ASSESSMENT OF MOTHER’S KNOWLEDGE
ATTITUDE AND PRACTICE TO WARDS THE
EIGHT VACCINE PREVENTABLE CHILDHOOD
DISEASES
By
Ewunet Ayalew
PROPOSAL TO BE SUBMITTED
TO
JIMMA UNIVERSITY, COLLEGE OF MEDICAL AND PUBLIC HEALTH,
DEPARTMENT OF NURSING AS PARTIAL FULFILLMENT FOR THE
DEGREE OF BACHELOR OF SCIENC
Jan, 2010 GC
JIMMA ETHIOPIA
ASSESSMENT OF MOTHER’S KNOWLEDGE ATTITUDE AND
PRACTICE TO WARDS THE EIGHT VACCINE PREVENTABLE
CHILDHOOD DISEASES IN SERBO TOWN.
By
Ewunet Ayalew
Advisors:
Ato Temamen Tesfaye(BSC)
Jan, 2010 GC
JIMMA UNIVERSITY
JIMMA ETHIOPIA.
ABSTRACT
Introduction
Infant and under five mortality rates in Ethiopia is among the highest in the world. About
472,000 children die each year before their fifth birthdays. The highest proportion for
childhood deaths is due to Vaccine preventable diseases. .
EPI program encompass multiple activities to be conducted by different bodies at
different level of organization and health sectors.
Objective
Assessing the mothers KAP towards the eight vaccine preventable disease is the objective of the study.
Methods
The study will be conducted in Serbo town, Kersa Woreda, Jimma Zone, Oromiya region , from Jan 15-30/2010 using a descriptive cross sectional study with mixed data collection method. Quantitative data will be obtained from document (EPI card) and qualitative data from observation. From 512 children the total of 104 samples will be selected. The data is collected using purposive sampling techniques. Training data collectors follow up and supervision will be conducted, data will be checked, cleared, compiled and analyzed manually, and using SPSS soft ware. Later of approval from Jimma University, Later of consent from Woreda health office, and consent from clients will be expected and respected
Result Final result of the study will be disseminated to the Woreda health office and concerned bodies.
The quality of the data will be assessed. A total of 8794 birr planed to conduct these study.
Acknowledgement
I would like to acknowledge My Advisor Mr. Temamen Tesfaye (BSC) for his valuable
comments in developing this proposal.
I would like to acknowledge Serbo Town Health office for cooperation on my work.
I would like to acknowledge w/r Liya Ragasa and Eleni G/Senbet for typing this
manuscript.
My thanks also goes to all my teachers.
I would like to acknowledge all my colleagues for their invaluable suggestions on the
proposal development.
Finally my Acknowledgement goes to my Dawiteye for his valuable, unreserved,
constructive comments, supports and supplying necessary documents during this proposal
development.
TABLE OF CONTENTS PAGE
ABSTRACT ......................................................................................................
ACKNOWLEDGEMENT....................................................................................
TABLE OF CONTENTS......................................................................................
LIST OF TABLES...............................................................................................
LIST OF FIGURE...............................................................................................
ABBREVATIONS..............................................................................................
CHAPTER: -1.........................................................................................................................
1.1 BACK GRAWND
1.2 STATEMENT OF THE PROBLEM ....................................................................................
1.3 SIGNIFICANCE OF THE STUDY .......................................................................................
CHAPTER: – 2. LITERATURE REVIEW....................................................................................
CHAPTER: – 3. OBJECTIVES .................................................................................................
3.1 GENERAL OBJECTIVE........................................................................
3.2 SPESIFIC OBJECTIVE .........................................................................
CHAPTER: – 4. MATERIAL AND METHODOLOGY..................................................................
4.1 STUDY AREA..................................................................................................................
4.2 STUDY DESIGN ...............................................................................................................
4.3STUDY PERIOD................................................................................................................
4.4 POPULATION.................................................................................................................
4.4.1 SOURCE POPULATION ................................................................................................
4.4.2 STUDY POPULATION...................................................................................................
4.5 STUDY VARIABLES ........................................................................................................
4.5.1 INDEPENDENT VARIABLES .........................................................................................
4.5.2 DEPENDENT VARIABLES..............................................................................................
4.6 SAMPLE SIZE AND SAMPLING TECHIQUE ......................................................................
4.7 DATA COLLECTION.........................................................................................................
4.7.1 PRETEST AND QUALITY CONTROL ..............................................................................
4.8 DATA ANALYSIS PRESENTATION AND INTERPETATION .................................................
4.9 OPERATIONAL DEFINITION OF TERMS.........................................................................`
4.10 DATA QUALITY ASSURANCE.........................................................................................
4.11 ETHICAL CONSIDERATION...........................................................................................
4.12 LIMMITATION OF THE STUDY ......................................................................................
CHAPTER:- 5 BUDGET OF THE PROJECT............................................................................
CHAPTER:- 6 WORK PLAN PROJECT MANAGEMENT..........................................................
7. REFRENCE ........................................................................................................................
8. ANEX 1 ........................................................................................................................
8.1 DUMMY TABLE .............................................................................................................
8.2 QUESTIONAIRE ..............................................................................................................
LIST OF TABLE
Table1Socio-demographic characteristics of mothers surveyed at Serbo town
Kersa Woreda Jimma Zone Jan 2010..................................................
