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Human Vaccines & Immunotherapeutics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/khvi20
Public awareness regarding children vaccination in Jordan a
b
b
b
Majed M Masadeh , Karem H Alzoubi , Sayer I Al-Azzam , Hassan S Al-Agedi , Baraa E Abu b
b
Rashid & Tariq L Mukattash a
Department of Pharmaceutical Technology; Jordan University of Science and Technology; Irbid, Jordan b
Department of Clinical Pharmacy; Jordan University of Science and Technology; Irbid, Jordan Published online: 07 May 2014.
Click for updates To cite this article: Majed M Masadeh, Karem H Alzoubi, Sayer I Al-Azzam, Hassan S Al-Agedi, Baraa E Abu Rashid & Tariq L Mukattash (2014) Public awareness regarding children vaccination in Jordan, Human Vaccines & Immunotherapeutics, 10:6, 1762-1766, DOI: 10.4161/hv.28608 To link to this article: http://dx.doi.org/10.4161/hv.28608
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Research Paper Research Paper
Human Vaccines & Immunotherapeutics 10:6, 1762–1766; June 2014; © 2014 Landes Bioscience
Public awareness regarding children vaccination in Jordan Majed M Masadeh1,*, Karem H Alzoubi2, Sayer I Al-Azzam2, Hassan S Al-Agedi2, Baraa E Abu Rashid2, Tariq L Mukattash2 Department of Pharmaceutical Technology; Jordan University of Science and Technology; Irbid, Jordan; Technology; Irbid, Jordan;
1
2
Department of Clinical Pharmacy; Jordan University of Science and
Immunization can contribute to a dramatic reduction in number of vaccine-preventable diseases among children. The aim of this study is to investigate mothers’ awareness about child vaccines and vaccination in Jordan. This study was a community-based, cross-sectional study that was performed at public places in Irbid City. Data was collected from 506 mothers. After verbal approval, mothers were interviewed to assess their knowledge, attitudes, and practice toward vaccination. Results show that majority of mothers had acceptable knowledge and positive attitude toward vaccination. Most of mothers (94.7–86.8%) were able to identify vaccines that are mandatory as per the national vaccination program. Lower knowledge was observed among mothers (71.6%) for HIB vaccination being mandatory. Most mothers (97.2%) had vaccination card for their baby form the national vaccination programs. Vaccination delay was reported by about 36.6% of mothers and was shown to be associated with significantly (P = 0.001) lower vaccination knowledge/attitude score. Additionally, mothers who reported to be regularly offered information about vaccination during visits and those who identified medical staff members as their major information source had significantly higher vaccination knowledge/attitude score (P = 0.002). In conclusion, vaccination coverage rate is high; however, some aspects of knowledge, attitudes, and practice of vaccination need to be improved. Knowledge and attitudes of mothers were directly associated with their practice of vaccination. Medical staff education about vaccination during each visit seems to be the most effective tool that directly reflects on better practice of vaccination such as reducing the possibility for vaccination delay.
Introduction Vaccines are unquestionably one of the most cost-effective interventions in the health system. It costs a little, although, it presents enormous benefits for the health and well-being of populations. According to WHO records, 10.6 million children die yearly before the age of 5; while an estimated 1.4 million of those are due to diseases that could have been prevented by vaccines.1,2 Worldwide, vaccines can save more than 3 million lives yearly; in addition to protecting millions more people from diseases and disability.3 For example, it was also estimated that 5 million people are walking today who would probably have been paralyzed by the poliovirus, since introduction Polio vaccine.4 Therefore, maintaining a high level of immunization coverage is important in the control and elimination of many cases of vaccine-preventable diseases. In Jordan, the National Program of Vaccination covers on a rate of about 95%. It provides vaccines for all children against 11 diseases free of charge. The vaccines included in the national vaccination schedule are Bacille Calmette Guerin (BCG), oral polio vaccine, diphtheria-pertussis-tetanus (DPT) vaccine, measlesmumps-rubella (MMR), and hepatitis B (Hib) vaccine.5 Although they have huge benefit, a proportion of people still do not use vaccinations effectively in terms of either not
vaccinating at all, or not completing their vaccination programs.2,6-8 Characterizing reasons for non-vaccination is a key in order to increase coverage rates and implement interventions for control and elimination of vaccine preventable diseases. In this study, we used community-based survey of mothers about vaccination status, knowledge, attitudes, and practice of vaccination. This study is aimed to help health policy makers to determine the priorities and plan interventions to improve the vaccination coverage.
