Knowledge, Attitude and Practice Regarding the Universal Immunization Schedule among Mothers of Infants

 

Mrs. Aparnna T Jose1*, Mrs. Greeda Alexander2, Dr. Anuradha Bose3, Dr. Visalakshi Jeyaseelan4

1 PG Student (2012-2014 batch), Community Health Nursing department, College Of Nursing, Christian Medical College , Vellore.

2Department of Community Health Nursing, College of Nursing, Christian Medical College, Vellore,

3Professor of Paediatrics, Department of Community Health, Christian Medical College, Vellore,

4Department of Biostatistics, Christian Medical College, Vellore,

*Corresponding Author Email: aparnnajose@gmail.com

 

ABSTRACT:

Context: Despite the introduction of new vaccines in the national immunization schedule, the existing reported cases of vaccine preventable diseases among children illustrates the lack of information among mothers.

Objectives: This study was aimed to assess and compare the knowledge, attitude and practice regarding revised universal immunization schedule among the mothers of infants residing in rural and urban areas of Tamil Nadu in India.

Methodology: This descriptive study was undertaken in the selected rural and urban areas of Vellore. Pilot study was conducted, the study design and tool were found to be feasible. Using convenient sampling technique, 200 mothers were enrolled in the study. Data collection instrument was prepared by the investigators .The Content Validity Index was 0.90.The data were collected and analyzed by using descriptive and inferential statistics.

Results: Most of the mothers were in the age group of 21-25 years in the rural and urban areas (55%, 61%) respectively.Main proportions of the mothers were Hindus (85%) in rural areas and (57%) were Muslims in urban areas.Regarding the educational status of mothers, majority were attained middle school education, 53 % from rural areas and 52 % from urban areas. It was found that inadequate knowledge prevails among mothers both in rural (44%) and urban (14%) areas. Higher percentage of the mothers had moderately favorable attitude regarding revised universal immunization schedule in rural areas(99%) and urban areas (100%) respectively.100% immunization coverage was found both in rural and urban areas.There was a highly significant association between the knowledge and place of residence (P<0.001).

Conclusion: This study identified an existing wide gap between the knowledge and practice which need to be addressed by large scale awareness campaigns for the health promotion of the country.

 

KEYWORDS: Immunization; Mothers; Infants; Knowledge;  Attitude; Practice.

 

 INTRODUCTION:

Disease prevention plays a critical role in safeguarding the public health. It is always better to check a disease than to treat it. Vaccines can protect both the people who receive them and those with whom they come in contact. Immunization is a process of protecting an individual from diseases through the introduction of live, killed or attenuated organisms in an individual system.

It is the quintessence of preserving the public health as it is one of the most cost effective public health interventions. It has been a major catalyst in the decline of under -5 mortality rate from 233 to 63(per 1000) in last five decades in India 1.Immunization is seen as vital for the wider strengthening of health systems and a chief element of efforts to attain the Millennium Development Goals; vaccines are put to best use in improving health and safety globally2 .

 

BACKGROUND:

Immunization against common childhood diseases has been an integral component of mother and child health services in India since adoption of the primary health care approach in 1978 being reinforced by the Declaration of Health Policy in 1983. India's immunization programme is one of the largest in the world in terms of quantities of vaccines used, numbers of beneficiaries, number of immunization sessions organized and the geographical area covered.

 

The dual goals of childhood immunization are to protect individualchildren from disease by vaccinating them as early as possible and to protect communities from disease outbreaks by vaccinating adequate numbers. This goal of “protecting the herd” has highlighted the need for programs at scale for several decades. It has also made immunization a very visible intervention3.

 

The current century has witnessed many important events in the control of infectious diseases that mostly affect children. In addition to the eradication of smallpox, the interruption of poliomyelitis transmission in many countries with a distinct possibility of its eradication by the turn of this century are some of the major achievements. Also, the rates of other vaccine preventable diseases such as measles, pertussis and diphtheria have gone down significantly2.

 

Infants are particularly vulnerable to infectious diseases; that is why it is critical to protect them through immunization. Immunization is one of the most important things a parent can do to protect their children’s health4. Failure to vaccinate may mean putting children at risk for serious diseases.

 

SIGNIFICANCE:

With the discovery and use of antibiotics as one of the biggest agent of change in the domain of health, the last century was in many aspects, the century of treatment. This century promises to be the century of vaccines, with the power to eradicate, eliminate or suppress a number of dangerous, life-threatening or debilitating contagious diseases, and with immunization as the centre of preventive strategies. It also ensures that the vision for the decade of vaccines becomes a reality and is a powerful step in that direction5. Immunization is, and should be acknowledged as a core component of the human right to health. It should also be recognized as an individual, community and governmental responsibility. Immunization prevents an estimated 2.5 million deaths each year6. Immunized children have the good time to thrive and a better chance of realizing their full potential being protected from the threat of vaccine-preventable diseases. These benefits are further increased by vaccination in adolescence and adulthood .Vaccines and immunization are an essential investment in a country’s—indeed, in the world’s—future as these contribute a major part of the comprehensive package of interventions for disease prevention and control 5.

