INDIAN JOURNAL OF PEDIATRICS Vol. 44
PRACTICES OF M O T H E R S T O W A R D S P O L I O DROPS* DHARAM ]3. SFIARMA AND E . G . LAHORI
Eradication of small pox in this country has been a m a j o r triumph of preventive medicine. However, diseases like poliomyelitis, diphtheria, whooping cough, tetanus and tuberculosis which by virtue of the a v a i l a b i l i t y of immunising materials are well within the range of preventive medicine continue to occur with such frequency as to pose a constant challenge to the treating physician a n d to entail an enormous loss to the nation. Studies from various parts of the country have documented an alarmingly low rate of immunisation against these diseases among infants and preschool children (Gupta and Agarwal 1972, Chansoria et al. 1975, R e d d y and Bhaskar R a o 1975). At the time of inception of the D e p a r t m e n t of Paediatrics at the G o v e r n m e n t Medical College, J a m m u , we w e r e impressed by the observation that a large n u m b e r of mothers brought their children to the newly established child health clinic in the d e p a r t m e n t for polio drops exclusively. T o *From the Department of Paediatrics, Government Medical College ar,d Associated Hospital, Jammu (J&K). Address for Communications: D.B. Sharma,3~--Danis Gate, Iammu (J&K) Received on September 9, 1976.
know whether this awareness of polio drops pointed towards a real or apparent impact of health education, we set out to study the knowledge and practices of mothers towards polio vaccine. Material and Methods The Child H e a l t h Clinic was established in the D e p a r t m e n t of Paediatrics at the G o v e r n m e n t Medical College, Jammu~ in August, 1974, with the objective to provide facilities for periodic health evaluation of infants and preschool children, to conduct immunisation programmes and to render advice regarding family planning. Prior to this, facilities for polio and triple vaccination in J a m m u city existed at the m u n i c i p a l health centres and m a t e r n i t y and child welfare centres and those for BCG at the district tuberculosis centre. I n order to assess the impact of health education pertaining to imrnunisation programmes it was decided to interview the urban mothers regarding their awareness of vaccines and to study their knowledge and practices towards polio vaccine in particular. The study which was conducted over a period of six months between August, 1974 to February, 1975 involved questionnaire interview with 650 urban
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mothers who attended the child health clinic for the first time for procuring the vaccines for their children. The information gathered was entered on a specially p r e p a r e d proforma. 500 mothers had not attended any other clinic earlier and were grouped as freshers. 150 mothers visited the child health clinic for a second dose of polio vaccine after having received the first dose elsewhere and were grouped as repeaters. Observation
T a b l e 1 depicts the comparative a w a r e n e s s / r e g a r d i n g polio, triple antigen, BCG, and small pox vaccines a m o n g the fresher and repeater mothers. White 88 per cent of the ti~eshers and I00.0 per cent of the repeaters were aware of the availability or existence of polio drops, only 13.6 and t 9 2 per cent respectively of the former a n d 24.0 and 21.3 per cent respectively of the latter knew about triple and BCG vaccines. The correlation between the education of the mothers and their awareness regarding vaccines is shown in T a b l e 2. Whereas
T a b l e 1.
a m o n g the fresher mothers educated beyond matriculation, the frequency of awareness of polio, triple antigen, BCG a n d small pox vaccine was 100.0, 30.6, 38.8 and 100.0 per cent respectively and a m o n g the repeaters with similar education 100.0, 36.4, 45.4 and 100.0 per cent respectively it was 86.7, 26.7 40.0 and 100.0 per cent respectively a m o n g those fresher and 100.0, 21.9, 17.2 and 100.0 per cent respectively a m o n g those repeater mothers whose education level was below matriculation. 74.0 per cent of the treshers and 82.0 per cent of the repeaters attended the child heaJth clinic for polio drops exclusively. l?actors which influenced the fresher mothers for their first visit to the clinic were (i) advice of neighbours, friends and relatives (68.2 per cent) (ii) medical advice (13.4 per cent) (iiij occurrence of cases of poliomyelitis in neighbourhood (9.2 per cent) and tiv) self consciousness of child health (~.2 per cent). T h e answer to the question as to what they viewed as the role ot polio drops was rather interesting (Table 3). While 29.4 per cent of the fresher and 65.4 per cent of
Distribution of the 3tudy group according to the awareneJs of availability or the existence of vaccines.
Distribution according to awareness of the availability or existence of vaccines Triple BCG Small pox
Repeaters (n-~ 150)
sHARMA AND LAHORI--KNOWLEDGE
T a b l e 2.
A N D P R A C T I C E S OF MOTHERS
Distlibution of vaccine aware mothers according to the level of education. Distribution according to the awareness of vaccines
Freshels Matric and above
Repealers Matrie and above
the repeater mothers knew that the drops were protective against a crippling disease, 2.6 per cent of the former and 7.3 per cent of the latter considered it as cure for the disease. 56.0 per cent of the freshers and
T a b l e 3.
