RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Mr. Anoop Thomas

1. Name of the candidate and address
(in block letters)
2.
Name of the Institution
1st year M.Sc nursing,
East west college of nursing,
# 63, Magadi road,BEL layout.
Bangalore-560091
Karnataka.
East west college of nursing,
# 63, Magadi road,BEL layout.
Bangalore- 560091
Karnataka

3. Course of Study and Subject M. Sc. NURSING

PAEDIATRIC NURSING

4. Date of Admission to the Course 03-06-2009

5. Title of the study:

KNOWLEDGE AND ATTITUDE ON OPTIONAL VACCINES AMONG THE

MOTHERS.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

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When there is prevention available, why should we take a chance? As the years go on, it

will help to reduce both physical suffering and financial costs, Dr. Chandramohan says.1

Immunization forms one of the most important and cost effective strategies for the

prevention of childhood sicknesses and disabilities and is thus a basic need for all

children. Parents are constantly concerned about the health and safety of their children

and they take many steps to protect them. These preventive measures range from child-

proof door latches to child safety seats. In the same respect, vaccines work to safeguard

children from illnesses and death caused by infectious diseases.

Children have an immature immune system and have no natural immunity against

conditions. Therefore they are at an increased risk for contracting infections and diseases

like mumps, rubella, typhoid and hepatitis B. Even today millions of children die each

year from vaccine preventable diseases such as measles diphtheria, tetanus and

pneumonia. Vaccines are meant to protect your child against a variety of preventable

diseases and hence it is every childs right to be vaccinated. 2

Children, with their weaker immune systems, are especially vulnerable to infections.

Immunizing your child is one way of guarding against some serious diseases. This is

because vaccines introduce weak or dead versions of bacteria or virus into the body,

prompting it to produce necessary antibodies to fight back the germs. 3

The government of India recommends and provides some vaccines as per the Expanded

Program of Immunization (EPI). These vaccines include the BCG, oral polio vaccine,

DPT (both primary and booster), measles and tetanus toxoid. Hepatitis B and MMR are

included in some states. Apart from these there are a few mandatory and optional

vaccines which are not on the government immunization schedule at this point of time.

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These vaccines can be classified as vaccines not covered under EPI but recommended by

The Indian Academy of Pediatrics or IAP (the national body of Pediatricians). These

include:

1. Rotavirus vaccination for below 6 months old

2. Haemophilus influenzae b (Hib) vaccine

3. Influenza vaccine

4. Varicella (Chickenpox) vaccine at 15-18 months

5. Hepatitis A vaccination

6. Human Papilloma Virus vaccine

7. Meningococcal Vaccine 2

The merits of optional vaccines for individual use must be considered on the basis of the

degree of prevalence of the infection and disease; age prevalence of mortality, morbidity

and sequelae of the disease; risk of severe disease in susceptible adults after weaning of

vaccine- induced immunity; and the effects of childhood vaccination in modifying future

epidemiology. Socioeconomic factors must be seriously considered before including an

optionalvaccine in the national immunization schedule.4

The number of vaccines has increased greatly in the last decade, and the child of today

probably feels like a pincushion by the first birthday. While combination vaccines do

reduce the number of pricks given, there is still some reluctance to subject babies to so

many injections. Apart from this, some diseases are mild and self limiting, some

vaccines are expensive, and some diseases are of uncertain importance in India.5

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For different reasons, some vaccines are classified as optional vaccines. Parents should

think about each one and make a careful decision about whether to give it to their child.

6.2 NEED FOR THE STUDY

There are many grey areas and lacunae in our understanding of infections and vaccines. It

is prudent that we build our own epidemiological data to evolve a sound strategy in this

area, though we may be forced to take some decisions temporarily in the absence of

reliable data. It is also true that the epidemiology of infections keeps changing over time,

requiring appropriate modifications in our immunization strategies.

India may be considered a conglomeration of many countries within a country. A national

policy must be evolved after considering many variables. One may justify selective

protection of individuals with certain vaccines on a scientific basis (such as

pneumococcal vaccine in splenectomised patients), but one must be cautious about the

routine use of optional vaccines. It is important to think beyond mere availability and

affordability. 4

An estimated 527,000 children aged <5 years die from rotavirus diarrhea each year, with

>85% of these deaths occurring in low-income countries of Africa and Asia.6

Most (approx. 70%) cases of meningitis occur in children under the age of 5 or in people

over the age of 60.7 Out of that an annual incidence of 86 per 100,000 (95%CI 69 to 109)

in 0-4 yr old children, and 357 per 100,000 in 0-11 month infants in India.8

In India rotavirus causes 5 lacks of hospitalization annually. Usually the hospitalization

occurs within 6 months of age. The W H O estimates that the two bacteria alone Hib and

