Obuhvat imunizacijom i pravovremeno sprovođenje imunizacije na teritoriji Južnobačkog okruga

Abstract

<p>Immunization is the fastest and the cheapest preventive measure of them all and also ecconomically most viable. It had a direct influence on reduction of incidence and mortality rates of communicable disease and also has changed a structure of communicable diseses. Immunization coverage is measeured according to the immunization schedule. In the most of the countries it is being measured administratively and represents indicator of work succes of the health care providers. Besides administratively in some of the countries combination series of vaccines is used for measurement of immunization coverage. Combination series of vaccines is sum of all doses of individual vaccines which child was able to receive according to immunization schedule. Child can be fully immunized, incompletely immunized or unimmunized at 6, 12 and 24 months of age or according to the actual age. Immunization is coinsidered timely if it is conducted at recommended age. Reasons of childs underimmunization can be medical contraindication or nonmedical reason. Medical error in immunization can be missed opportunity or invalid immunization. Missed opprtunity is a visit during which child was eligible to receive a vaccine but vaccine was not given or vaccines were not given at all. Invalid immunization occurs when a vaccine is given before minimal recommended age or with interval shorter than minimal recommended interval. Nonmedical error in immunization is missed opportunity because of lack of vaccine or because parents did not come for a scheduled visit. Goal of this research was to determine: Percentage of children with scattered immunization records; UTD immunization coverage with combination series of vaccines at age 6, 12 and 24 months of age; Percentage of unimmunized and percentage of doses given to incompletely immunized children eith the structure of incompletely immunized children according to doses that were received; Time interval of immunization with each dose of the combination series and evaluation of timely immunization based on the grace periods set by the law; Percentage and structure of medical and nonmedical errors in immunization according to th law; Level of knowledge of health care workers on immunization according to the law; Parental attitudes on immunization of thier childreen. Population of childreen born in the period 2001-2005 were covered by the research. Sistematic sample was used. Total of 2226 children were included in the sample making it 8,3 percent of the total population. Total of 2058 (92,5 percent of the sample) children were covered by the research making it 7,7 percent of the population. Total of 168 (7,5 percent of the sample) were excluded from the research by the previously set criteria. Total of 913 (41 percent of the sample) parents were investigated for parental attitudes by the use of anonimuos questionaire. Level of knowledge of health care workers on immunization according to the law was determined for 169 (55,0 percent) of 304 health care workers from primary health care and private practice who are conducting immunization in South Backa County by the use of anonimuos questionare. In cooperation with health care providers and parents immunization records were gathered and search for scattered immunization records in case of migration within South Backa County was conducted in order to determine complete immunization hystory of each child. Immunization records on immunization against diphtheria, tetanus, whooping cough, poliomyelitis, measles, mumps and rubela for each child were checked for combination series of vaccines 3:3 (3 doses DTP/DTaP and 3 doses of OPV/IPV) at age 6 and 12 months and regarding combination series of vaccines 4:4:1 (4 doses DTP/DTaP, 4 doses of OPV/IPV and 1 dose of MMR vaccine) at age 24 months. In order to evaluate timelines of immunization time intervals of immunization of 95 percent of fully and incompletely immunized children were measured and also arithmetic mean with 95 percentCI were measured for each interval. Grace periods for immunization with each dose of vaccine for primary immunization and revaccination based on the law were used in order to determine UTD immunization coverage at 6, 12 and 24 months of age and in order to evalute timelines of immunization. Medical and nonmedical errors were determined by cheking immunization records and patients health records. Level of knowledge of health care workers on immunization according to the law was determined and parental attitude on immunization of their children were investigated by anonimous questionares. Effective protection and safe level of immunity against vaccine prevantable diseases is not achieved by the immunization program performance because only 60,1 percent of children at 6 months of age were fully and timely immunized with combination series 3:3 according to the law. Within following 6 months missed oportunities were compensated and at age of 12 months high UTD covergae with combination series 3:3 of 94 percent was achieved. At 24 months of age only 85,8 percent of children were fully immunized with combination series 4:4:1 due to untimely revaccination. Reaseons of lower UTD coverage vary during the period of immunization program performance. Main reason of the lower UTD coverage at 6 months of age are missed opportunities due to false medical contraindications and in the period after that in older age nonmedical reasons become main reasons of lower coverage predominantly because parents not bringing children for a scheduled visit and vbecause of migration of children to various vaccination stations and different health care providers. Eisk of vaccine prevantable disease exists due to untimely immunization of children despite high UTD coverage. Suficient level of knowledge of health care workers on immunization according to the law is not enough to ensure good immunization practice. Lack of agreed doctrinary attitudes in immunization performance in ceratin clinical conditions is the cuse of larger number of missed opportunities. In the settings were high percentage of immunization records are scattered and when onethird of children migrates between different health care providers during the first two years of life computerized immunization registry iz essential prerequisite for timely immunization and high UTD coverage.</p>