Perceptions regarding childhood immunization among mothers in Kunnukara Panchayat, North Paravur, Ernakulam, Kerala

INTRODUCTION

Immunization is a proven cost-effective preventive measure which has considerably reduced the burden of infectious diseases. In addition, it has surged up life expectancy and improved the quality of life tremendously. Vaccines are biological substances that confer acquired immunity to a particular disease.

WHO has launched in 1974, an Expanded Programme of Immunization (EPI) against six vaccine preventable diseases (VPD) to reduce childhood mortality and morbidity viz BCG, DPT, OPV, TT .It came into practice in India in 1978.¹ In 2010, an estimated 1.7 million people around the world died of VPD of which 1.4 million children were under five years of age.² In India, infants were immunized against seven vaccine preventable disease viz Tuberculosis, Diphtheria, Pertussis, Tetanus, Poliomyelitis, Measles and Hepatitis B under National Immunization Programme. In addition to DPT and Hepatitis B vaccine, Haemophilus Influenza type B was a new addition, given together as Pentavalent vaccine which started in 2009. Primary immunization is essential in preventing the mortality and morbidity due to VPDs. Fully immunized child is the one who has received all vaccines recommended in the National Immunization Schedule by one year of age.³ In India, according to latest census, infant mortality is 39.4/1000 live births. Despite the continued efforts of government and other health agencies, a large proportion of infants in India remain partially immunized or unimmunized. Our country has 10 million such children. National Family Health Survey (NFHS)-4 (2015-2016) reports that only 62% children received primary vaccines and in Kerala, it is 82%.⁴ Negative parental perceptions of vaccination are also a barrier to timely immunization.²

In the state of Kerala, diphtheria outbreaks alarmed the general public between the years 2015 and 2017. Moreover, perception and practice of immunization was inadequate in those areas.⁴ It is a well-known fact that successful immunization depends on parents’ positive attitude and knowledge. Therefore, in this context, this study was conducted to know the perceptions regarding vaccination and practice of immunization among mothers in Paravur Taluk, Ernakulam, Kerala. Factors determining the practice of immunization were also determined.

METHODS

A community-based cross - sectional study was conducted in Kunnukara panchayat in Paravur Taluk of Ernakulam district for a period of one month. The voluntary participants were mothers with children between 1- 5 years of age who have been residing in Kunnukara Panchayat for a period of not less than six months. If there were more than a child between 1- 5 years, the first child was selected. Those Mothers who had a pre-existing severe psychiatric condition or didn’t have immunization card/any hospital records were excluded. Sample size was obtained from a KAP study, where p (knowledge level regarding vaccine) was 77%.⁵ The calculated sample size by the above-mentioned formula was found to be 120. Sample size taken was 125. Simple random sampling was used to choose three wards from a total of 15 wards from Kunnukara Panchayat. All the houses having mothers with children from one to five years were surveyed. The study participants were interviewed using a semi - structured questionnaire comprising of-

Socio-demographic variables: Age, education, occupation, income and source of information regarding immunization among the respondents.

Immunization status: Immunization up to date, fully immunized, partially immunized, unimmunized.

Data was collected from house to house survey with the help of semi – structured questionnaire. Collected data was entered in MS Excel and analysed using Statistical package for social sciences (SPSS) 20 software. Frequencies and percentages were calculated. Chi- square test was used to analyse the association between socio-demographic details and knowledge, attitude and practice regarding immunization. P<0.05, was considered statistically significant. Approval was obtained from the institutional research and ethical committee. Written consent was obtained from the participants prior to the study.

RESULTS

A study was conducted among 125 mothers in Kunnukara Panchayat, Paravur Taluk, Ernakulam district. Among the 125 families, 87 (69.6%) were nuclear families and the rest 38 (30.4%) were joint families. Fifty-three (42.4%) of the mothers were Muslims. Out of the 125 children surveyed, the number of male children was 74 (59.2%) whereas the female children was 51 (40.8%).

It was observed that more than half of the mothers surveyed i.e. 64 (51.2%) were unemployed. 124(99.2%) women are currently married and one mother was a widow (0.8%). Majority of the decision-making regarding vaccination were taken by the mother- 86 (68.8%), 36 families (28.8%) considered the father as the decision maker and three families (2.4%) took the decision together. According to revised Modified B G Prasad socio-economic classification scale 2019, majority of the families 77 (61.6%) belong to upper high class, 22 (17.6%) belong to high class, 8 (6.4%) belong to upper middle class, 13 (10.4%) belong to lower middle class and 5 (4.0%) belong to poor category.

Eight mothers (6.4%) were postgraduates, 56 (44.8%) were graduates, 48 (38.4%) completed their higher secondary or diploma, 10 (8.0%) studied till high school and 3 (2.4%) completed upper primary school. No mother was found to have an education lower than upper primary. Of the 125 respondents, majority, 119 (95.2%) strongly believed that vaccines are beneficial and 6 (4.8%) of them responded that vaccines may be beneficial. Among the 125 respondents, majority i.e., 94 (75.2%) of the respondents had good knowledge regarding the schedule of BCG and only 44 (35.2%) were aware of the disease prevented by the vaccination.

