“A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF MOTHERS OF UNDER FIVE CHILDREN REGARDING Hib VACCINATION IN SELECTED HOSPITALS AT TUMKUR WITH A VIEW TO DEVELOP INFORMATION GUIDE SHEET”
PROFORMA FOR REGISTRATION OF SUBJECT FOR THE DISSERTATION
SUBMITTED BY:
SOWMYA.K.ANTU
FIRST YEAR MSc NURSING
CHILD HEALTH NURSING
SRI SIDDHARTHA COLLEGE OF NURSING
AGALAKOTE, B.H.ROAD
TUMKUR
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1 / Name of the candidateAnd Address / MISS.SOWMYA K ANTU
FIRST YEAR MSc NURSING
SRI SIDDHARTHA COLLEGE OF NURSING, AGALAKOTE
TUMKUR 572 107
2 / Name of the Institution / SRI SIDDHARTHA COLLEGE OF NURSING, B.H.ROAD, TUMKUR
3 / Course of the Study and Subject / DEGREE OF MASTER OF NURSING
CHILD HEALTH NURSING
4 / Date of Admission / 15TH JUNE 2008
5 / Title of the Topic /
A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF MOTHERS OF UNDER FIVE CHILDREN REGARDING Hib VACCINATION IN SELECTED HOSPITALS AT TUMKUR WITH A VIEW TO DEVELOP INFORMATION GUIDE SHEET.
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“What a child doesn’t receive, he can seldom later”
-James.
Immunization is vital; it protects nearly 3/4th of children against major childhood illness. There are several diseases, which can be easily prevented by timely vaccination as a part of routine immunization. Every child has the right to benefit from the appropriate traditional and new life saving vaccinations.
Haemophilus influenzae serotype [Hib] is one of the major pathogens in acute invasive bacterial infections like pyogenic meningitis, pneumonia, epiglottitis, septic arthritis, pericarditis and thrombophlebitis in children under five years of age. Although safe and effective Hib vaccine exists, they are underutilized in developing countries, especially in India.1
All mothers wish good health for their children. Health workers desire all children immunized against vaccine preventable diseases. The government wants them protected from progressive diseases. But many vaccines do not reach a majority of infants and children. Decreased awareness, patient compliance and cost effectiveness play a major role in limiting the success of vaccine.
6.1 NEED FOR THE STUDY
“He who cures a disease may be the ‘skill fullest’
but he that prevents it is the safest physician.”
- Thomas Fuller.
Protection from infectious diseases is one of the greatest benefits that any country can offer to its population. Vaccination is recognized as one of the prevention strategy, which contributed to the decreased global mortality and morbidity. Haemophilus influenzae type b [Hib] causes various bacterial infections in under five children including meningitis and pneumonia. World Health Organization estimates that Hib annually cause 3 million cases of serious illness and 4 lakh deaths worldwide, among
under five children.2
While we feel proud that India has the largest population of youths, it is also true that our country has the dubious distinction of higher morality rate among children less than 5 years of age. One of the reasons for these is said to be pneumonia. Experts say that at least 4,00,000 kids die of this disease every year in India. India accounts for almost 40% of worldwide childhood pneumonia cases. In most studies Hib is estimated to cause over 20% of life threatening childhood pneumonia. According to latest ‘states of world’s children report’ by UNICEF, more than 1000 children under the age of 5 die of pneumonia every day in India. Of the 2.1million children die every year in India, 19% are due to pneumonia. 3
It is estimated that 30% of meningitis cases are due to Hib infections. Incidence of Hib meningitis in India is estimated to be 50-70 cases per 1 lakh population, below the age of 5 years. Nearly 25-30% of children surviving Hib meningitis have permanent neurological sequelae, the most serious of which are hearing loss and mental retardation. Recent data suggests that the prevalence of Hib disease in India has been underestimated due to a lack of adequate microbiological facilities4.
