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Epidemiological studies on measles in Karachi, Pakistan -- mothers' knowledge, attitude and beliefs about measles and measles vaccine.
ACTA PAEDIATRICA JAPONICA. 1992 Jun; 34(3):290-4.In Pakistan, the Accelerated Health Program has greatly improved the immunization coverage rates, and local area monitoring revealed a marked decrease of measles between 1974 and 1984. In October 1988, 287 randomly selected mothers living in Karachi who took their children to the Civil Hospital or to the Abbasi Shahid Civil Hospital were interviewed by means of a questionnaire about their knowledge of the clinical manifestations of measles, their own children's history of morbidity and mortality, and any history of immunizations, and attitude and beliefs about measles and measles vaccine. In 1989 and 1990, in a community-based survey visits were conducted in Neelam Colony, Karachi, with a population of about 3000, and infantile mortality rate of 153/1000 births, and an immunization acceptance rate up to 1 year of age of about 35%. More than half of the women mentioned serious complications of measles, including diarrhea and malnutrition. Of 1076 children whose parents gave usable answers, only a few had repeated episodes of measles. The age of contraction of measles varied widely from 4 months to 12 years with high prevalence: 89% of them contracted it before 6 years of age, primarily between 9 and 18 months of age. The vaccine efficacy rate was 72%. The severity of the illness and complications were well known and immunizations were appreciated. In traditional families, grandparents had made the decision about immunization, but many mothers were starting to assume that responsibility. The vaccine acceptance rate had increased sharply in recent years, as a result of local health educators' activities in clinics providing regular health checks and especially owing to TV programs. The importance of promotion of primary heath care by collaboration of motivated mothers and community health workers is emphasized.
CHILD SURVIVAL ACTION NEWS. 1988 Apr; (9):1-2.Present thinking regarding the control of neonatal tetanus (NT) suggests that the accepted protocol in the past, i.e., immunizing pregnant women with tetanus toxoid (TT) during antenatal care, is not sufficient in countries where antenatal care may be unavailable. Current control strategies, experts, and official World Health Organization (WHO) recommendations now indicate that efforts should reach beyond immunization of pregnant women and the training of traditional birth attendants in hygienic cord care practice to immunization of all women of childbearing age. Babies continue to die form NT because it is so difficult to reach women during pregnancy for immunization. Lack of commitment to expanding immunization programs as Who recommends stems in part from failure at both national and local levels to acknowledge the extent of the neonatal tetanus problem. NT is vastly underreported for several reasons: cultural practices often include the seclusion of women and their babies during the period after birth; people in developing countries have a fatalistic attitude because so many children die within the 1st year of life; newborns are rarely taken to health centers for treatment; health workers may fail to report NT for fear that their superiors will blame them for failure to immunize or for poor care of the umbilical cord; Western medicine and research has a curative rather than a preventive focus; and gathering information on NT by asking mothers to recall deaths of newborns with symptoms of NT is difficult because many women are ashamed or otherwise unwilling to report the event. The WHO believes that conventional reporting systems in developing countries identify only 2-4% of actual NT cases. Without sound documentation of the problem, it is difficult to gain financial and political commitment to eradicating NT. The VIII International Conference on Tetanus that occurred in Leningrad during 1987 outlined WHO's recommendation for a mixed strategy to control and eliminate tetanus: immunize all women of childbearing age, with special emphasis on pregnant women and women known to belong to high risk groups; assure hygienic delivery and umbilical care through training and supervision of birth attendants; and investigate cases to determine what action could have prevented them.
INTERNATIONAL HEALTH NEWS. 1988 Apr; 9(4):4-5.In the effort to realize Universal Child Immunization by 1990, an active search is underway to find ways to raise immunization coverage levels. The World Health Organization's (WHO) Expanded Program on Immunization (EPI) has developed excellent systems that develop such program components as supply management, equipment maintenance, disease surveillance, clinical practice, and supervision. Program performance has shown a steady improvement over the years in those countries which have adopted such systems, yet the trend has not been as marked as expected. Coverage levels in many countries have remained below 60%, and figures show a "dropout" with the multi-dose vaccines. The dropout figures suggest that parental acceptance of immunization is difficult to sustain throughout the entire series, which is spread over the first 9 months of life. To reduce dropout and boost coverage levels still further, recent program directions have emphasized social mobilization to increase the public response to immunization. It is tempting to conclude that with the implementation of improved management systems the final success will come from persuading parents to avail themselves of immunization services, but field reports suggest that this may not be the case. Health records show missed immunizations despite numerous visits to clinics, suggesting widespread problems in the implementation of the WHO systems. A combination of causes seem to ensure that children attending with their mothers do not get immunized, including errors and omissions on the part of field staff which reduce the chances for immunizations by families making return visits to the clinics. Few programs incorporate immunizations in daily practice. In a series of immunization coverage surveys conducted recently in 1 African country, the most striking fact was that the limitations of the data collected meant that the calculated contribution of clinical error could only be a gross underestimation of true clinical error contribution. This suggests that social mobilization to improve clinical attendance is likely to be ineffective until problems with the provision of services have been solved, but improving services has the potential to increase coverage levels as well as the potential to motivate parents to bring their children to the clinics.
Tropical Doctor. 1984 Jan; 14(1):34-40.A description of the Dominican Child Health Passport (CHP) and its clinic-based counterpart are presented. These are adaptions of the World Health Organization (WHO) growth chart. A prototype of the chart was introduced in June, 1980 for a pilot project in the town of Portsmouth. At 7 consequtive child welfare clinics all parents who received a CHP at an earlier visit were interviewed. Questions were asked about some aspects of clinic attendance, the use of and attitude towards the CHP; and understanding of it. The children ranged in age from 1-21 months with a mean of 7 months. 31 parents (61%) had visited the clinic 4 weeks ago (the usual period between visits) and the average was 5 weeks. Weighing was the reason that 49% of the mothers brought their children to the clinic. This could mean that there is already an awareness of the importance of weighing for monitoring child health. Of the 51 parents, only 1 had forgotten the CHP. 10 children possessing a CHP were taken to a doctor. 6 mothers took the CHP along, and on 5 occasions the doctor showed an interest. Opinions on various aspects of the CHP are given. The price--60 cents Eastern Caribbean Currency (=US $0.22) was considered acceptable. Almost all mothers liked to have the CHP at home. However, a substantial % did not like the idea of having child spacing methods entered on the card. 4 CHPs with different weight curves were shown to mothers, who were asked if they would worry about a child who showed the growth pattern indicated. Severe underweight with loss of weight was recognized by 51% of the interviewees. Obesity was not usually considered something to worry about; this is understandable in a place where undernourishment is common in infants. About 1/3 of the respondents recognized the danger if an infant was still in the normal range of weight-for-age but was losing weight.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.