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pneumococcal causes 50% of pneumonia deaths in children under five years of age in

India. In 2006, 206 polio cases were reported in India. In 2007 a total of 864 polio cases

were reported. In 1988 polio was endemic in 125 countries. By mid 2009 poliovirus

remained endemic in only four countries India, Pakistan, Afghanistan, and Nigeria. The

mothers play a vital role in the care of children are unaware of many dreadful diseases its

complications and its prevention.9

Chicken-pox is one more newer vaccine in our armamentarium against infectious

diseases. Due to its extremely contagious nature, varicella is experienced by almost every

child or young adult in the world. Each year from 1990 to 1994, prior to availability of

varicella vaccine, about 4 million cases of varicella occurred in the United States. Of

these cases approximately 10,000 required hospitalization and 100 died. Although

varicella is not commonly perceived as an important public health problem, the

socioeconomic consequences in industrialized countries of a disease that affects

practically every child and causes the carrier absence from work should not be

underestimated.10

Hepatitis A in most developing countries is a sporadic childhood disease, but lately focal

outbreaks have been observed among children in India. A study conducted during 2004,

investigated a large-scale outbreak of hepatitis among children living in a residential

colony in Daund Taluk of District Pune in the western region of India. In total, 123 overt

and 56 sub-clinical cases were detected. This report of a large-scale, explosive outbreak

of hepatitis A in Indian children once again emphasizes the need to evolve proper public

health strategies, especially for vaccination, in countries in the transitional phase from

hyperendemicity to intermediate endemicity.11

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Data from national cancer registries in India indicate that cervical cancer is the most common

cancer/ cause of cancer related death in Indian women. 15 Approximately 1,32,000 cases occur

annually with 74,000 deaths. Indian women face a 2.5% cumulative lifetime risk of cervical

cancer and 1.4% cumulative risk of death from cervical cancer. HPV types 16 and 18 account for

76.7% of cervical cancer in India. There is no data on burden of anogenital warts in the general

community; warts have been reported in 2-25.2% of STI clinic attendees in India. 12

Although one-third of the world cervical cancer burden is endured in India, Bangladesh,

Nepal and Sri Lanka, there are important gaps in our knowledge of the distribution and

determinants of the disease in addition to inadequate investments in screening, diagnosis

and treatment in these countries. Prevalence of human papillomavirus (HPV) infection

among the general populations varies from 714% and the age-specific prevalence across

age groups is constant with no clear peak in young women. High-risk HPV types were

found in 97% of cervical cancers, and HPV-16 and 18 were found in 80% of cancers in

India. Cervical cancer is a relatively neglected disease in terms of advocacy, screening

and prevention from professional or public health organizations. 12

While HPV vaccination provides hope for the future, several barriers prohibit the

introduction of prophylactic vaccines in these countries such as high costs and low public

awareness of cervical cancer. Efforts to implement screening based on the research

experiences in the region offer the only currently viable means of rapidly reducing the

heavy burden of disease.13

During the survey the researcher had the opportunity to interact with the parents .It was

found that the parents of the under five children were unaware of giving vaccines and its

importance in the health of their child. In the light of the above facts, it is an essential fact

that mothers of under five should bring up their knowledge and attitude about the

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optional vaccines in order to bring up a new generation with less risk. This is just one

common misconception about immunizations. The truth is, most diseases that can be

prevented by vaccines still exist in the world. The reality is that vaccinations still play a

crucial role in keeping kids healthy.

6.3 CONCEPTUAL FRAMEWORK:

In the present study the conceptual framework is based on J.W.Kennys input,

throughput and output theory.

6.4 REVIEW OF LITERATURE

Here the investigator has gone through previous studies and research papers which are

related to the study. It comprises of reviews about the attitude and knowledge regarding

optional vaccines

A report is devoted to analyze the effect that compulsory vaccination has on the

compliance of the population, compared with the results obtained by massive campaigns

for optional vaccinations. The implementation of a specific software for the management

of individual schedules helps to reach a substantial complete coverage of the individuals

for the first ones, while improving but incomplete results regard the vaccines agaist

pertussis and measlesmumps-rubella, optional in Italy. The optimization of data

management at the local health unit level improves the quality and the satisfaction of the

work performed by the personnel, but has a limited effect on the already nearly complete

coverage for the compulsory immunizations. The mounting percentage of children

immunized with optional vaccines can be explained both by the massive campaigns of

