NURS13137 Outward Bound Nursing Studies

Learning Outcomes Assessed

1. Use effective communication skills and cultural intelligence to apply principles from the nursing process to aid the health of individuals and cultural groups
2. Acquire, evaluate and utilise person centred resources (human, material, technological and environmental) to aid the health education of individuals and cultural groups
3. Appreciate the differences between Australian’s multicultural society and those considered during any activity related to an outward-bound nursing experience
4. Function within legal and ethical frameworks and scope of practice of a nursing student in accordance with the Nursing and Midwifery Board of Australia (NMBA) Registered nurse standards for practice during any activity related to an outward-bound nursing experience.

Background

Your assessment relates to the Global Vaccine Action Plan (GVAP).

http://www.who.int/immunization/global_vaccine_action_plan/en/

As part of the campaign, WHO and its partners aim to:

• Highlight the importance of immunisation, and the remaining gaps in global coverage
• Underscore the value of vaccines to target donor countries and the importance of investing in immunization efforts
• Highlight the ways in which everyone, from donors to individuals can and must drive vaccine progress.

Task

You are a nursing student visiting India, Nepal or Cambodia as part of an outward bound program and have been placed in a community setting to deliver primary health care assessments. You have been asked to prepare a brief to funders who may support a vaccination education session in your community.

Students going on an outward bound experience should select the country they have been to. Students who are not going overseas, can select either Nepal, Cambodia or India.

Step 1.

Outline the distribution of the population in the country you have selected and provide statistics and maps to help present your data. Identify the ethnic groups and any cultural aspects which may impact the uptake of immunisations. Highlight current attitudes towards immunisation in your chosen population.

Step 2.

Identify the vaccinations currently available in the country you selected and compare this to vaccinations that are provided in Australia.

Step 3.

Consider the health risks related to a lack of immunisation for that country. Compare these risks to those in the Australian setting.

Step 4.

Identify the barriers to providing and receiving immunisation in your chosen country? Suggest 2- 3 strategies to overcome these barriers.

Step 5.

Provide examples of how vaccination education is presented by healthcare workers in your country.

Answer:

Introduction

Immunization or vaccination is one of the essential aspects of public health. Vaccinations help protect individuals from getting infectious diseases such as polio, measles tetanus and hepatitis B among others. By getting immunized, individuals help to protect themselves and those around them. Immunization is necessary for both adults and children. Vaccination has been recommended by a large number of health professionals, professional medical organizations and medical researchers. They are considered to be the best way of preventing infectious diseases. Through the use of vaccination in the United States of America, the cases of dangerous infections have significantly declined (Vaccineinformation.org, 2019). Vaccination programs in the country are highly prioritized to ensure that most infectious infections which are quite common in developing countries are not spread by a high number of travelers coming into the country. Lack of vaccination could make children more prone to these infections. According to the World Health Organization, outbreaks of measles in many regions have been caused by low coverage.

As a consequence, many people have died. This also points out to the evidence of the failure by many national immunization programmes to achieve their goals (Global Vaccine Action Plan, 2018). Many outbreaks of preventable infections arise also arise as a result of failure by parents to vaccinate their children. It is therefore important that a collaborative approach is utilized when rolling out immunization programs to facilitate the success of the program. Stakeholders play an important role in the achievement of the objectives of the program. They not only participate in the delivery of the immunization but also help policymakers to understand the perspectives and needs of their communities. This report focuses on the Indian population, the available vaccinations in the country health risks of lack of immunization in the country. It also provides a comparison of India and Australia identifies any barriers in the rolling of immunization programs.

Distribution of Population in India

 The Republic of India is the second most populous country in the world, coming after China whose population is currently estimated at 1.4 billion people. Based on current United Nations estimates India’s population currently stands at 1,362,335,715 which represent 17% of the world’s global population. Recent statistics have put Uttar Pradesh as the most populous states in India with a population of 199,812,341 according to 2011 census. It is closely followed by Maharashtra, Bihar, West Bengal, Madhya Pradesh, Tamil Nadu, Rajasthan, Karnataka, Gujarat, Andhra Pradesh, and Odisha respectively. Lakshadweep and Sikkim are ranked as the states with the lowest populations in the country. The country’s population is concentrated around the first five states. This population is however not dependent on the sizes of each of the states. For example despite Rajasthan being the largest state it has only contributed about 5.5% of India’s population (Toppr, 2019).

