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  • Infant Immunization Cluster Form

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    Owais Ahmed
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    This document appears to be a survey collecting immunization status data from children under 1 year old in Hansra Basti, Bahawalpur. It collects information such as gender, availability of immunization cards, which vaccines the children have received (BCG, Pentavalent doses 1-3, Polio doses 0-3, measles), their immunization status (not immunized, partially immunized, fully immunized), and reasons for lack of immunization (unawareness, lack of motivation, obstacles). The data is being collected through interviews to assess immunization rates and barriers in the area.

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    This document appears to be a survey collecting immunization status data from children under 1 year old in Hansra Basti, Bahawalpur. It collects information such as gender, availability of immunization cards, which vaccines the children have received (BCG, Pentavalent doses 1-3, Polio doses 0-3, measles), their immunization status (not immunized, partially immunized, fully immunized), and reasons for lack of immunization (unawareness, lack of motivation, obstacles). The data is being collected through interviews to assess immunization rates and barriers in the area.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    9 views3 pages

    Infant Immunization Cluster Form

    Uploaded by

    Owais Ahmed
    This document appears to be a survey collecting immunization status data from children under 1 year old in Hansra Basti, Bahawalpur. It collects information such as gender, availability of immunization cards, which vaccines the children have received (BCG, Pentavalent doses 1-3, Polio doses 0-3, measles), their immunization status (not immunized, partially immunized, fully immunized), and reasons for lack of immunization (unawareness, lack of motivation, obstacles). The data is being collected through interviews to assess immunization rates and barriers in the area.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 3

    STATUS OF IMMUNIZATION IN CHILDRENS UNDER 1 YEAR OF HANSRA BASTI, BAHAWALPUR

    1. Date _____________ 2. Area _____________ 3. Name _____________ 4. Age

    _____________ male female yes no yes no + + + o o o o o Source_____________ o Source_____________ o o o Source_____________ Source_____________ Source_____________ + + + + Source_____________ Source_____________ Source_____________ Source_____________ no

    5. Gender

    6. Immunization Card available? 7. BCG vaccine? 8. Scar?

    yes

    9. 1st Pentavalent (6 weeks)

    Date__________ Date__________ Date__________


    10. OPV0 (at birth)

    2nd Pentavalent (10 weeks) 3rd Pentavalent (14 weeks)

    Date __________ OPV1 (6weeks) Date __________ OPV2 (10weeks) Date __________ OPV3 (14weeks) Date __________
    11. Measles 1st

    + +

    Date___________ Measles 2nd Date___________

    12. Immunization Status

    Not Immunized Partially Immunized Fully Immunized 13.Lack of Information Unaware of need for immunization Unaware of need to return for 2nd or 3rd dose Place of Immunization Time of Immunization Fear for side reactions Other
    14. Lack of Motivation

    Postponed until another time No faith in immunization Rumors Other 15.Obstacles Place of immunization too far Time of Immunization Inconvenient Vaccinator absent Vaccine not available Mothers too busy or ill Child ill (not brought) Child ill (brought but not given vaccination) Long waiting time Others Signature of Interviewer______________

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