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information conducted in recent years and by the better tracking of individual

immunization schedules.15

A cross sectional study to assess postpartum Mothers attitudes, knowledge, and trust

regarding vaccination in USA. The data collected via written survey to postpartum

mothers in a large teaching hospital in Connecticut. Results of 228 mothers who

participated in the study, 29% of mothers worried about vaccinating their infants:

23% were worried the vaccines would not work, 11% were worried the doctor

would give the wrong vaccine, and 8% worried that they are experimenting when

they give vaccines. Mothers reported that the most important reasons to vaccinate

were to prevent disease in the baby (74%) and in society (11%). Knowledge about

vaccination was poor; e.g., 33% correctly matched chicken pox with varicella

vaccine. Although 70% wanted information about vaccines during pregnancy, only

18% reported receiving such information during prenatal care. Mothers would

benefit from additional knowledge regarding the risks and benefits of vaccines

particularly during prenatal care.16

A study to examine how maternal socio-demographic factors, together with mother's

education, knowledge, and perception of immunizations, can affect the uptake of optional

vaccinations of preschool children in Italy. Convenience samples of 1,035 mothers were

interviewed. Fifty-nine percent of the respondents reported to have had their child

immunized with the MMR vaccine and 54% reported to have had their child immunized

against pertussis. The findings suggest that mothers' attitudes, educational level, and

socio-demographic characteristics, as well as socio-economic factors and local health

policies, can influence children's immunization uptake. Health promotion, based on a

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partnership between parents and health professionals, should become a priority in Italian

vaccination policies.

A study carried out to find out the acceptability of a human papillomavirus (HPV) trial

vaccine among mothers of adolescents in Cuernavaca, Mexico. A survey was carried

out in a random sample of 880 women between the ages of 15 and 49 years in the

metropolitan area of Cuernavaca, Mexico. These women were interviewed to obtain

information concerning their knowledge of risk factors for cervical cancer and their

perception of the usefulness of vaccines. Afterward, they were provided with

information on the main risk factors for cervical cancer and the future availability of

a human papillomavirus (HPV) vaccine to prevent cervical cancer. Finally, we

explored, with parents, the possible acceptability of an HPV vaccine for their

teenaged daughters. The degree of acceptability and its association with a series of

sociodemographic and reproductive factors were assessed. The respondents had

little knowledge regarding the etiology of cervical cancer. Only 1.9% said that the

principal risk factor was infection with HPV; however, 84.2% were aware of the

usefulness of vaccines and 83.6% of the women indicated that they would allow their

daughters to participate in a trial to evaluate the effectiveness of an HPV vaccine that

helps prevent cervical cancer. Acceptance of a potential HPV vaccine was high in

this sample of Mexican women.17

A study conducted to find out the use of formative research in developing a knowledge

translation approach to rotavirus vaccine introduction in developing countries. This

paper presented the formative research results of a qualitative survey of public health

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 providers in five low- and middle-income countries to determine if and to what

degree rotavirus is perceived to be a problem and the priority of a vaccine. Open-

ended surveys were carried out through focus group discussions and one-on-one

interviews. Researchers discovered that in all five countries knowledge of rotavirus

was extremely low, and as a result was not considered a high priority. However,

diarrhea among young children was considered a high priority among public health

providers in the three poorest countries with relatively high levels of child mortality:

India, Indonesia, and Nicaragua.18

A study was done in maternal socio demographic factors, together with mothers

education, knowledge and perception of immunizations, can affect the uptake of optional

vaccinations. Interviews of mothers were performed using a structured questionnaire. The

study concludes that mothers attitudes educational level, and socio demographic

characteristics, as well as socio economic factors and local health policies, can influence

children immunization uptake. Health promotion, based on partnership between parents

and health professionals, should become a priority in vaccination policies.

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6.5 Statement of the problem:

A comparative study to assess the knowledge and attitude on optional

vaccines among the mothers of under five in a selected urban and rural areas in

Bangalore.

6.6 Aim of the study:

To assess and compare the knowledge and attitude of mothers in urban and ruaral areas

regarding optional vaccines.

6.7 Objectives of the study:

1. To assess the level of knowledge regarding optional vaccines among the mothers

of under five in urban area

2. To assess the level of knowledge regarding optional vaccines among the mothers

of under five in rural area

3. To assess the level of attitude regarding optional vaccines among the mothers of

under five in urban area

4. To assess the level of attitude regarding optional vaccines among the mothers of

under five in rural area

5. To determine the relationship between the level of knowledge and attitude among

the mothers of under five in urban area.

6. To determine the relationship between the level of knowledge and attitude among

the mothers of under five in rural area.

7. To compare the level of knowledge among the mothers of under five between

rural and urban area.

