhelming 99.0 % could correctly identify the National Immunisation day as Sunday and 92.4% could tell the location of the nearest booth. In a study conducted in east Delhi, only 37% of the respondents could the correctly state the NID as Sunday.5 Table IV: Source of information about NID Source of Number Percentage information Print media 39 18.6% Electronic media 126 60% Posters and Banners 135 64.3% Announcements 12 5.7% Neighbours, friends 27 12.9% Health worker 18 8.6% Posters and banners were the most popular source of information according to 64.3% of the people followed by electronic media by 60% of the people. Least popular medium was announcements. Health workers were quoted by 20.8% people as the source of information regarding NID in a study in Chandigarh.3 Table V: The place of immunisation of the children Place of Number Percentage immunisation Booth 94 58.1 % In house by team 57 35.2 %

Refused immunisation Total

11 162

6.7 % 100 %

58.1% children were brought to the booth for immunisation while 35.2% children were immunized in homes by the teams. 6.7% of the children could not be immunised. This is in contrast to 90.3% coverage in booths and 6.6% by teams in the houses in Haryana.6 Table VI: Reason for Reason Bad weather Child too small Team will come home Child not well Others forgot Did not find time Total not coming to booth Number 23 7 18 2 2 5 57 Percentage 40.4 % 1.8 % 31.6 % 3.5 % 3.5 % 8.7 % 100 %

Bad weather was quoted as the main reason by 40.4% people for not bringing the children to the booth for immunisation while the fact that teams make home visits was the explanation given by 31.6% people. On the other hand, inconvenience in reaching the booth was cited as the reason for not immunising the child by 46.7% respondents in Chandigarh.3 The team will bring vaccine home kept 30.2% children away from booth in Kolkotta.7 Table VII: Reason for refusing immunisation Reason Number Percentage Child not well 3 27.2 % Given too many times 4 36.3 % Not sure about quality of 4 36.3% vaccine Total 11 100 % 11 children were found unimmunised as 3 of them were reportedly not well and the parents of 4 children opined that the vaccine was given too many times. Other 4 respondents were not too sure of the quality of vaccine. 24% respondents felt that the vaccine had been given too many times already and did not get their child immunised as revealed by a study by Dasgupta et al.8 Table VIII: Status of immunisation in the past Status Number Percentage Never missed 27 16.6 % Rarely missed 93 57.4 % Often missed 42 30.0 % Always missed 0 0

Total

162

100 %

57.4% respondents had rarely missed getting their children immunised in the IPPI days while there were none who reported always giving a wide berth to the NID.

Table IX: In case the child has minor ailment, what will you do Action Number Percentage Give OPV regardless 60 28.6 % Refuse immunisation 116 55.2 % Consult doctor first 34 16.2 % Total 210 100 % 55.2 % of the respondents said that they will not get their child immunised if the child is not well while 28.6 % said that will do so. Table X: Attitude on your unimmunised child being immunised in the school Attitude Number Percentage Berate school 127 60.5 % authority Applaud school 34 16.2 % authority Cannot say 49 23.3 % Total 210 100 % 60.5 % of the respondents will berate the school authorities if their unimmunised child is immunised without their consent in the school. Table XI: Reasons for continuing presence of polio in Punjab Reason Number Percentage Migrant labour 144 68.5% Slums 86 41.0 % Unhygienic living conditions 79 37.6 % Poor sanitation 113 53.8 % Others Malnutrition 15 7.1 % Lack of immunisation 124 59.0 % Vermin(flies, mosquitoes, 31 14.8 % rodents, stray animals) Cannot say 46 22.0 %

68.5% respondents blamed the migrant labour from UP and Bihar as the main scrooge for continuing presence of polio while 53.8 % attributed it to poor sanitation. 41.0 % laid the blame on proliferating slums in the cities.22% had no opinion. 84.2 % respondents believed that OPV should not be given if the child has received the drops a day earlier.72.3 % people did not know whether polio can be transmitted from a child with polio limb. Only 10.7 % opined that OPV should be given to a polio afflicted child. Only 1 respondent affirmed seeing a polio afflicted child in the neighbourhood. 83.8 % people were satisfied with the quality of coverage. 49 % respondents were unaware of the transit teams. Only 42.4 % respondents believed that polio can be eradicated. Table XII: Opinions and knowledge Opinions and knowledge Yes

No

Should OPV be given again even if it was given a day earlier? Can healthy child contact polio from a child with polio limb? Should a child with polio be given OPV? Have you seen a child with polio in your neighbourhood? Do you find immunisation coverage satisfactory? Are you aware of immunisation teams for people in transit? Can polio be eradicated?

5 (2.3%)

177 (84.2 %) 12 46 (5.7%) (21.9 %) 23 116 (10.9%) (55.2 %) 1 184 (0.4%) (87.6 %) 176 32 (83.8 %) (15.2 %) 64 43 (30.4 %) (20.4 %) 89 54 (42.4 %) (25.7 %)

Do not kno w 28 (13.3 %) 152 (72.3 %) 71 (33.8 %) 25 (11.9 %) 2 (0.9 %) 103 (49.0 %) 67 (31.9 %)

Tot al 210 210 210 210 210 210 210

In the 15 odd years of the pulse polio campaign running, the booth coverage has decreased and house to house coverage increased. People are well aware of the day and age limit of immunisation. Information for the same is largely gleaned from banners and posters. Migrant labour is considered to be the leading cause for continuing presence of polio in the state. They are generally

satisfied with the quality of coverage but are ambivalent about predicting polio eradication. References: 1. http:// www.who.int/ mediacentre/ news release/2006/pro5/en. Accessed on 25.02.10. 2. www.npspindia.org. 3. Swami HM, Thakur JS, Bhatia SPS, Bhatia V, Bhan VK. Coverage evaluation survey of pulse polio immunisation in Chandigarh. Indian J of Community Med 2000 Apr-Jun; 25(2): 83-85. 4. Census of India, Govt. of India - Ministry of Home Affairs . [Online]Available from: URL: censusindia.gov.in ( www.censusindia.net/ ) 5. Sharma R, Bhasin S. Routine immunisation-Do people know about it? A study among caretakers of children attending Pulse Polio Immunisation in East Delhi. Indian J of Community Med 2008 Jan; 33(1): 31-34. 6. Grover A, Lakshmi PVM, Aggarwal AK. Evaluation of house to house strategy for intensive pulse polio immunisation in Rural area of Haryana. Indian J of Community Med 2006 Jan- Mar; 31(1): 33 7. Chatterji T, Haldar A, Mitra SP, Saha AK and Rai M. intensified pulse polio immunisation coverage in slums of a metropolitan city: an appraisal. J Commun Dis 2002 Dec; 34(4): 281-6. 8. Dasgupta R, Chaturvedi S, Adhish V, Ganguly KK, Rai S, Sushant L and Arora NK. Social determinents and Polio Endgame. A Qualitative study in High Risk Districts of India. Indian Pediatr 2008; 45: 357-65.