Population density Map

Source: www.toppr.com

Cultural groups in India

The Republic of India has enormous ethnic and racial compositions. Scholars have defined it as the most ethnically diverse country in the world. The country’s main ethnic groups include Indo-Aryans, Western Brachycephalics, Mediterranean, Mongoloid, Proto Australiods and Negrito. This population also comprises huge linguistic diversity. The Indo-Aryans are the largest ethnic group primarily located in central and North India. The group also doubles up as the most ethnically diverse group among the six (Sousa, 2019). The Brachycephalic who have an African descent are considered to be the earliest people to arrive in India. They live in the Nicobar Islands and Andaman which are their original habitats. The present diversity among the Indian population is believed to have been contributed by the large scale migration of people from Asia into India. This population speaks a wide range of languages including Hindi, Malayalam, Kannada, Gujarati, Urdu, Tamil, Marathi, Telugu and Bengal. The languages spoken by the people of South India are significantly different from those spoken by People who live in the North. Apart from language differences, these ethnic groups also have different customs, traditions, and beliefs (Sousa, 2019). These differences in language and customs are likely to have an impact on the uptake of the immunization.

 Both positive and negative perceptions of vaccination exist among the Indian population. The attitude towards immunization is largely dependent on the attitude towards healthcare providers. For example, mothers who perceive healthcare providers negatively are unlikely to adhere to vaccination programs. Consequently, mothers with a positive perception on the healthcare providers are likely to complete vaccination (Streefland, Chowdhury & Ramos-Jimenez, 2009).

Vaccinations Currently Available in India

In an attempt to minimize the spread and infection of vaccine-treatable infection, the government of India launched the universal immunization program in 1985. With this program which is among the largest in the world, the government of India looked forward to covering all the districts in the country (Nigam, Saxena, Acharya, Mishra & Batra, 2014). The basic vaccines under this policy include:

Oral polio vaccine

Oral polio vaccine is administered to protect children from poliomyelitis. The first dose of oral polio vaccine is administered at birth. Other doses are administered at 6,10, and 14 weeks. It is administered orally (Rastogi,2018).

Calmette-Guerin vaccine

The administration of this vaccine is intended to protect children from disseminated Tb and tubercular meningitis. The vaccine is administered between the time of birth and when a child is one year old. It is administered through a left arm injection (Rastogi,2018).

Hepatitis B Vaccine

 This vaccine protects from an infection caused by the Hepatitis B virus. The vaccine is administered at birth or within 24 hrs .subsequent doses are combined with Hib and DPT and administered at 60, 10 and 14 weeks through an injection(Rastogi,2018).

Pentavalent Vaccine

This is a combined vaccine intended to protect children from Hepatitis B, Influenza type B infection, Haemophilis, Pertusis, Tetanus, and Diptheria. The vaccine is made up of three doses administered at 6,10 and 14 weeks respectively(Rastogi,2018).

Rotavirus vaccine

Rotavirus vaccine is intended to protect children and infants from rotavirus diarrhea in selected states. The vaccine is administered orally at 6, 10 and 14 weeks (Verguet, Murphy, Anderson, Johansson, Glass & Rheingans, 2013).

Pneumococcal Conjugate vaccine

The administration of the vaccine is meant to children and infants against infections caused by Streptococcus Pneumoniae Bacterium. Primary doses are administered at 6 and 14 weeks. At nine months, an infant is then given a booster dose at the age of 9 months. It is administered through an injection(Rastogi,2018).

Fractional Inactivated Poliomylitis

This vaccine boosts protection against Poliomylitis. It is administered through an injection at 6 and 14 weeks(Rastogi,2018).

Measles vaccine

This is administered to protect against measles at between the age of 9 months and one year. The second dose is administered at between the age of 16 months and two years. In case it is not administered during this period, an administration can be done before an infant attains five years. It is administered through an injection (Rastogi,2018).