Hib vaccine is used over 120 countries would wide has been proven to be safe and effective. After the introduction of Hib conjugate vaccine in 1990 for routine administration to infant in United State the number of children with invasive Hib disease decreased drastically.5 A new study from Bangladesh showed that 1/3rd of life threatening pneumonia cases and approximately 90% of Hib meningitis cases were prevented by Hib immunization.6
Hib conjugate vaccine has been widely used in industrialized countries for nearly 20 years. However, primarily because of financial constraints and lack of aware ness among both public health officials and public regarding Hib disease burden and benefits of the vaccine, use of these vaccine has been low in developing countries7. In India a large proportion of children are at a higher risk due to increasing resistance to antibiotics as well as limited access to health care facilities. With this view IAP advocates routine immunization against Hib for who can afford the vaccine.8
According to NFHS-3 report, the percentage of children who received all basic vaccinations in Karnataka was only 55% and 6.9% receives no vaccinations. These indicates that India still lags far behind the goal of universal immunization coverage of children.9 All these reveals that targeted education and vaccination campaigns are essential to achieve the elimination of childhood infections.
Studies suggest that mother’s attitude, education level, socio-demographic characteristics as well as socioeconomic factors can influence the children’s immunization uptake.10 After reviewing these researcher felt that there is a compelling need to assess the knowledge and attitude regarding Hib vaccination and identifying the learning needs, based on this specific health education module can be developed.
6.2. REVIEW OF LITERATURE
According to Abdellah and Levine “the material gathered in literature review should be created as an integral part of research”
The purpose of literature review is to discover what has previously been done about the problem to be studied, what remains to be done11.
1. A comparative study was conducted to assess the knowledge and attitude of mothers towards Hib vaccination and Hib vaccination coverage among Amish Children in Pennsylvania. 298 mothers were from Amish community and 136 Non Amish mothers were selected as a comparison group. . Hib vaccination coverage was low in Amish communities [28%] as compared with non-Amish group [95%]. Among Amish parents who did not vaccinate their children only 25% identified either religious or philosophical objection as factor. 51% reported that vaccinating was not priority compared with other activities of daily life. 73% would vaccinate their children of vaccinate their children if vaccine were offered locally. Study concluded that targeted education regarding the vaccination is essential to achieving elimination of Hib diseases.12
2. A study was performed to assess current attitude of parents regarding prevalent issues related childhood vaccination. Of 6025 participants, 95% regarded their pediatrician as the most important source of information followed by leaflets 48%, health magazine 44.7% and the interest 38.7%. Of currently recommended immunization against Hib. Parents considered it is least important for their children. 22.6% of parents felt that immunization is administered too early in life, 21% thought that it is overload and 12% afraid of its side effects. Study concluded that there is a need for information strategies to counteract the existing misperception. 13
3. A descriptive study was conducted to evaluate knowledge attitude, and behavior of 841 Italian mothers regarding the immunization. Over all 28.5% of mothers were aware about Hib vaccination. Respondent’s attitude towards the utility of vaccination was favourable only for 22.5%. The results of a multiple logistic regression analysis showed that the knowledge was significantly greater among mother with a higher education level and among those who were older at the time of childbirth. Study emphasized the need for health education programmes for promoting immunization of under five children.14
4. A study was aimed to identify knowledge and perception of population regarding the pentavalent vaccine [ DPT, Hep.B and Hib]. 600 mothers were interviewed for data collection. Virtually all mothers like the idea of getting more protection with less effort, but a small group 5% are worried that 5 doses together may be dangerous and cause more side effects. The great majority of mothers already believe that meningitis is a serious disease and they want their children vaccinated against it and pneumonia.15
5. 20 surveys carried out between 1991-2001 to obtain information on mother’s knowledge and attitude towards immunization, in England. More than 15,000 interviews were conducted as part of routine programme of research. These surveys show that public wants clarity, consistency factual information and openers from those delivering immunization servces.16
6. A descriptive study was conducted to explore the maternal response to addition of Hib vaccine to primary schedule. 23 mothers of babies aged 1-2 years were interviewed. Acceptability of vaccine was principally attributable to maternal perception. Barriers to the uptakes of the vaccine include suspicion regarding newness of the vaccine a fear of vaccine overload in such young babies and the distress of injections.17
7. A cross sectional survey was performed to assess the knowledge, attitude and practice of mother regarding expanded programme of immunization. The study revealed that 88% of patients had knowledge about EPI programme 92% of parents had positive attitude towards EPI. The most common reason for not vaccinating their children was laziness and wrong concepts about vaccination. This study concludes that there is need for more clear and appropriate health education messages regarding vaccination of chileren.18
8. A descriptive study was conducted in England to explore the parental decision-making about the ‘five in one’ vaccine. Semi-structured interviews were conducted with 22 parents if babies aged between 4 and 13 weeks old. Although parents had concerns, most of them complained with the recommended programme rather than making an informed decision. This study implies there is need for more clear information regarding the combined vaccinations.19
9. A study was carried out to examine mothers practice and attitude in relation to their child’s immunization. 1295 mothers were selected and data were collected using standardized questionnaire. Four immunization types were established based on the perception of immunization knowledge and practice. The 57% mothers were complaint, 19% complaint- ambivalent, 17% moderately resistant and 7% resistant towards vaccination. Results confirm the existence of a resistance to child vaccination. It should be attributed to ignorance.20
6.3 STATEMENT OF THE PROBLEM
A study to assess the knowledge and attitude of mothers of under five children regarding Hib vaccination in selected hospitals at Tumkur, with a view to develop information guide sheet.
