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OJHAS Vol. 11, Issue 1:
(Jan-Mar 2012) |
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| Immunization of Children in a Rural Area of North Kashmir, India: A
KAP Study. |
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Shamila Hamid, Senior Resident, Dept. of Community Medicine, SKIMS, Srinagar, J&K, India,
Syed Arshad Hussain Andrabi, B Grade Consultant in Internal Medicine, Multispeciality Hospital, District
Hospital Pulwama, J&K, India,
Anjum Fazli,
Associate Prof. of Community Medicine, SKIMS, Srinagar, J&K, India,
Rohul Jabeen, Associate Prof. of Community Medicine, SKIMS, Srinagar, J&K, India. |
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Address for Correspondence |
B-Grade Specialist in Medicine, in Health & Medical Education,
Multispeciality Hospital,
Tropical Medicine Unit,
District Hosptal Pulwama,
J&K, India,
E-mail:
syed.arshadhussain@yahoo.co.in |
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Hamid S, Andrabi SAH, Fazli A, Jabeen R. Immunization of Children in a Rural Area of North Kashmir, India: A KAP
Study. Online J Health Allied Scs.
2012;11(1):10 |
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Submitted: Mar 21,
2012;
Accepted: Mar 26, 2012; Published: Apr 15, 2012 |
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| Abstract: |
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Background: Knowledge, attitude and practices about
immunization among mothers of children aged 1-2 years was assessed. Method: 300 mothers were administered a semi-structured
questionnaire at PHC Hajan from 1st march to 1st may 2011 to elicit the information about the knowledge, attitude and
practices of the mothers regarding immunization. Results: 100% of mothers knew that vaccination is beneficial and protects their
children from diseases. 39% knew OPV protects from polio while only 1% were aware of protective role of BCG. All mothers
knew about immunization in pregnancy but 86% were unaware about its preventive role. 26% mothers believed that 3 doses of
T.T (tetanus toxoid) are to be given during pregnancy. Whereas 98% of children were completely immunized, 93% completed on
schedule. Eighty percent of mothers reported of fever following DPT. All mothers had received tetanus toxoid during pregnancy. Conclusion:
Considering mothers' poor knowledge and good attitude, health education on immunization is emphasized to improve their practices.
Key Words:
Mothers; Knowledge; Attitude; Practices; Immunization; Children
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Expanded programme on immunization (EPI) target diseases are one of the leading
causes of high childhood morbidity and mortality as evidenced by high IMR (Infant mortality rate) in developing countries.(1) Immunization
is a timely step for prevention of mortality and morbidity due to communicable diseases in the 0-5 yrs of age group.(2) The WHO rates
immunization as one of the interventions with a large potential impact on health outcomes.(3) However its impact is not even throughout
countries.(4) In the past few decades immunization coverage rates have improved sufficiently in developed countries, thereby conferring
herd immunity, whereas most of the developing countries are still struggling with faltering rates.(5-7) The delivery systems of the
immunizations have many inherent problems to which an addition may be made by the people themselves, with their prejudices,
conclusions and apathy.(2)
Immunization is not only one of the best indicators to evaluate
the health outcomes and services distributed across social and economic groups but also one of the most cost-effective interventions
to prevent a series of major illnesses, particularly in environments where children are undernourished and die from preventable diseases.
Given the extensive benefits of immunization, any inequities in Knowledge, Attitude and
Practices are a cause of serious policy concern.
There is evidence of inequities in immunization in India, despite the fact that childhood immunization has been an important part of
maternal and child health services since 1940s.(9) Even more dismal is the situation in rural areas as compared to urban areas.
Reasons underlying poor coverage has been studied by researchers worldwide and besides other factors, parental knowledge and beliefs
have been documented to influence immunization uptake.(9-10) The challenge for immunization services providers therefore, is to offer
parents balanced and comprehensive information about the risks as well as benefits of immunizations.(11) With this background this
study was conducted at PHC Hajin, a rural area of Kashmir, India, to assess mother’s knowledge, attitude and practices so as to identify
the existing gaps that need to be fulfilled in order to achieve the immunization targets.
Objectives:
- To know the mothers Knowledge, attitude and practices related to
immunization
- Make recommendations based on findings of the study
Study design: Cross sectional study
Study period: 1st march 2011 to May 2011
Place of study: Primary Health Centre (PHC), Hajan, Kashmir.
Study instrument: Semi-structured questionnaire.
Study subjects: Mothers of children aged 1-2 years.
