Assessment of knowledge, attitude and practices regarding immunization among mothers of under-five children in Chitoor district, Andhra Pradesh

INTRODUCTION

Immunization is the process of making a person immune or immune to an infectious disease, usually by administering a vaccine. India’s UIP provides free vaccination against 11 life-threatening diseases-tuberculosis, diphtheria, pertussis, tetanus, polio, hepatitis B, pneumonia and Haemophilus influenza type b (Hib) meningitis, measles, rubella, Japanese encephalitis (JE) and rotavirus diarrhoea. (Rubella, JE and rotavirus vaccine in some states and regions).¹

Vaccines prevent more than 20 life-threatening diseases and help people of all ages live longer, healthier lives. Vaccinations currently prevent 3.5 to 5 million deaths each year from diseases such as diphtheria, tetanus, pertussis, influenza, and measles^.2

Many parents have a poor understanding of vaccine-preventable diseases (VPD), and many believe that there is misinformation about vaccine content, side effects, and effectiveness.³ Mothers' knowledge of vaccination, a public health measure that has significantly reduced mortality and morbidity worldwide, is very important because they play an important role in child care. Their ability to obtain correct information improves their practice and attitude towards immunization.⁴

This study aims to assess the knowledge, attitudes and practices of immunization among mothers of under five children and also to correlate the knowledge and attitude of immunization and find out the association between knowledge and attitude of immunization with the selected demographic variables.

METHODS

Study design

It was a cross sectional study

Study setting

The study was conducted in one of the PHC of Chitoor district, Andhra Pradesh.

Study population

Study population included mothers who are having children below five years of age and comes under the jurisdiction of PHC.

Inclusive criteria

All the mothers located near PHC who have under five aged children and willing to participate in the study.

Exclusive criteria

The mothers who are having the children aged above 5 years and not willing to participate in the study.

Sample size

Sample size for estimated proportion⁵

N=(Z1-α/2)2 p (1-p)/d² Where,

P-Proportion of knowledge regarding immunization among mothers of under five children=53%

D=absolute precision=0.12

Z1-α/2=1.96 at 5% level of significance

N=with a non-response rate of 0.1 (10%)

Calculated sample size is 66.4

Hence, the minimum required sample size from above calculations is computed to 66.4 participants; however, 80 participants samples were collected.

Sample technique

The study was done using purposive sampling technique.

Study duration

Study carried out for three months (May 2022 to July 2022).

Data collection method

Structured interview questionnaire was developed from the data of MCP card and immunization schedule, that includes demographic data and other part consists of questions on knowledge, attitude, and practice of mothers on immunization.^6,7 Paper-based data collection method was followed to collect the information on knowledge, attitude and practice.

Data analysis

Collected data was entered in MS-excel and analysis was carried out using Stata 14.0 version. Results were described in terms of frequency, percentage for qualitative variables and scoring method is used to determine the distribution of knowledge of mothers and chi-square test was conducted to find the association of demographic variables with the knowledge scores.

The scoring method was used to determine the percentage of the knowledge among the participants by using modified blooms cut off method-<60%=poor knowledge, 60-79%=moderate knowledge and 80-100%=good.

RESULTS

In total, 80 mothers consented to participate in the study and were interviewed. Mothers were grouped based on their age. Mothers aged up to 25 years were 17.5% (n=14), 26-30 years were 47.5% (n=38) and over 30 years were 35% (n=28). Majority of mothers were literate with mother’s completed their secondary education was 42.5% (n=34). Majority of mother’s, worked as daily wage earners that is 45% (n=36). More than half of the mothers had single families 57.50% (n=46), with 78.7% (n=63) of them being Hindu. over half of the families 53.75% (n=43) yearly income ranged between Rs. 50,001 to Rs. 100,000.

Knowledge of mothers towards child vaccination

All the mothers were aware of the importance of vaccinations however just 52.5% (n=42) of them knew about the measles vaccine and 67.5% (n=54) about the polio vaccines and had very limited knowledge about PCV, Hepatitis-B, IPV and Rota virus. More than two-fifths of the mother's had knowledge about contraindications such as malnutrition, diarrhoea, minimal infection and immune disorder. The 77.5% (n=58) of mothers who were aware of vaccination card but 66.25% (n=53) of mothers were knowledgeable about intervals between vaccine doses. Nearly half of mothers had knowledge regarding vaccine sites.

Attitude of mothers towards child vaccination

All the mothers agreed that vaccine is important, safe and maintain child health. Also, they would recommend others to vaccinate their child. More than half of the mothers agreed that vaccination have severe side effects but almost all the mother’s considered that vaccination was important for both boys and girls 98.75% (n=79).

