An exploratory study to assess the immunization coverage and factors leading to dropout among mothers of children in selected rural areas of district Mohali, Punjab with a view to develop an information booklet.

 

Rupinderjeet Kaur¹, Kh. Nita Kumari², Lakhpreet Kaur²

¹Village Bagge Ke Khurd PO. Lumbari Wala Teh. and Dist. Ferozepur-152002, Punjab, India

²Mata Sahib Kaur College of Nursing, Mohali, Punjab, India

 

ABSTRACT:

Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease. This study aimed to assess the immunization coverage and factors leading to dropout among mothers of children in selected rural areas of district Mohali, Punjab with a view to develop an information booklet. A quantitative research approach with exploratory research design was adopted. It included 300 mothers of children selected by using purposive sampling technique in selected rural areas of district Mohali. Survey sheet was used to assess the immunization coverage and dropout and Checklist was used to identify the factors leading to dropout among mothers of children. Study showed that 244 (81.3%) mothers of children show coverage and the remaining 56 (18.7%) mothers of children shows non-coverage. Out of 56 mothers of children who reported dropout, the factors for drop out were further studied. In factor “awareness factors” the maximum number of drop outs were due to lack of awareness in various vaccines contributing to 11(19.6%), in factor “beliefs” maximum 6 (10.7%) were due to fear of side effects, in factor “family circumstances” maximum 8 (14.2% ) were due to family/caregiver forget the day of vaccination, in factor “availability of health care settings and personnel” maximum 4 (7.1% ) were due to vaccines out of stock and in factor “child health status” child was sick at the time of immunization contributed maximally in 14 (25%). There was significant association between immunization coverage and non-coverage with educational level of mother, type of family, religion and is immunization card available. There was no significant association between immunization coverage and non-coverage with age of child (in years), gender, working status of mother, working status of father and monthly family income (in rupees).

 

 

INTRODUCTION:

Immunization plays an important role in maintaining good health of a child. Immune system comprising of T cells and B cells help to fight the infection in our body. In case body has already fought the infection then it’s much stronger the next time. Showing something, which looks similar to a particular virus or bacteria comprises the immunization. It helps in strengthening the immune system when it is fighting against the real infection.¹

 

Immunization is vital; it protects nearly 3/4th of children against six killer diseases including Diphtheria, Pertussis, Tetanus, Tuberculosis, Poliomyelitis and Measles and other childhood illness. Every child has the right to benefit from the appropriate traditional and new life saving vaccination. Immunization is often cited as being one of the greatest achievements of 20th century but effective immunization requires coverage levels of 90 to 95% depending upon vaccine preventable diseases.²

 

A study was conducted to evaluation of vaccination coverage and dropout rates among children of age 0-5 years in slums of Amritsar city. The study results showed that out of 1131 (0-5 years) children, 45.19 % were fully immunized, 31.12% were partially immunized and 23.69% were unimmunized. Fully immunized coverage status among the children of literate mother was higher   than illiterate mother. This study revealed higher dropout rate for BCG-Measles (38.5%), DPT1-Measles (33.5%) and DPT1-DPT3 (26.1%) than target cut off of 10%. The study concluded that Vaccination coverage was quite low as compared to state data which indicates the insufficient services provided in slums. So consistent efforts need to be made in slums so that vaccination coverage can be improved for better survival of children.³

 

Each child has basic human needs like adults to fulfil 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 are to help the parents to emphasize on promotion of health, prevention of illness, maintenance of health and restoration of health.⁴

 

OBJECTIVES:

·      To assess the immunization coverage and dropout among mothers of children in selected rural areas of district Mohali, Punjab.

·      To assess the factors leading to dropout among mothers of children in selected rural areas of district Mohali, Punjab.

·      To associate the findings with selected socio-demographic variables.

