Assessment of knowledge about adverse events following immunization among health care workers of Raipur city

INTRODUCTION

Immunization is an effective measure to protect individual and public from vaccine preventable diseases. Vaccines used in national immunization program are extremely safe and effective. Although, no vaccine is 100% safe and effective and chances of adverse effects are not zero. Immunization is among the most successful and cost-effective public health interventions. It has led to the global eradication of smallpox as well as the elimination of poliomyelitis in regions of the world. Immunization currently averts an estimated 2 to 3 million deaths from diphtheria, tetanus, pertussis (whooping cough), and measles every year in all age groups.¹ Process of immunization itself is potential source of adverse reactions. Increased immunization coverage, mass campaigns and introduction of newer vaccines have increased vaccine use, causes more vaccine reactions and coincidental events. AEFI is untoward medical event following immunization which does not necessarily causal relationship with usage of vaccine. AEFI’s has 5 categories: 1. Vaccine product related, 2. Vaccine quality defect-related reaction, 3. Immunization error-related reaction (formerly "program error"), 4. Immunization anxiety-related reaction and 5. Coincidental event.¹

Health care workers should be well aware about all AEFI and know about importance of timely reporting of AEFIs. Objective of this study was to assess knowledge about AEFI among health care workers of Raipur city (C.G.).

METHODS

The present cross sectional descriptive study was conducted by department of community medicine, Pt. J.N.M. medical college, Raipur (C.G.) on auxiliary nurse midwife, staff nurses and MPW posted in primary health centers of Raipur city (C.G.), during December 2019 to January 2020 included 157 health care workers from all the 18 PHCs of Raipur city (C.G.).

Inclusion criteria

ANM, staff nurse, MPWs who has given consent to participate in the study were included in the study.

Exclusion criteria

ANM, staff nurse, MPWs not given consent and those on maternity or other leave were excluded from the study.

Ethical consideration

Informed verbal consent was taken from the participants.

A pilot study was conducted before starting of final survey. Informed verbal consent was taken from all the health care workers. All ANM, Staff nurse and MPWs, who were present at the time of study were interviewed. Total 157 health care workers interviewed by using a predesigned, pretested questionnaire. Details regarding their socio- demographic characteristics, possible causes, AEFI, management and reporting about AEFI were asked. Data was compiled, checked for its completeness and analyzed in MS Excel.

RESULTS

Total 157 subjects participated in the study, mean age of the participants were 36.4±8.8, with majority were from age group 26-30 years (24.8%) and 94% were females. Among the study participants 66.9% were ANM, 32.5% were Staff nurse and 0.6% were MPW. Majority (59%) were not taken any training on AEFI (Table 1). About knowledge of possible causes of AEFI, more than 80% participants were knowledgeable about vaccine dose, proper storage, route, site of vaccine administration, use of vaccine when there is suspected contamination of vaccine or diluents, use of vaccine which is incorrectly stored but within the period of expiry. The 60.5% health care workers knew patient anxiety is one of the possible causes of AEFI and 70.1% had knowledge of approach such patient (Table 2). 87.3% participants knew swelling as one of the commonest AEFI, while 30.5% knew pain as commonest AEFI. Maximum were aware about systemic AEFI, 98.3% 84.1%, 75.15%, 72.6% fever, myalgia, irritability, malaise respectively. 99.1% HCW knew anaphylaxis as one of serious AEFI, followed by 77.7%, 72.6% hypotensive hyporeactive episode and seizures as another serious AEFI respectively (Table 3). The 91.1% respondents knew AEFI should be reported.

DISCUSSION

The present study was done with objective to assess the knowledge of health care workers about AEFI in Raipur city (C.G.). There are few studies done about AEFI in India. The health care workers are who are directly involved in delivery of vaccine to the community, it is very crucial for them to have knowledge, management and timely reporting of AEFI. In this study mean age of respondents was 36.4±8.8, and majority of them were females. Majority of the respondents had knowledge about possible causes of AEFI, finding of this study is consistent with findings of study by Saha et al in community health nurses in West Bengal.² While in contrary to study done in Africa among health care workers and Gupta et al.⁴ In a study by Masika et al, in Kenya using binary logistic regression model, 29.2%, 32.1%, and 45.3% of the respondents had good knowledge, good practices, and good perceptions on AEFI surveillance, respectively.⁽⁵⁾ Current study shows that more than half of the respondents were not trained for AEFI, this is similar with study done by Yamoah et al, Gupta et al and this finding is opposite to previous studies done by Saha et al and Semere et al.^2-4,6 more than 80% of the healthcare workers knew that fever, myalgia and swelling at injection site were clinical signs and symptoms of AEFI and 99.4% knew anaphylaxis as serious AEFI, this finding is similar to findings of studies in Nigeria Haryana, Lagos.^2,7,8 Over 90% of respondents knew about AEFI should be reported, while study participants have poor knowledge regarding reporting of an AEFI incident.² New vaccines have been introduced for the benefits of community, training of health care workers regarding AEFI is vital to make them competent enough for identification and reporting of AEFI for patient safety to make community confident on immunization services provided by government.

CONCLUSION

There was knowledge present regarding possible causes, types and management of AEFI among health care worker, but still there was lack of training, there is need of training and retraining of health care workers to ensure best practices in national immunization programs.

ACKNOWLEDGMENTS

Author would like to thanks for assistance and cooperation of the M.B.B.S. students and all staff who participated in the study.

Funding: No funding sources

Conflict of interest: None declared

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

REFERENCES

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