Table 2 Accessibility of means of communication by number and percent of mothers at serbo town Kersa Woreda Jimma Zone Jan 2010
Table 3 Association between mother’s Educational status and Immunization practice among Sarbo town residents Jimaa Zone Oromiyaa region Jan 2010
Table 4 Monthly income and immunization status of served children in serbo town, kersa
woreda, Jimma zone Jan 2010
Table 5 Vaccination status of mothers and childrens in serbo town kersa woreda, Jimma zone Jan 2010
Table 6 Distribution of children b/n 12-36 month of age by vaccine type received in serbo town kersa woreda, Jimma zone Jan 2010
Table 7 Reasen for not being immunized in children b/n 12-36 month of age in serbo town kersa woreda, Jimma zone Jan 2010
Table 8 The reason for defaulting immunization inservedchildren’s in serbo town kersa woreda, Jimma zone Jan 2010
Table9 Type of vaccines and mother’s who identify the Vaccines in serbo town kersa woreda, Jimma zone Jan 2010
Table 10 Association of educational status with child immunization and recalled child hood vaccine preventable diseases by mothers, in serbo town kersa woreda, Jimma zone Jan 2010
Table 11 Distribution of respondents by their socio-Demographic factor and their knowledge Attitude and Practice towards the eight vaccine preventable disease at Serbo town Kersa Woreda Jimma Zone Jan 2010
List of figuresFigure1Type of vaccines and mother’s who identifies the Vaccines in serbo
town kersa woreda, Jimma zone Jan 2010
Figure 2 vaccination statuses of mothers and children in serbo town kersa woreda, Jimma zone Jan 201
FIGUER3 Immunization statuses of children in Serbo town Kersa Woreda Jimma
Zone Jan 2010
Abbreviations
AEFI: adverse effect following immunization
BCG; bacillus calmette Guerin
BSC: Bachlore of science
DTP: diphtheria–tetanus–pertussis
EFY: Ethiopian fiscal year
EPI: Expanded program of immunization
FMOH: Federal Ministry of Health
GAVI: Global alliance Vaccine and Immunization
Heb: Hepatitis type b
Hib: Homophiles influenza type b
HSDP: Health sector development program
IMR: infant mortality rate
MCH: Maternal and Child Health
MDG: millennium development goal
NGO: Non-governmental organization
NPW: Non pregnant women
OpV: oral Polio Vaccine
PEI: Polio Eradication Initiative
PI: Principal Investigator
PW: Pregnant women
RED: Reaching every district
RHB: Regional health Bureau
SOS: sustainable outreach service
TT: Tetanus toxoid Vaccine
UN: United Nations
UNICEF: United Nations children fund
URTI: upper respiratory tract infection
V.P.D: vaccine preventable diseases
WCBA: Women child bearing Age
WHO: world health organization
DEFINITION Not immunized: child who didn’t receive vaccine against the eight vaccine
preventable disease except oral polio vaccine (OPV) which is given in polio eradication vaccine33
Defaulter: child who starts to receive vaccination against eight (EPI) diseases but discontinued before finishing the full dose33
Fully immunized : A child who relived one dose of BCG, one
dose of measles , and three dose of Hib—Heb-DPT/OPV 33
Missed opportunities for immunization: when the child age is eligible for immunization and there was no for receipt of the vaccine, but there was not given7
Knowledge: knowing about things, all that are known, body of information34
Attitude: position of body, way of thinking or behaving34
Practice: action as oppose to theory34
CHAPTER ONE
1.1 BACK GRAUND
Infant immunization is considered essential for improving infant and child survival. 1
In 1974 when the world health organization (WHO) launched the Expanded program of
immunization (EPI), the program was based on the belief that most countries already had
some elements of nation immunization activities which could be successfully expanded if
the program become a national priority with the commitment from the government to
provide managerial manpower and fund to provide service to at least 85% of the target
population .i.e. children under four years.1
Because of differences in epidemiological factors the common childhood diseases
targeted for vaccination in Expanded Program on Immunization (EPI) are vary in
different countries around the world. WHO recommended targeted diseases, and also
adopted in Ethiopia are measles, pertussis (whooping cough), tuberculosis, tetanus,
poliomyelitis and diphtheria. 1
Recently Hepatitis B virus and Homophiles Influenza type b are included in EPI
program in Ethiopia. 2
EPI was started in Ethiopia in 1980 with the aim of reducing morbidity and mortality
of children and mothers from vaccine preventable diseases. During the inception of EPI
the objective was to increase immunization coverage by 10 % annually but this target has
not been realized even after two decades because of factors such as poor health
infrastructure, low number of trained manpower, high turnover of staff and lack of donor
funding. The same factors still affect the program today. The target group when the
program started were children under two years of age until it changed to one year in 1986
to be in line with the global immunization target.3,4
Ethiopia has developed a health policy in 1993 and revised EPI policy in 1997.12The
national EPI policy recommends that health workers should use every opportunity to
immunize eligible children according to the recommended schedule. The policy says
children who are hospitalized should be immunized as soon as their general condition
improve and at least before discharge from hospital. An individual with known or
asymptomatic HIV infection should receive all EPI vaccine at as early age as possible.
Patients with overt AIDS should receive all vaccine except BCG and yellow fever. EPI
service should be routinely available preferably on daily bases in all facilities
(Governmental, NGO and private).The policy also state about the need to screen and
assess status of children and women at every contact prior to giving antigens. The
program strategies of EPI are directed for increasing immunization coverage, to reduce
missed opportunities/ defaulters, increasing the quality of immunization service, improve
public awareness and community participation, to sustain high immunization coverage
and disease Eradication/control/Elimination strategies.5
One of the strategy to combat vaccine preventable disease is immunization , 2001
EFY national report showed that the immunization coverage of DPT3,measle and fully
vaccinated has reached to 72.6%,64.9%,and 52.5% respectively and in Oromia region
the coverage was 74.4% 81.8% and 51.0 % respectively5
The Polio Eradication Initiative (PEI) is a global program with the target of a polio free
world by the year 2005. Ethiopia has achieved tremendous progress in its Polio
Eradication Initiative activities since it commended in 1996. 6
The immunization program is funded primarily by partners and government; vaccine
cost by UNICEF, salary by government, cold chain equipment, transport equipment,
social mobilization and some operational cost by WHO, UNICEF and other development
partner .In terms of health financing and budget provisions, the government has taken
steps to reallocate resource from curative to preventive care targeting the rural
population.16 So the involvement of stakeholders/partners is important for strengthening
immunization service and the achievement of high coverage7.
