International Journal of Health Sciences and Research

www.ijhsr.org ISSN: 2249-9571

Original Research Article

Influence of Education and Socioeconomic Status on Immunisation Status

of Children in Rural Areas of Dakshina Kannada District of Karnataka
Shabnam Syed1, Supriya Kushwah2, Prakash R M Saldanha3, Anitha S Prabhu4
1
Junior Resident, 2Assistant Professor, 3Professor and HOD, 4Professor,
Department of Pediatrics, Yenepoya Medical College, Mangalore.
Corresponding Author: Shabnam Syed

Received: 14/09/2016 Revised: 03/10/2016 Accepted: 03/10/2016

ABSTRACT

Objectives:
1) To assess the immunisation status of children aged 6 to 48 months residing in Bantwal Taluk
of Dakshina Kannada district, Karnataka
2) To assess the educational and socioeconomic status of the parents of the study population and
to determine its effect on the immunisation status of the children
Materials and Methods: Four-hundred and sixty children aged 6 month to 48 months who attended
health camps held in 7 villages of Bantwal Taluk of Dakshina Kannada district were included in the
study. The data regarding age, sex, religion, immunisation status, optional vaccination, socioeconomic
status, mothers and fathers education was collected from parents using a semi-structured questionnaire
using interview method and from the immunisation cards. A child who had missed any of the
vaccinations according to the National Immunisation Program was classified as partially immunised
while those who had not received any vaccination or those who had received only BCG and Pulse
Polio vaccines were classified as non- immunised.
Results: Of the 460 children, 95.7% were fully immunised according to the national immunisation
schedule, while the rest were partially immunised. But only 2.6 % of the children had taken any
optional vaccines. Majority of the population (78.5%) belonged to lower middle socioeconomic class
(Kuppuswamy Class 3). Immunisation status was not significantly related to socioeconomic status as
the percentage of children who were fully immunised were equally high in both upper and lower
socioeconomic class (p=0.315). Educational status of the father and the mother were significantly
related to immunisation status (p<0.001).
Conclusions: The status of immunisation of children in the rural areas of Dakshina Kannada is
exceptionally good. With the widespread implementation of the national immunisation program,
education plays a significant role in improving the immunisation status of our children.

Key Words: Child, Immunisation, Education, Socioeconomic status, Dakshina Kannada

INTRODUCTION as Hemophilus influenza B (Hib), Measles,

Immunisation is one of the most cost Pertussis and Tetanus. (2) WHO estimated
effective public health interventions to that 17% of global annual under-5 mortality
decrease childhood morbidity and mortality. could be prevented through increasing
Worldwide 6.9 million babies under the age routine vaccination coverage. (3)
of 5 years die every year. (1) A significant India has one of the lowest
proportion of these deaths are attributable to immunisation rates worldwide despite a
vaccine-preventable infectious diseases such long standing Universal Immunization

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Vol.6; Issue: 10; October 2016
Shabnam Syed et al. Influence of Education and Socioeconomic Status on Immunisation Status of Children in
Rural Areas of Dakshina Kannada District of Karnataka.