DPT Booster

This vaccine is a combination meant to protect children from Diptheria, Pertussis, and Tetanus. The first booster of the vaccine is given at between 16-24 months while the second booster is administered at the age of 5-6 years (Rastogi,2018).

Tetanus Toxoid vaccine

The vaccine is administered to protect against Tetanus.Its administration is done early during pregnancy for pregnant women and between the age of 10 and 15 years(Rastogi,2018).

Japanese encephalitis Vaccine

This is administered in selected districts to protect against Japanese Encephalitis disease. Its two doses are administered between the ages of 9 months and 24 months(Rastogi,2018). 

Health Risks associated with lack of immunization in India

Immunization is meant to prevent individuals from acquiring dangerous infections. It is also meant to minimize the spread of such infections. India being a populous country, lack of immunization can have many impacts on the country’s population (Vaccineinformation.org, 2019). Being one of the most populous countries in the world, India also has the highest number of births estimated at over 26 million annually. With its high birth rates, India also accounts for 20% mortality rates globally. Several immunization sessions are organized annually in the country targeting over 30 million pregnant women and infants. Despite these concerted efforts to curb the spread and prevalence of Infectious infections in the country, the country still has the highest number of non immunized children estimated at over 7 million (UNICEF, 2019).

There are many health risks associated with lack of vaccination in India.

The first health risk associated with lack of immunization is that it leaves the population weak and unprotected from preventable infections. The Lack of vaccination makes the Indian population not be protected from deadly infections such as tetanus, polio; hepatitis B among others. It makes the population unhealthy and prone to preventable disease (Vaccineinformation.org,2019). An unhealthy population is a sick nation. Therefore the lack of vaccination is likely to drain health care resources hence becoming an economic burden to the country.

Secondly, lack of vaccination can leave children and adults unprotected from complications and illnesses associated with preventable diseases. These complications include brain damage, convulsions, loss of hearing capacity, paralysis of limbs, or amputations of both legs and arms(Vaccineinformation.org,2019). In extreme cases, it can also lead to death.

Thirdly, lack of vaccination is likely to increase the cases of hospitalization resulting from illnesses such as immunizable diseases such as a whooping cough and measles. These infections can also lead to death(Vaccineinformation.org,2019). It can also lead to the coming back of diseases of immunizable which have already been eliminated from India bust still available in other parts of the world.

Fourthly, although India has experienced a decline in the number of some infections in recent years, lack of immunization can leave its populations exposed to infections brought from other countries. Every year, a high number of people travel to India from countries where these diseases are extremely common (Vaccineinformation.org,2019). In the absence of vaccinations, therefore, there is an increase in the likelihood of the spread of these infections by travelers.

Additionally, in the absence of vaccinations the possibility of the spread of infections to people with weak immune systems such as cancer patients or children under the vaccination age increases. The consequence of these could be lasting health complications or death. It also leaves family members of an infected person exposed to infection (Vaccineinformation.org,2019).

Finally, lack of vaccinations increases the prevalence of outbreak of infectious disease which is preventable through vaccines. These outbreaks can lead to deaths of a high number of people and lead to multiple health complications. Lack of vaccination is also likely to derail the efforts made from the 1980s when the first institutions dedicated to medical research were established as a way of enhancing the protection of the public against preventable diseases (Lahariya, 2014).

In Australia lack of vaccination is linked to increased death and illnesses as well as the increase in the rates of spread of infectious diseases. These risks are especially high among Adults who form the largest percentage of under-vaccinated Australian population compared to children (The Conversation, 2019).

Barriers and strategies of overcoming the barriers

Many challenges have contributed to the current under-vaccination of the Indian population. Some of these barriers include the presence of gaps in critical areas such as cold chain management, logistics and predicting demand. The little number of staff is also a challenge. This is particularly a big challenge at the field level and within the poor performing states (Madhivanan, Krupp, Yashodha, Marlow, Klausner & Reingold, 2009). One of the major barriers is also the lack of a dynamic system to track the prevalence of diseases that can be prevented through vaccination.T here are also differences in gender intake, geographical barriers, regional and urban-rural differences are also some of the important barriers. Gender barriers are also a contributing factor. The number of girls receiving immunization is relatively lower compared to that of Boys UNICEF, 2019).

