Publication:

Assessment of immunization among newborns: comparison between children delivered vaginally and by cesarean section

Background Timely administration of vaccines, particularly for hepatitis B birth dose within 24 hours of birth is of immense importance. It is considered as an indicator of quality of immunization programme. This study aimed to assess effect of mode of delivery and type of hospital on immunization among newborns.

Methods This large multi-site study was conducted in Pune district having population of 9.43 million. A total of 13 hospitals were selected which included all government hospitals performing more than five cesarean sections per month, and one government and one private medical college hospital. Cesarean section and vaginally deliveries were enrolled in 1:1 ratio. Their children were followed till discharge. Data were collected by obstetrician or qualified nurse.

Results During study period 3,112 women were enrolled.  The relative risk of not getting vaccine Hepatitis B birth dose before 24 hours among cesarean delivered newoborns was 1.08. The relative risk of not getting zero polio and BCG among cesarean delivered newborns was 0.71 and 0.76 respectively. All these differences were significant. The coverage for all vaccines was better in sub district hospitals than others. Coverage of all vaccines in government teaching hospital was better than private.

Conclusions Cesarean section enabled better coverage among newborns probably due to length of stay. Whereas the physical and mental stress after cesarean section resulted lesser coverage of hepatitis B birth dose within 24 hours. Opportunities of timely Hepatitis B birth dose administration were missed probably due to lack of knowledge among health workers about ideal timing.