Diphtheria, a vaccine preventable disease persists as a
public health concern due to poor immunisation coverage
in India.
[3] Immunisation coverage rates are typically lower
among migrants as seen in studies.
[9,10]
In this study,
migration was an integral part of these families. It is driven
both by their tradition as well as livelihood issues.
Providing secured livelihood is an important intervention
which can reduce their vulnerability if not migration. Both
the families were not much aware about the vaccine
preventable diseases and this lack of knowledge is an
important social determinant of their behaviour. Investing
in education and specifically health education would be
important means of countering the ignorance. It has been
shown that personalised service provision by health care
system increases chances of a child receiving full
immunisation.
[9] There is need to develop health care
services specifically for migrant communities. If ignored,
then it would lead to high risk susceptible areas in rural
India where children will be susceptible and in close
proximity with each other. In such epidemiological
situation, disease agent will continue to transmit and result
in periodic outbreaks. Families, in the study, preferred
private practitioners rather than government system even
though the former is not affordable for them. Therefore,
health care delivery structure for migrants should include
private practitioners. Since migrants will be highly mobile
population, it is important to have micro-plans to reach out
to them. Along with these measures to prevent, a case of
diphtheria from occurring, need is to develop systems that
would mount sufficient public health response. District
health authorities vaccinated all unimmunized children in
one village. Since the two cases described, had been
travelling from one village to other; there was need of a
coordinated effort of all authorities in both the districts.
This calls for need of a strong surveillance system which
would not only trigger disease control activities but also
plan, implement and evaluate programmes