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Knowledge, Attitude and Practices on Childhood Immunisation among Parents Attending Paediatric OPD at a Tertiary Care Centre, Kanchipuram District, Tamil Nadu, India |
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Parvathy Devi, Sowjan Manohar, R Lavanya, Sekar Pasupathy 1. Assistant Professor, Department of Paediatrics, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India. 2. Associate Professor, Department of Paediatrics, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India. 3. Senior Resident, Department of Paediatrics, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India. 4. Head, Department of Paediatrics, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India. |
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Correspondence Address : Dr. Sowjan Manohar, Associate Professor, Department of Paediatrics, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India. E-mail: sowjan86@gmai.com |
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| ABSTRACT |  | |||||||||||||||||||||||||||||||||||||||||||||||||||||
: Introduction: Vaccine-preventable diseases (VPD) are considered one of the leading causes of sicknesses and deaths among children worldwide. Parents’ knowledge and attitude towards immunisation are likely to influence uptake. Vaccination is one of the most cost-effective public health tools, to prevent infectious diseases. Aim: The present study assessed parents’ knowledge, attitudes, and practice towards their children’s vaccination. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics, at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India from April 2019 to June 2019. Two hundred and sixty-six parents of 0 to 12-year-old children, attending the Paediatric Outpatient Department (OPD), were recruited for the study. A prestructured questionnaire on knowledge, attitude, and practices regarding immunisation was administered, and other socio-demographic details were collected. Descriptive analysis was done by frequency and percentage. Data entry and analysis were performed in Microsoft Excel. Results: Among the 266 parents studied, a majority 129 (48.5%) of the mothers were 26-30 years old, and fathers were in the age group of 31-35 years 98 (36.8%). The majority 89 (33.5%) of the fathers were semi-skilled workers, and mothers were unskilled workers 180 (67.7%). Overall, 36.5% of children were 6-10 years old, and 53.4% were male children. Among the parents, 98.1% stated vaccines were safe, 95.1% knew that vaccine would prevent their children from diseases. A total of 99.2% agreed that, all children should be vaccinated, 96.2% maintained a vaccination card, 81.2% were aware of the following vaccination date for their children. Conclusion: According to the present study findings, there is generally good knowledge, attitude, and practices regarding vaccination of children among their parents. Knowledge regarding optional vaccinations needs to be improved through creating awareness. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Keywords : Optional vaccines, Outpatient department, Vaccine acceptance, Vaccine preventable diseases | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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DOI and Others :
DOI: 10.7860/IJNMR/2022/57543.2359
Date of Submission: May 06, 2022 Date of Peer Review: Jun 04, 2022 Date of Acceptance: Jul 04, 2022 Date of Publishing: Dec 31, 2022 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: May 09, 2022 • Manual Googling: Jul 04, 2022 • iThenticate Software: Aug 31, 2022 (19%) Etymology: Author Origin |
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| INTRODUCTION |
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The process by which a person is made immune or resistant to an infectious disease, typically by administering a vaccine, is called immunisation. Vaccines help stimulate the body’s own immune system to protect the person against subsequent infection or disease; it describes the body’s ability to develop immunity (1). Immunisation is a successful and cost-effective public health intervention. It has prevented more deaths in the past years than any other health intervention has done globally (2). A latest study done in the year 2020 showed that, after the occurrence of COVID-19 pandemic the concerns about the potential risk of vaccination increased among the population studied (3). Childhood immunisation is vital, as it guarantees protection from various significant diseases. Worldwide, millions of deaths are prevented by immunisation, and the scientific community widely considers it “overwhelmingly good” (4). However, nearly 2.5 million deaths a year are caused by diseases that may have been prevented by proper vaccination, mainly in Africa and Asia, among children less than five years of age (4). Hence, there is an urgent need to increase vaccination coverage and encourage parents to have their children vaccinated (5). Although global vaccination coverage is steady, an estimated 22 million infants worldwide are still missing out, on essential vaccines (1). World Health Organisation (WHO) reports that 115 million infants worldwide receive Diphtheria-Tetanus and Pertussis vaccines. In addition, about 85% of the world’s children receive one dose of measles vaccine and polio vaccine; however, two countries remain polio-endemic (Afghanistan and Pakistan) (6). WHO and UNICEF estimate that national immunisation coverage is about 99% in India, and it has been very high since 2005 (7). In contrast, immunisation prevents an estimated two to three million deaths each year from Diphtheria, Tetanus, Pertussis (whooping cough), and Measles (8). In India, after the launch of mission Indradhanush, there was an overall increase in 6.7% full immunisation coverage (7). This shows that even with a major national wide program launch there is only a small increase in the full immunisation coverage. The need of the hour is exploring the vccaination status due to the impact created by the pandemic and the hesitenacy towards vaccination. The has been change in the mindset of people against vaccination in the recent past (3). The present study aimed to assess parents’ knowledge, attitude, and practice toward children’s immunisation. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Material and Methods |
