Knowledge and Attitude Towards Childhood Immunization among Parents in Al-Mukalla, Yemen

ORIGINAL CONTRIBUTION / CLINICAL INVESTIGATION

WORLD FAMILY MEDICINE/MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 16 ISSUE 2, FEBRUARY 2018

Knowledge and Attitude Towards Childhood Immunization among Parents in Al-Mukalla, Yemen

Fauzia Faraj Bamatraf (1) Mazin Ahmed Jawass (2) (1) Associate Professor of Community Health, Department of Community Medicine College of Medicine and Health Sciences, Hadhramout University, Republic of Yemen (2) Associate Professor of Pediatrics, Department of Pediatrics, College of Medicine and Health Sciences, Hadhramout University, Republic of Yemen

Correspondence: Fauzia F Bamatraf Associate Professor of Community Health, Department of Community Medicine College of Medicine and Health Sciences, Hadhramout University, Republic of Yemen Mobile: +967 735306070 Email: [email protected]

Abstract

Background: According to the World Health Organi- zation, millions of children worldwide are not fully immunized, mostly in developing countries. WHO has estimated that access to services, parental at- titudes, knowledge and practices seems to play a significant role in this regard. This study aimed to assess the knowledge and attitudes towards child- hood immunization amongYemeni parents in Al- Mukalla city.

Methods: A cross-sectional analytical study was conducted in four governmental kindergartens in Al Mukalla city, Hadhramout Governorate, Yemen, between December 2013 and March 2014. A multi- stage sampling method was used for the selection of participants. Data was collected by using pre- tested self-administered questionnaires.

Results: A total of 400 Yemeni parents participat- ed in the study. Out of them, mothers comprised (73%) of the sample and the remaining (27%) were fathers. In general, the study showed that parents had a positive attitude towards childhood immuni- zation with respect to most of the subjects investi- gated and (63.3%) had moderate knowledge scores towards them. Health workers were the main source of information for the majority of parents (90.7%). Furthermore statistically significant differences was found in the mean score of parents’ knowledge with their age group and the number of their preschool children (P <0.025 and p <0.001, respectively)

Conclusions: Parents demonstrated moderate knowledge scores and a positive attitude towards childhood immunization. There is a need for health education to upgrade parents’ knowledge with em- phasis on young parents as well as health workers.

Key words: Childhood Immunization, Parents, Knowledge, Attitude, governmental kindergartens, Yemen

Please cite this article as: Fauzia Faraj Bamatraf, Mazin Ahmed Jawass. Knowledge and Attitude Towards Childhood Immunization among Parents in Al-Mukalla, Yemen. World Family Medicine. 2018; 16(2): 24-31. DOI: 10.5742/MEWFM.2018.93239

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ORIGINAL CONTRIBUTION / CLINICAL INVESTIGATION

WORLD FAMILY MEDICINE/MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 16 ISSUE 2, FEBRUARY 2018

Introduction

As highlighted by the World Health Organization (WHO), vaccination is one of the most cost -effective health interventions available, saving millions of people from illness, disability and death each year from vaccine- preventable diseases including diphtheria, hepatitis B, measles, mumps, pertussis, pneumonia, polio, rotavirus diarrhea, rubella and tetanus.(1) WHO reported that “the number of deaths per year in children between the ages of 1 and 59 months was 5.2 million.

About 29% of these deaths in children in this age group are due to vaccine-preventable diseases.(2) In addition WHO estimated that “if all the vaccines now available against childhood diseases were widely adopted as part of the Expanded Program on Immunization (EPI) in some regions of the world. and if countries could raise vaccine coverage to a global average of 90%, an additional two million deaths a year could be prevented among children under five years old”.(1)

In Yemen, to maintain high levels of immunization coverage among children, health authorities have taken important steps to support routine immunization and to implement supplementary immunization activities.(3) Yet, despite the concerted efforts of the government, a large proportion of vulnerable infants and children in Yemen remain unimmunized. Although EPI has been implemented in Yemen since 1979 (4) and despite it being available free of charge to the public the full coverage of immunization among Yemeni children in the age group of 12-23 months was only 37.2%.(5)

According to the World Health Organization (WHO), millions of children around the world are not fully immune, mostly in developing countries, because of immunization issues, which are the most common factors that lead to incomplete vaccination of children. (6) In addition, the WHO has estimated that access to services, parental attitudes, knowledge and practices appears to play a greater role among children who have not received any vaccination.(6)

The knowledge, attitudes and practices of parents have also been identified by many studies as factors related to the success or failure of the immunization program.(7,8,9) Previous studies observed that, parents’ knowledge and attitudes towards immunization were significantly associated with childhood immunization coverage and can affect the immunization status of children. (9,10) Furthermore, other studies have demonstrated an association between parental sociodemographic characteristics and child’s immunization coverage, such as education and age of the parents, number of preschool children, and family income.(11,12,13) Previous studies have shown that healthcare providers also play an important role in the rate of immunizing children.(14,15) It was found that parents’ knowledge and attitudes towards vaccinating their children depends on the quality of information provided to them by health care providers about the importance, timing and

safety of vaccination.(16,17) They may affect parents’ knowledge, practices and their decisions about child vaccination.(18,19)

There are currently no studies available on parents’ knowledge and attitudes towards childhood immunization in Yemen, as in Al-Mukalla local area. it is high time for such a study to be carried out to assess the knowledge and attitudes towards childhood immunization and their associated factors among Yemeni parents. It is believed that this study may provide useful information to the Yemeni community and Yemeni authorities such as the Ministry of Health to perform more effective vaccination programs.