Ethiopia is using different strategies and innovations to increase the national EPI
coverage throughout the country to benefit from it in reducing child and infant
mortality that is one of the millennium development goals of 2015 but still national EPI
coverage is low. During the years 2001-2002 there was an increasing trend in EPI
coverage where the national coverage based on DPT3 reached 70% and after wards the
coverage began to decline to 65 % in 2003/4. 7
To achieve the Millennium Development Goal 4 (MDG) of reducing child deaths by
two-thirds in 20153Ethiopia has adopt strategies such as SOS and RED that focus on
identifying bottlenecks and developing community ownership of the services in order to
improve routine immunization services and increase coverage.6
RED is a multi-faceted approach with the goal of reaching >80% DTP3 coverage in
every district in >80% of developing countries by 2005. This goal is referred to as the
"80/80 goal". It is the accepted approach to achieve a sustained and equitable access to
good quality immunization services and accelerate progress towards achieving the 80/80
goal. This approach means reaching every child in every district with quality
immunization services. The main components of RED include re-establishing outreach
vaccination, supportive supervision, linking communities and services, monitoring for
action, and planning and management of resources. The Comprehensive Approach for
Immunization are Increase and monitor vaccination coverage, Improve health system
service delivery and management , Decrease drop-out rate, Improve logistics system ,
Promote positive behaviors in support of immunization , Improve epidemiological
surveillance System , Increase supervision: process review and follow-up , Maximize
cost-effectiveness ,Improve inter-agency coordination.7,15
Currently, EPI policy guideline has revised in 2007,the country’s immunization effort
move from developmental phase focusing on coverage to a phase that concentrates on
disease control and eradication and this showed that the country commitment for
strengthening immunization service and sustaining high immunization coverage. The
country has a program strategy to meet objectives “to reduce infant and maternal
morbidity and mortality by immunizing every child and women of child bearing age
against vaccine preventable diseases “and contribute to the achievement of the MDG.13
Improving public awareness through intensive, regular and wide implemented
social mobilization and health information activities. Develop information, education
and communication (IEC) materials in different language to argument the public
understanding about the immunization service. Increasing public demand for
vaccination and vita A supplementation through IEC behavioral change ,
communication, health information in health institution , dissemination of progresses
and achievements increase communication skill of health workers in public and private
sectors through training and review meetings , Increase the involvement and support of
community political and direct contacts with health workers through eldership and
directives from higher political and religious is EPI policies 20
EPI program at Serbo town
The Werda health office has currently worked together with Serbo health center to provide excellent EPI coverage to the town. The health center has currently 12 nurses, 2 HO, 2 pharmacists, 2Lab.Tech, 1HA, and 17administrative staffs. A total of 36 men power are stands for the town health service22
EPI coverage at Serbo town in the year 2001 was BCG 82%, Penta1 75.8% Penta3 61.1%, Measles 48.7%, fully immunized 42.4%, TT2+pw 43.6, TT2+npw 7.4 %22
1.2 STATEMENT OF THE PROBLEM
Ethiopia has an estimated population of approximately 76million.Although infant
mortality rate (IMR) has declined from 97/1000 in 2000 to 77/1000 in 2005 it is still
among the highest in the world from a total under five deaths in Ethiopia 28% is due to
pneumonia 25% due to neonatal condition 20% each due to malaria and diarrhea 4% due
to measles and the rest by other. Yet there is effective low cost intervention to prevent
two/third of these deaths of every 100 children in Ethiopia. 14 do not celebrate their
birthday due to vaccine preventable disease through EPI8
Every year more than 10 million children in low- middle-income countries die
before they reach their fifth birthdays. Most die because they do not access effective
interventions that would combat common and preventable childhood illnesses.3
About 472,000 Ethiopian children die each year before their fifth birthdays. This
make under five mortality rate bout 140/1000 with variations among the regions from 114
to 233/1000 .This tragic fact places Ethiopia sixth among the countries of the world in
terms of the absolute number of child deaths. Among the cause of mortality, vaccine
preventable diseases are the major ones. 2
Diphtheria affects people of all ages, but most often it strikes immunized children. In
2000, 30 000 cases and 3000 deaths of diphtheria were reported worldwide.2
Pertussis or whooping cough is most dangerous in infants. In 2004 and 2005, a total
of 26,335 and 22,139 cases in Africa and 236,844 and 121,799 cases globally reported
from 165 and 156 countries respectively. Whereas the DPT3 coverage at that time were 68
and 72% in Africa and 85 and 86% globally from 182 and 183 countries report. In 2002,
an estimate of 294,000 deaths occurred worldwide due to pertussis. 14
Poliomyelitis or polio is a crippling disease .Since the global initiative to eradicate
polio was launched, the number of reported cases of polio has been reduced from an
estimated 350,000 in 1988 to 483 cases associated with wild poliovirus in 2001.13
People of all ages can get tetanus. But the disease is particularly common and
serious in newborn babies. This is called neonatal tetanus. Most infants who get the
disease die. It is particularly common in rural areas where most deliveries are at home
without adequate sterile procedures. In 2000, WHO estimates that neonatal tetanus killes
about 200,000 babies.13?
Not everyone who is infected with tuberculosis bacteria develops the disease. In 2001,
approximately two million people worldwide died of tuberculosis. 13
Hepatitis B is caused by a virus that affects the liver. Adults who get hepatitis B
usually recover. However; most infants infected at birth become chronic carriers i.e. they
carry the virus for many years and can spread the infection to others. In 2000, there were
an estimated 5.7 million cases of acute hepatitis B infection and more than 521,000
deaths from hepatitis B related disease.13
Homophiles influenza type b (Hib) is one of six related types of bacterium. In 2000,
H .influenza type b (Hib) was estimated to have caused two to three million cases of
serious disease, notably pneumonia and meningitis, and 450,000 deaths in young
children.13
Measles is a problem in Ethiopia, due mainly to the low measles immunization rate
[estimated coverage of 51% in 2001). A total of 3,797 cases and 58 deaths due to measles
were reported in 2002-03. ]
Tetanus is caused by the microscopic bacteria clostridium tetani. is a dangerous disease that affects both children and adults. Nevertheless, new born babies are mostly and severely affected.The World Health organization report indicates that tetanus kills 500,000 -1000, 000 infant sever year. Therefore, most children who are infected with tetanus in their first week of life are prone to die due to this disease. In Ethiopia over 17,900 children are affected by tetanus every year, out of which, 13,400 of them die. Statistics also show that about 2000 mothers also die due to tetanus.