A cross-sectional study was conducted at PHC, Hajan. Hajan is the field practice area of department of
community medicine of the tertiary care institute SKIMS,
Soura Srinagar. The interns posted in the department during the said period were duly trained to administer a
semi-structured questionnaire to the mothers attending the immunization section of the PHC. Immunization is
conducted on alternate days (3 days a week) at the PHC. All the mothers coming for vaccinating their children aged
1-2 years were included in the study. During the survey, 300 mothers having children between 1-2 years were
interviewed through a pre-tested semi-structured questionnaire. It was thus a cross sectional study of non randomized sample
of 300 mothers. The questionnaire included questions on socio-demographic variables, mothers' knowledge on immunization and
questions to know attitude and practices regarding immunization. Also, questions regarding maternal
immunization during pregnancy were also administered.
The data so collected was compiled, entered and analysed by using SPSS version 15.
Definitions used in the study:
Fully immunized: The child was considered fully immunized if he/she received one dose each of BCG
and measles and three doses of DPT and polio (apart from zero dose of polio at birth) by his /her
1st birthday.
Partially immunized: Those who had missed only one vaccine out of the six primary vaccines.
Unimmunized: Those children who had received nil vaccine up to their first birthday.
Table 1 shows the sociodemographic profile of the mothers. Among the mothers, 80% were illiterate or had only
primary education and 93% were house wives. Majority of the mothers(66%) themselves took decisions regarding immunization of
the child. Health workers were the main source of information(88%).
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Table 1: Sociodemographic characteristics of the study population. |
Characteristics
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Number
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Percentage (%) |
Number of study subjects
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Males |
0 |
0 |
Female |
300 |
100 |
Educational status
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Illiterate-primary |
240 |
80 |
Middle-high |
54 |
18 |
Intermed-graduate |
6 |
2 |
occupation
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House wife |
279 |
93 |
Govt. employee |
12
|
4
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Self employee |
9 |
3 |
Farmer |
0 |
0 |
Decision maker (in matters of immunization of children)
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Father |
42 |
14 |
Mother |
198 |
66 |
Both |
60 |
20 |
Source of information for immunization programme.
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Radio |
30 |
10 |
Television |
6 |
2 |
Health institution |
264 |
88
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Socio-economic status of families
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<4ooo INR/month
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30
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10
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4001-10,000
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258
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86
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>10,000 |
12 |
4 |
Table 2 ,3 and 4 show the knowledge of mothers regarding child and
maternal immunization.
All the mothers (100%) had the knowledge that immunization is
important and beneficial for the child. All the mothers knew that immunization is to be started at birth, 39% of mothers knew that OPV protects against polio, 20% mothers were knowing the disease prevented by DPT vaccination, while 99% mothers were ignorant about
the disease for which BCG is used. All (100%) mothers were of view that there is no problem with vaccination (Table 2).
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Table 2 Immunisation related knowledge of mothers. |
Question
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Response |
Number |
Percentage (%) |
Do you know about childhood immunization?
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Yes |
300 |
100 |
No |
- |
- |
Why immunization is important ?
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Cures diseases |
0 |
0 |
Prevents diseases |
300
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100
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Both |
0 |
0 |
Don,t know |
0 |
0 |
At what age immunization is to be started ? |
At birth |
300 |
100 |
At 6 weeks |
0 |
0 |
Any time
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0 |
0 |
Name the diseases against which child is immunized.?
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Polio |
117 |
39 |
Measles |
30 |
10 |
BCG |
3 |
1 |
Hep B |
90 |
30 |
DPT |
60 |
20
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Are there any problems related with vaccination? |
Yes |
0 |
0 |
No |
300
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100 |
All (100%) mothers were knowing about antenatal vaccination with
tetanus toxoid, however, 86% were unaware about its role while 9% were knowing that it prevents neonatal tetanus. Twenty six percent
of mothers had knowledge that tetanus toxoid is to be administered 3 times in antenatal period. (Table 3)
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Table 3: Knowledge of mothers regarding maternal immunization during pregnancy. |
Questions |
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Number |
Percentage (%) |
Do you know about antenatal vaccination of mothers?
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Yes |
300 |
100 |
No |
0 |
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What disease antenatal vaccination prevents? |
Mother from tetanus |
15 |
5 |
Neonatal tetanus |
27
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9
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Don’t know |
258 |
86 |
When to start antenatal vaccination?
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At any time |
0 |
0 |
During pregnancy |
300 |
100 |
How many times antenatally vaccinated?
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3 times |
78 |
26 |
2 times |
222 |
74 |
All the mothers considered that vaccination is important and
should be completed as per schedule, as per the instructions of the health workers. All (100%) mothers believed that vaccination should
be done in Govt. health facility. All the mothers considered side-effects not dangerous (Table 4).
