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According to the Sample Registration System Bulletin (2014), Assam has the highest infant mortality rate in the country i.e. 54 deaths in infants less than a year old per 1,000 live births as compared to the national average of 40. Although India has had a national programme for universal immunisation since 1985, only 65.2 per cent of children aged 12-23 months are fully immunised. In Assam, the coverage rate for full immunisation drops to 55.3 per cent. The dropout rates between the second and third dosage of the DPT and Oral Polio Vaccine are much higher (15.9 per cent and 18.6 per cent respectively) compared to national figures of 11.2 per cent and 11.9 per cent respectively (as reported by the Rapid Survey On Children conducted in 2013-14).
The award has been granted to Public Health Foundation of India.
- To evaluate the impact of the intervention on:
- full immunisation coverage amongst children aged between 12-23 months old,
- coverage rate of vaccines with poor adherence (e.g. DPT3 coverage amongst infants and children aged between 6-23 months)
- dropout rates between different doses of DPT and OPV'
- The study will also analyse the intervention's effect on:
- age-appropriate immunisation,
- inequities in coverage by gender, birth order and tribal or non-tribal population,
- awareness of provision of immunisation service among mothers.
The study will evaluate the impact of the SALT approach of community engagement to increase immunisation coverage. The SALT approach is based on the premise that communities can think and act for themselves and have the capacity to bring about change. A facilitator starts the SALT process by creating a sense of shared ownership of the challenge and building a common vision among community members. The facilitator then leads the community through a self-assessment framework and moderates the process by ensuring every voice gets expressed. Based on the common vision, the facilitator aids the community in creating an action plan based on the premise of shared ownership. The community then implements the plan, through which the facilitator assists in helping them assess their own performance, decide on a course of action using locally available resources and establish parameters for gauging progress while reflecting on outcomes. In the end, community members are also encouraged to share what they have learned through the SALT process with each other.
The study will use the randomised controlled trial method to assess the impact of SALT. It will assign 120 villages each to the control and intervention groups across three districts in Assam. In each district, 40 villages will be assigned to the control and intervention groups respectively. The villages will be selected through stratification and then a random sample of eligible households will be chosen from these selected villages. A household survey will be carried out both at the baseline and the endline. The study aims to evaluate the uptake of DPT3 amongst a total of 3600 infants and children in the age group of 6-23 months. It will also analyse the full immunisation status of 2400 children in the age group of 12-23 months.
The study will also use qualitative methods such as focus group discussions (FGDs) and key informant interviews to assess the impact of SALT. The FGDs will be conducted at baseline and endline with men and women, as well as other relevant community stakeholders (e.g. mothers in law, community leaders). Key informant interviews will also be conducted with selected stakeholders (at baseline and endline) such as health care providers, local government (Panchayati Raj) representatives as well as local NGO representatives.