Knowledge regarding the schedule of Hepatitis B vaccine was poor (37.6%). Only 53 (42.4%) of the respondents knew that Hepatitis B could be prevented by this vaccination.

Most of the respondents, 90 (72%) knew that OPV was given to prevent Polio and majority of them, 122 (97.6%) had vaccinated their children with OPV. Less than half of the study population, 36.8%, was unaware of the disease (Polio) prevented by IPV and only 15.2% of them had knowledge regarding the schedule of IPV. Regarding Pentavalent vaccination, among the 125 respondents, 13(10.4%) of them were aware of the schedule and only 11 (8.8%) of them were aware of the disease (Diphtheria, Pertussis, Tetanus, Haemophilus B, Hepatitis B) prevented by this vaccine.

43.2% of the mothers knew the reason for vaccinating their children with MR and a very few, 28.8% were aware of the schedule. Thirty-four (27.2%) of them were aware of the Vitamin A supplementation and only 20(16%) of them knew about its schedule. Forty-seven (37.6%) of them had knowledge about the OPV booster vaccine but 102 (81.6%) of them were unaware of the timing of the vaccine.

Among 125 mothers, majority 114(91.2%) had not missed any scheduled vaccines whereas 11(8.8%) mothers failed to do so due to various reasons like illness, flood and unavailability of vaccine.

And 112 (89.6%) children had not experienced any reactions to vaccines while 13 (10.4%) had experienced reactions.

Last of all, 120 (96%) out of 125 mothers had been a part of Pulse Polio Program while 5 (4%) had not been due to reasons like lack of information, illness and being out of station.

One hundred and seven (86%) mothers preferred Government Hospital for vaccinating their children while 18 (14%) mothers resorted to private hospitals for the vaccination of their wards.

Among 125 mothers, 122(97.6%) of them had not felt the distance to the nearby vaccination centre was a hindrance to delay the vaccination for their children whereas the rest felt it posed inconvenience.

Out of 125 mothers, 98 (78.4%) mothers were prompt in administering vaccines to their wards.

Among the 125 respondents, majority, 123 (98.4%) of them had vaccinated their children with BCG. 122 (97.6%) of the mothers showed high practice of OPV and pentavalent vaccination.

*P<0.05 – significant

Mothers with a positive perception regarding vaccination had good practice of immunization compared to those with negative perception. This difference was statistically significant (p=0.026).

DISCUSSION

In our study, majority of the mothers (95.2%) believed that vaccines were beneficial .This is found to be similar to a study conducted among the mothers in a tertiary care hospital in Kollam, Kerala where it was 93.8%.Our study also showed that 80.8% of the mothers have acquired information regarding immunization from health workers which is much higher compared to the study conducted in Kollam (35%).This might be due to better accessibility of the mothers to health workers in our study area.⁶

In this study, 95.3% mothers showed positive perceptions towards immunization of their children. Result obtained was higher than a study conducted in Mangalore, Karnataka where about 89% of mothers showed positive perceptions towards immunization which was similar to our study. This might be due to higher literacy rates among mothers in Kerala compared to those in Mangalore.⁷

Among 125 mothers, majority (91.2%) had not missed any vaccines while 8.8% failed to do so due to various reasons like infirmities, natural calamities and unavailability of vaccine. In a study conducted in North India by Kumar et al, 18% were completely immunised whereas majority (82%) missed vaccination. Most common reasons included lack of information regarding immunization and its subsequent dose, fear of side effects, and a certain misconception that only oral polio vaccine is required.⁸

Similar findings were reported by the study conducted by Tariq et al. It showed that majority of the mothers had a good perception towards immunization and most of them preferred to get their children vaccinated in Government hospitals. This was because the health care workers had played a leading role in bringing awareness about immunization in rural areas. Free supply of vaccines to their children was another main reason which made them do so.⁹

In our study among 125 mothers in Kunnukara panchayat, Paravur Taluk, 88% had completely immunized their children while, 12% had missed the vaccinations. However, another study conducted in the same taluk showed that the proportion of children fully immunized was 96.3%. The slightly reduced immunization status in our study might be due to socio-economic factors.¹⁰

This study showed that 92.3% mothers practiced immunization. Similar findings were reported by Lamiya in her study which showed that 88% mothers practiced immunization. This might be due to the role of health workers and mass media in spreading awareness regarding immunization in Kerala. ¹¹

CONCLUSION

The mean age of respondents was 29±4. Education of the general public is an integral part of a prevention-oriented approach to health and disease problems, and the basis of all education is communication. Education can help to improve good perceptions among the public which will ultimately determine the behavioural practice among the general folks. In this study, perception regarding vaccination is 95.2% and practice of immunization is 92.3%. This study showed that good perception regarding childhood immunization among mothers had led to improved practice of immunization in their children. There was a statistically significant association between female children and practice of immunization. There was also a statistically significant association between perceptions regarding vaccination and practice of immunization.

Recommendations

Individual attention must be given to those who missed even one vaccination. Perceptions regarding immunization can be further improved through health education sessions.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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