Results General Characteristics of the Participants The study sample consisted of 506 mothers out of 605 approached (83% response rate). The mean age was 30.95 ± 20.76 y. About 97% of mothers were married. Concerning educational level of mothers, about 45% hold university degree and more, followed by about 44% with secondary qualifications. The majority of mothers (about 74%) were not working. About 26% of mothers were workers, of whom, about 9.9% worked between 20–40 h per week. Most mothers (60.5%) reported that their family monthly income was less than 400 JD. Mothers reported having children within the range of 1 to more than 3. The age of
*Correspondence to: Majed M Masadeh; Email: [email protected] Submitted: 12/15/2013; Revised: 03/08/2014; Accepted: 03/20/2014; Published Online: 05/07/2014 http://dx.doi.org/10.4161/hv.28608 1762
Human Vaccines & Immunotherapeutics
Volume 10 Issue 6
©2014 Landes Bioscience. Do not distribute.
Downloaded by [University of Manitoba Libraries] at 20:11 15 February 2015
Keywords: vaccination, knowledge, practice, attitudes, mothers
Table 2. Knowledge of mothers about national vaccination program
Variable
Values
Age (y) (mean ± SD)
30.95 ± 20.76
Social status N (%) Married Divorced Widowed
493 (97.4) 10 (2) 2 (0.4)
Mother’s education level N (%): Primary Secondary University and higher Illiterate
53 (10.5) 222 (43.9) 225 (44.5) 6 (1.2)
Mother’s work N (%) Not-working* Medical profession Non-medical profession
376 (74.3) 52 (10.3) 74 (14.6)
Mother’s working hours per week N (%) 40
42 (8.3) 50 (9.9) 33 (6.5)
Family monthly income JD N (%) 800
306 (60.5) 152 (30) 29 (5.7)
No of children N (%) 1child 2 children 3 children More than 3 children
118 (23.3) 144 (28.5) 102 (20.2) 142 (28.1)
Age of last child N (%) 12 mo
157 (31) 170 (33.6) 179 (35.4)
*These mothers were not working but were generally responsible for housekeeping related work at their houses.
