INTRODUCTION:

Immunization is defined as the process of inducing the immunity in an individual against an infectious organism or agent, through the vaccination (Satish Gupte 2002). In May 1974, the WHO officially launched a global immunization programme known as Expanded Programme of Immunization (EPI), to protect all the children of the world against six vaccine preventable diseases namely- Diphtheria, Whooping Cough, Tetanus, Polio, Tuberculosis and Measles by the year 2000. In India, the EPI was launched on January 1978.(K. Park) In 1990, by United Nations Integrated Children’s Emergency Fund (UNICEF), EPI was renamed into Universal Child Immunization and it was launched in India on November 19, 1985 and was dedicated to the memory of Smt. Indira Gandhi. (K. Park) An important contribution of microbiology to medicine has been immunization. By this, many vaccine preventable have been virtually eliminated. (C. P. Baveja, 2005) Vaccine is an immunological substance designed to confer specific protection against a given disease. It stimulates immune system (either humoral or cell mediated) to generate specific protection against an infectious agent. Vaccine may be prepared from live modified organisms, inactivated or killed organisms, toxoids, or combination of these. Polio vaccine was invented by Jonas Edward Salk in 1952. The immune system protects an individual against invasion by foreign bodies, specifically microbial agents and their toxoid products. (Ananthanarayan, 2004).

NEED FOR THE STUDY:

One of the key and most cost effective health interventions is achieving hundred percent immunization status. It was formulated to attain the goal of Health For All.

Anderson LM, Wood DL and Sherbourne (2005) conducted a study and examined the relationship between the occultation levels of poor Latina woman (688) in Los Angels and children’s immunization status. Receipt of three doses of DPT vaccine and two doses of OPV by age 12 month was considered adequate immunization. Results show that 1/4^thwere inadequately immunized children. Less occult rated mothers were more likely to have adequate immunized children. Poor prenatal care, lack of close family members, child birth position, and more than one family relocation during child’s life time were associated with inadequate immunization. Findings challenged the notation that children of recent immigrants bear a higher risk of under immunization.

A stratergy for 21^st century focuses on certain emerging infectious diseases and people at risk historically. Childhood vaccination rates have been higher in white population than racial and ethnic population. Vaccination rates for preschool children in racial and ethnic groups with lower vaccination rates however have been increasing at a more rapid rate, significantly narrowing the gap. Recommendations of the immunization practices advisory committee (ACIP, 2005) addressed the issues such as-

a) The risk and benefits if Pertusis vaccine for children with family history of convulsions.

b) Antipyretic use in conjunction with DPT vaccine absorbed.

Jonas Edward Salk (1952) discovered first polio vaccine. Many physically handicapped people still live in Kerala. In 1952 alone, 57628 polio cases were reported in America. He first experimented on his body and gave to 1830000 school students in 1953 and vaccine was introduced to public in 1955. Six years later, in 1961, another American, Albert Sabin, discovered the medicine drops that are popular now Number of researchers said that immunization will be highly beneficial to implement this approach to mothers who have under five children. Nurse working in community has an important role in immunization programme and to have the mother to develop knowledge, attitude and for such mothers nurse can well plan an organize programme and nurses have greater opportunity to assess knowledge and attitude of mothers and to prevent many communicable diseases. Hence, the assessment of knowledge and attitude about immunization among the mothers has a greater significance in the present world.

STATEMENT OF THE PROBLEM:

A study to assess the knowledge and attitude on immunization among the mothers of under five children, at Halaga village, Belgaum, Karnataka.

OBJECTIVES:

1) To assess the knowledge on immunization among the mothers of under five children.

2) To assess the attitude towards the immunization among the mothers of under five children.

3) To correlate the knowledge and attitude on immunization.

4) To find out the association between knowledge and attitude on immunization with selected demographic variables.

OPERATIONAL DEFINITIONS:

Knowledge on Immunization:

In this study, it refers to the awareness of mothers on meaning, types, storage, importance and complications of immunization.

Attitude on Immunization:

In this study, it refers to the opinion or belief of mothers regarding immunization.

Immunization:

In this study, it refers to the act of creating immunity by artificial means or vaccines.

Mothers:

In this study, mothers refer to those who are having under five children.

