About DLHS
The District Level Household & Facility Survey is one of the largest ever demography & health survey carried out in India, with a sample a size of about seven lakh households covering all the districts of the country. The ministry of Health & Family Welfare (MOHFW), Govt.of India, initiated DLHS in 1997 to provide district level estimates on health indicators to assists policy makers & program administrator in decentralized planning, monitoring & evaluation.
The DLHS-3 which is the third in the series proceeded by DLHS-1 in 1998-99 & DLHS-2 IN 2002-04 is designed to provide estimates on maternal & child health, family planning & other reproductive health services. For the first time, a population linked facility survey has been conducted in DLHS-3.It covers then all the District Hospitals, Community Health Centre, Primary Health Centers & all Sub Centre. Field work in Madhya Pradesh was conducted during Dec 2007 to May 2008, gathering information from 51,419 households.
Why Child Immunization?
Babies are born with some natural immunity which they get from their mother and through breast-feeding. This gradually wears off as the baby's own immune system starts to develop. Children are highly susceptible to develop infections, as they have never been exposed to it earlier. Immunization gives child extra protection against illnesses which can kill.
What is Immunization?
Immunization is a way of protecting the human body against infectious diseases through vaccination. Immunization prepares our bodies to fight against diseases in case we come into contact with them in the future.
Ideal Immunization Schedule for the Infants
(Recommended by the Ministry of Health, Searchvt. of INDIA)
Status of Child Immunization & DLHS-3
As per the DLHS-3 report only 36.2% children in the state & in rural areas only 31.4% children are fully immunized against the government claims that 62.5% in 2007-08, & 63.6% [Health Bulletin 2008-09, Department of Public Health & Family Welfare, Govt. of M.P] in 2008-09 children are fully immunized under child vaccination programme. And Health Bulletin of Public Health & Family Welfare department declares that 47 districts have more then 50% children fully immunized.
Under DLHS-3, the status of child immunization under the age group 12-23 months has been pointed out with a sample size of total 4765 children out of that 3784 children are from the rural area & 981 children from urban Madhya Pradesh.
The vaccination of children against six serious but preventable has been a cornerstone of the child health care programme under the public health system in Madhya Pradesh. But unfortunately in Madhya Pradesh, children (age 12-23 months) the most productive future assets are not even fully immunized against preventable diseases, reveals the DLHS-3 report.
As per the DLHS-3 report only 36.2% children in the state & in rural areas only 31.4% children are fully immunized against the government claims that 62.5% in 2007-08, & 63.6% [Health Bulletin 2008-09, Department of Public Health & Family Welfare, Govt. of M.P] in 2008-09 children are fully immunized under child vaccination programme. And Health Bulletin of Public Health & Family Welfare department declares that 47 districts have more then 50% children fully immunized.
DLHS-3 report further exposed the fact that 11.3% children from rural Madhya Pradesh & total 9.8% children through out the state have not at all received any vaccination.
DLHS exposes such claims with the fact that the five districts in the state including two IMNCI [IMNCI - Integrated Management of Neonatal & Childhood Illness under NRHM] districts (namely Datia & Shivpuri) had less then 20% fully immunized. Out of the 12 districts undertaken as IMNCI districts only 4 districts having more then 40% child immunization. Situation is most awful in rural areas across the state where 12 districts (including 4 IMNCI district) has less then 25% full immunization.
Status of TT immunization
In Madhya Pradesh merely 60.4% mother had received at least one TT injection. And in rural areas in the state only 55.2% mothers have received one TT dose. In Shivpuri only 30.1% women are immunized against tetanus.
Why Tetanus Toxide Injection? - TT injections to protect pregnant women and her-to-be-born child against tetanus. On becoming pregnant, every pregnant woman must take two doses of Tetanus Toxoid (T.T.) injection.
Status of BCG immunization
The situation is little better of for BCG vaccination as the state has 84.2% children immunized for BCG but still 15.8% children had not received immunization against the chronic disease. In the tribal populated district Jhabua (87% tribal population) only 56.6% children are given BCG vaccination. Guna, another IMNCI district 30.9% children are not immunized against Tuberculosis.
Why BCG Vaccine? - The vaccine can be administered right after the birth and if not taken then, then it can be taken as early as possible with other vaccines. This vaccine affords protection against Tuberculosis.
Status of Immunization in 12 IMNCI districts of Madhya Pradesh
District |
Children Fully Immunization % |
Children received BCG % |
Children received DPT % |
Children received 3 Polio doses % |
Children received Measles Vaccine % |
Children received Vitamin A supp.
