KNOWLEDGE, ATTITUDE AND PRACTICES OF RURAL MOTHERS WITH

CHILDREN UNDER FIVE YEARS OF AGE ABOUT VACCINATION: A NON

EXPERIMENTAL STUDY

K.Ravishankar1, *M.Vinodkumar2, E.Surendra3, G.Aasrtiha Williams3

1
Prinicipal and Professor, Sri Sai Aditya Institute of Pharmaceutical Sciences & Research,
Surampalem, Kakinada
2
Assistant Professor, Aditya Institute of Pharmaceutical Sciences & Research, Surampalem,
Kakinada
3
Fifth year Pharma-D students, Aditya Institute of Pharmaceutical Sciences & Research,
Surampalem, Kakinada
*
Email:[email protected].

Abstract:

Background: Immunization is a highly cost effective way of improving child survival in

developing countries.
Aim and objectives: To assess the knowledge, attitude and practices of mothers with five years
children of age about vaccination. To educate them regarding the vaccination schedule and
importance of vaccination.
Methodology: It is a Non experimental exploratory study design. Purposive sampling technique
was used for selecting study subjects. Data was collected from 60 rural mothers who visited
pediatric department during the study. Mothers with children under five years of age, mothers from
rural area are included in the study.
Results: 61.6% of mothers completed their preschool education and majority of them are
housewives (63.30%).Both mother and father used to make decision regarding child immunization
(71.7%). TV/Radio, Anganwadi workers ,Hospitals remain the major sources of information about
immunization .65% of mothers know the correct age to start vaccination and majority( 58.33%)of
mothers believe that vaccines are not harmful. Most of the mothers believe that child with fever
and cold should not be vaccinated. The attitude of mothers towards vaccination was satisfactory
.93.33% of mothers believe that vaccination is important and 91.66% of mothers believe that it is
important to follow the vaccination schedule. The practices of mothers towards immunization were
found to be satisfactory.
Conclusion: The attitude and practices of mothers were found to be satisfactory. Their knowledge
was to be improved to promote better immunization coverage. Appropriate information and
awareness campaigns may improve the knowledge of mothers regarding vaccination.

Keywords: Knowledge, Attitude, Vaccination, Rural mothers.

INTRODUCTION:

Vaccines are one of the most successful health interventions that bring about significant reductions
in infectious diseases and adverse health consequences and improve quality of life in the
population. Over the years vaccines have provided highly cost effective improvements to human
health by reducing avoidable human suffering, costs of care and treatment, economic
consequences of work i.e. lower productivity and loss of work. More and more diseases are
becoming vaccine preventable; including those for prominent killers like pneumonia and
diarrhea.[1]Immunization is a highly cost effective way of improving child survival in developing
countries.[ 2,3] However in the past few decades’ immunization coverage rates have improved
sufficiently in developed countries whereas most of the developing countries are still struggling
with low rates.[4] India has one of the largest immunization program in the world but diseases like
Maternal and neonatal tetanus (MNT) has alone led to 58,000 newborns deaths in 2010 and a
significant number of women also die to due to maternal tetanus every year.[5] Infant mortality rate
(IMR) is considered as one of the most sensitive indicators of health status of a community. Infant
mortality figures in India are very high and the two important causes which contributes maximum
to the IMR is inadequate breastfeeding and immunization. [6] Despite India being a leading
producer of vaccines, it harbors one-third of the world’s unimmunized children.[7] Only four
diseases – respiratory infections, diarrhoeal diseases, other infectious and parasitic diseases
and malaria – account for about half of under-five deaths in India.[8] The current scenario
depicts that immunization coverage has been steadily increasing but the average level remains far
less than the desired. Still only 44 per cent of the infants in India are fully immunized (NFHS-III)
which is much less than the desired goal of achieving 85 per cent coverage.[9] In India, under
Universal Immunization Programme (UIP) vaccines for six vaccine-preventable diseases
(tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, and measles) are
available for free of cost to all. UIP was launched in 1985 with much dynamism to attain the target
to immunize all eligible children by 1990. Lot of energy and money has been spent on the UIP but
it does not reap the much hyped outcome. Unmistakably, various survey results show the glaring
gap between the target and achievement even after several years.[10] Though there is increased
accessibility of health care services in both urban and rural areas, still the utilization of health care
services is low by the different segments of the society.[11]