 

The National Technical Advisory Group for immunization (NTAGI), the apex technical body for Government of India on immunization after a series of deliberations recommended the phased introduction of Hib vaccine in India. Government of India has expanded the Universal Immunization Programme (UIP) by introducing Hepatitis B and Pentavalent vaccination. The second dose of measles vaccine was also introduced in UIP. The target was to vaccinate more than 12 crore children through Supplementary Immunization Activity (SIA) in 14 states. This was estimated to prevent 1 lakh measles related death.Pentavalent, a combination vaccine against five diseases (Diphtheria, Peruses, Tetanus, Hepatitis B and Haemophilus influenza B) has been introduced on pilot basis in 2 States – Tamil Nadu and Kerala - in mid December 2011 in India7.

 

NFHS-3 survey reported that 57.6% of urban infants were fully vaccinated compared to 38.6% in the rural areas. The percentage of infants who were not vaccinated was 5.7% in rural areas compared to 3.3% in urban areas8. UNICEF 2009-’10 survey recorded complete vaccination in 58.5% rural infants compared to 67.4% urban infants; the respective unvaccinated infants were 8.5% and 5.2%9.The ICMR (1999) survey also reported a rural –urban imbalance in complete vaccination (urban 71.7% / rural 58.5%) as well as no vaccination (rural 11.9% / urban 5.7%).Thousands of children in India still die from vaccine-preventable diseases each year10. So the protection of children, a task every health care provider takes on, is a high calling.

 

The mother is the person who will be the best person to take care of her baby in all the ways .If the mothers are aware about immunization, then the most of the children mortality and morbidity can be minimized. As researchers, the investigators thought that if mothers’ knowledge, attitude and practice regarding revised universal immunization schedule are assessed properly ,then the outcome will be better for the future generation, and the immunization schedule will be effective for all the families.

 

OBJECTIVES:

·         To assess the knowledge, attitude and practice of mothers of infants regarding revised universal immunization schedule in the rural and urban areas.

·         To compare the knowledge, attitude and practice of mothers of infants regarding revised universal immunization schedule in the rural and urban areas.

·         To determine the relationship between the knowledge, attitude and practice of mothers of infants regarding revised universal immunization schedule in the rural and urban areas.

·         To determine the association between knowledge, attitude and practice of mothers of infants with selected demographic variables.

 

 

MATERIALS AND METHODS:

A comparative study was used to determine the knowledge, attitude and practice of mothers of infants regarding revised universal immunization schedule in the rural and urban areas of Tamil Nadu in India. The study was conducted in the rural and urban areas of Vellore district.A sample of 200 mothers who fulfilled the study criteria was selected. In this study purposive sampling technique was employed to select villages in rural areas and streets in the urban area. Convenient sampling was employed to select the mothers of infants. Data collection was done for a period of six weeks. The data collection instrument was prepared by investigators after systematically reviewing the literature and under the guidance of experts from the field of Community and Child health nursing.The content validity of each item was calculated and Content Validity Index (CVI) was 0.90.The instrument was translated into Tamil and the consistency of the translated instrument was checked by back translation. The feasibility of the study was tested during the pilot study. The instrument consisted of two sections. The socio demographic profile, which comprises of age, religion, educational status, occupation, family income and type of family; and the structured questionnaire, which comprises of  knowledge questionnaire, likert scale and practice questionnaire.

 

The knowledge questionnaire consisted of 31 questions related to different vaccines, immunization schedule, purpose and common reactions after immunization.Each correct answer was scored ‘one’ mark and wrong answer was scored with ‘zero’ mark. The total score was calculated and converted into percentages and interpreted. The attitude of mothers was assessed using a four point Likert scale.This scale consisted of ten attitude statements. Out of these, five statements were positive and five statements were negative.

 

The practice of mothers related to revised universal immunization schedule was assessed using a structured questionnaire. Practice questionnaire were interpreted as practising or not practising the same.

 

The study was conducted after obtaining approval from the dissertation committee of college of nursing, Christian Medical College, Vellore. Informed consent was obtained from the subjects before the data collection.The confidentiality and anonymity were maintained throughout the study. The collected data were analyzed, tabulated using Statistical Package for Social Sciences 19.0 for Windows using descriptive statistics such as frequency distribution, percentage and chi-square test.

