Optimal immunization practices for the special supplemental nutrition program for women, infants, and children

Abstract

took primary responsibility for revising, managing, and keeping the writing on schedule. AcknowledgmentsThis work was funded in part by grant RO1 DA 10181 from the National Institute on Drug Abuse. The project was approved by the Institutional Review Board of the University of Alaska, Anchorage.We wish to thank Heather and Joie for their assistance. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) can have an important role in improving immunization rates for children from low-income families. References1-3 However, at the same time that WIC has been promoting actions to support immunization assessments and referrals, access to health care (such as immunizations) and support services may have changed for the many WIC clients who are also on Medicaid in response to the growth of managed health care. 4,5 For example, in Detroit, most infants enrolled in Medicaid after 1997 are covered by a Medicaid qualified health plan. To obtain preliminary insight into issues that might affect the way WIC activities help support immunizing such a population of infants from low-income families, we evaluated current practices and immunization-related outcomes in Detroit WIC clinics.During the summer of 1999, a research assistant visited the 9 clinics supervised by the Detroit Health Department that serve most of the WIC clients in Detroit; these clients are predominantly African American. A standard questionnaire was used to collect information such as available WIC and other health care activities for the morning and afternoon sessions at each location, staffing levels, and overall operational activities (including current use of the newly developed state immunization registry). Codes indicating whether infants had their immunizations assessed at recertification visits when they were aged 1 year, as well as the outcome, were obtained from computer records of the WIC administrative system; personal identifiers such as names and addresses were excluded.6 Additional information was obtained by investigators visiting WIC clinics and the WIC program office, and through discussions with staff of the state immunization program.WIC records showed that only 7 clinics had assessed the immunization status of more than 50% of 1-year-old infants in the first 6 months of 1999. Overall, only 4 clinics had "up-to-date" rates of greater than 20% for assessed 1-yearold infants (41%, 64%, 76%, and 98%). These 4 clinics were those in which an immunization nurse was available during about 50% to 100% of the sessions in which infants were evaluated by WIC. Other clinics did not have immunization services regularly scheduled for the times when WIC infants were most likely to be evaluated. Rank order statistical analysis showed that on-site immunization was related to positive outcomes, but no other factor we assessed was found to be significant (Table 1).Weaknesses in this study include the small size of the clinic sample, the potential for various sources of error or bias in data collected, and the potential for an ef...