title: Attitudes of pediatricians and primary health center physicians in India concerning routine immunization, barriers to vaccination, and missed opportunities to vaccinate.
abstract: BACKGROUND
  India has some of the lowest immunization rates in the world. The objective of this study was to determine the attitudes and practices of pediatricians and physicians working in primary health centers (PHCs) regarding routine immunization and identify correlates of missed opportunities to vaccinate children. We focused on Uttar Pradesh and Bihar, which has faced some of the greatest challenges to achieving high routine immunization coverage.
  
  
  METHODS
  A sample of pediatricians from Uttar Pradesh and Bihar was selected from the national membership of the Indian Academy of Pediatrics to participate in either a phone or mail survey. For the sampling frame, the PHCs within selected blocks were enumerated to provide a list from which individuals could be randomly sampled. In all, 614 PHCs in Uttar Pradesh and 159 PHCs were selected for in-person surveys.
  
  
  RESULTS
  The response rate for pediatricians was 47% (238/505) and 93% for PHC physicians (719/773). The greatest barrier to vaccinating children with routine immunizations, reported by both pediatricians (95.7%) and PHC physicians (95.1%), was parents' lack of awareness of their importance. Correlates of missing an opportunity to vaccinate for PHC physicians included holding other health care workers responsible for vaccination. PHC physicians were 50% to 70% less likely to vaccinate a child themselves if they thought another type of health care worker was responsible.
  
  
  CONCLUSIONS
  Future interventions to increase vaccination coverage should address parental knowledge about the importance of vaccines. Understanding and addressing factors associated with missed opportunities to vaccinate may help improve vaccine coverage in Uttar Pradesh and Bihar.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA. lgargan@emory.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Gargano
authors.forename: Naveen
authors.initials: N
authors.lastname: Thacker
authors.forename: Panna
authors.initials: P
authors.lastname: Choudhury
authors.forename: Paul S
authors.initials: PS
authors.lastname: Weiss
authors.forename: Karen
authors.initials: K
authors.lastname: Pazol
authors.forename: Sunil
authors.initials: S
authors.lastname: Bahl
authors.forename: Hamid S
authors.initials: HS
authors.lastname: Jafari
authors.forename: Manisha
authors.initials: M
authors.lastname: Arora
authors.forename: Walter A
authors.initials: WA
authors.lastname: Orenstein
authors.forename: James M
authors.initials: JM
authors.lastname: Hughes
authors.forename: Saad B
authors.initials: SB
authors.lastname: Omer
mesh_terms: D001291:Attitude of Health Personnel; D002675:Child, Preschool; D006801:Humans; D007114:Immunization; D007194:India; D007223:Infant; D007407:Interviews as Topic; D010820:Physicians; D011361:Professional Competence; D014612:Vaccines / Q000008:administration & dosage*
chemical_list: D014612:Vaccines