 

RESULTS:

Regarding socio demographic variables, most of the mothers(55% ,61%) were in the age group of 21-25 years in rural and urban areas respectively .Majority of mothers (85%)were Hindus in rural areas and (57%) were Muslims in urban areas as shown in table 1.

 

Table 1: Distribution of mothers of infants based on their demographic variables

Sl no

Demographic variables

Rural

Urban

 

 

No

%

No

%

1

Age

 

 

 

 

 

20 years and below

10

10

5

5

 

21 to 25 years

55

55

61

61

 

26 to 30 years

26

26

32

32

 

31 and above

9

9

2

2

2

Religion

 

 

 

 

 

Hindu

85

85

40

40

 

Christian

3

3

3

3

 

Muslim

12

12

57

57

3

Educational status  of the mother

 

 

 

 

 

Illiterate

12

12

14

14

 

Primary school

13

13

23

23

 

Middle school

53

53

52

52

 

High school

19

19

10

10

 

Graduate

3

3

2

2

4

Occupation of the mother

 

 

 

 

 

Private employee.

1

1

2

2

 

Government employee

0

0

1

1

 

House wife

99

99

97

97

5

Educational status  of the father

 

 

 

 

 

Illiterate

4

4

12

12

 

Primary school

11

11

33

33

 

Middle school

65

65

47

47

 

High school

18

18

7

7

 

Graduate

2

2

1

1

6

Occupation of the father

 

 

 

 

 

Private employee.

17

17

16

16

 

Government employee

3

3

0

0

 

Daily laborers

79

79

84

84

 

None

1

1

0

0

7

Monthly income

 

 

 

 

 

Less than Rs.1000

2

2

3

3

 

Rs.1001 to 2000

16

16

21

21

 

Rs.2001 to 3000

52

52

60

60

 

> Rs.3001

30

30

16

16

8

Type of family

 

 

 

 

 

Nuclear

53

53

29

29

 

Joint/Extended

47

47

71

71

The first objective was to assess the knowledge, attitude and practice of mothers of infants regarding revised universal immunization schedule in the rural and urban areas. Present study revealed that none of the mothers had adequate knowledge in the rural areas as shown in the figure1.

 

 

 

Figure1.Distribution of mothers of infants according to their overall knowledge  regarding revised universal immunization schedule in rural and urban areas.

 

 

Present study shows that the higher percentage (99%, 100%) of the mothers had moderately favourable attitude regarding revised universal immunization schedule in rural and urban areas respectively. Present study reveals that 100% of mothers both in rural and urban areas had taken the children for regular immunization. Higher percentages 97% in rural and 100% in urban areas were verbalized health care provider as the information provider. Majority 82% in the rural and 81% in the urban areas had gone to primary health centre for immunization.

 

The second objective was to compare the knowledge, attitude and practice of mothers of infants regarding revised universal immunization schedule in the rural and urban areas. Present study showed that there was a highly significant association between the knowledge of the mothers and place of residence (***p<0.001). There was no significant association between the attitude of mothers and place of residence (p= 0.316).The study showed that 100% of mothers both in rural and urban areas had taken the children for regular immunization irrespective of place of residence.

 

The third objective was to determine the relationship between the knowledge, attitude and practice of mothers of infants regarding revised universal immunization schedule in the rural and urban areas.Present study illustrates that 2.3 % of the women who had inadequate knowledge in the rural area were found to be had favorable attitude.100 % of the women in the urban areas had moderately favorable attitude irrespective of their knowledge level. There was no association between the knowledge and attitude of mothers in rural and urban areas.

 

The fourth objective was to determine the association between knowledge, attitude and practice of mothers of infants with selected demographic variables.

 

Socio demographic variables and knowledge:

Present study reveals that there was no association between the age, educational and occupational status of the mother and the knowledge level.

 

Socio demographic variables and attitude:

Current study revealed that there was no significant association between the   demographic variables and attitude of mothers regarding revised universal immunization schedule.

 

Socio demographic variables and practice:

Present study showed that there was no association between the age of mother and the practice of immunization. Current study showed that there was association between the education of father and practice of immunization. There was association between the educational status of the father and practice of keeping a note on next due date (p value=0.002) and place of immunization (p value=0.000).

 

DISCUSSION:

The study showed that majority of the mothers had moderately adequate knowledge regarding revised universal immunization schedule in rural (56%) and urban areas (78%) respectively as shown in figure 1. These were like the finding of (Siddiqi, Khan, Nisar, & Siddiqi, 2007)11.The author reported that mothers had quite low knowledge regarding Expanded Programme on Immunization. Out of 210 mothers, the number and proportion of them correctly identified the seven EPI diseases were as follows; Tuberculosis 57 (27.1%), Diphtheria 53 (25.2%), Peruses 71 (33.8%), Tetanus 70 (33.3%), Measles 85 (40.5%), Polio 91 (43.3%) and Hepatitis B 65 (31.0%).Findings of the study by (Hamid, Andrabi, Fazli, & Jabeen, 2012)12 in North Kashmir found out that all the mothers knew that immunization is to be started at birth, but only  39% of mothers knew that OPV protects against polio, 20% mothers were knowing the disease prevented by DPT vaccination, while 99% mothers were unaware about the disease for which BCG is used. Thus,many mothers attended immunization sessions without knowing exactly for which vaccines they were there.Confusion about the immunization scheme characterizes incomplete immunization.