Materials and method

This was a cross-sectional study conducted at public kindergartens in Al-Mukalla, the capital of the Hadhramout Governorate, Yemen, between December 2014 to March 2015. The study population consists of all parents whose children were learning in public kindergartens. All public kindergartens (total 4) were selected from the different areas of Al-Mukalla.

A sample size of 384 parents was determined by using recommended statistical methods.(20) It was increased to 400 for an expected non-response. The sample size of parents was distributed proportionally among all four selected kindergartens according to total number of children in each kindergarten and the parents of children were selected randomly. A total of 400 questionnaires were distributed to parents of children attending selected kindergartens. The questionnaire was sent along with a letter explaining the objectives of the study to the parents, as well as an envelope to facilitate the return of the completed questionnaire. Parents were asked to return the completed questionnaires in the envelopes submitted before the deadline by submitting them to the class teacher.

Written consent was obtained for participation in the study from all participants. The researchers collected the completed questionnaires through kindergarten teachers. When a teacher did not receive a questionnaire from a child during 3 to 5 days, the teacher sent a reminder home with the child. Data were collected with self-administered pre-tested questionnaire. The questionnaire was divided into two parts; the first part covered questions on personal and socio-demographic characteristics of parents and the second part covered questions which were pre-designed to assess their knowledge and attitude to childhood immunization.

Responses to the questions of knowledge were recorded as “Yes”, “No”, and “Don’t know”. A three point-Likert scale was used to assess parents’ attitudes about child immunization, with the following responses: (“Agree”, “Not sure”, “Disagree”,). The pre-testing of the questionnaire of the study was conducted on 15 parents. The sample of parents used in this pre-test was not included in the study. During the pre-test a few difficult words in some questions

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were found and these words were changed into simple local words, and the final questionnaire was modified according to the necessary results.

Statistical Analysis: Data was coded, reviewed and entered using Statistical Package for Social Science (SPSS) version 20. Knowledge scores were assessed using a scoring system as following: Knowledge scale: The knowledge scale consisted of 15 items. Each correct answer was given 1 score and zero score for a wrong or unknown answer. The total knowledge score ranged from 0 to 15 and was classified as, high knowledge score : > mean + SD, moderate knowledge score: mean −SD to mean + SD and low knowledge score l :< mean −SD. One-way

ANOVA was used to assess if there was any significant difference between socio-demographic characteristics and mean scores of knowledge of parents. p-values less than 0.05 indicated statistical significance.

The study protocol was approved by the Medial Research & Ethics Committee of the College of Medicine &Health Sciences at Hadhramout University (HUCOM). A letter was obtained from the Ministry of Education of Al-Mukalla district to the manager of each of the 4 selected public kindergarten to facilitate our data collection. The objective of the study was explained to the subjects, and written consent was obtained from all parents before enrollment in the study as explained above.

ORIGINAL CONTRIBUTION / CLINICAL INVESTIGATION

WORLD FAMILY MEDICINE/MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 16 ISSUE 2, FEBRUARY 2018

Results

Four hundred questionnaires were distributed to parents and 400 participants agreed to participate in the study. Response rate was 100%. Table 1 summarized demographic characteristics of parents. Mothers participants comprised (73%) of the sample and the remaining (27%) were fathers. In terms of age, the parents’ age ranged from 25 to 48 years. The mean of their age was 37.01±4.76 years. The majority (64%) of them were in age group 30 – 39 years. University graduates and secondary educated were (34% & 28% respectively). The majority of mothers (73.8 %) have taken decisions concerning the immunization of their children.

Table 1: Demographic characteristics of the parents

* Standard Deviation

With regards to knowledge of childhood immunization, participants answered a total of 15 closed ended, multiple choice questions. Each response was given one mark with a total of 15 marks. The mean knowledge score for the participants was 8.58.± 2.19 ( Table 2). Based on the scoring system described in the methodology it was found that the majority of the parents (63.3%) had “ moderate “ knowledge scores, 23.3% of them had “high knowledge “while 13.5% had “low knowledge ( Table 2).

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Data revealing the parents’ knowledge of immunization are shown in Table 2. It is apparent from the table that all parents (100%) had heard about immunization and the main source of their information were the health workers (90.7%). The majority of parents (93.8%) knew that immunization prevents disease and they know also it’s complications and the majority of them considered that vaccination should be completed as per schedule less than 2 years (82.3%) and that a healthy child needs vaccination (92.8%). While only the minority (41.2%) of them know when to start the vaccination schedule.

The results also showed that more than half of the participants (57.7%) correctly answered that the vaccine was for all ages while only 41.3 knew that more than one vaccine at the same time had no adverse effects on the child’s immunity. On the other hand, more than half of the parents (51.3%) know that multiple doses of vaccine given at time intervals are important for the child’s immunity.

With regards to the name of the diseases against which children are immunized, all parents correctly knew that Oral Polio Vaccine (OPV) protects against polio and measles Vaccine protects against measles disease (100%). While a small percentage of them knew BCG protects against Tuberculosis (17.8%), Hep B protects against Hepatitis B (26.3%) and DPT vaccination protects against three diseases (Diphtheria, Pertussis and Tetanus) (10% ). Most of the parents did not accept that harm of the vaccine is more than benefits (92.8%). Common colds, ear infections and diarrhea were considered as contraindications for vaccination by (45%) of the parents Table 2.