STATEMENT OF PROBLEM:
An Exploratory Study To Assess The Knowledge And Practices Regarding Immunization Among Mothers Of Infants Attending Pediatric OPD Of Bebe Nanaki Mother And Child Care Centre, Guru Nanak Dev Hospital, Amritsar.
OBJECTIVES OF THE STUDY:
1 To assess the knowledge of immunization among mothers of infants.
2 To assess practices regarding immunization among mothers of infants.
3 To associate findings with selected variables i.e. age, education, occupation, number of children and area of residence.
OPERATIONAL DEFINITIONS:
1 Assess: - In the present study assess
refers to the organized systematic and continuous process of gathering information
on immunization from mothers of infants.
2 Exploratory study: - The study aims to explore phenomenon of immunization.
3 Knowledge: - It refers to the ability of the mothers of infants in giving correct responses to the questions asked as measured by self structured knowledge questionnaire
4 Immunization: - It refers to the process of protecting children against vaccine preventable diseases like diphtheria, polio, tetanus, whooping cough, tuberculosis and measles by following the prescribed schedule.
5 Mothers of infants: - In the present study it refers to the mothers who have children below 1 year of age.
6 Practices: - It refers to the ability of the mothers of infants in application of the knowledge regarding immunization in their life style.
ASSUMPTION:
Mothers of infants will have inadequate knowledge regarding immunization.
DELIMITATIONS:
· The study is limited to only mothers of infants in Pediatric OPD of Bebe Nanaki Mother and Child Care Center, Amritsar.
· The knowledge and practice of mothers of infants will be assessed only through a self-structured questionnaire regarding immunization.
INTRODUCTION:
“Children are the wealth of tomorrow; Take care of them if you wish to have a strong India, Ever ready to meet various challenges” P. NEHRU
The goal of immunizing children against chief diseases responsible for child mortality and morbidity is indeed a noble one. However, it is not an easy task to achieve. In a developing country like India, the sheer logistics of the numbers of the target population that stretches across geographically diverse regions make universal immunization of children a Herculean task. However, the health sector of this country is making admirable achievements in that several millions of potential life years have been saved from getting lost to vaccine preventable diseases through the universal immunization program .1
There are several reasons to aim for universal coverage. The Indian culture promotes safe nurturing of children. Hardly do we find parents who risk their children to life-threatening diseases, unless they being unaware or misinformed. All vaccines under the routine immunization programme are provided free-of-charge. The current level of coverage of ‘fully-immunized’ children under the national immunization programme is quite low, as pointed out by several studies.2
According to UNICEF immunization is currently preventing an estimated two million deaths among children under five every year. India has one of the highest under five mortality rates in the world with an estimate of 64/1000 live births in 2010. One of the factors contributing to infants’ mortality is the ignorance of child care.3
Global immunization coverage has greatly increased since WHO’s expanded programme on immunization began in 1974. In India expanded programme on immunization was launched in January 1978. UNICEF renamed the expanded programme on immunization as Universal Immunization Programme (UIP) and it was launched in India in November, 1985.4
In 2010, global DPT3 (three doses of the diphtheria, Pertusis, tetanus combination vaccine) coverage was 68% up from 50% in 2005. However, 27 million children worldwide were not reached by DPT3 in 2010, including 9.9million on south Asia and 9.6 million in sub-Saharan Africa.5
Each child has basic human needs like adults to fulfill the essentials of life and to promote growth and development. Immunization is one of the needs of the children. The responsibilities of the nursing personnel is to help the parents to emphasize on promotion of health, prevention of illness, maintenance of health and restoration of health.6
NEED FOR THE STUDY:
The physical health of a child is important because it is associated with the mental and social development of a child. Mothers are the first care providers of their children, is needed to reduce the infant mortality rate. One of the ways to achieve reduction of infant mortality is to educate the mothers on matters pertaining to child care.7
A descriptive study was conducted to determine the relationship between the literacy status and immunization coverage among 100 mothers of under five children in Kolar district in Bangalore. The analysis revealed a fairly low immunization coverage (<33%) for all vaccines and it was found that literacy status of mothers had a significant influence on the immunization level. Lack of awareness and motivation was cited as the main reason for non-immunization. The study recommended giving awareness by health care personnel among mothers to improve their knowledge which in turn changes their attitude.8
Each year since 1990, immunization with routine vaccines has reached more than 70 %of children worldwide. At the UN General Assembly special session in 2007 the international community adopted the specific target of immunizing by 2010 at least 90 percent of children in each country.9
Worldwide approximately 130 million children are born every year in which 91 million are from developing countries. America and Europe maintains over 90% of immunization and western pacific maintains 92% of immunization while eastern Mediterranean maintains 86% of immunization.114 countries has reached 90% of immunization where 150 countries has reached 80% of immunization.10