·      To develop and administer an information booklet regarding immunization

 

MATERIAL AND METHOD:

Research approach: Quantitative research approach

Research design: Exploratory research design

Research setting: Rural areas

Sampling Technique: Purposive sampling

Sample: 300 mothers of children

 

Research variables: Immunization coverage and factors leading to dropout among mothers of children

Tool:

·      Section A: Socio demographic variables

·      Section B: Survey sheet ta assess the immunization coverage and dropout

·      Section C: Checklist to identify the factors leading to dropout among mothers of children

Inclusion criteria: The study includes:

·      mothers who were available at the time of data collection.

·      mothers who were willing to participate in the study.

·      mothers who can understand Punjabi, Hindi or English.

Exclusion criteria: The study excludes:

·      mothers who were not willing to participate in the study.

 

Data analysis: Analysis was done by using descriptive and inferential statistics

 

RESULTS:

Table 1: Frequency and percentage distribution according to selected socio demographic variables.                                      N =300

Sr. No.	Socio-demographic variables	Frequency (f)	Percentage (%)
1. a) b) c)	Age of child (in years) 0-1 2-3 4-5	71 109 120	23.7 36.3 40.0
2. a) b)	Gender of child Male Female	155 145	51.7 48.3
3. a) b) c) d) e)	Educational level of mother No formal education   Up to primary level Up to secondary level Up to higher secondary level Graduate and above	41 89 84 53 33	13.7 29.7 28.0 17.6 11.0
4. a) b)	Working status of mother Working Non - working	74 226	24.7 75.3
5. a) b)	Working status of father Working   Non -working	290 10	96.7 3.3
6. a) b)	Type of family Nuclear family Joint family	157 143	52.3 47.7
7. a) b) c) d)	Religion Sikh Hindu Muslim Christian	83 192 12 13	27.7 64.0 4.0 4.3
8. a) b) c) d)	Monthly family income (in rupees) ≤ 10,000 10,001 -20,000 20,001 -30,000 30,001 or above	236 49 14 1	78.7 16.3 4.7 0.3
9. a) b)	Is immunization card available? Yes No If no, please specify the reason for non-availability	279 21	93.0 7.0

The table-1 depicts the frequency and percentage distribution according to selected socio-demographic variables such as age of child (in years), gender of child, educational level of mother, working status of mother, working status of father, type of family, religion, monthly family income (in rupees) and availability of immunization card.

 

According to age of child (in years), majority 120 (40%) of the mothers had children in the age group of 4-5 years, 109 (36.3%) mothers had children in the age group of 2-3years and 71 (23.7%) mothers had children in the age group of 0-1years.

 

According to the gender of child, 155 (51.7%) of the mothers had male children and 145 (48.3%) mothers had female children.

 

According to educational level of mother, 89 (29.7%) had education up to primary level, 84 (28%) up to secondary level, 53 (17.6 %) up to higher secondary level, 41 (13.7%) received no formal education and 33 (11%) studied graduate and above.

 

According to working status of mother, 226 (75.3%) were non -working and rest of 74 (24.7%) were working.

 

According to working status of father, 290 (96.7%) were working and rest of 10 (3.3%) were non- working.

 

According to type of family, majority 157 (52.3%) belonged to nuclear family and 143 (47.7%) belonged to joint family.

 

According to religion, 192 (64%) belonged to Hindu religion, 83 (27.7%) belonged to Sikh religion, 13 (4.3%) belonged to Christian religion and 12 (4%) belonged to Muslim religion.

 

According to monthly family income (in rupees), 236 (78.7%) had monthly family income (in rupees) ≤10,000, 49 (16.3%) had monthly family income (in rupees) 10,001-20,000, 14 (4.7%) had monthly family income (in rupees) 20,001-30,000 and 1 (0.3%) had monthly family income (in rupees) 30,001 or above.

 

According to the variable “Is immunization card available?” 279 (93%) mothers had the immunization card and the remaining 21 (7%) did not have the immunization card. The reason behind non-availability of the immunization card was that they lost it.

 

Table 2: Frequency and distribution according to immunization coverage among mothers of children.                                       N =300

Immunization coverage	Frequency (f)	Percentage (%)
Coverage	244	81.3
Non-coverage	56	18.7

The above table shows the immunization coverage among mothers of children. Out of 300 children, 244 (81.3%) mothers of children shows coverage and the remaining 56 (18.7%) mothers of children shows non-coverage.

