## Causes of Non-Compliance in UIP **Key Point:** Lack of awareness and inadequate health education is the single most common cause of incomplete immunisation in rural India, accounting for 40–50% of dropouts. ### Epidemiology of Immunisation Dropout | Cause | Prevalence | Remarks | |-------|-----------|----------| | Lack of awareness | **40–50%** | **Most common** | | Parental refusal (religious) | 10–15% | Localized, community-dependent | | Fear of AEFIs | 5–10% | Often myth-based | | Vaccine unavailability | <5% | Rare in UIP-supported facilities | | Accessibility issues | 15–20% | Distance, transport, time | ### Why Awareness Deficit is Dominant 1. **Limited health literacy** in rural populations 2. **Poor IEC (Information, Education, Communication)** activities at grassroots level 3. **Misinformation** spreads faster than correct information in low-literacy settings 4. **Lack of reinforcement** — mothers forget the schedule or importance of booster doses 5. **Absence of written reminders** (cards, SMS, ASHA follow-up) ### High-Yield Fact **High-Yield:** ASHA (Accredited Social Health Activists) and ANM counselling are the most effective interventions to improve compliance. States with active ASHA engagement show >90% full immunisation coverage; those without show <60%. ### Mnemonic: Barriers to Immunisation **AFIRE** — Awareness, Fear, Inaccessibility, Religious beliefs, Equity - **A**wareness (lack of) — **Most common** - **F**ear (of AEFIs) - **I**naccessibility (distance, time) - **R**eligious beliefs - **E**quity issues (gender, caste discrimination) ### Clinical Pearl **Clinical Pearl:** Dropout between DPT-1 and DPT-3 is highest in areas with poor ASHA-ANM coordination. Targeted IEC campaigns in these areas can recover 20–30% of dropouts.
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