The child mortality rate or infant mortality rate is the number of children who die by the age of one, per thousand live births. In 2007, the world average was 68 (6.8%) In 2006, the average in developing countries was 79 (down from 103 in 1990), whereas the average in industrialized countries was 6 (down from 10 in 1990). The world's child mortality rate has dropped by over 60% since 1960.11
Around 10 million children die under the age of five every year and over 27 million infants in the world do not get full routine immunization. The predicted world’s infant mortality rate during the year 2005 to 2010 is 47 per 1000 birth where the actual infant mortality rate is 57 per 1000 births.12
In India over all statistics says that 80% immunization has been covered. In 1985, the Universal Immunization Program was started in India with the aim of achieving at least 85% coverage of primary immunization of infants. 93 percent of all under-5 deaths occur in Africa and Asia. Half of these deaths occur in five countries: India, Nigeria, Democratic Republic of Congo, Pakistan, and China.13
In India the infant mortality rate (IMR), total is 40.5 deaths per 1000 births and 39.2 per 1000 for males while 41.8 per 1000 for female infants (est. 2016). In state of Punjab IMR counts at 30 per 1000 live births and maternal mortality rate is 172 per 1000 as established in 2013.14
REVIEW OF LITERATURE:
A cross sectional study was conducted on National Immunization survey (NIS) which was designed to measure vaccination coverage estimates for the 10 states of United State. The NIS includes a random-digit-dialed telephone survey and a provider record check study. Data are weighted to account for the sample design and to reduce non response and non coverage biases in order to improve vaccination coverage estimates. The survey reports communicated that 92% of the children in 10 state of United State has been covered by vaccination and prevented from all vaccine preventable diseases.15
An exploratory study was conducted to assess immunization coverage among 500 mothers of children under the age of 5 years belonging to a low income group. All were attending the pediatrics out patient department of a large teaching hospital in New Delhi, India. Only 25% were found to have received complete primary immunization as per the National Immunization schedule (bacilli calmette – Guerin at birth, 3 doses of diphtheria, pertussis and tetanus and oral poliovirus vaccine at 6, 10 and 14 weeks and measles at 9 months). The major reasons for non-immunization of the children were migration to a native village (26.4%), domestic problems (9.6%). The immunization centre was located too far from their home (9.6%) and for child was unwell when the vaccination was due (9%). The lack of awareness and fear of side effects constituted a small minority of reasons for non-immunization.16
A comparative study was conducted to estimate the vaccination coverage level of children living in rural and urban areas identify statistically significant differences. Children aged between 19-35 months residing in Kolar District of Bangalore participating on the 2008 National Immunization Survey were included in the study. Statistically significant differences in vaccination coverage levels between the rural population and their urban counterparts were determined for individual vaccines and vaccine series as evidenced by 28% of the children were covered by immunization residing in rural areas whereas 46% were covered in Urban area.17
An evaluative study was conducted in Udupi District, Karnataka to determine the knowledge of mothers on immunization of children and to the effectiveness of structured teaching programme (STP) in selected pediatric wards. One group pre test post test design and non probability convenience sampling was used. Data were collected from 50 samples by structured knowledge questionnaire and STP was administered. Data were analyzed by descriptive and inferential statistics. The t – test showed that post test knowledge means score (29.74%) were significantly higher than that of pre – test mean score. (16.16%) t (49) = 27.77 p<0.01. This indicated that the STP was effective in improving the knowledge level of mothers regarding immunization. Majority of the mothers (87.7%) strongly agreed that STP was highly effective to a great extent.28
A study was conducted to assess effectiveness of planned teaching programme on immunization among mothers of under five children staff in selected hospital of Udupi. The sample consisted of 35 mothers. Study has conducted in two phases. In the first phase learning needs were identified and in the second phase, planned teaching programme was developed based on identified learning needs. The findings revealed that the post-test knowledge score (26.53%) was higher than the pre-test knowledge score (13.5%). Therefore, planned teaching programme was found to be an effective media for educating mothers regarding importance of immunization.29
An evaluative study was conducted among 50 mothers of under five children in selected pediatric hospital, Pondicherry. The aim of the study was to evaluate the effectiveness of structured teaching programme (STP) regarding immunization. A closed ended questionnaire with 30 items related to immunization was used to collect the data followed by intervention of STP. The study finding shows that the post-test knowledge score (22.73) was higher than the pre-test knowledge score (12.78). The study claimed that STP is effective to enhance mothers mother knowledge regarding the importance of immunization.30
METHODOLOGY:
RESEARCH APPROACH: For the present study non-experimental research approach was used as it aims to assess the level of knowledge and practices of mothers of infants regarding immunization.