 

Table 3: Frequency and percentage distribution according to factors leading to dropout among mothers of children.           N =56

Sr.No.	FACTORS	Yes
		(f)	(%)
1.	Awareness factors	12	21.4
2.	Beliefs	9	16.07
3.	Family circumstances	18	32.1
4.	Transport	0	0
5.	Availability of health care setting and personnel	5	8.9
6.	Child health status	15	26.7

 

The above table shows the factors leading to dropout among mothers of children in selected rural areas of district Mohali, Punjab. Out of 56 mothers of children, 18 (21.4%) revealed “Family circumstances”, 15 (26.7%) revealed “Child health status”, 12 (21.4%) revealed “Lack of awareness”, 9 (16.07%) revealed “Beliefs” and 5 (8.9%) revealed “Availability of health care setting and personnel” as factors leading to drop out among mothers of children.

 

Table 3.1: Frequency and percentage distribution according to “Awareness factor” among mothers of children.                       N=56

Sr. No.	Awareness factors	Yes
		(f)	(%)
a)	Various vaccines	11	19.6
b)	Time of vaccination	8	14.2
c)	Place of vaccination	2	3.5
d)	Benefits of vaccination	5	8.9

 

Above table shows the frequency and percentage distribution according to “Awareness factors” among mothers of children:

In “Awareness factors “out of 56 mothers of children, 11 (19.6%) revealed lack of awareness of various vaccines, 8 (14.2%) revealed times of vaccination, 2 (3.5%) revealed place of vaccination and 5 (8.9%) revealed benefits of vaccination as a factor leading to drop out among mothers of children.

 

Table 3.2: Frequency and percentage distribution according to factor “Beliefs” among mothers of children.                            N=56

Sr. No	Beliefs	Yes
		(f)	(%)
a)	Disbelief in immunization	4	7.14
b)	Fear of side effects	6	10.7

 

Above table-3.2 shows the frequency and percentage distribution according to factor “Beliefs” among mothers of children:

In beliefs out of 56 mothers of children, 6 (10.7%) revealed fear of side effects and the remaining 4 (7.14%) revealed disbelief in immunization as a factor leading to drop out among mothers of children.

Table 3.3: Frequency and percentage distribution according to factor “Family circumstances” among mothers of children.    N=56

Sr.No.	Family circumstances	Yes
		(f)	(%)
a)	Family / caregiver is too busy to take the child for immunization	6	10.7
b)	Family / caregiver forget the day of immunization	8	14.2
c)	Lack of knowledge regarding immunization	4	7.1

 

Above table-3.3 shows the frequency and percentage distribution according to factor “Family circumstances” among mothers of children

 

In family circumstances out of 56 mothers of children, 8 (14.2%) revealed that family/caregiver forget the day of immunization, 6 (10.7%) revealed family/caregiver is too busy to take the child for immunization and 4 (7.1%) revealed lack of knowledge regarding immunization as a factor leading to dropout among mothers of children.

 

Table 3.4: Frequency and percentage distribution according to factor “Availability of health care setting and personnel” among mothers of children.                                                                      N=56

Sr.No.	Availability of health care setting and personnel	YES
		(f)	(%)
a)	Vaccines out of stock	4	7.1
b)	Vaccinator is not skilled	1	1.7

 

Above table-3.4 shows the frequency and percentage distribution according to factor “Availability of health care setting and personnel” among mothers of children:

In availability of health care setting and personnel out of 56 mothers of children, 4 (7.1%) revealed vaccines were out of stock and the remaining 1 (1.7%) revealed vaccinator was not skilled as a factor leading to drop out among mothers of children.