Program (UIP) that provides free childhood Bantwal taluk of Dakshina Kannada district
vaccines. (1) The Indian government’s of Karnataka in the months of October-
universal immunisation program provides November 2015. The villages included
vaccines against six diseases to all infants Bantwal, Kurnadu, Mani, Manchi, Navooru,
free of charge: one dose of Bacillus Pudu and Sajipanadu. The data was
Calmette Guerin (BCG), three doses of collected through health camps conducted in
Diphtheria-Pertussis-Tetanus (DPT), three the villages by the Pediatric department of
doses of Oral Polio Vaccine (OPV) and one Yenepoya Medical College.
dose of Measles-containing vaccine. (4) The Four hundred and sixty children
most recent data on vaccine preventable between the ages of 6 months and 48
mortality in India is from a 2008 study, months were included in the study. Data
which estimated that of the 826,000 deaths was collected using a pre-designed, semi
in children aged 1-59 months, almost three- structured questionnaire which included
quarters were due to vaccine preventable questions regarding age of the child, sex,
diseases. (3) immunisation status, optional vaccination,
Indian children who receive all socioeconomic status, mothers and fathers
recommended doses of the four UIP education. Interview method was used for
vaccines are considered fully vaccinated by collection of data from the parents
WHO; a child lacking any of the preferably mothers and vaccination status
recommended doses is considered under- was verified by cross checking the
vaccinated, and children who have not immunisation cards when available.
received any vaccinations are considered Informed consent was taken from the
non-vaccinated. The Indian government’s interviewed subjects.
nationally representative District Level Children who had received all the
Household and Facility Survey 2008 vaccines according to National
(DLHS3) reported that only 54% of children Immunisation Schedule (NIS) according to
aged 12-23 months were fully vaccinated, age were classified as fully immunised. (6)
41% were under-vaccinated, and the Children who had missed even one of the
remaining 5% were non-vaccinated. (5) vaccines in the NIS were classified as
However significant variations exist across partially immunised and those who had not
the 34 Indian states and union territories. received any vaccination or those who had
Reasons for lack of immunisation received only BCG and Pulse Polio vaccines
vary from logistic ones to those dependent were classified as non- immunised. Parents
on human behaviour. Numerous factors education and socioeconomic status was
have been studied including gender, age, recorded using Kuppuswami scale. (7)
birth order, family size, household income, Statistical analysis was done using
religion, caste and maternal education. SPSS version 14. The p-value of <0.05 was
Very few studies have been considered significant. Chi-square test was
undertaken regarding immunisation among done to determine the statistical significance
children in Dakshina Kannada district of of the association between immunization
Karnataka. The present study was under status and other factors.
taken to determine the status of The study was approved by the
immunisation among the study population ethical committee of Yenepoya Medical
and its relationship with socioeconomic College, Mangalore. Informed consent was
status and parental education .particularly taken from the parents of the study subjects.
maternal education.
RESULTS
MATERIALS AND METHODS Out of the 460 children in the study,
A community based cross sectional 226 (49.1%) were boys and 234 (50.9%)
study was undertaken in 7 villages of were girls. The mean age was 1.87 years.

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Vol.6; Issue: 10; October 2016
Shabnam Syed et al. Influence of Education and Socioeconomic Status on Immunisation Status of Children in
Rural Areas of Dakshina Kannada District of Karnataka.

Among the children, 440 (95.7%) were fully and rubella) vaccine and 2 had received
immunised and 20 (4.3%) were partially varicella vaccination.
immunised. None of the children were According to Kuppuswamy
unimmunised. Only 12 (2.6%) out of the classification, 78.5% belonged to Lower
448 children in the study had received Middle Class (Class 3). 6.7% belonged to
optional vaccination. Out of the 12 children, Upper Middle Class (Class 2) and 14.8%
10 had received MMR (measles, mumps belonged to the Upper Lower Class (Class
4).

Table 1: Relationship of immunization status with socio-economic and demographic factors.

Completely Immunized Partially Immunized Total P-Value
Variable (N=440) (N=156) (100%)
No % No %
Sex
Male 217 96.0 9 4.0 226 0.706
Female 223 95.3 11 4.7 234
Socioeconomic Status
Upper middle class 28 90.3 3 9.7 31
Lower middle class 347 96.1 14 3.9 361 0.315
Upper lower class 65 95.6 3 4.4 68
Father’s Education
Professionals 1 100 0 0 1
Graduate/postgraduate 27 93.1 2 6.9 29
Intermediate 48 94.1 3 5.9 51
High school 220 100 0 0 221 <0.001
Middle school 134 91.8 12 8.2 146
Primary school 10 100 0 0 10
Illiterate 0 0 3 100 3
Mother’s Education
Professionals 1 33.3 2 66.6 3
Graduate/postgraduate 26 100 0 0 26
Intermediate 45 95.7 2 4.3 47
High school 183 94.8 10 5.1 193 <0.001
Middle school 167 100 0 0 167
Primary school 18 85.7 3 14.3 21
Illiterate 0 0 3 100 3

Table 1 shows the relationship of increased. It was revealed by the fact that
immunisation status with gender, 85.7%, 100%, 94.8%, 95.7% and 100%
socioeconomic status as well as parental children of mothers educated upto primary,
education. There is no significant difference middle school, high school, intermediate
in the immunisation status between boys and graduation/post graduation level
and girls with 96% (n=217) of the boys respectively had completed their
being fully immunised and 95.3% (n=223) immunisation. This positive association
of the girls being completely immunized. between immunisation status of children
Surprisingly, a higher percentage of and level of education of their mothers were
children belonging to lower socioeconomic statistically significant (p<0.001). Similarly
group had received complete immunisation, it was seen that the immunisation status of
with 95.6% among those belonging to children improved with increased education
Kuppuswamy class 4 being fully level of the father also. The relationship
immunised, 96.1% among Kuppuswamy between immunisation status of children
class 3 and 90.3% among Kuppuswamy and fathers education was also statistically
class 2. The association between significant (p<0.001).
immunisation status and socioeconomic Table 2 shows the relationship of
status was not statistically significant optional vaccination with socioeconomic
(p=0.315). status and parental education. There was a
Immunisation status of children statistically significant relationship between
improved as the mother’s education level socioeconomic status and optional