(9-35 month) % |
Datia |
17.2 |
78.5 |
32.2 |
36.9 |
40.8 |
24.1 |
Shivpuri |
17.7 |
78.5 |
23.6 |
42 |
29 |
15.7 |
Guna |
24 |
69.1 |
27.3 |
39.4 |
41.6 |
18.5 |
Satna |
25.6 |
84.6 |
45.8 |
54.8 |
58.4 |
49.9 |
Vidisha |
26.9 |
77.9 |
46.3 |
43.6 |
40.9 |
25 |
Morena |
34.9 |
86.9 |
44.7 |
53.7 |
54.2 |
36.7 |
Jabalpur |
36.8 |
97.1 |
54.5 |
67.1 |
66.9 |
61.5 |
Bhind |
37.8 |
85.3 |
52.1 |
53.5 |
62 |
38.2 |
katni |
50.3 |
86.6 |
52.3 |
65.3 |
71.6 |
54.3 |
Ratlam |
55.6 |
91.2 |
68.6 |
67.7 |
69.7 |
50.3 |
Sehore |
60.1 |
90 |
65.6 |
66.1 |
65.7 |
47.4 |
Bhopal |
70.1 |
99 |
78.7 |
76 |
81 |
62.4 |
Source: DLHS-3 report, 2007-08
Status of DPT vaccination
Total 51.1% (23) districts have less then 50% children immunized with DPT vaccine against the three very chronic diseases. Rural areas in 37 districts (82.2%) have less 60% immunization. The situation is very pathetic in rural areas of Jhabua, Tikamgarh, Damoh & Shivpuri with 17%, 19.1%, 20.7% & 20.8% of immunization against DPT respectively.
Why DPT Vaccine? - This is given when the child is 1 1/2, 2 1/2 and 3 1/2 months old with a booster at the age of 1 1/2 years. It protects against three diseases viz: Diphtheria, Pertussis (Whooping Cough) and Tetanus.
Status of Polio vaccination
The state Health Bulletin report claims 97.7% achievement in 2007-08 in polio vaccination. But the tribal districts of Jhabua & Dindori still have only 23.5% & 28.5% of immunization against polio divulge the DLHS-3 report. Only 55.1% of children 12-23 months have received 3 doses of polio vaccine in the state.
Why Polio Vaccine? - It is given at the age of 1 1/2, 2 1/2 and 3 1/2 months that immunizes children against all three types of polio virus. Booster doses are given at the age of 18 months. Additionally for the last few years the Searchvt. of India has been running the Pulse Polio Program in which all children under the age of 5 years are given Polio drops twice a year in addition to their vaccination schedule.
Status of Measles vaccination
Merely 53.6% in rural area & total 57.7% children in the state are immunized with measles vaccine in the state. Jhabua & Shivpuri are having less than 30% measles vaccination.
Why Measles Vaccine? - Measles Vaccine is a given at an age of 9 months. Measles is very infectious disease of the respiratory tract. The complications occur in a fair percentage of children who feel it. These include chest infectious, fits, brain damage etc.
Status of Vitamin A supplementation
Less then 25% Children (9-35 months) have received at least one dose of Vitamin A in 9 districts in the state. Again in Jhabua with only 31.5% literacy rate, the percentage of children received one dose of Vitamin A supplement is only 18.4.
Why Vitamin A Supplement? - Almost all children are born with low stores of vitamin A. Infants and young children need vitamin A for optimal health, growth, and development. Exclusive breast feeding increases babies’ vitamin A stores. But in Madhya Pradesh only 0.6% children [National Family Health Survey, India. NFHS-3, 2005-06] (0-6 months) are given exclusive breastfeeding, so the state must ensure at least one doses of Vitamin A to all the children under the age 9-35 months.
How far systems for Child Immunization are safe?
Another question raised by DLHS-3 report is how far the process of child immunization is safe? Are they really preventing children for some chronic diseases or putting them under the grip of some more dangerous diseases?
Optimal compliance with storage guidelines requires refrigeration, while some should be frozen until use. Many vaccines, such as the measles vaccine, are inactivated at high temperatures.
Availability of Deep Freezer in CHCs/PHCs: The importance of proper storage conditions for vaccines has been overlooked in Madhya Pradesh. Among the 278 CHC prevalent in the state only 184 CHC are having large deep freezer and 178 PHCs out of 1142 PHCs in the state are having large deep freezer. Although the inconsistence power/electricity supply in the state is also a matter of great concern, as Health institutions are not treated as emergency service institutions and face power cut.
Use of Auto-Disposable Syringe: Child immunization programme should not only focus on promotion of full immunization but it should also ensure the safe immunization through the use of Auto-Disable Syringe which reduces the risk of cross contamination and the spread of blood borne pathogens. Only 14.37% Sub Health Centers, the basic village health unit are having auto-disposable syringes i.e. only 1270 SHCs out of 8834 [Health institution, Department of Public health & Family Welfare] sub centers are having auto-disposable syringes. This indicates the multiple usages of syringes that may even cause HIV/AIDS among the infants & children.
Seema Jain |