Regional inequalities are a major barrier to the realization of vaccination targets in the country. As a consequence of these inequalities, the likelihood of a rural child getting a full vaccination is very dismal. States that are most affected by this inequality include Uttar Pradesh. There is also high inequality between urban and rural areas. The most affected states are Haryana, Chhattisgarh, and Kerala (UNICEF, 2019).

Another notable barrier is the amount of money set aside by the government for routine immunization. The government of India spends very little on regular immunization with only 2.1% of its total budget being set aside for this exercise. Adequate funding is a critical component for the successful implementation of an immunization (Lahariya, 2014). Given India’s high population and the increasing number of births, the amount set aside is insufficient hence it is one of the barriers.

Other barriers include the lack of good data on the immunizable disease to put in the picture the priorities of the vaccination. There is also a lack of surveillance data that is necessary for monitoring the impact of the vaccination (Lahariya, 2014). Additionally, the process is also likely to be hampered by the absence of trained personnel at both state and National levels.

Lack of demand for vaccination services is also a major barrier to coverage. The lack of demand has been associated with poor education levels in India (Shrivastwa, Gillespie, Kolenic, Lepkowski & Boulton, 2015). The lack of education, especially in rural areas, pose a major challenge in the completion of vaccination schedules (Lahariya, 2014). This has also been contributed by cultural barriers attributed adverse effects attributed to vaccination by certain media houses. In most cases, however, these adverse effects are not related to  vaccination

The administration of poor quality vaccines in India has led to poor performance of past vaccines such as Pulse polio program. The poor quality of vaccines has been attributed to the fact that a significant number of the manufacturers of these vaccines are not prequalified WHO (Lahariya, 2014). This is likely to have an impact on the on the public perception and confidence in vaccination programs.

Strategies to overcome these barriers

These barriers can be overcome by improving communication regarding the benefits and side effects of vaccinations. Improving public awareness on the benefits of being vaccinated and offering clarifications on the notion that treatment is associated with certain adverse effects can help to increase demand (Megiddo et al., 2014).

Secondly, adequate funding can also play a role in overcoming coverage barrier. The 2.1% of the budget set aside by the government is not sufficient for putting in mind the country’s high population and a high number of births annually (Megiddo et al., 2014). This can improve the confidence that the public has in the immunization program. Increasing this amount can, therefore, enable the barriers to be overcome.

Thirdly, these barriers can be overcome by minimizing regional inequalities in the country. Doing away with the regional inequalities will improve the chances of both urban and rural populations getting a full vaccination (UNICEF, 2019).

How Healthcare providers in India present vaccination Education

Healthcare providers play a significant role in reducing the prevalence of immunizable diseases in India. They on a daily basis attend to patients affected by these infections or interact with the families of those who are affected. Because of their privileged position Healthcare providers play an informative role by creating awareness on immunizable diseases(Johri et al.,2015).  They also inform the public on various ways in which they can identify noticeable signs and symptoms of such diseases.   

Health care providers also provide accurate information on vaccine-preventable infections to the people they interact with. By providing precise information, they ensure that people receive appropriate vaccinations in appropriate doses and at the recommended times (Johri et al.,2015). They also demystify various myths about vaccines that exist within the society making parents o realize the necessity of vaccines and minimizing exposure to vaccine-preventable diseases.