last child varied between 12 mo (about 35%) (Table1). Knowledge about Vaccination Mothers’ knowledge about vaccination is shown in Table 2. The majority of mothers (63%) reported that the National Vaccination Program requires to be initiated at first month of life of a child. Most mothers (94.7–86.8%) were able to indentify vaccines that are mandatory as per the National Vaccination Program. Lower knowledge was observed among mothers (71.6%) about HIB vaccination being mandatory. Concerning vaccines that are not mandatory by the National Vaccination Program, 18.8–42.6 of mothers reported influenza, rota, pneumococcal, and varricella vaccines as being mandatory. Moreover, about 76% and 68% of mothers reported their agreement that hepatitis A and meningococcal vaccinations are mandatory, respectively (Table 2). Attitudes toward vaccination Information about mothers’ attitude toward vaccination is shown in Table 3. Majority of mothers had positive attitude toward vaccination as they agreed or strongly agreed that carful safety checks are performed for vaccines, vaccination is an
www.landesbioscience.com
Variable
Participants Frequency (N)
Percentage (%)
480
94.18
BCG
462
91.3
Polio
479
94.6
DPT
479
94.7
The initiation of vaccination program is at delivery or first month Mandatory vaccines include
MMR
43
86.8
Measles
467
92.3
HBV
465
91.9
HIB
364
71.9
Hepatitis A
382
75.5
Meningococcal
342
67.6
Influenza
176
34.8
Rota
214
42.3
Pneumococcal
95
18.8
Varricella
167
33
indicator of child’s good health, vaccinations strengthen immune system, provide immunity for child against diseases, and protect children against spread of contagious diseases. However, majority of mothers (77.2%) had the incorrect perception that vaccines are medicines, which are capable to kill bacteria and viruses. On the other hand, majority of women disagreed or strongly disagreed for allowing non-immunized children to be sent to school (63.6%), for using alternative ways to protect their children from infection (66.6%), and not offering vaccination to children because of injection associated pain (78.1%). Only 39.2% of women strongly agreed or agreed that vaccines lead to side effects. Finally, most women strongly agreed or agreed that they were satisfied with national vaccination program (86.8%), and with nursing services through which vaccines are introduced to their child (81.6%). Practice of vaccination Vast majority of mothers (97.2%) had vaccination card for the national vaccination programs (Table 4). Vaccination delay was reported by about 36.6% of mothers, and about 8.7% reported that at least one vaccine has never been given to their baby. About 8.3% of mothers reported that they ever vaccinated their child while the child was sick. On the other hand, most mothers had a child who suffered side effects from vaccination (83.2%). The places for vaccination included public health centers (50.2%), and maternity and child health centers (35.4%). Information about vaccination was mainly from medical staff (62.8%). Finally, education about vaccination by medical staff during visits was reported by 82.4% of mothers (Table 4). Correlation between vaccination awareness score and sociodemographic variables and practice of vaccination Scores for mother’s knowledge/attitude toward vaccination were calculated to facilitate studying possible correlation between
Human Vaccines & Immunotherapeutics 1763
©2014 Landes Bioscience. Do not distribute.
Downloaded by [University of Manitoba Libraries] at 20:11 15 February 2015
Table 1. General characteristics of participants
Table 3. Attitudes of mothers toward vaccination
Downloaded by [University of Manitoba Libraries] at 20:11 15 February 2015
Neutral
Disagree/ strongly disagree
N
%
N
%
N
%
Available vaccinations are carefully checked for safety
458
90.5
37
7.3
11
2.6
Immunizing a child is an indicator of his good health
368
72.5
60
11.7
78
15.4
Vaccines strengthen the immune system.
422
83.4
61
12.1
23
4.6
Vaccines are administered at intervals to keep long- term effect
359
70.9
88
17.4
59
11.7
Vaccines protect my children against spread of contagious diseases
358
70.7
59
11.7
89
17.6
Vaccines are sufficient to provide immunity for my child against diseases
288
56.9
84
16.6
134
26.5
Vaccines are medicines that are capable to kill bacteria and viruses
391
77.2
45
8.9
70
13.9
Mothers should be allowed to send their child to school even if not immunized
130
25.7
54
10.7
322
63.6
I think vaccines cause side effects.
198
39.2
92
18.2
216
42.7
If there is alternative ways to protect my child from infection, I may not give him the vaccine
114
22.5
55
10.9
337
66.6
I do not offer vaccination to my children because of injection associated pain
74
14.6
35
6.9
395
78.1
I am satisfied with vaccination program offered by Ministry of Health.