ASSUMPTIONS:

1. Immunization is necessary to prevent much of diseases.

2. The mothers will have good knowledge on immunization.

3. The mothers will have positive attitude towards immunization.

DELIMITATIONS:

The study is limited to:

1. The mothers who have under five children.

2. The mothers of Halaga village, district Belgaum.

3. 50 mothers who have under five children

REVIEW OF LITERATURE:

The review of literature is an extensive systematic securitization of potential sources of previous study and work. This process helps in identification and selection of problems, background of the study, formation of tool, choosing methodology, formulating hypothesis. The review of literature is done from published articles, textbooks, reports, Google, yahoo, medline, pub med search. Prema (2006) conducted a descriptive study on utilization of immunization services among under five children at Raichur district Karnataka.150mothers (75 in rural and75 in urban areas) have been selected and interview technique followed to assess knowledgeand utilization of immunization services. The findings shows that the total knowledge score was 50.In urban area 80% were having low awareness, 16% were having average awareness, 4% having no awareness .In rural area 96%of mothers were having low awarenessand 4%mothers having average. And lack of knowledge both in urban and rural area are related to mothers andtheir belief.

Szilagyi P et al (2001) assessed the effectiveness of recall systems in improving immunization rates andcompared the effects of various types of reminder in different settings and children (birth to18year) or adults (18andup) were selected data collection was done and each study was independently by to reviewers . The results shows that the patient recall system was effected in improving immunization rates in 33of 41 included studies, irrespective of baseline immunization rates, patient age type of setting or type of vaccination .The patient reminder recall system in primary care settings or effective in improving immunization rates.

Datta PK, VazL Singh H (2003) conducted a study on knowledge, attitude and beliefs about measles andvaccination coverage in a rural area in Jammu region. The data was collected on the attitude, belief and customs of mothers regarding occurrence of measles among children in rural area in Jammu region .Simultaneously an effort was also made to evaluate the vaccination coverage of measles vaccine in the study area 2 and half year after its introduction into the universal immunization programme (UIP). This study brings out the scope of the health education in the eventual goal of eradicating measles in the country.

Salman DA, et al (2005) conducted a study to assess knowledge, attitude and beliefs of school nurses and personnel and associations with non medical immunization exemption surveys were done and random sample of thousands schools in Colorado, Massachusetts, Missour and Washington. Surveys were returned by 69.6% of eligible participants. A child attending a school with a respondent who was a nurse was significantly less likely to be have an exemption than a child attending a school with a respondent who was not a nurse (odds ratio 0.39;95%). The majority of respondents believed that children (95.6%) and the community (96.1%) benefit when children are vaccinated.

Terrero C et al (1991) conducted a study to assess mother’s attitude and behaviors regarding vaccination and the outpatient clinic of hospital in Santo Domingo. 200 mothers were prospectively interviewed. 57 % of children were incompletely vaccinated and 7.5% were completely unvaccinated. 98.5% of mothers stated their belief that vaccination protects children.125 of the mothers reported they had access to orientation about vaccination.

Anderson LM, Wood DL, Sherebouren CD (2005) conducted a study to assess maternal acculturation and childhood immunization levels among children in Latino families in Los Angels. The household interviews were conducted in east Los Angels and south central Los Angels with mothers (n=688) of one randomly selected child aged 12 to 36 months. Results shows that ¼ of the children were inadequately immunized. Less acculturated mothers were more likely to have adequately immunized children .The findings challenge the notion that children of recent immigrants bear high risk of under immunization.

Singh MC, Badole CM, Singh MP(2003) conducted a study to assess the immunization coverage and knowledge and practice of mothers regarding immunization in rural area. 130 mothers (15-44 yrs) and 142 children aged 12-59 months were selected by cluster sampling method from nine villages in Wardha district. Out of these 100 mothers, 122 children could contact regarding immunization, 52.5% children were fully and45.1% were partially immunized. Vaccine coverage of BCG and OPV/DPT was 95.9 % and 85% respectively. Mothers had fair knowledge regarding need for immunization but a poor knowledge regarding disease prevented and doses of vaccines.

Abbas Bhuiya, Ismat Bhuiya, Mustaque Choudhury (1989) conducted a survey to assess the factors affecting acceptance of immunization among children in rural Bangladesh. Acceptance of DPT, Measles and BCG vaccines were dependent variables. The independent variables includes proximity to health facilities, frequency of visit by health worker, respondents mobility , media exposure , education , age , economic status , region of residence and gender of child. Logistic analysis was performed to assess the net effects of the variables in addition to univariate analysis. Among independent variables age, education, gender of child, economic condition, and proximity of health facility showed statistically significant association with acceptance of immunization. The effect of mother’s ability to visit health centre alone was also dependent on ownership of radio, economic condition and education.