A 2001 vaccine-preventable diseases estimate of WHO showed that the greatest
burden of disease in Sub-Saharan Africa were deaths of pertussis, tetanus, and measles
which account 58 percent, 41 percent, 59 percent, and 80 percent respectively. East Asia
and the Pacific have the greatest burden from hepatitis B with 62 percent of deaths
worldwide. South Asia also experienced a high disease burden particularly for tetanus
and measles. 11
In 2007, A total of 24.3 million infants not immunized DPT3, from which Africa
account 7.3%, South East Asian account 11.5% ,Europe account 0.4%, Western pacific
and Eastern Mediterranean account 1.95 each and America account 1.1%.12
Infant and under five mortality rates in Ethiopia are among the highest in the world.
Diarrhea diseases, vaccine preventable diseases (V.P.Ds) and malnutrition are responsible
for a majority of childhood deaths in Ethiopia.16
Delivering immunization service to mothers and children is affected by verity of factors .these are Availability of resources to provide the service, motivation of health provider and creating good interaction with clients in providing the service vaccinating children properly provision of necessary health massages to the client about the importance of vaccine and appointing clients in the right schedule and Appling policy to create suitable appropriate and conductive environment to clients.
Generally the EPI coverage is not as it expected by the national ministry of health.
CHAPTER TWO LITRATURE REVIEW
EPI is essential for improving infant and child survival although the coverage can be
improved by increasing KAP of the population.
A survey conducted in China about KAP towards Vaccine preventable disease the result shows that the level of immunization knowledge among parents was positively associated with attitude and practice of immunization. Immunization coverage was 89.3% in the high stratum in 63.8% in the low stratum service area 28
A study in Bangladesh KAP was majored before and after an educational program shows that an increase in knowledge range from 13% to 37% regarding signs and symptoms in all EPI target diseases also noted increase of 27 to 37% knowledge about vaccine only 1 – 2 % of respondent had knowledge of the EPI vaccination schedule before educational interval. Before educational program 77% of parents agreed that child immunization is necessary after the program 100 % agreed 23
In Africa, a serious 30 cluster immunization coverage survey was undertaken as a survey of KAP among parents result of the survey showed 90% of population begins immunization but 30% drop out. The single largest obstacle immunization was a failure to six children 29
The survey conducted in Ethiopia and the weighted national immunization coverage assessed by card plus history for children aged 12-23 months vaccinated before the age of one year was BCG 83.4 5, DPT1 84.3%, DPT3 66.0% ,measles 54.3% , and fully immunized children 49.9% . The weighted national TT2+ Coverage and rate of protection at birth /PAB/ assessed by card plus history was 75.6% and 63.0 % respectively.
The survey showed A 10 percentage point of increment in DPT 3 coverage compared to 2001 survey converges. How ever progress was not uniform in all regional of the country. despite the improvement in the access to immunization in the country .DPT3 coverage was less than 30% and drop out rate remained very high in three merging region effective change communication /BCC/ strategies need to be designed and implemented to tackle high drop out rate in the program .besides health workers training program on interpersonal communication and reaching every district /RED/ approach should be fully implemented to increase and sustain high level of immunization coverage in Ethiopia. 21
A community based cross sectional survey in Ziway town eastern showa shows 53% of children was fully immunized, 19 % was defaulters and the rest were totally none
immunized. The reasons for defaulters were inconvenience of vaccination time child sickness and lack of information about the need for repeated vaccinate on 30
April 1995 in Gonder and surrounding villages in West Ethiopia cluster sampling was conducted to assess immunization coverage in area and problem associated with vaccination delivery, among the sample children 47.4% fully immunized while 30% were not immunized at all. The reason given for not immunizing children were lack of knowledge 39.7% social problem 38.7% various obstacles 22% such as child sickness and health institution related problems31
A cross sectional community based study was carried out in Jimma town South west Ethiopia to determine reason for defaulting from expanded program of immunization ( EPI) using structured questionnaire in March 1997 a total of 376 children aged 12 to 23 months and their mothers were covered in study. Out of total 376 children 46.5% were fully immunized 53.5% were defaulters. The reason given by mothers for not completing vaccination, Were missed appointments time 48.8% mothers and no enough time 25.9% and child was sick 23-4% maternal age, neonatal care , parity, education knowledge about vaccine preventable disease and immunization32
Another study in Jimma town shows higher acceptance of immunization by mothers who have been educated to above 6 grade and the higher of educational status the higher rate of completing the vaccination schedule and the relation between occupation and child immunization were government employee was the first to fully immunize their child that is i.e. 94% and the least was house made that is 50% the reason for this might be government employee could have access to know the benefit of immunization from their passed education and daily activities but house maids might have lack of education & economy . Also the study had been identified factors associated with non immunization and defaulters was illiteracy, lack of knowledge about EPI target diseases
Attitude of mothers were 45.6% said very useful, 54.1% said useful and the rest 0.3% said not useful. Therefore, knowledge about vaccine, benefit of immunization and attitude towards immunization were all found to have significance association with educational status of the mothers (P value >0.00) 32
Currently a great consideration have given for immunization, the result have been under expected. The aim of this study will be to assess the obstacles in relation to the mother KAP to child immunization.
CHAPTER THREE
3.1 SIGNIFICANCE OF THE STUDY The highest proportion for child hood death is due to vaccine preventable disease2
The service with the provision of health message to the population about the vaccine is the first to increase the EPI coverage.
Non- immunization was associated with low socioeconomic status maternal illiteracy and lack of mother’s knowledge on vaccine preventable diseases as recommended by the expanded program on immunization 23
The problem of management of intersectional co-ordination and lack of public awareness of the purpose and importance of immunization persisted25.Lack of information about the child’s immunization status and complexities of immunization schedules and misconception regarding multiple vaccine contradiction and adequate emphasis to parent about the importance of the timely completion of immunization 25
Lack of community participation was also found to be crucial constraining factors 26
However, the two principle problems in the way of achieving effective immunization for all children are lack of awareness and lack of knowledge. Miss information about immunization is amongst the most serious traits to the success of immunization program. Some examples of rumors are:
“Vaccines are contraceptives to population or to limit the size of certain ethnic group”
“Vaccines are contaminated by AIDS virus “
“Children are ding after receiving vaccines “
The consequence of rumors can be serious and if not unchecked those can drawback the EPI program 21
This study helps to detect mothers KAP towards the eight vaccine preventable disease, common defects of mothers for not vaccinate their child also the result could be help to plan for child immunization based health education to the community, facilitate better and large scale study in the town and better practice among mothers for child immunization are encouraged based on findings. These studies is intended to supplement information to improve EPI coverage of the town
The finding of this study will offer an insight to the EPI service providers at Serbo town for effective program implementation.
