No. 81 77 59 58 56 34 34 32 Kumar D et al. Total* (n=267) % 30.3 28.8 22.1 21.7 20.9 12.7 12.7 11.9 Immunization status of children in North India Reason Lack of knowledge of immunization Immunization has side-effects Lack of knowledge of subsequent immunization Lack of faith in effectiveness OPV is the only vaccine No vaccine for diarrhoea/ARI Child is sick at scheduled visit Reaction during first dose Partially immu- nized (n=156) No. % 7 4.5 Non-immunized (n=111) No. % 74 66.6 40 59 23 17 28 34 32 25.6 37.8 14.7 10.9 17.9 21.7 20.5 37 0 35 39 6 0 0 33.3 0 31.5 35.1 5.4 0 0 Table 2. Most frequent reasons for partial immunization/non-immunization *Some had multiple reasons; ARI=Acute respiratory infection; OPV=Oral polio vaccine immunization, the commonest reason was lack of knowledge about immunization. Other reasons were: doctors did not give advice (n=25); vaccine causes sterility (n=17); vaccine was not available (n=6); vaccinator was not available (n=6); and par- ents went to native places (n=2). DISCUSSION Immunization is the most cost-effective interven- tion in child health. There is an impending risk of outbreak of vaccine-preventable diseases due to in- creasing urbanization, migration, increasing slums, high density of population, continuous influx of a new pool of infective agents, and poor coverage of primary immunization. Attempts to improve the coverage have been going on for years. The results of our study showed that only 58 (17.8%) children were immunized till one year of age, 48% were partially immunized, and 34.15% were non-immu- nized. Contrary to the results of previous studies on immunization which were conducted on out- patient children, the present study was carried out on admitted patients. A similar observation was reported by Mathew et al. who found that 25% of children were fully immunized (9) and Saxena et al. found that 30% were completely immunized (5). The higher coverage of immunization varying from 50% to 70% was observed in other studies (6-8,11- 13). Results of our study indicate a poor immuni- zation status compared to the national average ac- cording to the NFHS 3 (2005-2006) which showed that 43.8% of children were fully immunized (4). Most previous studies included children from slums or rural districts, or were carried out among children attending the outpatient department. In this study, patients admitted to the paediatric ward were only included. This could be the reason for the lower coverage as non-immunized children are more likely to get infections and require admis- Volume 28 | Number 3 | June 2010 sion in the paediatric ward. They have an increased level of morbidity and mortality. In the study in Delhi, the rate of immunized children was 71.7%, partially immunized 19.8%, and non-immunized 8.5% (7). The immunization cards were available with 72.5% of them (7). Kar et al. found complete immunization in 69.3% of children in a slum area of Delhi (11). In our study, the coverage of com- plete immunization was 17.84%. This may be be- cause of the fact that most of our study children were from slum areas of the nearby states where the immunization coverage is lower than Delhi. The immunization cards were available with only 31.38% of the patients in this study compared to 74.4% in a study by Saxena et al. (5). The immuni- zation cards were found in a higher percentage of the completely-immunized children compared to the partially-immunized and non-immunized chil- dren. This highlights the need for emphasizing the importance of record-keeping during immuniza- tion visits. All the partially-immunized and 83.78% of the non-immunized patients received OPV dur- ing the pulse polio immunization campaign. Many of them thought that pulse polio was the only im- munization to be given or that the health workers would come to their home and immunize them. These issues need to be addressed to increase the coverage of immunization. In our study, the fully-immunized children were predominantly male. The female children were less likely to receive complete immunization and more likely to remain in the non-immunized or partial- ly-immunized group. These findings were also sup- ported by the findings of other studies (5,7,13). Of the children (n=104) from Delhi, 37.5% were com- pletely immunized compared to 8.55% of the com- pletely-immunized children in those from outside Delhi, signifying a better immunization coverage 303