Angelillo, Ricciardi, Partisans, E Langiano, M Pavia (2000) conducted a descriptive study to assess knowledge, attitude and behavior about vaccination among mothers of Italy. 841 samples have been selected and evaluated. The result shows that overall 57.8% 0f mothers were aware about all vaccines and knowledge was significantly greater in educated mothers and older mothers. Attitude were very favorable and education programmers promoting child immunization.

Moultan LH, et al (2001) conducted a study on factors associated with refusal of child hood vaccines among parents of school aged children. Surveys were mailed to the parents of 815 exempt children and 1630 fully vaccinated children recruited from 112 private and public elementary schools. Surveys were completed by 2435 parents (56.1%). The results shows that most children [209(75.5%) of 277] with non medical exemptions received at least some vaccines. The most common vaccine not received was Varicella [147 (53.1%) of 277exempt children].The most common reason stated for requesting exemptions [190 (69%) 0f 277] was concerned that vaccines might cause harm.

Mount Sonai, Tong A, Biringer A and Upshur R (2006) conducted a cross sectional study of maternity care providers and women’s knowledge, attitude and behaviors towards influenza vaccination. Two cross sectional surveys, one maternity care providers and one of post partum woman were carried out. Results shows that there is high level of knowledge about vaccination (95%) and positive attitude towards vaccination (95%).

Soeung SC, Grundy J, Morn C and Samnang C (2005) conducted a study for evaluation of immunization knowledge, practices and service delivery in the private sector in Cambodia. A questionnaire survey was conducted with 127 private facilities. Results shows that the prevalence of private sector provision of immunization services, 93% of private inpatient clinics survey provided immunization services and have adequate knowledge.

Chhabra P et al (2007) conducted a study to assess the immunization coverage of BCG, DPT, OPV, Measles, MMR and Hepatitis B in two urbanized villages of East Delhi. Children of 24-47 months were selected using systematic random sampling by house to house visit. The coverage levels were 82.7% for BCG, 81.5% for DPT and OPV 1, 76.8% for DPT and OPV 2, 70.7% for DPT and OPV 3, 65.3% for Measles vaccines. It was 41.4% and 41.6% for DPT booster and MMR vaccines.

RESEARCH METHODOLOGY:

This chapter includes research approach and design, setting, population, sample size, sampling techniques, development and description of the tool, scoring procedure, data collection procedure and plan for data analysis.

RESEARCH APPROACH AND DESIGN:

Descriptive approach and non-experimental design was used in this study. The descriptive studies are aimed at accurate portrayal of the characteristics of person, situation or group and the frequency with which certain phenomenon occur. Here in this study the descriptive approach was used and aimed at investigating the knowledge on selected immunization measures and attitude of mothers of under five children on immunization.

SETTING OF THE STUDY:

The study was conducted among the mothers of under five children at Halaga village, Belgaum, Karnataka.

VARIABLES:

Independent Variables:

Age, religion, family income, number of children, type of family, education, socioeconomic status, information on immunization.

Dependent Variables:

knowledge and attitude of mothers of under five children.

POPULATION:

The target population of the study was mothers of under five children in Halaga village, Belgaum district, Karnataka.

SAMPLE SIZE:

The total enumerated sample consists of 50 mothers of under five children at Halaga village, Belgaum.

SAMPLING TECHNIQUE:

Sampling is the process of selecting a portion of population to represent the entire population. In this study convenient and purposive sampling technique was used.

DEVELOPMENT AND DESCRIPTION OF TOOL:

The tool for data collection was developed by the researcher on his own. This self reporting questionnaire consists of three parts. They are:

v Demographic data

v Structured knowledge assessment questionnaire on immunization.

v Structured attitude scale on immunization.

DESCRIPTION:

Part A:

Comprised of demographic data consisting of 10 items.

Part B:

Questionnaire to assess knowledge on immunization, which comprised of 15 questions with multiple choices. The total score of questions was 15. The correct response was given score one.

Part C:

Structured attitude scale on immunization. It measured the opinion or belief of the mothers of under five children about immunization, which comprised of 10 statements. The total score of tool was 20. It was a five point scale which consisted of both positive and negative statements. Every correct response was awarded 2 and 1. The scoring was done in following ways:

Type of Statement	Strongly Agree	Agree	Uncertain	Disagree	Strongly Disagree
Positive Statement	2	1	0	0	0
Negative Statement	0	0	0	1	2

DATA COLLECTION PROCEDURE:

The data was collected by distributing the self reported questionnaire developed by researcher after getting due permission from the medical officer, rural PHC, Yellur. The mothers of under five children were included in the sample. After a brief introduction on research and immunization, they were allowed 25 minutes to complete the questionnaire including demographic variables.

