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ORIGINAL ARTICLE |
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| Year : 2003 | Volume
: 57
| Issue : 4 | Page : 158-163 |
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Maternal knowledge and perceptions aboutthe routine immunization programme--a study in a semiurban area in Rajasthan.
U Manjunath, RP Pareek
Management Group, Medical Center, Birla Institute of Technology and Science (BITS), Pilani 333 031,
| Date of Acceptance | 07-Jan-2003 |
Correspondence Address:
U Manjunath
Management Group, Medical Center, Birla Institute of Technology and Science (BITS), Pilani 333 031
PMID: 14510348
A cross sectional study on immunization coverage in the town of Pilani was conducted and a total of 166 mothers were interviewed using a pre-tested interview schedule/questionnaire on Knowledge, Attitudes, Perceptions and Expectations (KAPE). The results showed that among the 12-24 month old children 50% fully, 31.3% partially and 18.7% not at all immunized. High levels of initial vaccination rates and low levels of OPV3/DPT3 (62.7%) and measles (51.8%) vaccines indicate that completing vaccination schedule needs attention. Almost all the children in the study, 165 out of 166 received two doses of polio vaccine from the Pulse Polio Immunization programme. Majority of the mothers expressed favourable attitudes and satisfaction regarding the programme. Though many were aware of the importance of vaccination in general, specific information about importance of completing the schedule and knowledge about vaccine preventable diseases other than poliomyelities was very limited. Obstacles, misconceptions/beliefs among the mothers of partially immunized children and lack of information among not at all immunized group were the main reasons of non-immunization. The implications of the study are: to enhance the maternal knowledge about the vaccine preventable diseases and importance of completing the immunization schedule through interpersonal mode and to overcome obstacles to immunization such as accessibility and lack of family support.
Keywords: Child, Preschool, Female, Health Knowledge, Attitudes, Practice, Human, Immunization, utilization,Immunization Programs, India, Infant, Male, Mothers, psychology,
How to cite this article:
Manjunath U, Pareek R P. Maternal knowledge and perceptions aboutthe routine immunization programme--a study in a semiurban area in Rajasthan. Indian J Med Sci 2003;57:158-63 |
How to cite this URL:
Manjunath U, Pareek R P. Maternal knowledge and perceptions aboutthe routine immunization programme--a study in a semiurban area in Rajasthan. Indian J Med Sci [serial online] 2003 [cited 2013 May 19];57:158-63. Available from: http://www.indianjmedsci.org/text.asp?2003/57/4/158/11921 |
Government of India (GOI) launched its Expanded Programme of Immunization (EPI) in 1978.[1] The aim of routine immunization programme is to deliver a complete number of doses of potent vaccines in a timely, safe, and effective way to all children and women. Coverage data are traditionally considered as the best indicators of an immunization programme's performance because they reflect the management of, access to, and utilization of services. India nearly spends Rs.138 crores annually on the Universal Immunization Programme and 98% of the funding comes from the Govemment.[2],[3] However, the success has not been resounding. GOI[4] reports a much higher coverage with 85.9% for BCG, 80.8% for DPT, 81.0% for OPV and 66.5% for measles, (1997-1998). There is difference in coverage data between the Government health statistics and other studies.[4],[5],[6],[7] In general, Rajasthan has been one of the poor performing states in India with reference to immunization.
The above studies indicate that it is important to understand the needs/problems to better manage the programme at the local level. This study aimed to examine maternal knowledge and perceptions about the programme in relation to immunization status of one to two year old children in the town of Pilani.
| ¤ Methods and materials | |  |
A cross sectional survey using a two stage random sampling of all the house holds in the town for obtaining community based data on immunization status of children was conducted. In the first stage the lists of houses from all the wards were randomly selected. In the second stage all the mothers in those houses with 12-24 month children were interviewed using a pre-tested Knowledge, Attitudes, Practice and Expectations (KAPE) Questionnaire/ interview Schedule. Reasons for nonImmunization as per mother's report were recorded.
The data on getting one dose each of BCG and measles; three doses of DPT/ OPV were collected. Accuracy on immunization data was improved by checking the immunization cards, and when cards were unavailable, mothers reporting of having given a vaccine or not was recorded. Further, scar of BCG vaccine was checked for each child included in the study. The basic data on immunization was collected as per WHO recommendations.[8],[9] Information on receiving two doses of oral polio vaccine during the recent Pulse Polio Immunization (PPI) was also included for the study. Data from the survey was statistically analyzed using Microsoft Ekcel and spreadsheet.
| ¤ Results | | |
Immunization Status of 12-2 Month Children: A total of 166 children in the age of 12 to 24 months were included in the study with a mean age of 18.21 months and a standard deviation of 4.74 months. This sample included 98 boys and 88 girl children. 83 out of 166 children in the study (50.0%) were fully immunized, 52 (31.3%) were partially immunized and 31 (18.7%) were not at all immunized. 165 out of 166 (94.4%) had received two doses OPV through the PPI campaign held in December 2000 and January 2001.
[Figure - 1] shows the percent of children aged 12 to 24 months who had received specific vaccinations according to the information recorded on the immunization card or as per the mother's report. The analysis of vaccine-specific data indicates a high level coverage for the six EPI vaccines except for OPV3/ DPT3 and Measles. Among 132 children who received the first dose of DPT only 104 got the third dose he. a dropout rate of 21.2% for DPT1/OPV1 to DPT3/ OPV3.34.9% dropout rate (46 children) from DPT1/OPV1 to measles vaccine was seen. B.C.G. coverage was slightly lower than DPT1/OPV1 in the study.