RESEARCH DESIGN:
For the present study, exploratory research design was selected to accomplish the objective that is to explain the nature of situation under study.
RESEARCH SETTING:
The present study was conducted in Pediatrics OPD at Bebe Nanaki Mother And Child Care Centre, Guru Nanak Dev Hospital situated at Majitha Road, Amritsar, Punjab.
TARGET POPULATION:
The target population of the present study was Mothers of infants.
SAMPLE AND SAMPLING TECHNIQUE:
Purposive sampling technique is used for sample selection. Total sample size of 50 mothers of infants was selected.
RESEARCH VARIABLE:
Age of mother (in years), Education, Occupation, Number of children, Area of residence, Knowledge of mothers regarding immunization.
INCLUSION CRITERIA:
1 Mothers of Infants who are willing to participate in the study.
2 Mothers who can understand Punjabi, Hindi or English.
EXCLUSION CRITERIA:
1 Mother with qualification in the medical profession.
2 Mothers of infants those who are not willing to participate in the study.
3 Mothers who are not available at the time of data collection.
4 Mothers who cannot understand Punjabi, Hindi or English.
DEVELOPMENT AND DESCRIPTION OF TOOL:
As per the research experts opinion self-structured knowledge questionnaire was prepared. It consists of:
1 Socio demographic profile.
2 A self- structured questionnaire will be prepared to assess the knowledge and practices of mothers of infants regarding immunization.
VALIDITY OF TOOLS:
It was determined by experts’ opinion relevance of items. The tool was given to nursing experts and language experts in English and Punjabi for content validation. As per the guidance and suggestion from experts, suggested amendments were made in the tool.
RELIABILITY OF TOOLS:
Reliability refers to the accuracy and consistency of measuring tool. Reliability of the tool was computed by using Split-half method. The reliability of the tool part 2 i.e. self structured questionnaire on knowledge and practices regarding immunization was calculated to be r=0.78. Hence, tool was highly reliable.
PILOT STUDY:
Pilot study was started from July 15, 2017 to July 20, 2017 at the selected setting i.e. Pediatrics OPD of Bebe Nanaki Mother and Child Care Center, Guru Nanak Dev Hospital, Amritsar The sample for pilot study i.e. mothers of infants attending Pediatric OPD were selected by purposive sampling technique and the sample size for pilot study was 10% of the total sample size. The analysis of the study was done in accordance with the objectives and feasibility of the study was achieved. Data was analyzed by using descriptive statistics (mean, standard deviation and co-relation) and inferential statistics i.e. chi-square and graphical representation.
METHODS OF DATA COLLECTION:
Prior to data collection, permission was obtained from the concerned authority. After accepting the permission the following steps will be taken up:
· Step1–Researcher introduces herself and explains the purpose of the research study to the subjects.
· Step2–Administration of self-structured questionnaire on knowledge and practice regarding immunization by asking questions listed in it.
· Step3–Collection of research tools from subjects of research study.
· Step4–Analysis of data collected.