Role oJpolio vaccine as viewed by the mothers.
Polio-vaccine aware mothers Groups
Freshers : (500) Repeaters : (150)
27.3 per cent of the repeaters were vague in their answers which were as follows: (i) good for children, (ii) children grew better, (iii) they did not know, (iv) they wanted it just because somebody had told them.
RoIe of polio vaccine as viewed by the mothers. Protection against Cure Vague disease of the answers disease
INDIAN .JOURNAL OF PEDIATRICS
79.0 per cent of the repeater mothers were late by over eight weeks for the second dose of polio vaccine.
Discussion Awareness a m o n g the clinic mothers, freshers as well as repeaters, of the availability or existence of polio vaccine was in striking contrast to their ignorance about triple antigen and BCG vaccine a n d was related to the maternal education marginally only. Ease associated with oral administration of polio vaccine could perhaps be a factor for its greater popularity. Only 29.4 per cent of the fresher mothers understood the a d v a n t a g e of polio vaccine in terms of its protective role. While it was not possible because of inadequate records to study the drop out rate a m o n g those who had attended the other clinics it can be speculated from their ignorance of the role of the vaccine (34.6 per cent) and their inability to adhere to the scheduled dates for the second dose that it would have been significantly large. It was, therefore, strongly felt that for making immunisation programmes a success, attempts must be m a d e to abolish the disparity between the public awareness and their actual knowledge of the protective role of the vaccines. Mathur (1975) from his experience with under five clinics at H y d e r a b a d stated that most of the mothers, if explained about the role of immunisation, brought their children for routine immunisation and the drop out rate was negligible. T h e factors which determined their first visit to the clinic were rather interesting. 68.2 per cent of the fresher mothers were advised by neighbours, friends, or relatives. T h a t a majority of them followed the advice blindly was evident from the fact
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that only a small proportion of the mothers actually knew about the protective role of the vaccine. Little credit goes to the medical profession because only I3.4 per cent of the freshers visited the clinic on medical advice. It is, therefore, necessary to improve the public awareness of the actual need for immunisation which can be achieved by pamphlets, posters, frequent radio talks and setting up immunisation camps within walking distance o f the public (Bhargava 1972). Lack of awareness a m o n g mothers for triple antigen and BCG vaccine recorded in the present study demonstrated the importance of delivering all the available vaccines from one immunisation clinic.
Summary A study of the knowledge and practices of J a m m u mothers about polio drops revealed that 74 per cent of those who visited the child health clinic or immunisation clinics had done so for polio drops exclusively. Although advice of the neighbours, friends and relatives was a determining factor for their visit to the clinic, yet less than one-third of the mothers knew about the protective role of polio drops. This pointed towards a tendency a m o n g them tor blind following. Even a m o n g those who attended the child health clinic for the second dose of" polio drops after having received the first dose elsewhere, the proportion of mothers who did not know about its protective role was 34.6 per cent which reflected that even the immunisation clinics had done little to a b o l i s h the disparity between the public awareness and their actual knowledge of the role of polio vaccine.
StlAIRMA ANI.* L A I - [ O R I - - K N O ' ~ V L E D ( 3 E A N D P R A C T I C E S
(2;'." M O T I I E R S
T h e igmorance a b o u t triple a n t i g e n a n d vaccine was q u i t e a l a r m i n g , even
fami'ly plamling and on inamunisation status of children. Indian Pediat. 8, 447.
a m o n g those mothers who were e d u c a t e d b e y o n d the m a t r [ e ~ l a t i o n stage.
Chansoria, M., Taluja, R.K., Mukmjee, B. and KauI, K.K. (1975). A study of immunisation status of children in a defined urban population. Indian Pediat. 12, 879.
present study d e m o n s t r a t e d that
lhere is an u r g e n t n e e d tbr i n c r e a s i n g public awareness o f a v a i l a b l e vaccines. F u r t h e r m o r e , the clinics responsible for c a t e r i n g to the i m n m n i s a t i o n services must stress u p o n :the p a r e n t s the a c t u a l role o f the vaccines so as to ensure a d e q u a t e follow up. References
Gupta, M. atld Agarwal, K.N. (1972). Importance of parenlal education and socio.economic status in
Reddy, S.V.R., Bhaskar Rao, C. andJagdeshwri, N. (I.~175). A retrospective study of 800 families mbectomised and va~ectomised under the family planning programme. Indian Pediat. 12, 899, Mathur, Y.C. (197.5). Under five clinic. Indian Pedial. 1,127.
Bhargava, S.K. (1972). Evaluation of methods for mass immunisatim in children. Indian Pediat. 7, 378.