PLAN FOR DATA ANALYSIS:

Both descriptive and inferential statistics were used to analyse the data collected.

I. Descriptive Statistics:

1. Frequency and percentage distribution were used to analyze the demographic data of mothers of under five children.

2. Mean and standard deviation to identify the knowledge and attitude on immunization of mothers of under five children.

3. Distribution of scores of knowledge on immunization to be interpreted by summarizing the scores into 3 categories – Inadequate, Moderately adequate and Adequate and Attitude scores into 3 categories – Low positive Attitude, Positive Attitude and High positive Attitude.

II. Inferential Statistics:

1. Intra co-relation method to find the correlation between knowledge and attitude.

2. Chi-square test used for association of knowledge and attitude with demographic variables.

DATA ANALYSIS AND INTERPRETATION

This chapter deals with the analysis and interpretation of data collected from 50 mothers of under five children from Halaga village, at Belgaum, Karnataka. The data has been tabulated and analyzed according to the objectives

PRESENTATION OF DATA:

SECTION I:

Demographic variables of mothers of under five children.

Table 1: Frequency and Percentage distribution demographic variables of mothers of under five children on immunization. n=50

Table 1 describes the demographic data of the samples regarding their age 72% belongs to 21-25 years and 64% were Hindus.

56% of samples family income was below 2000, 42% of mothers had 2 children, 76% lives in joint family and 92% were illiterate.

98% of samples possessed immunization card, 50% were middle class and 92% samples earlier heard about immunization.

Section II: Assessment of knowledge on immunization among mothers of under five children.

Table 2: Distribution of knowledge on immunization among mothers of under five children. n= 50

Knowledge

Number

Percentage

Inadequate (1-49)

Moderately Adequate (50-74)

Adequate (>75)

Table 2 describes that 58% of mothers had moderately adequate knowledge on immunization, 24% had inadequate knowledge and 18% had adequate knowledge (Fig.11).

Table 3: Mean and standard deviation of knowledge on immunization among mothers of under five children. n = 50

Statistics

Knowledge Score

Mean

Standard deviation

58.1

12.10

The above table explains that the mothers have a mean knowledge on immunization of 58.1 with a standard deviation of 12.10. (Fig.12)

Table 4: Distribution of Attitude on immunization among mothers of under five children. n = 50

Attitude

Number

Percentage

Low Positive Attitude (1-49) Positive Attitude (50-74)

High Positive Attitude (>75)

Table 4 explains that 50% of mothers, have low attitude on immunization and 50% have moderate attitude and nobody has more attitude.

Table 5: Mean and Standard Deviation of Attitude on immunization among mothers of under five children. n = 50

Statistics

Attitude Score

Mean

Standard Deviation

41.4

16.1

Table 5 shows that the mothers have mean attitude of 41.4 on immunization with the standard deviation of 16.1.

Section III: Correlation between knowledge and attitude on immunization. r=0.483

The above ‘r’ value shows that there is a positive correlation between knowledge and attitude of mothers on immunization.

Section IV: Association of demographic variables with knowledge and attitude on immunization.

Table 6: Association between knowledge and demographic variables among mothers of under five children. n=50

Table 6 denotes that there is no significant association between knowledge on immunization and demographic variables such as religion, family income, type of family, education, and socioeconomic status. There is association between knowledge on immunization and age, number of children, immunization card and information on immunization.

Table 7: Association between Attitude and demographic variables. n=50

Immunization and demographic variables such as age, religion, family income, number of children, education, immunization card and information on immunization. There is significant association between attitude on immunization and demographic variables such as type of family and socioeconomic status.

DISCUSSION:

Characteristics of selected demographic variables of the samples.72% were in the age group of 21-25 years,64% were belongs to Hindu religion,56% of family’s income below 2000,42% of mothers were having two children,76% mothers stayed in joint family,92% of mothers were educated,98% of mothers were possessing immunization card,50% came from middle class,92% of mothers were earlier heard about immunization,

Assessment of Knowledge on Immunization among Mothers of Under five Children.