439
86.8
42
8.3
25
5
I am satisfied with nursing services through which vaccines are introduced to my child
413
81.6
51
10.1
42
8.3
knowledge and attitudes toward vaccination and sociodemographic variables, and the actual practice of vaccination. None of the demographic variables including mother’s age, social status, education level, type of work, number of working hours, monthly income, number of children, and age of last child/ infant were significantly associated with vaccination knowledge/ attitude score. Concerning practice of vaccination, it was shown that those who delayed one vaccine for their baby had significantly lower vaccination knowledge/attitude scores (P = 0.001; Table 4). Additionally, those who reported to be regularly offered information about vaccination by medical staff during visits had significantly higher vaccination knowledge/attitude scores (P = 0.002). Additionally, mothers who got their information about vaccination from medical staff had higher vaccination knowledge/attitude scores compared with those who got the information from TV-radio-internet websites, posters/brochures offered by the medical center, and family members friends or neighbors (P = 0.002, Table 4). Finally, it was found that those who got their vaccination at a private clinic or hospital had higher vaccination knowledge/attitude scores compared with those who got their vaccination at public hospitals, health centers, or maternity and childhood centers (P = 0.005, Table 4).
Discussion The primary aim of this study was to assess knowledge, attitudes, and practice of/toward vaccination program, and to examine the relation among these variables. To the best of our knowledge, this the first study to report the knowledge, attitudes, and practice of Jordanian mothers regarding vaccinations. Related studies were performed in other countries,6,9-13 however, better attitudes and more knowledge were reported in this study among Jordanian mothers. This could be related to a number
1764
of factors such as low prevalence of vaccine-preventable diseases, availability of vaccination centers and information about vaccination, relatively high educational level among mothers, and different methods used to measure immunization status. In this study, mothers’ knowledge about vaccination was assessed by asking mothers to identify vaccines that are mandatory according to the National Vaccination Program. Most mothers were able to identify mandatory vaccine, yet, a significant percentage (18–76%) identified non-mandatory vaccines as being mandatory. Concerning mothers’ attitudes toward vaccination, the proportion of mother’s that showed positive attitudes toward vaccinations was high compared with other studies.6,9-11,13 This finding could be explained by the presence of awareness programs about vaccines safety as part of the National Vaccination Program. The actual practice of vaccination in Jordan was almost all (97.2%) through the National Vaccination Program. Only a small percentage (
Human Vaccines & Immunotherapeutics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/khvi20
Public awareness regarding children vaccination in Jordan a
b
b
b
Majed M Masadeh , Karem H Alzoubi , Sayer I Al-Azzam , Hassan S Al-Agedi , Baraa E Abu b
b
Rashid & Tariq L Mukattash a
Department of Pharmaceutical Technology; Jordan University of Science and Technology; Irbid, Jordan b
Department of Clinical Pharmacy; Jordan University of Science and Technology; Irbid, Jordan Published online: 07 May 2014.
Click for updates To cite this article: Majed M Masadeh, Karem H Alzoubi, Sayer I Al-Azzam, Hassan S Al-Agedi, Baraa E Abu Rashid & Tariq L Mukattash (2014) Public awareness regarding children vaccination in Jordan, Human Vaccines & Immunotherapeutics, 10:6, 1762-1766, DOI: 10.4161/hv.28608 To link to this article: http://dx.doi.org/10.4161/hv.28608
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Research Paper Research Paper
Human Vaccines & Immunotherapeutics 10:6, 1762–1766; June 2014; © 2014 Landes Bioscience
Public awareness regarding children vaccination in Jordan Majed M Masadeh1,*, Karem H Alzoubi2, Sayer I Al-Azzam2, Hassan S Al-Agedi2, Baraa E Abu Rashid2, Tariq L Mukattash2 Department of Pharmaceutical Technology; Jordan University of Science and Technology; Irbid, Jordan; Technology; Irbid, Jordan;
1
2
Department of Clinical Pharmacy; Jordan University of Science and
Immunization can contribute to a dramatic reduction in number of vaccine-preventable diseases among children. The aim of this study is to investigate mothers’ awareness about child vaccines and vaccination in Jordan. This study was a community-based, cross-sectional study that was performed at public places in Irbid City. Data was collected from 506 mothers. After verbal approval, mothers were interviewed to assess their knowledge, attitudes, and practice toward vaccination. Results show that majority of mothers had acceptable knowledge and positive attitude toward vaccination. Most of mothers (94.7–86.8%) were able to identify vaccines that are mandatory as per the national vaccination program. Lower knowledge was observed among mothers (71.6%) for HIB vaccination being mandatory. Most mothers (97.2%) had vaccination card for their baby form the national vaccination programs. Vaccination delay was reported by about 36.6% of mothers and was shown to be associated with significantly (P = 0.001) lower vaccination knowledge/attitude score. Additionally, mothers who reported to be regularly offered information about vaccination during visits and those who identified medical staff members as their major information source had significantly higher vaccination knowledge/attitude score (P = 0.002). In conclusion, vaccination coverage rate is high; however, some aspects of knowledge, attitudes, and practice of vaccination need to be improved. Knowledge and attitudes of mothers were directly associated with their practice of vaccination. Medical staff education about vaccination during each visit seems to be the most effective tool that directly reflects on better practice of vaccination such as reducing the possibility for vaccination delay.