There is increasing recognition within the international aid community that improving the health of
poor people across the world depends upon adequate understanding of the socio-cultural and
economic aspects of the context in which public health programmes are implemented. Such
information has typically been gathered through various types of cross-sectional surveys, the most
popular and widely used being the knowledge, attitude, and practice (KAP) survey.[12] The
attractiveness of KAP surveys is attributable to characteristics such as an easy design, quantifiable
data, ease of interpretation and concise presentation of results, generalisability of small sample
results to a wider population, cross-cultural comparability, speed of implementation, and the ease
with which one can train numerators.[25]
NEED FOR STUDY:

Many in rural India lack access to education, nutrition, health care, sanitation, land and other assets
and they are trapped into poverty. In rural India there is high number of Infant Mortality with low
Life Expectancy at Birth Rate. [22] While, in general, the urban-rural difference in health is a
phenomenon of developing countries and countries in transition, the gender gap in health and
mortality is typically endured in South Asian countries. Despite several programmatic initiatives,
urban-rural and gender difference in child immunization pose an intimidating challenge to India’s
public health agenda. Despite a decline in urban-rural and gender differences over time, children
residing in rural areas and girls remained disadvantaged. [23] The NFHS-3 survey reported that
57.6% of urban infants were fully vaccinated compared to 38.6% in rural areas. The percentage of
infants who were not vaccinated was 5.7% in rural areas compared to 3.3% in urban areas. The
urban-rural gap existed for all individual vaccines, although the gap was lowest with the 3 doses of
OPV. The UNICEF 2009-10 survey recorded complete vaccination in 58.5% rural infants
compared to 67.4% urban infants; the respective unvaccinated infants were 8.5% and 5.2%.[24]

AIM AND OBJECTIVE:

1. To assess the knowledge, attitude and practices of mothers with five years children of age
about vaccination
2. To educate them regarding the vaccination schedule and importance of vaccination

METHODOLOGY:

The study was carried out in department of pediatrics, Government General Hospital, Kakinada,
for duration of 3months.It is a Non experimental exploratory study design. Purposive sampling
technique was used for selecting study subjects. The study was approved by Institutional Ethics
Committee of the college. Data was collected from 60 rural mothers who visited pediatric
department during the study. They were explained about the importance of the study verbally and
upon their acceptance and will, they were interviewed, data was collected with help of semi
structured questionnaire. Mothers with children under five years of age, mothers from rural area
are included in the study. Mothers with children above five years of age, from urban areas, and
who are not willing to participate in the study are excluded. Mothers with significant difference in
knowledge, attitude and practices towards vaccination were educated about vaccination in
pediatrics using Indian Academy of Pediatrics (IAP) Recommended Immunization Schedule for
Children Aged 0 through 18 years – India, 2013 and Updates on Immunization guidelines.
RESULTS

Table 1: SOCIO DEMOGRAPHIC CHARACTERISTICS OF STUDY POPULATION

Characteristics Number Percentage

Illiterate 17 28.30%
Education Primary 37 61.60%
Secondary 6 0.10%
Graduate 0 0
Housewife 38 63.30%
Govt. Employed 3 0.05%
Occupation Self Employed 1 0.01%
House Maid 17 28.30%
Others 1 0.01%
Mother 13 21.60%
Decision Maker Father 4 0.06%
Both 43 71.70%
ANM 9 0.15%
Sources of TV/Radio 15 25.00%
Information Anganwadi 16 26.60%
Hospital 17 28.30%
Doctor 3 0.05%

Table1 shows the sociodemographic profile of the mothers. Majority of the mothers were educated
up to preschool (61.60%) and most of them were Housewives (63.30%).Both mother and father
together took decisions regarding the immunization of children.TV, Anganwadi workers and
hospitals played crucial role in providing information regarding immunization.

Table2: KNOWLEDGE OF MOTHERS REGARDING IMMUNIZATION

S.No. Questions Yes Perce No Perce Don’t percent
ntage ntage Kno age
w
1 Knew Reason For Vaccination 43.33 56.6% ---
26 % 34 ---
2 Knew Correct Age To Start
Vaccination
39 65% 21 35% --- ---
3 Are Vaccines Harmful 11.66 58.33 30%
7 % 35 % 18
4 Can Child With Cold Be Vaccinated 20% 58.33 21.66%
12 35 % 13
5 Can Child With Fever Be Vaccinated 6 10% 37 61.6% 17 28.3%

