Indian J Pediatr 1991; 58 : 691-695
Knowledge, Attitude and Practice of Immunization in an Urban Educated Population Bela Shah, Mahesh Sharma and S.N. Vani
Depan~rnent of Pedia#ics, B.L Medical College and Civil Hospital, Ahmedabad A KAP evaluation of urban educated parents revealed suboptimal, superficial transfer of immunization knowledge. Poorer dose-related knowledge as compared to vaccine awareness contributed to partial immunization. Non-availability of vaccine contributed to 18.7% unprotected children, and therefore all logistics must be overcome to remedy service default. The unacceptable level of knowledge found in final year nursing and medical students, points out the need to restructure immunization related teaching in our hospitals. Incorporation of immunization based knowledge in high school curriculum is also recommended. It is important that areas of relevant information and education must be delineated time to time with increasing vaccination coverage.
KeyWords :
Vaccine awareness ; Dose-related know~edge ; Urban educated parents ; University students
Immunization coverage targets set up under the Universal Immunization Program ~, though laudatory, appear difficult to achieve despite the efforts of government and voluntary organisations. Suboptimal immunization coverage in urban areas 2 point out to the need of evaluating knowledge, attitude and practice (KAP) as regards immunization amongst the upper class, educated, urban people at whose doorstep these services are existent for the last five years, and also of the generation of tomorrow's parents and health professionReprint requests : Dr.Mahesh Sharma, Assistant Professor, Department of Pediatrics, B.J. Medical College and Civil Hospital, Ahmedabad-380 016.
alS.
MATERIAL AND METHODS Two sections of population in Ahmedabad city were studied. Group 1 comprised of 100 educated (at least one graduate, the other high-schooled) parents of upper socio-economic class (score > 26) by Kuppuswamy's classification3. Group 2 was of non-parental section, made up of three subgroups A, B and C with 100 university students in each group. Group 2A had medical students in their clinical terms, group 2B had third year (B.Sc.) nursing students, and group 2C had university students from non-professional (arts, commerce and science) colleges in final year of graduation or in post-graduation.
691
692
Vol. 58, No. 5
THE INDIAN JOURNAL OF PEDIATRICS
A KAP study was performed by detailed interrogation (of mothers, students) using a predesigned, pre-tested questionnaire, so as to objectively ascertain, as regards BCG, DPT, OPV and measles : (i) awareness about existence of vaccine and the disease (s) it protects from; (ii) dose schedule, i.e. when and how many doses to be given; (iii) availability of vaccine; and (iv) contraindication to immunization. Correct responses were scored 1, partially correct or incorrect as zero. The number of correct responses were compiled into total scores. Thus, (i) vaccine awareness (VA) scores (1 for awareness about existence of vaccine, 1 for disease (s) it protects from) and (ii) dose related knowledge (DK) score (1 for when to give the vaccine and 1 for how many doses to give) were obtained for all the groups and individual vaccines. X 2 test was used for statistical significance. The immunization status of 100 children in Group 1 was determined by defming fully immunized child as one who had received BCG, 3 doses of DPT and OPV, and
measles vaccine by 1 year of age. Immunization status was obtained from cards and where ever these were not available from the mother, the latter is also sensitive and specific.+The reasons for non-immunization were ascertained. RESULTS Analysis of vaccine awareness (VA) scores (Table 1) showed significantly lower scores in group 2C, group 2B and group 1, DPT and measles had significantly lower VA scores. Thus, vaccine awareness varies considerably within an urban, educated population, and also from one vaccine to another. Dose related knowledge (DK) scores (Table 2) were significantly lower in group 2C and group 1 and also for measles and DPT. DK scores for all vaccine and all groups were lower than VA scores, the difference being highest for OPV. Vaccine availability was identified with hospital (private or government) by all in group 1 and 2 ; with doctors by all in group 2C, and with vaccination centres by all in
T~t~ 1. Vaccine Awareness Scores Group 1 Name
100) Disease
(n =
Group (n = 100) 2A Name Disease
Group (n = 100) Group (n = 100) Total score 2B 2C Name Disease Name Disease
BCG
98
98
100
100
100
100
83
73
DPT
95
54
100
81
85
51
78
46
752 590
OPV
100
100
100
100
100
85
100
100
785
80
80
87
87
83
78
53
53
601
Measles Total Score
705
755
682
586 I
(i) For individual study groups : X2 = 202.69 ; df=3 ; P
Knowledge, Attitude and Practice of Immunization in an Urban Educated Population Bela Shah, Mahesh Sharma and S.N. Vani
Depan~rnent of Pedia#ics, B.L Medical College and Civil Hospital, Ahmedabad A KAP evaluation of urban educated parents revealed suboptimal, superficial transfer of immunization knowledge. Poorer dose-related knowledge as compared to vaccine awareness contributed to partial immunization. Non-availability of vaccine contributed to 18.7% unprotected children, and therefore all logistics must be overcome to remedy service default. The unacceptable level of knowledge found in final year nursing and medical students, points out the need to restructure immunization related teaching in our hospitals. Incorporation of immunization based knowledge in high school curriculum is also recommended. It is important that areas of relevant information and education must be delineated time to time with increasing vaccination coverage.