Mothers' Perceptions and Knowledge: Majority of the mothers was able to mention at least one benefit of immunization as preventing illness, paralysis, or death. Polio prevention was the most often mentioned benefit as can be seen from the [Table - 1]. Mothers of fully and partially immunized children mentioned more than one benefit in general. Average number of correctly identified diseases for which EPI vaccines are given was only 2.01 among the mothers of fully immunized children. Further analysis of the data showed that 75.3% named "polio" correctly. Only four mothers named "Diphtheria" and two correctly identified all the diseases.
147 out of 166 (88.6%) expressed a favorable attitude towards the program, with 100% of the mothers of fully, 86.5% of the partially and 61.3% of the not immunized children showing favorable attitudes. 81.3% expressed satisfaction about the program. [Table - 1] clearly show that all the mothers of fully immunized children are satisfied and that the number decreased for partially and not immunized groups. 123 mothers said that interpersonal approach (direct interactions with the ANM, door to door campaign, doctor's advice etc) as the most effective way to improve the success of the existing program.
Reasons for Non-Immunization: "Obstacles" was the most often mentioned reason for non-immunization, 38.8% of the mothers reported. 25.2% had misconceptions/beliefs about immunization such as fever after immunization for a healthy child might be harmful, too many doses, elders believed that vaccines are not needed etc. 7.8% reported that the child was sick at the scheduled time and 9.7% lacked information about the programme. 18.5% said some non-specific reason such as "were lazy, forgot, lost the card etc."
| ¤ Discussion | | |
The results clearly indicate that Pilani falls short of 85% target for specific vaccines and lower than the government statistics for Rajasthan. The success of PPI in Pilani is attributed to the intense campaigning and delivering of the vaccines at home itself for those who did not go the identified center nearby. In fact many mothers expressed that they were very happy to get the service at the doorstep. Dropout rates are a clear indication that the programme management and monitoring should be geared towards motivating mothers to complete the vaccination schedule on time. Higher than state level literacy rates and female literacy rates[10] of Pilani, 83% & 62% respectively, does not seem to have had a significant impact on coverage rates. Much seems to be done in the case of measles vaccine coverage in Pilani.
Though majority expressed favorable attitudes and is satisfied with the program, mothers' inability to name or identify diseases other than poliomyelitis indicates that health education should be emphasized to enhance mother's knowledge about the complete program. Main reasons for non-immunization such as obstacles, misconceptions/beliefs and lack of information among mothers clearly indicate that they do not fully understand the importance of immunizing their children. Examining mothers' responses closely indicated that some expressed that they did not take the child for immunization because of gender; girl child was neglected at least in five instances in the study. Lack of information in addition to mother's illiteracy and inaccessibility to the immunization centers have also been reported to contribute to low levels of immunization in Rajasthan by Singh and Yadav (2001).[7] Studies have shown that understanding the maternal perceptions and knowledge about immunization helps health planners to develop health education programs.[11],[12],[13] The implications are appropriate information dissemination; aggressive campaigning and family involvement as crucial to the success of the programme.
| ¤ References | | |
| 1. | Government of India. Center Calling, Nov. 1987: New Delhi.  |
| 2. | Joshi P. Needed: Anti-apathy Vaccine. Hindustan Times, Sunday, dated 19 August, 2001 New Delhi: pp-12. |
| 3. | UNICEF 2001. The State of the World's Children. Http://www.unicef.com |
| 4. | Ministry of Health and Family Welfare (MOHFW). Evaluation of Routine Immunization. 1997-1998; Department of Family Welfare, MOHFW. 1999: New Delhi. |
| 5. | International Institute for Population Sciences. ZIPS & ORC Macro. The National Family Health Survey (NFHS-2) India, 19981999, ZIPS. 2000: Mumbai http:// www.nfhsindia.org |
| 6. | Singh P, Yadav R J. Immunization Status of Children of India. Indian Paediat 2000; 37:11941199. |
| 7. | Singh P, Yadav R J. Immunization Status of Children in BIMARU States. Indian Paediat 2001;68:495-499. |
| 8. | WHO/EPI. Protocol for Study of Immunization Status and Reasons for Postponing Immunization. WHO/EPI/GENI84.04. 1984. Geneva: WHO. |
| 9. | WHO/EPI. Immunization Policy: Global Programme for Vaccines and Immunization. WHO/EPI/GEN/95.03 Rev.1.1995. Geneva: WHO. |
| 10. | Census of India 2001. |
| 11. | Weeks M, Stelngalss R. Beyond Immunization to Disease Control. Child Survival BASICS Quarterly Technical Newsletter. 1996. No:3:8-9 |
| 12. | Murthy G V S, Kumar S. Knowledge about Mothers Regarding Immunization in a High Coverage Area-Need for Strengthening Health Education. Indian Paediat 1989;26: 1219-1222. |
| 13. | Singh M C, Badole C M, Singh M P. Immunization coverage and the Knowledge and Practice of Mothers Regarding Immunization In Rural Area. Indian Publ HIth, 1994;38:103-107. |
Figures
[Figure - 1]Tables
[Table - 1]
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