Most of the mothers don’t know the reason for vaccination but they knew the correct age to start
vaccination. Most of them believe that vaccines are not harmful .Most of the mothers were not
willing to vaccinate her child when he/she was suffering from cold and fever.
Table3: ATTITUDE OF MOTHERS TOWARDS IMMUNIZATION
S.No. Questions Yes Percenta No Percentag
ge e
1 Do You Think Vaccination Is Important 56 93.33% 4 6.66%
2 Is It Important To Follow Vaccination 55 91.66% 5 8.33%
Schedule
3 Where Do You Prefer To Receive Vaccination 53(G 88.33% 7(Priv 11.66%
ovt) ate)
4 Are You Satisfied With The Way In Which 60 100% --- ---
Vaccination Provided

Attitude of mothers towards vaccination was satisfactory because majority of the mothers believes
that vaccination is important and to follow the vaccination schedule for good health. Most of the
mothers preferred government hospital for vaccination than private hospital may be owing to free
supply of vaccines to child, which would be costly otherwise.

Table 4: PRACTICES OF MOTHERS TOWARDS IMMUNIZATION

S.No. Questions Yes Percen No perce
tage ntage
1 Was immunization was completed according to 54 90% 6 10%
schedule
2 Did side effects appear 49 81.66 11 18.33
% %
Fever 49 81.66 --- ---
3 If yes which were seen %
Pain 7 11.66 --- ---
%
Rash 4 6.66% --- ---
4 Did you inform to doctor /healthcare provider 42 70% 18 30%

The practice of mothers towards vaccination is satisfactory since majority of the mothers (90%)
completed the vaccination to child according to schedule. Fever was the most common side effect
appeared after vaccination.
DISCUSSION:

In our study it was observed that majority of mothers had primary education (61.6%).
However their knowledge towards vaccination is not up to the mark. In a study conducted
by K.Vikram et al [13] Educated mothers may have better knowledge of good medical practices
and thus be more aware of the benefits of medical care. Maternal education has often been
suggested to be the single most important factor explaining differentials in child health outcomes.
Mothers’ education leads to better human, social, and cultural capitals which then help increase
immunization rates for their children. [13]In a study conducted by Nenna TB et al, it was found that
most of the mothers had tertiary or secondary education. This seemingly high literacy level may
have influenced the knowledge of the reason for immunizing children. Though this may not reflect
the true knowledge of mothers in Enugu as it is a hospital based study, it does however show that a
better understanding of the reason for immunization is influenced by maternal education.[14]
In our study it was found that the major sources of information were TV/Radio, Anganwadi
workers and Hospital. Similar findings were found in a study conducted by Rachna Kapoor, [15]
H. Hayat et al, [16] M. M. Angadi et al. [17]

In our study it was observed that rural mothers have good knowledge regarding the importance of
vaccines and the correct age to start vaccination, as the infant will get vaccinated with the requisite
vaccines i.e. BCG and Oral polio Vaccine immediately after birth in both government and private
hospitals. However, the knowledge of mothers regarding the use of vaccines to prevent particular
diseases is poor. Most of the mothers known the particular use of BCG and Polio vaccine only.
Similar Findings were observed in studies conducted by Rachna Kapoor,[15]
Ms.Mereena.[18]Majority of mothers believed that their child should not get vaccinated in
conditions like cold and fever However it is a myth that you have to avoid or delay your child's
vaccination if they have a mild illness without a fever, such as a cough or cold, or if they have an
allergy, such as asthma, hay fever or eczema.[19]However if your baby has a fever, it's best to wait
until it subsides or till she becomes well again before you get her vaccinated. Your baby's immune
system produces antibodies when she gets an infection. These antibodies fight off similar
infections in the future. When your baby has a fever, the antibodies in her body are busy fighting
off an infection. That’s why it’s best to ensure that your babies immune system is not fighting
other infections at the same time as having immunization. [20]

In the present study it was found that majority of mothers has good attitude. Similar findings were
reported by study conducted by Ms.Mereena, [18] Shamila Hameed. [21]Majority of mothers prefer
to get their child vaccinated in Government hospital. Similar findings were reported in studies
conducted by M. M. Angadi et al, [17] Shamila Hamid et al. [21] In the present Study it was observed
that the practices of mothers was found satisfactory. Similar findings were observed in study
conducted by Shamila Hamid et al. [21]
CONCLUSION:

Our study reflected that mothers had significant lacunae in knowledge regarding immunization
whereas the attitude and practices towards immunization were good. Adequate health education
should be given to the rural mothers to increase their knowledge regarding immunization.
Pharmacists should play a lead role in bringing awareness about knowledge of vaccines in rural
areas by conducting awareness campaigns, by distributing leaflets which depicts importance of
immunization.

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