Introduction Vaccines are unquestionably one of the most cost-effective interventions in the health system. It costs a little, although, it presents enormous benefits for the health and well-being of populations. According to WHO records, 10.6 million children die yearly before the age of 5; while an estimated 1.4 million of those are due to diseases that could have been prevented by vaccines.1,2 Worldwide, vaccines can save more than 3 million lives yearly; in addition to protecting millions more people from diseases and disability.3 For example, it was also estimated that 5 million people are walking today who would probably have been paralyzed by the poliovirus, since introduction Polio vaccine.4 Therefore, maintaining a high level of immunization coverage is important in the control and elimination of many cases of vaccine-preventable diseases. In Jordan, the National Program of Vaccination covers on a rate of about 95%. It provides vaccines for all children against 11 diseases free of charge. The vaccines included in the national vaccination schedule are Bacille Calmette Guerin (BCG), oral polio vaccine, diphtheria-pertussis-tetanus (DPT) vaccine, measlesmumps-rubella (MMR), and hepatitis B (Hib) vaccine.5 Although they have huge benefit, a proportion of people still do not use vaccinations effectively in terms of either not
vaccinating at all, or not completing their vaccination programs.2,6-8 Characterizing reasons for non-vaccination is a key in order to increase coverage rates and implement interventions for control and elimination of vaccine preventable diseases. In this study, we used community-based survey of mothers about vaccination status, knowledge, attitudes, and practice of vaccination. This study is aimed to help health policy makers to determine the priorities and plan interventions to improve the vaccination coverage.
Results General Characteristics of the Participants The study sample consisted of 506 mothers out of 605 approached (83% response rate). The mean age was 30.95 ± 20.76 y. About 97% of mothers were married. Concerning educational level of mothers, about 45% hold university degree and more, followed by about 44% with secondary qualifications. The majority of mothers (about 74%) were not working. About 26% of mothers were workers, of whom, about 9.9% worked between 20–40 h per week. Most mothers (60.5%) reported that their family monthly income was less than 400 JD. Mothers reported having children within the range of 1 to more than 3. The age of
*Correspondence to: Majed M Masadeh; Email: [email protected] Submitted: 12/15/2013; Revised: 03/08/2014; Accepted: 03/20/2014; Published Online: 05/07/2014 http://dx.doi.org/10.4161/hv.28608 1762
Human Vaccines & Immunotherapeutics
Volume 10 Issue 6
©2014 Landes Bioscience. Do not distribute.