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A cross-sectional study was conducted in the Department of Paediatrics, at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India from April 2019-June 2019. Institutional ethical clearance was obtained (KIMS/F/2019/03) and informed written consent was signed by all study participants.Convenience sampling was followed. During the study period all the consenting participants were taken (universal sampling). Inclusion criteria: Parents of children from 0 to 12 years of age, who attended the paediatric OPD were recruited for the study. Exclusion criteria: Children who did not get their routine vaccination due to any pre-existing condition, immunocompromised children, HIV-infected children, and those on drugs like steroids. Study Procedure A prestructured questionnaire was used for data collection. The questionnaire was developed based on previous literature and validated by subject experts [5,8]. The questionnaire had sections on the following parameters knowledge, attitude, and practice (KAP) of parents regarding immunisation, socio-demographic profile such as the age of the mother, qualification of the parent, birth order of the child, the income of the parent, delivery place and questions on the advice of vaccination was given by doctors/paramedical, whether immunisation done on the correct date and whether optional vaccines were given. The questionnaire was administered in the local language (Tamil). Three independent researchers assessed the content validity of the questionnaire, and the questionnaire was back-translated to English to ensure language validity. The questionnaire was a pilot study, done on 20 parents, and minor modifications were done based on the responses. Information regarding the vaccination status was obtained from the immunisation card and on a recall basis by the respondents, in case of non availability of the card. Fully immunised children, who had received all the recommended vaccine doses for their age according to the Universal Immunisation Programme (UIP) schedule. Partially immunised were those who had received one or more doses of these vaccines, but not all doses and unimmunised were those who had not received a single dose of any vaccine. Statistical Analysis Descriptive analysis was carried out by frequency and percentage. Data entry and analysis were done in Microsoft Excel. The data has been represented in tables and graphs. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Results |
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Among the 266 parents studied, a majority 129 (48.5%) of the mothers were 26 to 30 years old, and fathers were in the age group of 31-35 years 98 (36.8%). The majority (33.5%) of the fathers were semi-skilled workers, and mothers were unskilled workers 180 (67.7%). Overall, 34.6% of the family belonged to the upper-middle class. Total 38% of the children were 1 to 5 years of age, 53.4% were males, 78.2% were of average weight. Among 266 mothers, 197 took two doses of vaccines during their pregnancy (Table/Fig 1). Among the study population, 65% of them received medical services from a government hospital. Among the 266 children, 115 had elder siblings. Among the siblings, 111 were fully immunised, and four were partially immunised (Table/Fig 2). Knowledge among parents: Among the parents, 98.1% said the vaccines were safe, 57.1% said they don’t know a child with a severe disease/disability which was caused due to not vaccinating the child, 95.1% agreed that think vaccination would prevent their child from diseases, and 53.8% were not aware of optional vaccines availability. Among parents, 82.3% said the reason for vaccination is prevention. Among 266, 248 answered correctly for the correct age to start immunisation (Table/Fig 3). Attitude towards vaccination among parents: Among the study population, 99.2% agreed that all children should be vaccinated, 97.4% agreed that the schedule should be followed, and 82.7% agreed that they should vaccinate the child during OPV campaigns, even though the child is fully vaccinated (Table/Fig 4). Practices towards immunisation among parents: Among the study population, 96.2% maintain a vaccination card, 81.2% were aware of the following vaccination date for their child, 80.1% have recommended vaccination to others, and 52.3% were not willing to pay for optional vaccines. Reasons for not giving optional vaccines were 36% cost, 11% thought they were harmful, and 10% thought no need (Table/Fig 5). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Discussion |
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The present study findings describe a snapshot of parents’ opinions from a cohort of 266 families. The overall knowledge and attitude were good among the study participants, whereas there was gap in their practices. The overall knowledge, attitude and practices of the parents might depend on their socio-demographic conditions. Some studies reported no influence of demographic background on the parents’ perception of a vaccine (8),(9). The results show that >90% had good knowledge toward children’s vaccination; very few had little knowledge, and no one said that children should not be vaccinated. This is in line with the study by Herath NC et al., where they have reported that 90.1% thought that, vaccinating their children is very important, did not delay or plan to delay a vaccine, and 3.5% stated that, they were not in favor of vaccination (10). Previous research reports a higher level of education with more knowledge about vaccination (11). The reason attributed to this is that, being more educated allows better communication with healthcare providers and fewer chances of acquiring wrong beliefs about vaccines (12). Same can be said about the income level of the family-studies conclude that having a higher income provides increased access to healthcare providers and physicians and more information regarding vaccines-as families with higher income have better access to good healthcare and feel secure and assured by vaccination programs without further investigation about the topic (13),(14). Some studies also suggest that a higher level of education was associated with negative vaccination practices (15). However, in the present study, parents had a positive attitude toward vaccination. This can be due to the penetration of government-provided free vaccination services and its awareness throughout India. The same is proven that the majority preferred to get vaccines from the government 227 (85.3%) than from private sources 37 (14%). The majority of the parents are of the opinion that vaccines are safe 261 (98.1%) and think that vaccines will prevent their children from diseases 253 (95.1%); they also think that all children should be vaccinated 264 (99.2%). These results go well with the literature that, a positive attitude among parents towards vaccination will increase vaccination rates (11),(16). A previously published study showed that most parents report receiving immunisation information from a physician (17). The present study also shows that doctors and healthcare workers were vital in providing information regarding vaccination to parents. The majority of the parents trust the healthcare worker to safely administer the vaccine to their child 232 (87.2%) and are informed by the doctor/healthcare worker about the side effects after vaccination 193 (72.6%). While it may not be possible for the physicians themselves, who have little time to communicate with parents, including informing parents of the benefits and risks of immunisations and answering questions, healthcare workers play a significant role (18), a pilot study showed that implementation of an educational intervention for physicians and nurses increased immunisation discussion with parents during the visit, with only a slight increase in time (19). This kind of direct presentation of information provides an opportunity to establish trust and improve the physician-patient relationship. Limitation(s) The limitation of the current study is its quantitative nature. This limited the exploration into finding the in depth reasons for hesitancy. Future qualitative studies exploring the behavioural and perceptions among parents of unvaccinated children will enable better understanding. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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