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Table 4: Immunisation related attitude of mothers. |
Questions
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Respondents Answers |
Number |
Percentage (%) |
Are you in favour of vaccination? |
Yes |
300 |
100 |
No |
- |
- |
Is it important to follow vaccination schedule |
Yes |
300 |
100 |
No |
- |
- |
Why on schedule?
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As advised by health instructors |
300 |
100 |
Where should children preferably receive vaccination?
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Government health institution |
300 |
100 |
Private health facility |
- |
- |
Are side effects dangerous? |
No |
300 |
100 |
Yes |
- |
- |
Table 5 depicts the practices of
mothers. Ninety eight percent children were completely immunized and 93% had been immunized on schedule. The reasons given for
partial immunization(2%) were sickness of child (4 in number) and unawareness (2 in number). Varied reasons were given for not
completing the immunization on schedule including unawareness, baby was sick, uncooperative husband or busy in house-hold work. Sixty six percent
of mothers reported side effects after immunizing the children and 80% reported fever after DPT. BCG scar was absent in 4%of cases.
All the mothers had received T.T during pregnancy and 16% had received 3 doses.
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Table 5: Questions related to Immunisation Practices of mothers. |
Questions
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Answers of respondents
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Number |
Percentage (%) |
| Immunisation status |
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Completely immunized |
294
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98
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Partially immunized
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6 |
2 |
Unimmunised
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0
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0 |
Was immunisation completed on schedule
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Yes |
280 |
93.4 |
No |
20 |
6.6 |
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Did side effects appear? |
Yes |
198 |
66 |
No
|
102 |
34 |
What side effects?
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Fever |
240 |
80 |
Swelling, pain, Redness
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60 |
20 |
Did you receive Tetanus Toxoid during pregnancy ?
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Yes |
300 |
100 |
No
|
0 |
0 |
Did you receive it as per schedule? |
Yes |
279 |
93 |
No |
21 |
7 |
Number of doses received
|
2 |
252 |
84 |
3 |
48 |
16 |
Worldwide many studies have reported on KAP’s of mothers regarding children immunization(12,17)
and showed that successful immunization depends on parents positive attitude and knowledge. Though the coverage rate was good in our study,
but still there is an urgent need to increase the coverage of UIP (universal immunization programme) vaccines so that not a single
child remains unimmunized and vulnerable to vaccine preventable diseases (VPDs). This necessitates the information on the knowledge, attitude
and practices of the people with respect to different aspects of immunization. In this study, therefore, an attempt has been made to get
an insight into the existing levels of awareness among the mothers and the areas needed to be improved.
In our study it was seen that mothers had good knowledge about
importance of vaccination but their knowledge about VPDs was limited and is consistent with many other studies.(18,19) Only 2% of
mothers knew about protective role of BCG. Health workers were the main source of information (88%). Similar findings were seen in their
studies where paramedics were seen as the main source of information.(19,20) In our study all the mothers considered that immunization was important and beneficial as it protects a child against diseases. Similar findings were seen in a study done in Congo.[21] In our study, majority of mothers showed positive attitude towards immunization. This positive attitude about vaccination is reported in many previous studies as well, from developing and developed countries and range from 80-98% in different studies.[22-24]
In our study, 98% of children were fully immunized. Zelaya et al in his
study has warned that a positive attitude is not a guarantee for full immunization.(25) But in our study it was seen that not only mothers
had positive attitude but their practices were also appreciating.
In our study ,mothers showed more trust in government health facilities
for vaccinating their children and showed compliance to health worker’s instructions. This finding suggests a unique opportunity to improve
the knowledge of mothers by improving the knowledge of health workers via regular trainings and awareness programmes. Also in our study we
found that 66% of mothers themselves took decisions regarding immunizing their children, so more focus should be on improving
their practices and knowledge.
In this study, we surprisingly found that 16% of mothers had received
3 doses of T.T during pregnancy. This may be attributed to poor memory of mothers or wrong knowledge and practices of the prescribing
doctors. There is a need to educate doctors in this area since they are found to be defective in knowledge about immunization.(26)
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Summary and Recommendations |
Though the attitude and practices of the mothers was good but can
be further improved by imparting awareness. The insufficient knowledge of the people requires sincere efforts on the part of the
health professionals and the policy makers to plan and execute the IEC (information, education & communication) initiatives.
There should be also regular CMEs for improving the knowledge of doctors and the paramedical staff. It is also suggested that health
education campaigns should specifically target mothers to achieve the targets of UIP. Further studies on this important public
health issue are also recommended. Moreover the role of media in providing information need to be improved.
Summarising, the health personnel at the primary level, mass media and
other means of IEC activities should be harnessed to the maximum extent so as to increase the knowledge and change the attitude
regarding immunization among people especially mothers.
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