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__________