Barriers to immunization among children of HIV-infected mothers in Kolkata, India: a qualitative study.

More than one fourth of children of HIV-infected mothers living in Kolkata city are not completely immunized by 12 months of age. This qualitative study aims to explore the barriers to immunization of these children as perceived by their caregivers and the local health care service providers. In-depth interviews were conducted after obtaining written informed consent. Audio recording and hand-recorded notes were used with permission. The transcripts were coded and analyzed using grounded theory. Deteriorating socioeconomic status, tightening of time schedule of caregivers due to illness in the family, stigma, discrimination, and lack of awareness about immunization prove to be major barriers for immunization of the HIV-exposed children. Interplay of these factors coupled with harassment and negative attitudes of service providers toward HIV-affected/HIV-infected people also impede immunization. The intervention efforts need to address these social barriers and adverse life events to improve immunization coverage.

Immunisation status and its predictors among children of HIV-infected people in Kolkata.

World Health Organization and United Nations International Children's Emergency Fund have strongly recommended a sustained coverage of universal immunisation among all children against tuberculosis, polio, diphtheria, pertussis, tetanus and measles. In India, these vaccines under the universal immunisation programme are made available absolutely free of cost to all children through the public health system. Information regarding immunisation coverage among HIV exposed children in India is still very limited. The objective of this study was to estimate the proportion of children of people living with HIV who had been completely immunised by the age of 12 months and to find predictors of complete immunisation. A community-based cross-sectional survey was conducted in the Kolkata Metropolitan Area between 15 June and 14 September 2009 using a pre-structured interview schedule. Data were analysed from 256 care-givers of children (85.5% response rate) whose parents were randomly selected from the Bengal Network of HIV-positive people. Multiple logistic regression was used to estimate and test associations of predictors with complete immunisation. The percentage of children of people living with HIV completely immunised at the age of 12 months was 73.0% (67.3% to 78.1%), which was not significantly different from that for all children at 12 months. Mothers having received antenatal care [OR (odds ratio): 7.29; 95% confidence intervals (CI): 2.39-22.25], mothers having postprimary education (OR: 3.37; 95% CI: 1.45-7.81), children of Hindu and Christian religion (OR: 3.74; 95% CI: 1.63-8.62), children not belonging to scheduled castes, tribes and 'other backward classes' (OR: 2.08; 95% CI: 1.02-4.25) were significant independent predictors of complete immunisation status of these children. This emphasises the imperative need for up-scaling of antenatal care among the pregnant mothers to ensure complete immunisation among their children. A special focus on girl child education should also be implemented to empower future mothers for a sustained improvement of child immunisation in the long-run. The current national immunisation programme should focus on the children from the Muslim community and those belonging to scheduled castes, tribes and other backward classes to improve coverage.