Downloaded by [University of Manitoba Libraries] at 20:11 15 February 2015
Keywords: vaccination, knowledge, practice, attitudes, mothers
Table 2. Knowledge of mothers about national vaccination program
Variable
Values
Age (y) (mean ± SD)
30.95 ± 20.76
Social status N (%) Married Divorced Widowed
493 (97.4) 10 (2) 2 (0.4)
Mother’s education level N (%): Primary Secondary University and higher Illiterate
53 (10.5) 222 (43.9) 225 (44.5) 6 (1.2)
Mother’s work N (%) Not-working* Medical profession Non-medical profession
376 (74.3) 52 (10.3) 74 (14.6)
Mother’s working hours per week N (%) 40
42 (8.3) 50 (9.9) 33 (6.5)
Family monthly income JD N (%) 800
306 (60.5) 152 (30) 29 (5.7)
No of children N (%) 1child 2 children 3 children More than 3 children
118 (23.3) 144 (28.5) 102 (20.2) 142 (28.1)
Age of last child N (%) 12 mo
157 (31) 170 (33.6) 179 (35.4)
*These mothers were not working but were generally responsible for housekeeping related work at their houses.
last child varied between 12 mo (about 35%) (Table1). Knowledge about Vaccination Mothers’ knowledge about vaccination is shown in Table 2. The majority of mothers (63%) reported that the National Vaccination Program requires to be initiated at first month of life of a child. Most mothers (94.7–86.8%) were able to indentify vaccines that are mandatory as per the National Vaccination Program. Lower knowledge was observed among mothers (71.6%) about HIB vaccination being mandatory. Concerning vaccines that are not mandatory by the National Vaccination Program, 18.8–42.6 of mothers reported influenza, rota, pneumococcal, and varricella vaccines as being mandatory. Moreover, about 76% and 68% of mothers reported their agreement that hepatitis A and meningococcal vaccinations are mandatory, respectively (Table 2). Attitudes toward vaccination Information about mothers’ attitude toward vaccination is shown in Table 3. Majority of mothers had positive attitude toward vaccination as they agreed or strongly agreed that carful safety checks are performed for vaccines, vaccination is an
www.landesbioscience.com
Variable
Participants Frequency (N)
Percentage (%)
480
94.18
BCG
462
91.3
Polio
479
94.6
DPT
479
94.7
The initiation of vaccination program is at delivery or first month Mandatory vaccines include
MMR
43
86.8
Measles
467
92.3
HBV
465
91.9
HIB
364
71.9
Hepatitis A
382
75.5
Meningococcal
342
67.6
Influenza
176
34.8
Rota
214
42.3
Pneumococcal
95
18.8
Varricella
167
33
indicator of child’s good health, vaccinations strengthen immune system, provide immunity for child against diseases, and protect children against spread of contagious diseases. However, majority of mothers (77.2%) had the incorrect perception that vaccines are medicines, which are capable to kill bacteria and viruses. On the other hand, majority of women disagreed or strongly disagreed for allowing non-immunized children to be sent to school (63.6%), for using alternative ways to protect their children from infection (66.6%), and not offering vaccination to children because of injection associated pain (78.1%). Only 39.2% of women strongly agreed or agreed that vaccines lead to side effects. Finally, most women strongly agreed or agreed that they were satisfied with national vaccination program (86.8%), and with nursing services through which vaccines are introduced to their child (81.6%). Practice of vaccination Vast majority of mothers (97.2%) had vaccination card for the national vaccination programs (Table 4). Vaccination delay was reported by about 36.6% of mothers, and about 8.7% reported that at least one vaccine has never been given to their baby. About 8.3% of mothers reported that they ever vaccinated their child while the child was sick. On the other hand, most mothers had a child who suffered side effects from vaccination (83.2%). The places for vaccination included public health centers (50.2%), and maternity and child health centers (35.4%). Information about vaccination was mainly from medical staff (62.8%). Finally, education about vaccination by medical staff during visits was reported by 82.4% of mothers (Table 4). Correlation between vaccination awareness score and sociodemographic variables and practice of vaccination Scores for mother’s knowledge/attitude toward vaccination were calculated to facilitate studying possible correlation between
Human Vaccines & Immunotherapeutics 1763
©2014 Landes Bioscience. Do not distribute.