 

Table 3.5: Frequency and percentage distribution according to factor “Child health status” among mothers of children.         N=56

Sr.No.	Child health status	YES
		(f)	(%)
a)	Child was sick at the time of immunization	14	25
b)	Any health problem during previous vaccination	1	1.7

 

Above table-3.5 shows the frequency and percentage distribution according to factor “child health status” among mothers of children:

 

In child health status out of 56 mothers of children, 14 (25%) revealed child was sick at the time of immunization and the remaining 1 (1.7%) revealed any health problem during previous vaccination as a factor leading to drop out among mothers of children

 

Table 4: Association of findings with selected socio-demographic variables.                                                                                              N =300

Sr.No.	Socio-demographic variables	Immunization Coverage  (n 1= 244)	Non-coverage (n2=56)	X2, df, p-value
		f1	f2
1. a) b) c)	Age of child (in years) 0-1 2-3 4-5	57 83 104	14 26 16	4.231, 2, 0.121NS
2. a) b)	Gender of child Male Female	126 118	29 27	0.000, 1, 1.000NS
3. a) b) c) d) e)	Educational level of mother No formal education  Up to primary level Up to secondary level Up to higher secondary level Graduate and above	20 71 73 48 32	21 18 11 5 1	38.767, 4, 0.0001*
4. a) b)	Working status of mother Working Non - working	58 186	16 40	0.565, 1, 0.452NS
5. a) b)	Working status of father Working  Non -working	234 10	56 0	1.273$, 1, 0.259NS
6. a) b)	Type of family Nuclear family Joint family	119 125	38 18	6.652, 1, 0.010*
7. a) b) c) d)	Religion Sikh Hindu Muslim Christian	78 150 11 5	5 42 1 8	24.223#, 3, 0.0001*
8. a) b) c) d)	Monthly family income (in rupees) ≤ 10,000 10,001 -20,000 20,001 -30,000 30,001 or above	185 44 14 1	51 5 0 0	7.260#, 3, 0.051NS
9. a) b)	Is immunization card available? Yes No If no, please specify the reason for non-availability	231 13	48 8	4.322$, 1, 0.038*

#  Fisher's exact test    $- Yates' corrected test   NS-Non significant * Significant at p < 0.05

 

The above table depicts the association between immunization coverage with selected socio-demographic variables among mothers of children which was calculated by using chi-square, Fisher’s exact test and Yates corrected test with software application.

 

There was significant association between immunization coverage with educational level of mother, type of family, religion and availability of immunization card at p <0.05 and there was no-significant association between immunization coverage  with age of child (in years), gender of child, working status of mother, working status of father and monthly family income (in rupees).

 

CONCLUSION:

In present study, it was concluded that 244 (81.3%) mothers of children show coverage and the remaining 56 (18.7%) mothers of children shows non-coverage. Out of 56 mothers of children who reported dropout, the factors for drop out were further studied. In factor “awareness factors” the maximum number of drop outs were due to lack of awareness in  various vaccines contributing to 11 (19.6%), in factor “beliefs” maximum 6 (10.7% )were due to fear of side effects, in factor “family circumstances” maximum 8 (14.2%) were due to family/caregiver forget the day of vaccination, in factor “availability of health care settings and personnel” maximum 4 (7.1%) were due to vaccines out of stock and in factor  “child health status” child was sick at the time of immunization contributed maximally in 14 (25%). There was significant association between immunization coverage and non-coverage with educational level of mother, type of family, religion and is immunization card available. There was no significant association between immunization coverage and non-coverage with age of child (in years), gender, working status of mother, working status of father and monthly family income (in rupees).

 

DISCUSSION:

·      In present study, out of 300 mothers of children, 244 (81.3%) shows coverage and the remaining 56 (18.7%) shows non-coverage. The above findings are supported by a similar study conducted by Kumar H, Roy C, Nayak S, Singh SD, Jha HK, Lal PK, et.al 2017 a community based cross-sectional study on immunization coverage in the rural field practice area, Bihar. The aim of study was to find out Immunization Coverage in the Rural Field Practice Area and results concluded that Full Immunization Coverage (12-23 months) was 85.65 % and Non-immunized was 10.45 %. ⁵