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 8. To compare the level of attitude among the mothers of under five between rural

and urban area.

9. To associate the level of knowledge and attitude regarding the optional vaccines

with selected demographic variables among the mothers in urban area.

10. To associate the level of knowledge and attitude regarding the optional vaccines

with selected demographic variables among the mothers in urban area.

6.8 Operational definitions:

In this study the researcher has define the following terms as:

a) Knowledge: refers to the level of understanding of mothers with under

five children regarding importance, meaning ,dosage frequency and side

effects of optional vaccines.

b) Attitude: refers the thought, feelings and opinion of mothers regarding

optional vaccines.

c) Vaccines: are the preparation used as an active immunizing agent against

the diseases which can be prevented by their timely administration.

d) Optional Vaccines: refers to vaccines which are taken additionally like

Rotavirus vaccination, pneumococcal vaccination, typhoid vaccination,

varicella vaccination, hepatitis A vaccination, H P V, Rabies.

e) Urban: refers to the mothers of under five who are residing in town or a

city.

f) Rural: refers to the mothers of under five who are residing in villages.

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6.9 Hypotheses :

H1- There will be a significant difference in the level of knowledge between

urban and rural mothers.

H2- There will be a significant difference in the level of attitude between urban

and rural mothers

H3- There will be a significant relationship between the level of knowledge

and attitude among the urban mothers.

H4- There will be a significant relationship between the level of knowledge

and attitude among the rural mothers.

H5- There will be significant association in the level of knowledge and attitude

with selected demographic variable among urban mothers.

H6- There will be significant association in the level of knowledge and attitude

with selected demographic variable among rural mothers.

6.10 Assumptions:

Urban mothers may have some knowledge and attitude regarding optional

vaccines

Rural mothers may have less knowledge and attitude regarding optional

vaccines

7 Methodology:

7.1 Research Approach :

Quantitative approach

7.2. Research Design :

Non experimental descriptive survey design

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7.3 Setting :

Selected urban and rural areas at Bangalore

7.4 Population:

Mothers of Under five children

7.5 Sample size:The sample size of the present study comprises of 50mothers of under

five from urban and 50 from rural area.

7.6 Sampling Technique:

Random sampling technique will be used to select the sample.

7.7 Sampling Criteria:

i) Inclusion Criteria;

1. Study includes mothers of under five

2. Those who are willing to participate in the study

3. Those who are present at the time of data collection.

4. Those who are able to speak and communicate in Kannada and English.

ii) Exclusion Criteria

1. Mothers with critically ill children

7.8 Tool:

The tool for data collection:

Section A: Socio demographic data of the study participants which includes age,

educational status, occupation, marital status, religion and type of family.

Section B: Structured questionnaire to assess the knowledge on optional vaccines among

mothers of under five children.

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Section C: Rating scale to assess the level of attitude on optional vaccines among

mothers of under five

7.9 Variables :

Study Variables Knowledge and attitude regarding optional vaccines among mothers

of under five.

Extraneous Variables- Demographic variables such as age, educational status,

occupation, marital status, religion and type of family.

7.10 Methods of data collection:

Structured interview method and attitude rating scale.

7.11: Methods of data analysis:

1. To assess the knowledge, attitude by using descriptive statistics.

(Bar diagrams and pie diagram.)

2. To assess the correlation between knowledge, attitude and practise in urban and

rural by using Karl Pearson Coefficient of correlation.

3. To find the association of knowledge of mothers of under five on optional

vaccines with selected demographic variables using chi square.

7.13 Duration of the study:

4 weeks

7.13 Projected outcome:

The study helps to improve the knowledge and attitude regarding optional vaccines

among under five mothers.

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7.14 Does the study require any investigation or intervention to be conducted on

patient or other human or animals? If so please describe.

NO.

7.15 Has ethical clearance been obtained from your institution in case of 7.3?

YES, ethical clearance report is here with enclosed.

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Tamil Nadu - Chennai Monday, Sep 29, 2008

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2. Vaccines recommended for Indian children

Available from URL: http://www.bolohealth.com/expertspeak/Indukhosla/healthy-

skin-and-hair/82-vaccines-recommended-for-indian-children

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skin-and-hair/82-vaccines-recommended-for-indian-children

4. Y K Amdekar. Optional vaccines: a critical appraisal. Issues Med Ethics.2000 Jan-

Mar;8(1) .

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5. Dr. Parang Mehta. Optional Childhood Vaccines. September 30, 2006.

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Available from URL : http://www.springerlink.com/content/j538440m15608226/

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17. Lazcano-Ponce E, Rivera L, Arillo-Santilln E. Acceptability of a human

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