CHAPTER FOUR OBJECTIVE OF THE STUDY
4.1 General Objectives
To assess knowledge attitude and practice of mothers in Serbo town towards the eight vaccine preventable disease.
4.2 Specific objectives
To determine the knowledge of mothers towards vaccine preventable disease
To assess the practice of mother to vaccinate their children in Serbo town.
To describe attitude of mother towards the eight vaccine preventable disease.
To determine the Socio-Demographic of mother in relation to child and mother immunization
To give recommendation based on the study result
CHAPTER FIVE METHDOLOGY AND MATERIAL
5.1 Study Area
The study will be conducted in Serbo town Kersa Wereda Jimma Zone South West Oromiya Ethiopia
Kersa Woreda one of the 17 Woredas that are found in Jimma Zone, it is situated 18 km away to the north east of Jimma town and 325 km away from Addis Ababa to the south of Ethiopia. The district has a total population of 176,667 and 978 km2 and bounded by Limmu Kossa, Tiro Afttata, ommo nadda and Manna, Dado to the north, east, west and south respectively 22
And the district has 31 Kebles and capital of the district is Serbo town. District is situated 315 km from Addis Ababa to the south west of Ethiopia. The climatic condition of the district is 10% Dega and 90% Weina Dega it is found on 1600-2400m above sea level 85% of the population economically depend on the agricultural the district has three health center and 26 health post and 30 Kebles has covered by health extension program22.
Serbo town is one of among high risk malarias area and the total population of the town is 6091 and 1218 of households are found and 1103 under five children, 213 under one year, 719 < 3 year , 512 1-3 years , PW 231, NPW 1054, WCBA 1346, in the Serbo Keble. And the average family sizes five per house hold and it’s found on attitude 1640m above sea level with Weina Dega climate condition. The annual temperature ranges between 11.2 and 29.6 0c the annual rain fall is 1150 mm. the town has one health center, three private clinic, four rural drug vendor and it has governmental and nongovernmental organization. Regarding to their ethnicity the majority of the resident is Oromo which accounts for 90% and Gurage, Amara, yem and other are accounts for 10%. Their economy is depends in cash crop trade 22
5.2 Study design
A descriptive cross sectional study will be undertaken to assess KAP among mothers of Serbo town towards the eight vaccine preventable disease.
5.3 Study period
From Jan 15- 30/ 2010 GC
5.4 Population
5.4.1 Source population
All children’s b/n age of 12-36 month.
5.4.2 Study population
Children and their mothers will be selected by sampling technique in order to represent the source population.
5.5 STUDY VARIABLE
5.5.1 Independent variables
Age
Sex
Occupation
Educational status
Monthly income
BCG scar
4.5.2 Dependent variables
Knowledge
Attitude
practice
5.6 Sampling size and sampling technique
5.61 sample size determination and sample size.
According to kersa woreda health department in 2001 EPI coverage of the Serbo town for penta 3 was 61.1%22 .Using this as a reference
The sample size will be determined by the following formula.
n= NZ 2 P(1-P)
D2(n-1 )+Z2P(1-P)
Where: n= sample size
N = source population
Z = standard normal distribution 95%
P= prevalence of penta 3 60.1%
D= degree of confidence interval (0.05)
Where Z = 1.96
N= 512(1.96)2 (0.6)(1-0.6)
(0.05)2 (512-1)+(1.96)2 (0.6)(0.4)
= 104
5.62 sampling technique
A total of 104 children’s & their mothers will be assessed by using purposive sampling techniques.
5.7 DATA COLLECTION AND PROCEGURE
The data is collected by student who completed grade 10 and supervised by diploma nurses.
Data collection will be collected using Questioner and checklist, interview of clients, observation and document review (EPI card)
The households in Serbo towns visited until 104 children 12-36 month age and their mother is found the households don’t have to be randomly selected and there may be visited in any order. Mothers were asked to show immunization cards for child &/ TT immunization. If immunization cards were lost then the maternal report of immunizations was taken. Presence of BCG scar was observed in surveyed infants.
5.8 DATA QUALITY CONTROL
To assure the quality of data
Training will be given for data collector for 1 day prior to data collection.
Data collection tool will be translated to “Oromiffa” and re- translated to
English.
Collected data will be checked for its completeness and clarity
On spot, Correction of data will be made
Follow -up and supervision will be conducted by supervisor during data
collection period and support will be given to data collectors as time of
difficulty.
5.9 DATA ANALYSIS AND INTERPRITATION
Data will be collected and compiled manually. Each collected data will be coded during
data entry period and entered in to SPSS version 16.0 software for analysis. Two methods
of analysis will be used in this study .for qualitative data the result will be
analyzed ,categorized and be written in narrative form and for quantitative data
percentage and frequency analysis will be computed and the result will be presented in
narrative forms.
Data will be interpreted using static tools like person correlation coefficient b/n variables
and Result will be presented using dimensions and critical finding will be displayed using
graph and table.
5.10 OPERATIONAL DEFINITION OF TERMS Satisfactory knowledge – those mothers /caretakers who answers
>60% of the knowledge questions 35
un Satisfactory knowledge – those mothers /caretakers who answers
< 60% of the knowledge questions35
Favorable attitude – those mothers/care givers who answers >60% of
the attitude questions35.
Unfavorable attitude – those mothers/care givers who answers <60%
of the attitude questions.
Good practice -those mothers/care givers who answers >60% of the
practice questions35
Poor practice- those mothers/care givers who answers <60% of the
practice questions35.
5.11 ETHICAL CONSIDERATIONThis study will be conducted after the approval of the proposal by Jimma University student research
office. Offical letter from Jimma University to Kersa Woreda Health Office will be written. Written letter
will be obtained from Woreda health office. Permission and verbal consent will be obtained from each
respondent during observation and interview and confidentiality will be also assured before conducting
data collection process. The raw data obtained from clients’ interview will be protected.