Downloaded by [University of Manitoba Libraries] at 20:11 15 February 2015
Table 1. General characteristics of participants
Table 3. Attitudes of mothers toward vaccination
Downloaded by [University of Manitoba Libraries] at 20:11 15 February 2015
Neutral
Disagree/ strongly disagree
N
%
N
%
N
%
Available vaccinations are carefully checked for safety
458
90.5
37
7.3
11
2.6
Immunizing a child is an indicator of his good health
368
72.5
60
11.7
78
15.4
Vaccines strengthen the immune system.
422
83.4
61
12.1
23
4.6
Vaccines are administered at intervals to keep long- term effect
359
70.9
88
17.4
59
11.7
Vaccines protect my children against spread of contagious diseases
358
70.7
59
11.7
89
17.6
Vaccines are sufficient to provide immunity for my child against diseases
288
56.9
84
16.6
134
26.5
Vaccines are medicines that are capable to kill bacteria and viruses
391
77.2
45
8.9
70
13.9
Mothers should be allowed to send their child to school even if not immunized
130
25.7
54
10.7
322
63.6
I think vaccines cause side effects.
198
39.2
92
18.2
216
42.7
If there is alternative ways to protect my child from infection, I may not give him the vaccine
114
22.5
55
10.9
337
66.6
I do not offer vaccination to my children because of injection associated pain
74
14.6
35
6.9
395
78.1
I am satisfied with vaccination program offered by Ministry of Health.
439
86.8
42
8.3
25
5
I am satisfied with nursing services through which vaccines are introduced to my child
413
81.6
51
10.1
42
8.3
knowledge and attitudes toward vaccination and sociodemographic variables, and the actual practice of vaccination. None of the demographic variables including mother’s age, social status, education level, type of work, number of working hours, monthly income, number of children, and age of last child/ infant were significantly associated with vaccination knowledge/ attitude score. Concerning practice of vaccination, it was shown that those who delayed one vaccine for their baby had significantly lower vaccination knowledge/attitude scores (P = 0.001; Table 4). Additionally, those who reported to be regularly offered information about vaccination by medical staff during visits had significantly higher vaccination knowledge/attitude scores (P = 0.002). Additionally, mothers who got their information about vaccination from medical staff had higher vaccination knowledge/attitude scores compared with those who got the information from TV-radio-internet websites, posters/brochures offered by the medical center, and family members friends or neighbors (P = 0.002, Table 4). Finally, it was found that those who got their vaccination at a private clinic or hospital had higher vaccination knowledge/attitude scores compared with those who got their vaccination at public hospitals, health centers, or maternity and childhood centers (P = 0.005, Table 4).
Discussion The primary aim of this study was to assess knowledge, attitudes, and practice of/toward vaccination program, and to examine the relation among these variables. To the best of our knowledge, this the first study to report the knowledge, attitudes, and practice of Jordanian mothers regarding vaccinations. Related studies were performed in other countries,6,9-13 however, better attitudes and more knowledge were reported in this study among Jordanian mothers. This could be related to a number
1764
of factors such as low prevalence of vaccine-preventable diseases, availability of vaccination centers and information about vaccination, relatively high educational level among mothers, and different methods used to measure immunization status. In this study, mothers’ knowledge about vaccination was assessed by asking mothers to identify vaccines that are mandatory according to the National Vaccination Program. Most mothers were able to identify mandatory vaccine, yet, a significant percentage (18–76%) identified non-mandatory vaccines as being mandatory. Concerning mothers’ attitudes toward vaccination, the proportion of mother’s that showed positive attitudes toward vaccinations was high compared with other studies.6,9-11,13 This finding could be explained by the presence of awareness programs about vaccines safety as part of the National Vaccination Program. The actual practice of vaccination in Jordan was almost all (97.2%) through the National Vaccination Program. Only a small percentage (