KeyWords :
Vaccine awareness ; Dose-related know~edge ; Urban educated parents ; University students
Immunization coverage targets set up under the Universal Immunization Program ~, though laudatory, appear difficult to achieve despite the efforts of government and voluntary organisations. Suboptimal immunization coverage in urban areas 2 point out to the need of evaluating knowledge, attitude and practice (KAP) as regards immunization amongst the upper class, educated, urban people at whose doorstep these services are existent for the last five years, and also of the generation of tomorrow's parents and health professionReprint requests : Dr.Mahesh Sharma, Assistant Professor, Department of Pediatrics, B.J. Medical College and Civil Hospital, Ahmedabad-380 016.
alS.
MATERIAL AND METHODS Two sections of population in Ahmedabad city were studied. Group 1 comprised of 100 educated (at least one graduate, the other high-schooled) parents of upper socio-economic class (score > 26) by Kuppuswamy's classification3. Group 2 was of non-parental section, made up of three subgroups A, B and C with 100 university students in each group. Group 2A had medical students in their clinical terms, group 2B had third year (B.Sc.) nursing students, and group 2C had university students from non-professional (arts, commerce and science) colleges in final year of graduation or in post-graduation.
691
692
Vol. 58, No. 5
THE INDIAN JOURNAL OF PEDIATRICS
A KAP study was performed by detailed interrogation (of mothers, students) using a predesigned, pre-tested questionnaire, so as to objectively ascertain, as regards BCG, DPT, OPV and measles : (i) awareness about existence of vaccine and the disease (s) it protects from; (ii) dose schedule, i.e. when and how many doses to be given; (iii) availability of vaccine; and (iv) contraindication to immunization. Correct responses were scored 1, partially correct or incorrect as zero. The number of correct responses were compiled into total scores. Thus, (i) vaccine awareness (VA) scores (1 for awareness about existence of vaccine, 1 for disease (s) it protects from) and (ii) dose related knowledge (DK) score (1 for when to give the vaccine and 1 for how many doses to give) were obtained for all the groups and individual vaccines. X 2 test was used for statistical significance. The immunization status of 100 children in Group 1 was determined by defming fully immunized child as one who had received BCG, 3 doses of DPT and OPV, and
measles vaccine by 1 year of age. Immunization status was obtained from cards and where ever these were not available from the mother, the latter is also sensitive and specific.+The reasons for non-immunization were ascertained. RESULTS Analysis of vaccine awareness (VA) scores (Table 1) showed significantly lower scores in group 2C, group 2B and group 1, DPT and measles had significantly lower VA scores. Thus, vaccine awareness varies considerably within an urban, educated population, and also from one vaccine to another. Dose related knowledge (DK) scores (Table 2) were significantly lower in group 2C and group 1 and also for measles and DPT. DK scores for all vaccine and all groups were lower than VA scores, the difference being highest for OPV. Vaccine availability was identified with hospital (private or government) by all in group 1 and 2 ; with doctors by all in group 2C, and with vaccination centres by all in
T~t~ 1. Vaccine Awareness Scores Group 1 Name
100) Disease
(n =
Group (n = 100) 2A Name Disease
Group (n = 100) Group (n = 100) Total score 2B 2C Name Disease Name Disease
BCG
98
98
100
100
100
100
83
73
DPT
95
54
100
81
85
51
78
46
752 590
OPV
100
100
100
100
100
85
100
100
785
80
80
87
87
83
78
53
53
601
Measles Total Score
705
755
682
586 I
(i) For individual study groups : X2 = 202.69 ; df=3 ; P
