Professional Documents
Culture Documents
By
Ewunet Ayalew
PROPOSAL TO BE SUBMITTED
TO
Jan, 2010 GC
JIMMA ETHIOPIA
By
Ewunet Ayalew
Advisors:
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. .
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.
I would like to acknowledge all my colleagues for their invaluable suggestions on the
proposal development.
ABSTRACT...............................................................................
ACKNOWLEDGEMENT..............................................................
TABLE OF CONTENTS..............................................................
LIST OF TABLES.......................................................................
LIST OF FIGURE.......................................................................
ABBREVATIONS.......................................................................
CHAPTER: -1................................................................................
4.3STUDY PERIOD....................................................................................
4.4 POPULATION......................................................................................
7. REFRENCE ...........................................................................................
8. ANEX 1 ................................................................................................
Table 4 Monthly income and immunization status of served children 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
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
DTP: diphtheria–tetanus–pertussis
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
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
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
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
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
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
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. ]
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
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
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.
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
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
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.
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
• Sex
• Occupation
• Educational status
• Monthly income
• BCG scar
• 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
n= NZ2P(1-P)
D2(n-1 )+Z2P(1-P)
N = source population
Where Z = 1.96
N= 512(1.96)2 (0.6)(1-0.6)
= 104
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.
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
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
4.12 LIMITATIONS
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
Tea/Coffee 5 5*5 25
Total 8375
Contingency 5% 419
Submission of PI
first draft of
proposal
Submission of PI
second draft
proposal
Submission of PI
final draft
proposal
Data collection PI and
Data
collector
Data entry PI
analysis and
interpretation
Report writing PI
First draft PI
report
submission
Second draft PI
report
submission
Final thesis Pi
report
submission
7, REFERANCE
4. http://www.who.int/countries/eth/areas/immunization/en/ (1 of 2) accessed in
8/25/2009 10:19:32 AM
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.)
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
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
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
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
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
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 –
Characteristics of surveyed
mothers No of Mothers surveyed
Educational status
No %
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
No %
Access to information
Radio
Television
News paper
Health institution
Other
Total
Illiterate
read and
Write
grade 1-6
grade 7-11
12+
Total
<150
150-300
300-600
600-1000
>1500
Total
Mother
Children
Total
Vaccine type No %
BCG
Pentavalent and OPV 1
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
Time inconvenience
Total
Change of place
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
satisfactor
y
Knowledge of
immunization unsatisfact
ory
To cure
Benefit of To prevent
immunization
other
Attitude favorable
towards
unfavorabl
immunization
e
Polio
BCG
Measles
Recalling of Hib
vaccine Diphtheria
preventable
childhood Pertusis
diseases
Heb
TT
NAL O O 2 VALU
E
STATUS
ILLITERATE
READ AND
WERITE
PRIMERY
SCHOOL
SECONDERY
SCHOOL +
TOTAL
MARITAL
STATUS
MARRIED
SINGLE
DIVORCED
WIDOWED
TOTAL
OCCUPATI
ON
HOUSE WIFE
GOVE.
IMPLOYE
FAREMER
OTHER
TOTAL
RELIGION
MUSELIM
ORETODOXE
PROTESTANT
OTHER
TOTAL
AGE
15-24 YEARS
25-44 YEARS
>45YEARS
TOTAL
Nursing department
Consent form
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--------------------------------
Sex------------------
Age---------------
Address /Keble/----------------
Age ------------
4. Religion
1. Muslim _________________
2. Orthodox______________
3. Protestant_______________
4. Other specify_____________
5. Ethnicity
1. Tigre
2. Oromo
3. Amhara
4. Yem
. 5. Others (specify)
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
1. Radio 3. Television
2. News paper 4. Health institution 5. other (specify)______
Part II- Knowledge towards eight vaccine preventable disease.
1. Yes 2. No
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?
6. Have you ever heard child having problem related with vaccination?
1. Yes 2. No
1. Yes 2. No
3. Other/specify---------------------------------
1. Tetanus 2. Meningitis
3. Other/specify-------------------------------------------------
1. Any time
2. during pregnancy
3 other/specify
5. Did you know how many times should a mother have to receive TT?
------------------------------------------------------------------
1. Yes 2. NO
2. If no Q No 1 reason
1. Yes 2. NO
7. What do you think about a child receiving vaccines from campaign, after he/she
completing routine immunization schedule?
1. Yes 2. No
1. Yes 2. No
2. If no Q No1 reason
4. Mother is sick
5. Time inconvenience
6. Other /specify/
4. If ‘B’ Q No 3 reason
3. Mother is sick
4. Time inconvenience
8. Other /specify/-----------------------------------------------------
6. Other/specify----------------------
6. Have you ever seen side effect of a vaccine while children’s have vaccinated?
1. Yes 2. No
1. Fever
3. Rash
4. Loss of apatite
5. Other /specify/_____________
1. Yes 2. No
1. Yes 2. No
Immunization given
1 2 3 1 2 3 4 5 Pre Not
sen prese
t nt
Date
1. Yes 2. No