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MALNUTRITION AND INFECTIOUS DISEASE MORBIDITY AMONG CHILDREN MISSED BY THE CHILDHOOD IMMUNIZATION PROGRAM IN INDONESIA

SCHIP’s success is contingent on children remaining insured. SCHIP has not, however, served as a bridge to private insurance coverage for children in the short term. Few low-income children have access to affordable private insurance. The vast majority of SCHIP enrollees remained insured because they continued to participate in public insurance. At followup, nearly 80 percent of SCHIP enrollees were enrolled in Medicaid or SCHIP. Some SCHIP enrollees, however, became uninsured. CHIRI™ research has shown that SCHIP coverage is frequently interrupted and that State renewal policies had a strong effect on a child’s likelihood of disenrollment. Provisions under CHIPRA (see box on next page) encourage States to continue simplifying State renewal policies similar to. | MALNUTRITION AND INFECTIOUS DISEASE MORBIDITY AMONG CHILDREN MISSED BY THE CHILDHOOD IMMUNIZATION PROGRAM IN INDONESIA Richard D Semba1 Saskia de Pee2 Sarah G Berger1 Elviyanti Martini3 Michelle O Ricks1 and Martin W Bloem1 4 1The Johns Hopkins Medical Institutions Baltimore MD USA 2Helen Keller International Asia Pacific Singapore 3Helen Keller International Jakarta Indonesia 4Nutrition Service Policy Strategy and Program Support Division World Food Program Rome Italy Abstract. Although it has been thought that child immunization programs may miss the children who are in greatest need there are little published quantitative data to support this idea. We sought to characterize malnutrition and morbidity among children who are missed by the childhood immunization program in Indonesia. Vaccination and morbidity histories anthropometry and other data were collected for 286 500 children aged 12-59 months in rural Indonesia. Seventy-three point nine percent of children received complete immunizations 3 doses of diphtheria-pertussis-tetanus 3 doses of oral poliovirus and measles 16.8 had partial coverage 1-6 of 7 vaccine doses and 9.3 received no vaccines. Of children with complete partial and no immunization coverage respectively the prevalence of severe underweight weight-for-age Z score -3 was 5.4 9.9 and 12.6 severe stunting height-forage Z score -3 was 10.2 16.2 and 21.5 and current diarrhea was 3.8 7.3 and 8.6 all p 0.0001 respectively. In families where the child had complete partial and no immunizations the history of infant mortality was 6.4 11.4 and 16.5 and under-five child mortality was 7.3 13.4 and 19.2 both p 0.0001 . Expanded programmatic coverage is needed to reach children who are missed by childhood immunizations in rural Indonesia as missed children are at higher risk of morbidity and mortality. INTRODUCTION Each year more than 10 million children die and the vast majority of child deaths are in developing countries Black etal 2003 . Although childhood