Practice of mothers towards child vaccination

Majority of the mothers had good practice towards their child vaccination. Nearly 87.5% (n=70) of mothers vaccinate their child as per schedule and more than three fourth of mothers reported vaccine side effects, more than half of the child suffered with high temperature and also managed fever, pain and swelling. More than three fifth of the mothers reported pain and swelling and all the mothers vaccinate both their boys and girls equally.

Overall mothers’ knowledge and factors associated

Knowledge of mother were further categorised into good, moderate and poor based on the scores received by each mother. Only 8.75% (n=7) of mothers had good knowledge regarding their child vaccination and 46.25% (n=37) mothers are having moderate knowledge whereas 45% (n=36) are having poor knowledge. Further association of the mother’s knowledge was done with all the demographic variables. It was observed that income per year was significantly associated with mother’s knowledge (p=0.014).

DISCUSSION

The aim of the study was to assess the knowledge, attitude and practice of mothers towards vaccinating their children and it was found that most of the mothers are aware of the importance of vaccination which may be due to the ongoing awareness programs of the government. achieve complete vaccination. Although maternal awareness is good, knowledge about vaccination per se and contraindications is limited. Knowledge on each topic was found to be above average, but mothers' general knowledge about their child was limited. An in-hospital study conducted at Indore rural medical college showed that mothers' knowledge about vaccination was inadequate, but their attitude towards immunization was good.⁸ On the contrary, a study conducted on mothers with at least one child under the age of 5 who attended paediatric polyclinics and immunization clinics at the university of Nigeria teaching hospital, Enugu found that most of the mothers studied had good knowledge and positive perception and practice of immunization.⁹ Similarly, a grey literature review found that the main reasons for under vaccination were related to vaccination services and the knowledge and attitudes of parents.¹⁰

In this study, sociodemographic variables have no significant relationship with maternal knowledge, except for the income variable. Similarly, a review that sought to identify and examine factors associated with disparities in routine childhood vaccination in India found an almost direct relationship between household wealth and vaccination rates. Vaccination rates are lower in infants whose mothers have little or no literacy and in families with insufficient female influence, while a community-based cross-sectional study of eligible caregivers found that lack of access to information and low maternal knowledge about routine immunization reported low community vaccination rates.^11,12A community-based study in Ethiopia showed low childhood vaccination coverage and demographic variables also showed a significant association with complete childhood immunization.¹³

As facility delivery increases, vaccination awareness has increased, but greater vaccination awareness is yet to be achieved, which will further help in achieving the goal of full immunization in India. In addition, misunderstandings and rumours related to vaccination are spreading on the internet, social media and society, especially during COVID-19.¹⁴ These rumours and misconceptions need to be addressed to improve maternal knowledge, attitudes and practices. The national family health survey-4 (NFHS-4) found that delayed vaccinations are high in India. Vaccine timeliness should be a key indicator of the vaccination program and focus more on groups that are more likely to receive delayed vaccination, i.e., home births, low-birth-weight newborns, poorer households, children of less educated mothers and children of Muslim families.¹⁵

That is why we focus on providing information to mothers and society about each vaccination and its importance, as was done with the COVID-19 vaccine to fight the pandemic. Similar strategies can be implemented to improve maternal knowledge about a particular vaccine, its importance, indications and contraindications.

Limitations are the small or limited sample size, so we cannot generalize the results of the study. This is limited to a rural geographic area, so further research can be done to compare urban and rural geographic areas.

CONCLUSION

Most of the mothers were aware of the importance of the vaccine and had a good attitude towards the vaccination of their children. However, the general knowledge of mothers was limited. The present study also shows that there was no association between the mother's knowledge and socio-demographic aspects, except annual income, which was found to be statistically significant.

The proposed recommendations are measures to convey the right message to mothers about the importance of timely vaccination with all scheduled vaccines to improve both knowledge and use of vaccination services. In high-risk areas, health education through IEC should be approached specifically and intensively. All doses must achieve universal vaccination coverage, and any gaps must be identified and vaccinated. Similar studies can be done on a large scale among different communities.

ACKNOWLEDGEMENTS

The authors would like to thank to medical officer of PHC Pedda Upparpalli Chittoor district, AP for giving the permission to conduct the study and also the staff of the PHC for cooperating in conducting the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee TRC-IEC No: IIPHH/TRCIEC/290/2022; Dtd:10/5/2022.

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