ETHICAL CONSIDERATIONS:
A formal permission to conduct the research study was taken from authority and informed verbal consent was also taken from mothers of infants. Keeping in mind the legal rights of the subjects, only those subjects who were willing to participate were included in the study. Anonymity of study subjects and confidentiality of information was also maintained.
METHOD OF DATA ANALYSIS:
Data will be analyzed by using descriptive and inferential statistics method:
(a) Descriptive statistics such as frequency, percentage, mean, standard deviation.
(b) Inferential statistic: ANOVA test will be used to find out the association between selected demographic variables with the level of knowledge regarding immunization among the study participants.
Major findings related to demographical variables:
· According to age the mothers of infants out of 50, majority were in age group 21–25 years 29 (58%) followed by 26 – 30 years 13 (26%) and 31 years and above 5 (10%) and least in 20 years and below 3 (6%) of age group.
· According to education of the mothers of infants, out of 50, majority were in the group of metric to senior secondary education i.e. 21(42%) followed by primary to high school education i.e. 18 (36%) followed by graduated mothers counting at 6(12%) and 5(10%) falls in illiterate group.
· According to the occupation of the mothers of infants majority is in housewife group 35(70%), followed by the labourer group 7(14%), in private jobs group 6(12%) and in government job group 2(4%).
· According to number of children the mothers of infants out of 50, majority falls in group 1 i.e. one children 26(52%), followed by with two children 19(38%), followed by three children 3(6%) and least falls in last group i.e. above 4 children 2(4%).
· According to the area of residence the mothers of infants are divided out of 50 as maximum in rural area 19(38%), followed by living in town 14(28%), in urban area 9(18%) and in slums 8(16%).
DISCUSSION:
OBJECTIVE 1:
To assess the knowledge of immunization among mothers of infants.
The analysis of data regarding level of knowledge regarding immunization among mothers of infants revealed that out of 50 subjects, majority of subjects had poor knowledge 27(54%) and 18 subjects that is 36% of the total had average knowledge regarding immunization while the remaining 5 subjects 10% had good level of knowledge. These results are consistent with findings of the study done by Shamila Hamid in north Kashmir (2011), about “immunization of children in a rural area of north Kashmir, India: A KAP study” revealed that only 1% were aware of protective role of BCG. In this study knowledge, attitude and practice regarding immunization in 99% of the mothers were ignorant about the disease for which BCG is used. 86.33% mothers knew that vaccine which prevent whooping cough is DPT. The results of the present study are similar to the above explained study that mostly mothers were ignorant about vaccine being given to their children.
OBJECTIVE 2:
To assess practices regarding immunization among mothers of infants.
The analysis of the data regarding
practices of immunization reveals that 28 out of 50 mothers that is 56% of
subjects show good practice related to immunization of infants while the rest
22 mothers which formed 44% of the total subjects show poor practice regarding
immunization of infants. In a similar study conducted on status of mother’s KAP
on child immunization in minority areas in Guizhou Province, Assam shown that mother’s
knowledge, attitude and practices on childhood immunization were at a low level
and influenced by educational background, country’s economic level, mother’s
age and ethnic group. This study results are contradictory to the present study
results. A survey on knowledge, attitude and practices of parents in Barangay
by Sylvia E. Caingles and Joanne J. Lobo (2011) regarding their child’s
immunization show that parents have good practices related to immunization that
is 80% of total subject were having good practice scores.
OBJECTIVE 3:
To associate findings with selected variables i.e. age, education, occupation, number of children and area of residence.
The association of the study findings depicts that selected socio demographical variables such as age of mother, education, occupation and area of residence are having significant association with level of knowledge of mothers of infants while number of children was not significantly related to level of knowledge regarding immunization. A study on knowledge and attitude regarding vaccines among mothers of under five children by Ms. Mereena and Mrs. Sujatha (2014) revealed that there was a significant association of knowledge with age education, religion, family income, occupation and number of children. The p<0.05, was found significant. The present study is in accordance to the findings of the above stated study findings that are there is association between variables and level of knowledge.
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Received on 04.10.2017 Modified on 28.11.2017
Accepted on 18.12.2017 ©A&V Publications All right reserved
Asian J. Nursing Education and Research. 2018; 8(3):379-384.
DOI: 10.5958/2349-2996.2018.00078.2