 

Present study showed that the higher percentage (99%, 100%) of the mothers had moderately favorable attitude regarding revised universal immunization schedule in the rural and urban areas respectively. This finding was almost similar to the study reports of (Adeyinka, Oladimeji, Adeyinka, & Aimakhu, 2009)13.Majority had good attitude to immunization with 84.3% having attitude scores of 75% and above in their study. Positive attitude towards immunization was prevalent in 93% of  mothers, out of 217 mothers in a study conducted by (Bernsen et al., 2011)14.

 

Present study revealed that 100% of mothers both in rural and urban areas had taken the children for regular immunization. Higher percentages 97% in rural and 100% in urban areas were verbalized health care provider as the information provider. This was supported by (Mapatano et al., 2008)15.This finding suggests a unique opportunity, but also should inculcate a primary responsibility in the health personnel, as mothers trust them as the most important source of information on immunization. Majority 82% in the rural and 81% in the urban area had gone to primary health centre for immunization. This was because of the fact that these health facilities seem to be most readily available and accessible to the people.

 

Present study showed that a highly significant association between the knowledge of the mothers and place of residence (***p<0.001). This was contradictory to the finding of (Cassell, Leach, Fairhead, Small, & Mercer, 2006)16 who had reported that 29% of mothers in the urban, and 48% in the rural mothers, reported wrong responses. Mothers had a more generalized, rather than disease-specific, understanding of the value of immunization irrespective of place of residence. There was no significant association between the attitude of mothers and place of residence (p= 0.316) in the present study. Current study showed that 100% of mothers both in rural and urban areas had taken the children for regular immunization irrespective of place of residence. Another study done by (Singh, 2013)17reported that there was considerable variations in child immunization coverage across the place of residence.In the same way (Prislin, Dyer, Blakely, & Johnson, 1998)18  reported that residence in rural areas are associated with low immunization coverage which was contradictory to the current study.

 

Present study illustrated that 2.3 % of the women who had inadequate knowledge in the rural area were found to be had favorable attitude.100 % of the women in the urban areas had moderately favorable attitude irrespective of their knowledge level. There was no association between the knowledge and attitude of mothers in rural and urban areas.This was supported by the study of (Manjunath & Pareek, 2003)19found out that majority(88.6% ) expressed favourable attitudes and is satisfied with the immunization program .They also found that mothers' had  inability to name the diseases which implies that health education should be emphasized to augment  mothers’ knowledge about the immunization schedule.

 

Present study revealed that there was no association between the age, educational and occupational status of the mother and the knowledge level. This was contradicting with the findings of study done by (Bernsen et al., 2011)14which reported  that the knowledge score was lower in those women with of a compromised educational standard. It is a fact that the knowledge increases with education. It is, however, doubtful whether those more informed women actually received their information from health professionals. This observation could be due to recall bias too. Another study done by (Angelillo et al., 1999)20showed that the knowledge was significantly greater among mothers with a higher education level.

 

Current study revealed that there was no significant association between the demographic variables and attitude of mothers regarding revised universal immunization schedule. Mothers who had no formal education also had favorable attitude. This drain of attitude among less educated can be justified by stating the relevance and significance of education programmes towards more acceptance of newly introduced vaccines. Present study showed that there was no association between the age of mother and the practice of immunization. This finding was similar to the study of (Mapatano et al., 2008)15who reported that whether she was young or old did  not  affect the immunization status of the child.

 

 

CONCLUSION:

Understanding the various factors that contribute to maternal knowledge, attitude and practice is very essential, as this is like a key that helps the health care providers to decide upon further measures to improve knowledge, attitude and practice. Study found that mothers who had favourable attitude irrespective of 100 % practice, failed to have adequate knowledge.Periodic evaluation of knowledge regarding the vaccines and immunization would help in filling the gap between knowledge and practice.Health professionals and the policy makers should actively participate in assessing, planning, educating and disseminating the information so that it will bring forth healthy citizens of the future.

 

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Received on 11.07.2017          Modified on 18.07.2017

Accepted on  28.08.2017      ©A&V Publications All right reserved

Asian J. Nursing Education and Research. 2018; 8(1): 33-38.

DOI: 10.5958/2349-2996.2018.00008.3