Conclusion

In conclusion, India is one of the most populated countries in the world. The country also has one of the highest birth rates in the world. This high population makes it and birth rates make India an important population of study in as far as vaccination is concerned. India’s is currently estimated at 1.3 billion people who are concentrated in its five main states. The population is however not distributed in any specific order and is not dependent on the size of a state as well. Some small states have higher populations than larger states. India also has the most ethnically diverse country in the world which s attributed to the large migration of people from Asia into India. Its main ethnic groups include Indo-Aryans, Western Brachycephalics, Mediterranean, Mongoloid, Proto Australiods and Negrito. With this multiple ethnicities, the country is characterized by multiple languages and different customs. In these multiple entities, varied opinions exist about vaccinations. People’s perception of vaccination is largely dependent on their perception of health care providers. To those who perceive them negatively, they are also likely to perceive vaccination negatively and vice versa. India has multiple vaccines classified under its national vaccination program. These vaccines include Oral polio vaccine, Hepatitis B vaccine, Calmette Guerin vaccine, pentavalent vaccine, rotavirus vaccine, pneumococcal conjugate vaccine, measles vaccine among others. There are many health risks associated with lack of vaccination in India. These include an increase in the number of complications associated with vaccine preventable diseases. Leaving the public unprotected from various preventable diseases, an increase in the rates of hospitalization and deaths. Some of the barriers include a lack of sufficient funding from the government, lack of sufficient data on immunization, regional imbalance, and poor public education. These can be overcome by increasing funding, improving public awareness and bridging the gap between different regions.

References

Global Vaccine Action Plan. (2018, November 12). Retrieved January 24, 2019, from https://www.who.int/immunization/global_vaccine_action_plan/en/

Johri, M., Subramanian, S. V., Sylvestre, M. P., Dudeja, S., Chandra, D., Koné, G. K., … & Pahwa, S. (2015). Association between maternal health literacy and child vaccination in India: a cross-sectional study. J Epidemiol Community Health, Jech-2014.

Lahariya, C. (2014). A brief history of vaccines & vaccination in India. The Indian journal of medical research, 139(4), 491.

Madhivanan, P., Krupp, K., Yashodha, M. N., Marlow, L., Klausner, J. D., & Reingold, A. L. (2009). Attitudes toward HPV vaccination among parents of adolescent girls in Mysore, India. Vaccine, 27(38), 5203-5208.

Megiddo, I., Colson, A. R., Nandi, A., Chatterjee, S., Prinja, S., Khera, A., & Laxminarayan, R. (2014). Analysis of the Universal Immunization Programme and the introduction of a rotavirus vaccine in India with IndiaSim. Vaccine, 32, A151-A161.

Nigam, A., Saxena, P., Acharya, A. S., Mishra, A., & Batra, S. (2014). HPV vaccination in India: a critical appraisal. ISRN obstetrics and gynecology, 2014.

Rastogi, A. (2018). Universal Immunisation Programme | National Health Portal Of India. Retrieved from https://www.nhp.gov.in/universal-immunisation-programme_pg

Shrivastwa, N., Gillespie, B. W., Kolenic, G. E., Lepkowski, J. M., & Boulton, M. L. (2015). Predictors of vaccination in India for children aged 12–36 months. American journal of preventive medicine, 49(6), S435-S444.

Streefland, P. H., Chowdhury, A. M., & Ramos-Jimenez, P. (2009). Quality of vaccination services and social demand for vaccinations in Africa and Asia. Bulletin of the World Health Organization, 77(9), 722.

Sousa, G. (2019). Biggest Ethnic Groups In India. Retrieved from https://www.worldatlas.com/articles/biggest-ethnic-groups-in-india.html

The Conversation. (2019). Millions of Australian adults are unvaccinated and it’s increasing disease risk for all of us. Retrieved from https://theconversation.com/millions-of-australian-adults-are-unvaccinated-and-its-increasing-disease-risk-for-all-of-us-74991

Toppr. (2019). The population of India: Characteristics, Growth, Distribution, Videos, Examples. Retrieved from https://www.toppr.com/guides/geography/population/population-of-india/

UNICEF.(2019). Immunization | UNICEF. Retrieved from https://unicef.in/whatwedo/3/immunization

Vaccineinformation.org.(2019). Vaccine Basics – Importance of Vaccines. Retrieved from https://www.vaccineinformation.org/vaccines-save-lives/

Verguet, S., Murphy, S., Anderson, B., Johansson, K. A., Glass, R., & Rheingans, R. (2013). Public finance of rotavirus vaccination in India and Ethiopia: an extended cost-effectiveness analysis. Vaccine, 31(42), 4902-4910.