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Vol.6; Issue: 10; October 2016
Shabnam Syed et al. Influence of Education and Socioeconomic Status on Immunisation Status of Children in
Rural Areas of Dakshina Kannada District of Karnataka.

vaccination with 9.7%, 1.9% and 2.9% of correlated with 1.8%, 2.1% and 10.6% of
children belonging to Kuppuswamy Class 2, the children whose mothers were educated
Class 3 and Class 4 receiving optional up to intermediate, high school and middle
vaccination respectively. (p=0.034). school respectively had received optional
Mother’s education and optional vaccination.
vaccination were also significantly

Table 2: Relationship of optional vaccination with educational status of parents

Variable Optional vaccination given Optional vaccination not given Total P-value
No. % No. % (100%)
Socioeconomic Status
Upper middle class 3 9.7 28 90.3 31
Lower middle class 7 1.9 354 98.1 361 0.034
Upper lower class 2 2.9 66 97.1 68
Father’s Education
Professionals 0 0 0 0 0
Graduate/postgraduate 0 0 29 100 29
Intermediate 2 3.9 49 96.1 51
High school 10 4.5 211 95.5 221 0.127
Middle school 0 0 146 100 146
Primary school 0 0 10 100 10
Illiterate 0 0 3 100 3
Mother’s Education
Professionals 0 0 3 100 3
Graduate/postgraduate 0 0 26 100 26
Intermediate 5 10.6 42 89.4 47
High school 4 2.1 189 97.9 193 0.03
Middle school 3 1.8 164 98.2 167
Primary school 0 0 21 100 21
Illiterate 0 0 3 100 3

DISCUSSION the ongoing efforts to improve vaccination

Immunisation is the most cost coverage. (9)
effective child health intervention. India’s The present study was conducted to
immunisation coverage remained assess the immunisation status among
unacceptably low in 2008, with slightly children less than 4 years of age in Dakshina
more than half of all children aged 12-36 Kannada, Karnataka. Most of the studies
months vaccinated with UIP recommended conducted earlier in different parts of India
vaccines and the remainder either under showed lower levels of immunisation when
vaccinated or not vaccinated at all. This compared to the present study. (10,11) This is
translates into a very large number of due to the different level of utilization of
children being at elevated risk for vaccine immunisation in different parts of India.
preventable diseases, which partially According to District Level Household
explains the continued high burden of Survey- 4, (12) in Karnataka 77.6% of the
morbidity and mortality from such diseases population was fully immunised. In the
in Indian children. same survey, it was found that 86 % of the
The Indian government launched the children were fully immunised in the district
National Rural Health Mission in 2005, of Dakshina Kannada. These values are
which resulted in substantial improvements higher than the national average and
in immunisation service delivery. (8) More comparable to our study.
recently the Indian Government declared in Similar to the findings of other
2012 that a renewed focus on strengthening studies (11,13) in India, no significant
routine immunisation services was needed, difference was observed between
which was followed by establishment of an immunisation status of boys and girls. This
Immunisation Technical Support Unit at the is contrary to the general observation that
public health foundation of India in female children are neglected for their
collaboration with other partners to revamp health care especially in developing

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Vol.6; Issue: 10; October 2016
Shabnam Syed et al. Influence of Education and Socioeconomic Status on Immunisation Status of Children in
Rural Areas of Dakshina Kannada District of Karnataka.

countries like India. CONCLUSION

Children of literate parents were With the strict implementation of the
found to have more chance of completing national immunisation program, promotion
their immunisation. In our study, father’s of education particularly girls’ education
education was found to be significantly and increase in awareness among parents,
associated with immunisation status with the immunisation coverage of children can
children of better educated fathers being be drastically improved as observed in the
more likely to be fully immunised. Other above study. But further steps need to be
studies conducted in other parts of India taken to increase awareness about the
(13,14)
has shown similar results with benefits of optional vaccination and to
significant difference in immunisation status improve its coverage especially among
of children of fathers having different level those who can afford it.
of education. In our study, mothers’
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How to cite this article: Syed S, Kushwah S, Saldanha PRM et al. Influence of education and
socioeconomic status on immunisation status of children in rural areas of Dakshina Kannada
district of Karnataka. Int J Health Sci Res. 2016; 6(10):40-45.

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