4.12 LIMITATIONS
Fear of getting child immunization card.
BCG scar may not present even if the chilled have received the vaccine.
CHAPTER FIVE
Budget of the proposal
Budget allocation for varies activities as proposal
No Budget Category Unit cost Multiplying factor Total Cost (Birr)
1 Personnel Daily wage (including per diem)
No of staff days (no of staff x no of working days)
Principal investigator 70 70*1*15 1050
Supervision 70 70*2*15 2100
Data Collectors 35 35*3*15 1575
Data Entry clerk 58 58*1*4 232
Secretarial work 58 58*1*4 232
Sub total Personnel Total 5189
2 Transport Cost per trip No of trip
Car 10 1*15*10 150
Sub Total Transport Total 150
3 Supply Cost per item Number
Questionnaire duplication 0.30 624*0.30 187
Clip board 25 5*15 75
flip Chart paper 25 1*25 25
Pen 2 5*2 10
Pencil 1 5*1 5
Eraser 1 5*1 5
Sharper 1 5*1 5
Marker 10 2*10 20
Printing Paper 75 2*75 350
Photo copy cost 0.30 47*0.30 14
Printing & Binding 5 3*5*141 2115
Sub Total Supplies Total 2811
4 Training Cost per item No of days
Hall rents 200 1*200 200
Tea/Coffee 5 5*5 25
Sub Total Training Total 225
Total 8375
Contingency 5% 419
Grand total 8794
CHAPTER SIX PROJECT WORK PLAN
THE GANT CHART
Activities Responsible
Sep Oct Nov Dec Jan Feb Mar April May June
Topic Selection PI
Submission of first draft of proposal
PI
Submission of second draft proposal
PI
Submission of final draft proposal
PI
Data collection PI and Data collector
Data entry analysis and interpretation
PI
Report writing PI
First draft report submission
PI
Second draft report submission
PI
Final thesis report submission
Pi
7, REFERANCE
1, M.K.JINADU, Lecturer, perspective in primary care: A case study in the
Administration of the expanded program of immunization in Nigeria, Journal of tropical
pediatrics, 1983 29(217-219)
2. World Health Organization, United Nations Foundation, (2004). “Immunization in
Practice” Modules for Health Staff 2004 update, United Printers, Ethiopia
3. FMOH, EPI policy guideline, Ethiopia 2007
4. http://www.who.int/countries/eth/areas/immunization/en/ (1 of 2) accessed in
8/25/2009 10:19:32 AM
5. FMOH, health and health related indicator, 999E.C (2006/7 G. c)
6. Expanded program of immunization, Ethiopia, November 8, 2008, accessed from
internet, in 26/8/2009
7. (FMOH, 2004). FMOH, Ethiopia Family Health Profile, 2003/4.
9, UNICEF, Immunization-expanding immunization coverage, accessed from internet in
Aug.25, 2009
10. FMOH, National strategy for child survival in Ethiopia, July 2005, AA, Ethiopia
11. Disease control priorities project Estimates of the Current Burden of Vaccine-preventable Diseases and of the Burden Averted by Vaccination, [http/www .dcp2.org/disease/47,accessed on internet on Aug 30, 2009.)
12. WHO, progress towards global immunization goals-2007, summary presentation of
key indicators, updated September 2008, slide Global immunization, PDF
13,JW Lee. Child survival: a global health challenge. Lancet 2003; 362: 262- (Cross
reference:http://www.who.int/bulletin/volumes/85/6/06-031526/en/index.html#R1.)
14. WHO Vaccine preventable disease: monitoring system, 2006 global summary,
WHO/IVB/2006
15. WHO and FMOH, Enhancing Routine Immunization Service in Ethiopia: field guide
and essential tools for implementation, no date]-2
16. FMOH, National strategy for child survival in Ethiopia, July 2005, AA, Ethio8.
FMOH, EPI: Comprehensive multi-year plan 2006-2010, August 2006 Ethiopia.
17. FMOH, National strategy for child survival in Ethiopia, Ethiopian National health
policy, July 2005, AA, Ethiopia
18. Onta, Sabroe & Hansen, The quality of immunization data from routine primary
Health care reports: a case from Nepal. Health Policy Plan 1998, 13:131-139. Pub Med
Abstract] [Publisher Full Text
19. WHO Regional Office for Africa, “Mid- Level Management Introductory Course for
EPI Managers) draft, March 2004
20. Expanded program on immunization, policy guideline, federal democratic republic of
Ethiopia minister of health revised in 2007
21. [Ethiop .J .Health Dev. 2008; 22(2):148-157]
22, kersa woreda health office yearly report 2001ec
23. Rahman MM; Esram MA; Mahalanab is D. Mother knowledge about vaccine preventable disease and immunization coverage of population with high rate of illiteracy journal of tropical pediatrics 1995 deci 41(6)376-8
24. Stratified K.SingarimbunM. Social factor affecting the use of child hood
immunization in yogyakata ,java ,Yogyakarta Indonesia ,Gadiah moda
university .population study center 1986 jun V.59
25. Gore prosannal ; Madhovan suresh, curry Duauld, MC clung gorden castiglia Marrye;
arosenbluth Sidney smego 48(1999) 1011-1024
26.Okoro Ji ,Eghwn in Essential facter in the implementation of EPI in an urban
periurban community in Nigera Asia Pac. J Public health 7(2);105-10;1994.
27. Shieferaw T.survey of immunization levels and facter affecting program participation
in Kaffa south weast Ethiopia ,Ethiopia journal health devt 1990 4(1)51-59
28. Zhang X wang L;Zhux wang K. Knowledge attitude and practice Survey on
immunization service delivery in Gu angxi and Gansu china ,social science and medicine
1999;49(8) 1125-7
29, Field R; Overcoming obstacles to immunization in Africa (unpublished)1993
presented at the 121st Annual meeting of the American public health Association .