6.4 OBJECTIVES OF THE STUDY
1. To assess the knowledge of mothers of under five children regarding Hib vaccination.
2. To assess the attitude of mother of under five children regarding Hib vaccination.
3. To find out the relation between knowledge and attitude of mothers regarding
Hib vaccination
4. To determine the association of knowledge and attitude of mothers with selected demographic variables.
5. To develop a health education module regarding the prevention of Hib diseases.
6.5 OPERATIONAL DEFINITION
Assessment: - It is the organized systematic and continuous process of collecting
data from mother of under five children regarding Hib vaccination.
Knowledge: - It denotes the awareness or information that the mothers posses
regarding Hib vaccination.
Attitude: - Refers to opinion of mothers towards Hib vaccination.
Mothers: - Mothers of under five children attending the immunization clinics of selected hospitals at Tumkur.
Hib Vaccination: - Vaccination against Haemophilus influenzae serotype b bacterium.
6.6 ASSUMPTION
The study assumes that,
i. Mothers play an active role in preventing child hood infections by
immunization of their children.
ii. Mothers will have some knowledge regarding Hib vaccination.
iii. Health education module will help the mothers to gain knowledge regarding
importance of Hib immunization.
6.7 HYPOTHESIS
H1 : There will be significant relationship between knowledge and attitude of
mothers of under five children regarding Hib vaccination.
H2 : There will be a significant association of the knowledge and attitude of
mothers with demographic variables.
7. MATERIALS AND METHOD OF THE STUDY
7.1 SOURCE OF DATA
Data will be collected from the mothers of under five children.
7.1.1 RESEARCH DESIGN
Non-experimental descriptive study will be used for conducting the research.
7.1.2.STUDY VARIABLES
Dependent variable: Knowledge and attitude of mothers of under five children.
Attributing variable: Demographic data of mothers include age, religion, education, occupation, family income and number of
children.
7.1.3. STUDY SETTING
Study will be conducted in the immunization clinics of selected hospitals at Tumkur
7.1.4 POPULATION
Population will be all the mothers of under five children attending the immunization clinics of selected hospitals at Tumkur
7.2 METHOD OF DATA COLLECTION
After getting permission from concerned authorities, Researcher will explain the purpose of the study to mothers of under five children. After obtaining their consent the questionnaire will be distributed and data will be collected.
7.2.1. SAMPLING TECHNIQUE
The sample of mothers with under five children will be selected by using convenient sampling technique.
7.2.2. SAMPLE SIZE
The sample size of the study constitutes 120 mothers of under five children (n=120).
7.2.3. CRITERIA FOR SAMPLE SELECTION
INCLUSION CRITERIA
1. Mothers who are having under five children.
2. Mothers who are attending the immunization clinic of selected hospitals, Tumkur.
3. Mothers who are willing to participate in the study.
4. Mothers who know Kannada or English.
EXCLUSION CRITERIA
1. Mothers who are unable to understand and read Kannada and English.
2. Mothers who are not willing to participate in the study.
3. Mothers who are not available at the time of data collection.
7.2.4. INSTRUMENT
A structured questionnaire will be prepared for data collection.
The tool will have 3 parts.
Part I: Proforma for collecting demographic data.
Part II: Consist of questions to assess the knowledge of mothers regarding
Hib vaccination.
Part III: Consists of attitude scale to assess the attitude of mothers regarding Hib vaccination
7.2.5. METHOD OF DATA ANALYSIS AND PRESENTATION