·      In present study, out of 56 mothers of children who reported dropout, the factors for drop out were further studied. In  “awareness factors” the maximum number of drop outs were due to lack of awareness in various vaccines 11 (19.6%), in factor “beliefs” maximum 6 (10.7%) were due to fear of side effects, in factor “family circumstances” maximum 8 (14.2%) were due to family/caregiver forget the day of vaccination, in factor “availability of health care settings and personnel” maximum 4 (7.1%) were due to vaccines out of stock and in factor  “child health status” child was sick at the time of immunization contributed maximally in 14 (25%). The above findings are supported by a similar study conducted by Vohra Rajat  et. al 2013 a cross-sectional study on reasons for failure of immunization among 12-23-month-old children of Lucknow, India.  The major  reasons for failure of immunization were unawareness of the need of immunization (12.6%), unawareness of the need to return for 2^nd and 3^rd dose (7.5%), fear of side reactions (3.1%), wrong ideas about immunization (1.1%), postponing it until another time (31.2%), lack of faith in immunization (7.9%), place of immunization being too far (7.11%), time of immunization being inconvenient (0.79%), vaccinator being absent (0.39%), mother being too busy (6.32%), family problem including illness of mother (0.79%), child being ill and hence not brought (13.43%), child being ill and brought but not vaccinated (0.79%), long waiting time (0.39%), polio was considered only vaccine (2.76%), and others (3.49%).⁶

 

·      In present study, it was found that there was significant association between immunization coverage with educational level of mother, type of family, religion and is immunization card available. There was no significant association between immunization coverage with age of child (in years), gender, working status of mother, working status of father and monthly family income (in rupees).The above findings are supported by a similar study by Madhavi N 2013 a hospital based cross sectional study on evaluation of immunization status and factors responsible for drop outs in primary immunization in children between 1-2 years in Govt. General Hospital, Kakinada, AP. The result revealed that 1810 were fully immunized (90.5%), 186 were partially immunized (9.3%) and 4 were unimmunized. Type of family and education of parents had a significant role in the immunization coverage of children whereas gender, religion and residence of children were not found to have significant impact on immunization status. Unwell child, lack of knowledge and migration to other places were found to be major contributing factors for poor immunization.⁷

 

ACKNOWLEDGEMENT:

I would like to express my sincere gratitude to the participants of study who had spent their valuable time for giving the information. Grateful acknowledgement is extended to Mrs. Neelam Kalia for the valuable help in statistical analysis.

 

ETHICAL CLEARANCE:

·      Permission for research study was taken from Principal of Mata Sahib Kaur College of Nursing, Mohali.

·      Permission for research study was taken from ethical committee of Mata Sahib Kaur College of Nursing, Mohali.

·      Permission for research study was taken from Sarpanch of selected rural areas of district Mohali.

·      Researcher explained the purpose of the study to the mothers of children and had taken written informed consent for their participation in the study.

·      Confidentiality of information of all respondents was maintained.

 

REFERENCES:

1.     Park K. Textbook of Preventive and Social Medicine. 18th ed. New Delhi1: M/S Banarsidas Bhanot Publishers, Jan 2005.

2.     Hockenberry MJ, Wilson D. Wong’s Nursing Care of Infants and Children 8th New Delhi; Mosbey; 2009.

3.     Evaluation of vaccination coverage and Dropout rates among children of age 0-5 years in slums of Amritsar city.Available from: https://www. researchgate.net/publication/325966256 Evaluation of vaccination coverage and Dropout rates among children of age 0-5 years in slums of Amritsar city Basavantappa BT. Paediatric child health nursing. 1^st ed.New Delhi: Jaypee Brothers Medical Publishers, Jan.2015

4.     Kumar H, Roy C, Nayak S, Singh SD, Jha HK, Lal PK, et al. A study of immunization coverage in the rural field practice area. 2017;22(3):4.

5.     Rajaat Vohra et.al 2013,Reasons for failure of immunization: A cross-sectional study among 12-23-month-old children of Lucknow, India 

6.     Qutaiba B Al-lela O, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 2014 Jan 25; 14:20.

 

 

Received on 10.10.2019        Modified on 28.11.2019

Accepted on 31.12.2019      ©A&V Publications All right reserved