30, Berhane Y;Masresha ,F;Zerfu M;Birhanu M;Kebede ,S;shashikant ,S; status of EPI in A rural to can
south Ethiopia .Ethiopia medical journal ,Vol 33,no 2;PP.83-93,1995
31,Gedlu ,E, tesemma,T, immunization coverage and identification of problem
associated with vaccination delivery in Gondar north west Ethiopia .east Africa medical
journal ,Vol 74,no 4;1997 pp23 9-241
32, Jira ,Chali ;MPH Reason for defaulting from expanded program of immunization in
Jimma town south western Ethiopia . Ethiopia journal of health science July 1999 vol 9
(2)93-99
33, Guide line of immunization in practice Ethiopia 2009 revised.
34. Joyce M.hawkins; the oxford mini dictionary clarendon press .New York 1991., 35.
35. Research on KAP about benefit of breast feeding by HO student’s 2009 at Metu
Hospital.
8: - ANNEX –
8.1 DUMMY TABLES
Table1: - Socio-demographic characteristics of mothers surveyed at Serbo town
Kersa Woreda Jimma Zone Jan 2010
Characteristics of surveyedmothers
No of Mothers surveyed
Educational statusNo %
Not able to read and write
Read and write
Primary schooling
Secondary school+
Total
Marital status
Married
Single
Divorced
Widowed
Total
Occupation
House wife
Gove. Employed
House maid
Self- employed
Farmer
Total
Religion
Muslim
Orthodox
Protestant
Total
Age
15-24 years
25-34 years
35-44 years
>=45 years
Total
Table 2 Accessibility of means of communication by number and percent of mothers at serbo town Kersa Woreda Jimma Zone Jan 2010
Access to information No %
Radio
Television
News paper
Health institution
Other
Total
Table 3: Association between mother’s Educational status and Immunization practice among Sarbo town residents Jimaa Zone Oromiyaa region Jan 2010
Educational Status
Immunization practice
Fully immunized
No (%)
Defaulter
No (%)
Non immunized
No (%)
X2 p-value
Illiterate
read and Write
grade 1-6
grade 7-11
12+
Total
Figure 1Type of vaccines and mother’s who identifies the Vaccines in serbo
town kersa woreda, Jimma zone Jan 2010
Table 4 Monthly income and immunization status of served children in
serbo town, kersa woreda, Jimma zone Jan 2010
Monthly income Not immunized
No (% )
Defaulter
No (% )
Fully
Immunized
No (%)
x2 p-value
<150
150-300
300-600
600-1000
>1500
Total
Table 5 Vaccination status of mothers and childrens in serbo town kersa woreda, Jimma zone Jan 2010
Not Immunized Defaulter Fully Immunized
Total %
Mother
Children
Total
Table 6 Distribution of children b/n 12-36 month of age by vaccine type received in serbo town kersa woreda, Jimma zone Jan 2010
Vaccine type No %
BCG
Pentavalent and OPV 1
Pentavalent and OPV 2
Pentavalent and OPV 3
Measles
Total
Table 7 Reasen for not being immunized in children b/n 12-36 month of age in serbo town kersa woreda, Jimma zone Jan 2010
Reason No %
Too far from vaccination site
Lack of information about vaccination
Child was sick
Mother was sick
Time inconvenience
Total
Table 8 The reason for defaulting immunization inservedchildren’s in serbo town kersa woreda, Jimma zone Jan 2010
Reason No %
Forgot to go for repeated vaccine
Change of place
Child was sick
Mother was sick
Un aware of need to return for 2nd 3rd dose
Time of immunization inconvenience
Total
Table9:- Type of vaccines and mother’s who identify the Vaccines in serbo town kersa woreda, Jimma zone Jan 2010
Type of vaccine No of mother’s %
Yes No
1 Polio
2 BCG
3 Measles
4 Hib
5 Diphtheria
6 Pertusis
7 Heb
8 TT
Total
Table 10 Association of educational status with child immunization and recalled child hood vaccine preventable diseases by mothers, in serbo town kersa woreda, Jimma zone Jan 2010
Characteristic Illiterate
No (%)
Read and write No (%)
Grade1-6
No (%)
Grade 7-11 No (%)
12+ No (%)
Total No ( %)
X2 p-value
Knowledge of immunization
satisfactory
unsatisfactory
Benefit of immunization
To cure
To prevent
other
Attitude towards immunization
favorable
unfavorable
Recalling of vaccine preventable childhood diseases
Polio
BCG
Measles
Hib
Diphtheria
Pertusis
Heb
TT
Figure: - 2 vaccination status of mothers and children in serbo town kersa woreda, Jimma zone Jan 201
Table 11 Desteribution of respondantes by thair socio-Demographic factor and their knowlage
Attitude and Practice towaredes the eight vaccine preventable diseas at serbo town Kersa Woreda
Jimma Zone Jan 2010.
Characteristic of
surveyed motherKNOWLAGE ATITTUDE PRACTCE
SATESFACT
ORY
UNSATESFA
CTORY
FAV
ERA
BLE
UNFA
VERA
BLE
GOOD POOR
EDUCATIONAL
STATUS
NO % NO % X2 P-VALUE N
O
% N
O
% X2 P-
VALUE
NO % NO % X2 P-VALUE
ILLITERATE
READ AND
WERITE
PRIMERY
SCHOOL
SECONDERY
SCHOOL +
TOTAL
MARITAL
STATUS
MARRIED
SINGLE
DIVORCED
WIDOWED
TOTAL
OCCUPATION
HOUSE WIFE
GOVE. IMPLOYE
FAREMER
OTHER
TOTAL
RELIGION
MUSELIM
ORETODOXE
PROTESTANT
OTHER
TOTAL
AGE
15-24 YEARS
25-44 YEARS
>45YEARS
TOTAL
FIGUER: - 3 Immunization statuses of children in Serbo town Kersa Woreda
Jimma Zone Jan 2010.
8.2 QUESTIONNARES
Jimmy University
Nursing department
Consent form
My name is______________________ I am from __________________________________.
The purpose of this interview is to assess knowledge attitude and practice of mothers towards the eight
vaccine preventable chilled hood dieses at Serbo town to provide useful information for program
managers and providers who enable them to improve the service provision .Your information is very
useful to this study. All information taken will be kept confidential. You have the right not to participate
in the interview or to refuse at any stage of interviewing.
