According to DLHS-3 in 2004-2008, the national routine measles vaccination coverage was 69% in Kayakumari District, measles coverage was only 78.2% in 2008, in spite of high literacy [6]. According to NFHS-3 in 2005-2006, in Tamilnadu, the measles immunization coverage was 60% [6]. But the immunization coverage of Tamilnadu obtained from a Non-governmental organization Makkal Nalavazhvu Iyyakam, Christian Medical College, Vellore is 87.6% and it reflects the true scenario in the state at the field level [7].

In Tamilnadu, although the State Health Mission Department has been claiming >90 immunization coverage, studies by organizations including UNICEF have shown a 20% drop in measles immunization coverage in the state since 2008. This drop in immunization coverage was due to various factors including the impact of death of four children at Tiruvallur district near Chennai in 2008 due to adverse effects, following immunization (AEFI) by measles vaccination.

Due to this, from the year 2009 the place of immunization has been changed from door steps to primary health centers. Again the measles vaccination was carried out in field since 2012. WHO targets measles, next to polio for eradication. The output of the measles immunization program is measured in terms of vaccination coverage and dropout rates. As vaccination coverage measures access to immunization services, dropout rates indicates service utilization [8].

However, still there have been wide gaps existing among people in utilizing measles vaccination services of health care centers in Kanyakumari district. In order to identify these gaps and facilitate the program managers and administrators working in the field of health to devise an appropriate change to improve measles immunization coverage, an empirical research study has been carried out in Kanyakumari District.

To ascertain measles immunization coverage, various factors leading to drop outs and parents’ knowledge, attitude and perceived practices on it.

A community based cross-sectional study design was adopted to study the children’s dropout in measles immunization.

With regard to their order of birth, 51.9% stood at second order, while 46.7% were at first order. According to the classification of modified Kuppusamy SES scale, their socio-economic status has been shown in the Table-1 In respect of marital life, 96.7% of the parents were leading legitimate marital lives. The status of administration of vaccine against Measle is apparently shown in the Figure-1

As regards possession of immunization card, age and time of vaccination, 84.8% of the children’s parents had cards showing various vaccinations administered to their children. 81.4% of them, who have been vaccinated against Measles, availed it minimum at their 278^th days and maximum at their 358^th days. The mean age of the vaccination was 293.94 days with the standard deviation of 26.012 days.

61.4% of the parents had utilized the services of government hospitals including PHCs and HSCs for their children’s vaccination, but only 35.1% had utilized the services of private hospitals for it. 58.5% of the parents have accompanied their children during the vaccination. In regard to factors associated with non-immunization, the below diagram gives nugget of information on them…Chi-square test was applied to find the association between the demographic factors and drop outs.

The upshot showed that there were no statistically significant associations between area of residence, place of birth, sex, parental marital status, mothers’ pregnancy status & availability of immunization card and drop out. Similarly, multiple regression analysis was applied to find out association between demographic factors and drop out. It was found that no such statistical significant associations were found between them.

With respect to religion & dropout and socio-economic status & drop out, 25.2% of the children professing Christianity and 11.8% of them professing Hinduism not got immunized. Likewise, 16.7% of the children from upper middle class and 18.1% from lower middle class were not administered vaccination against Measles.

93.3% of children’s parents were aware of Measles, of whom 39.8% gained knowledge through their relatives and 33.7% through their neighbours, 64.8% knew Measles is preventable disease, and 74.5% knew it should be administered at 9^th month.

Figure-1: Immunization Status

coverage was 87.1% with 12.9% dropouts, which was slightly higher than the current study [9]. However, it is slightly higher than the national immunization evaluation study done by UNICEF in 2009 with 80% immunization coverage for Measles [10].

Of the vast majority of the children immunized against Measles, 64.9% of the parents had chosen government hospitals to vaccinate their children and 35.1% of them chose private clinics to do so. It significantly correlates with Niyiawofeso et al study [11], where over three-fifth the parents opted to vaccinate their children in government hospitals. As for the factors associated with non immunization of children, 25.6% of the parents informed that forgetfulness was the common reason. However, 17.9% of the parents felt it was due to ignorance.

A similar study conducted in Surat city [12] wherein 12.9% of the parents stated that it was their ignorance due to which Measles vaccination was not administered to their children. There were statistically significant associations between factors like ignorance, fear of adverse impact and lack of information on place and time of immunization and drop outs in the present study and the study of Yadav et al [13].

Regarding dropout in relation to gender, female children were more likely to be dropout than male children, which was closely correlated with a study conducted by Rashmi Sharma et al [14]. On socio-economic status of children, according to Kuppusamy Scale, it was observed that the children belonged to low SES had higher dropout. However, there was no statistical significant association between SES and dropouts.

With regard to their parents’ knowledge, attitude and perceived practices on Measles, 93.3% had vast awareness, of whom, 39.8% gained it through their relatives and 33.7% through neighbours. In contrast, the other study carried out at Brigham University in US, [15] it was indicated that majority of the parents whose children had been immunized for Measles, gained knowledge through health care providers. It was evident that people living in rural setup had good knowledge about measles.

The study has shed some light on the wider coverage of measles vaccination of 81.4% with dropout of 18.6% in Kanyakumari district.