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Year : 2020  |  Volume : 45  |  Issue : 4  |  Page : 567-568

Health workers' approach toward Adverse Events following immunization – An insight from Madhya Pradesh

1 Department of Public Health, Public Health Foundation of India, Delhi, India
2 Department of Epidemiology, Indian Institute of Public Health Gandhinagar, Gujarat, India
3 Department of Immunization Cell, Health and Family Welfare, Government of Madhya Pradesh, India

Date of Submission22-Jan-2020
Date of Acceptance13-Jul-2020
Date of Web Publication28-Oct-2020

Correspondence Address:
Dr. Snehal Parmar
Plot No – 135/1, Sector – 1/B, Gandhinagar - 382 007, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijcm.IJCM_52_20

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How to cite this article:
Parmar S, Puwar T, Saxena D, Shukla S, Pandya AK. Health workers' approach toward Adverse Events following immunization – An insight from Madhya Pradesh. Indian J Community Med 2020;45:567-8

How to cite this URL:
Parmar S, Puwar T, Saxena D, Shukla S, Pandya AK. Health workers' approach toward Adverse Events following immunization – An insight from Madhya Pradesh. Indian J Community Med [serial online] 2020 [cited 2022 May 24];45:567-8. Available from: https://www.ijcm.org.in/text.asp?2020/45/4/567/299443


Adverse event following immunization (AEFI) is a medical incident that takes place after immunization.[1] AEFI is a threat for creating fear of vaccination among parents resulting in low uptake of vaccination.[2] Evidence indicates that the knowledge of AEFI surveillance and vaccination practices of health-care workers influence the quality, safety, and monitoring of the vaccination services which may potentially reduce vaccine-related illness, disability, and death.[1],[3],[4]

Government of India has issued guidelines[2],[5] on AEFI surveillance, investigation, reporting, and management of AEFI but the adherence of the same is reported suboptimal.[5] AEFI surveillance is a system to identify and collect adverse events associated with receipt of vaccines.[2] Further, scarcity of studies on AEFI in India hinders advancement in AEFI investigation, reporting, and management. The present study has assessed knowledge on routine immunization, AEFI management, investigation, reporting, and training received on AEFI among 72 primary health-care workers from Bhopal and Vidisha districts of Madhya Pradesh. We have also assessed vaccination practice and availability of the AEFI kit at the facility level. Primary health-care workers included this study were medical officers (MOs), auxiliary nurse midwifery (ANMs), and accredited social health activists (ASHAs).

In the present study, most MO and ANM knew adverse events following immunization; practices related to vaccine safety and routine immunization process but were unaware of the vaccine safety and reporting procedure [Table 1]. A different questionnaire was prepared for the ASHAs as per their level of comprehension and functional job responsibilities related to AEFI. [Table 2] depicts knowledge related to AEFI reported by ASHA.
Table 1: Knowledge of medical officer and auxiliary nurse midwifery on key domains of adverse event following immunization

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Table 2: Knowledge of accredited social health activist on key domains of adverse event following immunization

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Authors also assessed routine immunization practices at primary health centers (PHC) and outreach session sites using an observation checklist. The observation revealed varied practices across PHCs and outreach session sites. Compliance was observed in certain practices such as most of them (96%) had checked VVM status, expiry dates of vaccine vials, recorded vaccine's batch number before vaccination and also, informed guardians of children about the common side effects following vaccination and its treatment (79%). However, noncompliance in management, identification, and reporting was noted. For example, only five ANMs diagnosed AEFI and out of them, only one had reported the AEFI; 18 of them (75% of ANMs) did not carry their AEFI treatment kit at their vaccination room or the session site. More than (29%) had not cleaned the injection site before vaccination with a sterilized cotton swab, and 21% had not used sanitizer/soap for aseptic precaution. Although the reporting should be done in AEFI reporting forms as per prescribed guidelines, most of them stated that they reported to MOs through the telephone only. None of them had ever participated in the AEFI investigation and reporting of AEFI was observed to be suboptimal. Few ANMs stated that they did not report until it worsens because of the fear of victimization. Some of the participants, particularly ANM and ASHAs, stated that reporting of AEFI was not part of their clinical responsibilities. This emphasizes the need for sensitizing the health-care workers on AEFI surveillance and reporting.

ANMs and their supervisors have been provided logistics related to AEFI management. As per the Government AEFI guideline, all vaccination sites are provisioned AEFI treatment kits to provide first-aid to any kind of AEFI.[4] However, it was observed that the AEFI kit was not maintained as per the guideline at any of the vaccination sites. Of 24 sites, only 14 vaccination sites had complete AEFI kits and surprisingly none of them was having a complete set of materials/instruments.

Trainings on AEFI were conducted by the health department; however, trainings were sporadic, which may be a reason for limited knowledge and noncompliance to AEFI guidelines. Most trainings were conducted 2 years ago and surprisingly all these trainings had similar contents. In the last 3 years, only 10 MOs (out of 24) and 9 ANMs (out of 24) had received training. Most importantly, in the case of ASHAs, only three of them received the training.

The need for periodic trainings and supportive supervision to enhance practices related to AEFI is obvious. Cadre-specific training content, as well as a mode of delivery, should be planned. For example, MOs need to have a clear idea about its treatment, referral, and reporting of the risk-cases to the higher authorities whereas ANMs need competency on vaccine safety, AEFI surveillance, use of AEFI kits, and identification of cases. ASHA needs training on identification of symptoms of severe AEFI, immediate reporting, and referral in case of emergency. In addition to the training, learning resources such as job-aids in simple and vernacular language especially for ANM and ASHA and standard operating procedures on AEFI for MOs can be very useful. Posters of AEFI identification and reporting at PHC and sub-center or Health and Wellness Centre can support timely reporting of AEFI. Supportive supervision of health workers and cold chain points, as well as a weekly review of immunization and AEFI status of immunized children, may improve the accuracy of reporting. A better and coordinated response to AEFI can potentially decrease immunization related disability and increase the confidence of the community on vaccination.


We would like to acknowledge the support from the staff at Immunization cell at National Health Mission, Madhya Pradesh, India.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Mehmeti I, Nelaj E, Simaku A, Tomini E, Bino S. Knowledge, practice and approaches of health professionals to adverse events following immunization and their reporting in Albania. Heliyon 2017;3:e00331.  Back to cited text no. 1
Ministry of Health & Family Welfare, Government of India. Standard Operating Procedures (SOPs) Investigation of Adverse Events Following Immunization (AEFI). New Delhi: Publisher WHO; 2010. p. 10-1.  Back to cited text no. 2
Chitkara AJ, Thacker N, Vashishtha VM, Bansal CP, Gupta SG. Adverse event following immunization (AEFI) surveillance in India: Position paper of Indian Academy of Pediatrics, 2013. Indian Pediatr 2013;50:739-41.  Back to cited text no. 3
Shen AK, Fields R, McQuestion M. The Future of Routine Immunization in the Developing World: Challenges and Opportunities. Vol. 2. Global Health Science and Practice. Johns Hopkins University Press; 2014. p. 381-94.  Back to cited text no. 4
Ministry of Health & Family Welfare, Government of India. National Quality Assurance Standards for AEFI Surveillance Program. New Delhi: Ministry of Health & Family Welfare, Government of India; 2016. p. 100-03.  Back to cited text no. 5


  [Table 1], [Table 2]


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