I agree to continue---------------------
I disagree--------------------------------
Questionnaire for child and mother immunization status.
Part –I- Socio-demographic characteristics
1. Name of mother--------------------------------
Sex------------------
Age---------------
Address /Keble/----------------
2. Name of child ____________________________
Age ------------
Sex --------- Card no ---------
3. Marital status of the index child mother
1. Single 2.Married 3. Divorced 4.Widowed
4. Religion
1. Muslim _________________
2. Orthodox______________
3. Protestant_______________
4. Other specify_____________
5. Ethnicity
1. Tigre
2. Oromo
3. Amhara
4. Yem
. 5. Others (specify)
6, Educational status of the index child mother
1. illiterate
2. read and write
3. grade 1-6
4. grade 7-11
5. 12+
7. Occupation of the index child mother
1. House wife
2. Gove. employed
3. House maid
4. Self- employed
5. farmer
6. Other (specify) _____________
8. Monthly income of the family-----------------------------------
1. <150
2. 150-300
3. 300-600
4.600-1000
5. > 1000
9. Who in the family make the decision to take the child for vaccination?
1. Mother
2. Father
3. Both together
4. Other (specify) --------------------
10. Access to information about immunization.
1. Radio 3. Television
2. News paper 4. Health institution 5. other (specify)______
Part II- Knowledge towards eight vaccine preventable disease.
2-1 Knowledge towards child vaccination.
1. Did you know about child immunization?
1. Yes 2. No
2. If yes for Q,No 1 What is the benefit of immunization
1. To cure 2.To prevent 3. I don’t know 4. Other /specify/--------------------
3. If yes for Q no1 did you know at what age should your child start vaccination?
1. At birth 2.At 6 week 3. Any time 4. Other /specify--------------------------------------
4. Did you know how many times your child should receive vaccine?
1One times 2. Three times 3. Five times 4. Other /specify-----------------------------
5. Can you name childhood diseases that can be prevented by vaccine?
1. Polio 2.Mussels 3.TB 4 Hib 5. HEb
6. Peruses 7. Diphtheria 8.Tetanus
6. Have you ever heard child having problem related with vaccination?
1. Yes 2. No
7. If Yes for Q. No 6 what happens?
1. Paralyzed 2.Became deaf 3. Can’t breathe
4. Dead 5. I can’t remember 6. Other /Specify/------------------
2-2 Knowledge towards mothers immunization
1. Did you know about mother’s immunization?
1. Yes 2. No
2. If yes Q No1 what is the use?
1. To prevent mothers from tetanus disease
2. To protect neonatal tetanus
3. Other/specify---------------------------------
3. If yes QNo1 what kind of disease is prevented?
1. Tetanus 2. Meningitis
3. Other/specify-------------------------------------------------
4. Do you know when mothers should start TT vaccine?
1. Any time
2. during pregnancy
3 other/specify
5. Did you know how many times should a mother have to receive TT?
------------------------------------------------------------------
Part III Attitude towards eight vaccine preventable disease.
3.1 Attitude towards child vaccination.
1. Did you think vaccination is important?
1. Yes 2. NO
2. If no Q No 1 reason
1. Vaccines are contraceptive
2. ‘’ are contaminated by disease like HIV
3. ‘’ kill the infant or induced Abortion
4. ‘’ have no use at all
5. ‘’ IS agents’ religious belief
3. How did you think/feel/ about immunization
1. Very useful 2. Use full 3. Not useful 4. Other/specify/ -----------------------------
4. Do you think completing vaccination according to the schedule is important?
1. Yes 2. NO
5. For Q No 4 Yes/No Reason for ----------------------------------------------------------------------------
6. Where do you prefer to receive vaccine?
1. Health facility 2. From campaign 3.Other/specify----------------------------------------
7. What do you think about a child receiving vaccines from campaign, after he/she completing routine immunization schedule?
1. Important 2. Not important 3. Other specify------------------------------------------
8. Did you think the side effects of vaccines are dangers?
1. Yes 2. No
9. If Yes for Q. No 8 describe_________________________________________
3.2 Attitude towards mother vaccination.
1, What do you think about mothers immunization/TT/?
1. Important 2. Not important 3. Other specify------------------------------------------
2.When do you prefer to receive TT vaccine?
1. During pregnancy 2. According to the schedule 3.Other/Specify----------------------------------
Part IV Practice towards eight vaccine preventable disease.
4.1 practice towards child vaccination.
1. Have you vaccinated your child?
1. Yes 2. No
2. If no Q No1 reason
1. Too far from vaccination site
2. Lack of information about vaccination
3. Child was sick
4. Mother is sick
5. Time inconvenience
6. Other /specify/
3. If yes Q NO 1, Did he/she completed vaccination according to the schedule?
1. Yes /Fully immunized/ 2. NO /Defaulter/
4. If ‘B’ Q No 3 reason
1. Too far from vaccination site
2. Child was sick
3. Mother is sick
4. Time inconvenience
5. Unaware the need to return for repeated vaccine dose
6. Forget to go for repeated dose
7. Change in place of vaccination site
8. Other /specify/-----------------------------------------------------
5.How much times your child received vaccine?
1. Once 2. Twice 3.Three times 4. Four times 5. > Five
6. Other/specify----------------------
6. Have you ever seen side effect of a vaccine while children’s have vaccinated?
1. Yes 2. No
7. If Yes for Q. No 7 describe
1. Fever
2. Swelling, pain, readiness at the site of injection
3. Rash
4. Loss of apatite
5. Other /specify/_____________
4.2 practice towards mother vaccination.
1. Have you received TT vaccine?
1. Yes 2. No
2. Have you completed TT vaccine according to the schedule?
1. Yes 2. No
1. Check lists for direct observation
Immunization given
BCG Pentavalent and opv Measles TT BCG scare
1 2 3 1 2 3 4 5 Present
Not present
Date
2. Does the provider told you about the importance of immunization?
1. Yes 2. No
3. Do you have any idea how the service can be improved?
THANK YOU!
Name Interviewer _______________________ Date ______________ Sign_________
Name of supervisor ________________________Date ______________Sign__________