The mean value of knowledge on immunization of mothers of under five children was 58.1 which falls in the level of moderately adequate knowledge .This findings contradicts with the findings of the study conducted by Angelillo, Ricciardi (2000) on assessment of knowledge, attitude and behavior of vaccination among mothers from Italy which stated that the mothers had adequate knowledge and favorable attitude. Sangamesh Nidagunni (2006) conducted a study to assess the knowledge and practice of mothers of under five children regarding universal immunization programme. The results showed that overall mean knowledge score among respondents was found to be 52.72 % which coincides with the findings of the present study. Based on the present study findings revealed that 58% of the mothers of under five children had moderately adequate knowledge on immunization.

Assessment of Attitude on Immunization among Mothers of Under five children.

The mean value of attitude of mothers of under five children on immunization was 41.4 with standard deviation of 16.1%. This findings show that the mothers have low positive attitude towards immunization. It also depicts that mothers are possessing false belief regarding immunization. But if proper education is provided to the mothers then they will be capable of preventing communicable diseases among their children.

Correlation between Knowledge and Attitude of Mothers of Under five Children on Immunization.

The finding showed that there is a positive correlation between knowledge on immunization and attitude of mothers of under five children (r =0.483). This suggests that the mothers will develop positive attitude towards immunization though they posses moderately adequate knowledge.

Association of Demographic Variables with Knowledge on Immunization among Mothers of Under five children.

The findings depicts that there is no association between knowledge on immunization and demographic variables such as religion, family income, type of family, education and socio economic status. There is an association between knowledge on immunization and age, number of children, immunization card and information on immunization.

Association between Attitude on Immunization and Demographic Variables.

It denotes that there is no association between attitude on immunization and demographic variables such as age, religion, family income, number of children, education, immunization card and information on immunization. There is significant association between attitude and demographic variables like type of family and socio economic status.

SUMMARY:

As said “Prevention is better than cure”, immunization is one of the world wide methods for preventing many of the infectious diseases. It is essential to prevent many of the childhood diseases .So the knowledge on immunization among the mothers of under five children have greater significance. The present study is aimed at assessing the knowledge and attitude on immunization among mothers of under five children in rural community area Belgaum. The research approach used in this study was descriptive approach and research design was non experimental design .The setting of the study was rural community area of Halaga village Belgaum. The sample technique used was non – probability, convenience sampling. The tool used for the study was self reporting questionnaire on knowledge and attitude. The study was conducted after getting permission from the medical officer Yellur PHC, Belgaum .The data collected were analyzed by using descriptive and inferential statistics. There is a positive correlation between the knowledge and attitude on mothers of under five children in rural community area.

CONCLUSION:

The mothers of under five children of rural community area had moderately adequate knowledge on immunization and moderate positive attitude towards immunization. These findings reveal that the community health nurses should make little more efforts in educating the mothers so as to achieve 100% of immunization.

IMPLICATIONS:

The investigator has drawn the following implications from the studies which are vital concerns to the field of nursing services, nursing education, nursing administration, and nursing research.

Nursing Services:

The nurse should give adequate health education in the community as well as hospital set up on immunization, immunization schedule, advantages, contraindications etc and prevention of communicable diseases .So that the people will be able to take all scheduled vaccines. The main purpose should be on prevention of communicable diseases by educating the mothers about immunization.

Nursing Education:

The nurses and midwives are closer with the mothers and children in the hospital as well as in the community during their practices .So it is essential to include a topic on immunization in nursing curriculum. So that the emerging nurses can more emphasis on immunization and there by reduces many of the communicable diseases.

Nursing Administration:

The nursing administrators should focus on health promotion and prevention of diseases through home visit, mass health education programmes etc. The health workers in the hospital as well as community should be trained regarding immunization for the prevention of major communicable diseases and its prevalence.

Nursing Research:

Nursing research should focus on immunization and prevention of communicable diseases and effectiveness of education and training of the health workers and mothers in various aspects of immunization, to improve the health of children.

RECOMMENDATIONS:

The following studies can be under taken to strengthen the nursing research.

· The same study can be conducted in different regions of the state or nation so as to compare the results.

· The same study can be repeated on larger sample so as to generalize the results.

· The short term training program its effectiveness can be analyzed through a pre and post test method.

· Similar kind of study can be conducted among different population.

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Received on 03.08.2015 Modified on 22.08.2015

Asian J. Nur. Edu. and Research. 2016; 6(2): 191-198.

DOI: 10.5958/2349-2996.2016.00035.5