Let’s talk vaccination: These Mumbai kids need a shot at a healthier future
None of 25-year-old Amina Khan’s four children, residents of Rafi Nagar slum in Govandi in M (East) ward, have received complete immunisation.
World Immunization Week, the campaign to spread awareness ended two weeks ago. However, two of her youngest kids are among 27% children, under the age of two in 12 clusters of the ward, who have either not received or have partial immunisation, according to data maintained by a local NGO, Apnalaya, from twelve slums in the M-East. These clusters are Rafi Nagar 1 and 2, Sanjay Nagar, Nirankari Colony, Shanti Nagar, Indira Nagar 1 and 2, Mominpura, Sai Nagar, Padma Nagar and Buddha Nagar.
Khan stopped taking her children for vaccination shots six years ago after her eldest child, Anam, developed fever and swelling in her left leg after a vaccination shot. “My husband got very angry. He told me not to take any of them for the injections,” says Khan, whose husband is a tailor in a nearby factory and earns less than ₹500 a day. Although doctors told Khan that the swelling would subside, she did not see the point. “Someone told us that if the kids don’t get the injections, they won’t walk. But all my children started walking, so why give them the injections?” she says.
Apsari Akbar Khan, 27, a mother of five, who lives two alleys from Khan’s house, had a similar tone of scepticism, which was fuelled by rumours that the injections could leave the children disabled, blind or sterile.
None of her children have received all the mandated shots. “It is not like they will have no diseases even if we give them the injections. It is god’s will,” she says. Amina and Apsari’s children mirror the condition of other kids in the slum.
This is despite the fact that PM Narendra Modi in October 2017 said the Universal Immunisation Programme in India should aim to cover 90% of all children in 2018, especially those in low coverage pockets in sub-centre and urban slums with migratory populations, such as the slums in Govandi. Such slums have ‘high refusal rates’, said officials of the BMC’s health department.
In Rafi Nagar slum in Govandi, along with being unvaccinated, the children are exposed to poor living conditions, especially because of the nearby Deonar dumping ground.
Flies and mosquitoes buzz around garbage in the overcrowded slum lanes while children run barefoot in dirty water spilled on the streets.
Dr Mamta Manglani, ex-professor and head of paediatrics department, Lokmanya Tilak Municipal General Hospital, Sion, says poor immunisation rates in children dwelling in such unhygienic slums can swell infection and mortality rates.
“Bacterial gastroenteritis which causes diarrhoea is common in these kids. Their immunity drops after the infection, leaving them susceptible to more infections,” she says.
Mangalani adds these children become the source of infection for other children. “In a community, if majority of the children are immunised, herd immunity takes care of most of the other children,” she says.
Each shanty in Rafi Nagar slum on an average, houses a family of more than five people with the men working primarily as daily wage labourers and women doing sequin work or making tiffins.
The data documented by the NGO, shows that between 2016 and 2017, the area recorded 195 cases of upper respiratory tract infections and 53 cases of diarrhoea among children.
Presently, 16% of children under the age of six in the slum are malnourished. Dr Mangala Gomare, deputy executive health officer, Brihanmumbai Municipal Corporation (BMC) said although immunisation rates in all wards across the city is above 85%, it is a is a challenge in the M-East ward given the high migratory population, congested slums, poor hygiene levels and poor awareness.
Arun Kumar, CEO, Apnalaya, says there is underreporting in the number of people in the ward.
“As per the 2011 census, Shivajinagar area in Govandi has a population of 2. 39 lakh, but our data shows that the population now is close to six lakhs, which is why the number of children missing vaccinations is not reflected in BMC’s data,” he says.
Doctors say the only way to improve immunisation rates in such areas is through better awareness.
Dr Santosh Soans, president of Indian Academy of Paediatrics, says, “It is only through awareness activities that one can get more parents to immunise their children. In India, there is also a need to ensure adequate and accessible health facilities.”
Women health workers open up conversations with healthy recipes, strong rapport
In the 12 clusters in M-East ward, when health workers like Jyoti Late, 27, first started going door-to-door to talk about vaccinations, they met a lot of resistance.
“When we started talking to them, many just heard us but wouldn’t take their children for shots. A lot of them thought vaccines were propaganda to control population in the area,” says Late, who works with Apnalaya for a salary of ₹8,000.
After four years now, Late is at ease with women like Amina, who is now pregnant with her child, and visits them every month.
She has a strong rapport with most women in the slums and can discuss sensitive issues with them and their families.
“If you see in this area, each household has three to five children on an average. Women are not able to take care of all of them with limited financial resources, which is why their and their children’s health is neglected,” she says. Religious beliefs coupled with misconceptions about using contraceptives and family planning methods grip these families, she says. Like Late, Saira Khan, in her early forties, the leader of a mothers’ support group that promotes maternal health has been teaching new mothers to cook healthy recipes.
This helps her and other volunteers to educate them about vaccine preventable diseases.
“My grandchildren have not received all the vaccines. My daughter-in-law said no one in her family had vaccinated their children, so she didn’t want to do it for her kids either,” says Khan.
“I ask them to not miss the immunisation schedules.” Arun Kumar, CEO, Apnalaya, says it is the efforts of these health workers along with civic officials that has improved the immunisation rates in the twelve clusters of Shivajinagar and Govandi from 29% in 2014-15 to 76% in 2017-18.