Maternal Knowledge, Perceptions and Age-appropriate Coverage of Routine Immunization in Children under Five Years in Southern Sri Lanka
Keywords:knowledge, attitudes, immunization coverage, Expanded Programme of Immunization, Sri Lanka
Background: Immunization is one of the most cost-effective strategies used for control of life-threatening infectious diseases. Use of immunization services in childhood is greatly influenced by parental knowledge and attitudes regarding immunization and its benefits.
Objective: To assess the maternal knowledge, perceptions and coverage of routine immunization in children under five years in Bope-Poddala health division in Southern Province, Sri Lanka.
Methods: A cross-sectional study was conducted among 216 mother-child pairs attending Maternal and Child Health clinics in Bope-Poddala area. An interviewer-administered questionnaire was used to collect data on maternal knowledge, beliefs and attitudes regarding routine immunization of children under five years, under Expanded Programme of Immunization (EPI). The level of knowledge was determined by assigning marks to correct responses for questions on knowledge. Age appropriate immunization of children was assessed using Child Health Development Records. Data were analyzed using SPSS statistical software package.
Results: Although 32% of mothers knew that vaccination prevents communicable diseases, only 11% had good knowledge regarding the EPI vaccine schedule and the diseases prevented by these vaccines. Public Health Midwife was the source of knowledge in 91.2%. Mothers' knowledge was significantly associated with their occupation (p<0.001). Majority of the mothers (>75%) had positive attitudes towards immunization, while attitudes were not associated with maternal characteristics. Almost all of the children (99.5%) were appropriately vaccinated for their age.
Conclusions: Maternal knowledge regarding the EPI schedule is poor and is influenced by their occupation. In contrast, the attitudes and practices regarding immunization appear to be satisfactory. Further health education is necessary to eliminate misbelieves regarding immunization.
World Health Organization.Immunization. World Health Organization. 2018[Internet]Geneva:World Health Organization. 2017 [cited 23 January 2018]. Available from: http://www.who.int/topics/immunization/en/
World Health Organization.World Immunization Week, 24-30 April 2017 [Internet].Geneva:World Health Organization. 2017 [cited 27 September 2017]. Available from: http://www.who.int/campaigns/immunization-week/2017/en/
World Health Organization.10 facts on immunization [Internet].Geneva: World Health Organization. 2017 July [cited 27 September 2017]. Available from: http://www.who.int/features/factfiles/immunization/en/
Miller, M.A. and Sentz, J.T. Vaccine-preventable diseases. History of Vaccination in Africa. 2006 Apr 2;2:163
Palihawadana P, Peiris S, Amarasinghe A, Ginige S, Wijesinghe R, Premaratne R, Mallawarachchi V. Immunization Handbook. 3rd ed. Sri Lanka. Epidemiology Unit Ministry of Health. July 2012.21-27.
Xeuatvongsa A, Hachiya M, Miyano S, Mizoue T, Kitamura T. Determination of factors affecting the vaccination status of children aged 12â€“35 months in Lao Peopleâ€™s Democratic Republic. Heliyon. 2017 Jan 3;3(3):e00265.
Birhanu S, Anteneh A, Kibie Y, Jejaw A. Knowledge, Attitude and Practice of Mothers Towards Immunization of Infants in Health Centres at Addis Ababa, Ethiopia. Am J Health Res. 2016;4(1):6-17.
Bardenheier B, Yusuf H, Schwartz B, Gust D, Barker L, Rodewald L. Are parental vaccine safety concerns associated with receipt of measles-mumps-rubella, diphtheria and tetanus toxoids with acellular pertussis, or hepatitis B vaccines by children?. Archives of pediatrics & adolescent medicine. 2004 Jun 1;158(6):569-75.
Weeraratne NC. Factors affecting Improper Immunization Coverage of Children between Two â€“ Five years of age in Colombo District, Sri Lanka 2014. International Journal of Novel Research in Healthcare and Nursing. 2015;2(3):77-85.
Owais A, Hanif B, Siddiqui AR, Agha A, Zaidi AK. Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan. BMC public health. 2011 Apr 17;11(1):239.
Wang YY, Wang Y, Zhang JX, Kang CY, Duan P. [Status of mother's KAP on child immunization in minority areas, Guizhou Province]. Beijing da xue xue bao. Yi xue ban= Journal of Peking University. Health sciences. 2007 Apr;39(2):136-9.
Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bulletin of the World Health Organization. 1999 Mar 1;77(3):224-9.
Oliveira MF, Martinez EZ, Rocha JS. Factors associated with vaccination coverage in children< 5 years in Angola. Revista de saude publica. 2014 Dec;48(6):906-15..
Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual. World Health Organization; 1991.
Gunathunga W, Fernando DN. Assessment of community maternal care performance of public health midwives of a province in Sri Lanka: a multi-method approach. Southeast Asian J Trop Med Public Health. 2010; 31(2):310-8.
Exchange Rate Average (US Dollar, Sri Lankan Rupee) - X-Rates [Internet]. X-rates.com. 2018 [cited 5 February 2018]. Available from: http://x-rates.com/average/?from=USD&to=LKR&amount=1&year=2013
Siddiqi N, Siddiqi AE, Nisar N, Khan A. Mother's' knowledge about EPI and its relation with age-appropriate vaccination of infants in peri-urban Karachi. JPMA. The Journal of the Pakistan Medical Association. 2010 Nov;60(11):940-4.
Forder JA. Attitudes Towards Immunization in Cambodia: A Qualitative Study of Health Worker and Community Knowledge, Attitudes and Practices in Kompong Chhnang. PATH and AIHI. 2002.
Achappa B. Knowledge, attitude and perceptions of mothers with children under five years of age about vaccination in Mangalore, India. Asian Journal of Medical Sciences (E-ISSN 2091-0576; P-ISSN 2467-9100). 2014 Jun 23;5(4):52-7.
Tilakaratna KG, Satharasinghe A. Headcount Index and Population Below Poverty Line.Sri Lanka.Department of Census and Statistics 2002.7p.
Kumar C, Singh PK, Rai RK. Coverage gap in maternal and child health services in India: assessing trends and regional deprivation during 1992â€“2006. Journal of public health. 2013 Jan 27;35(4):598-606.
Rathaur V, Mehrotra A, Rathore T. Knowledge, attitudes and practice towards immunization among working and non-working mothers in Bareilly city. Indian Stream Research Journal [Internet]. 2014 [cited 21 April 2015]; 4(5):1-5. Available from: http://isrj.org/ColorArticles/4818.pdf
Qidwai W, Ali SS, Ayub S. Knowledge, attitude and practice regarding immunization among family practice patients. Journal of Dow University of Health Sciences. 2007 Apr 23;1(1).
Vikram K, Vanneman R, Desai S. Linkages between maternal education and childhood immunization in India. Social science & medicine. 2012 Jul 31;75(2):331-9.
Saunders N. Maternal knowledge, attitude and practices concerning child health among mothers of children younger than 60 months in kep District, Kingdom of Cambodia. University of Toronto, Faculty of Health. Center for International Health. 2005; 1:2-30.
Devasenapathy N, Jerath SG, Sharma S, Allen E, Shankar AH, Zodpey S. Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study. BMJ open. 2016 Aug 1;6(8):e013015.
Anand S, BÃ¤rnighausen T. Health workers and vaccination coverage in developing countries: an econometric analysis. The Lancet. 2007 Apr 20;369(9569):1277-85.
Patel AR, Nowalk MP. Expanding immunization coverage in rural India: a review of evidence for the role of community health workers. Vaccine. 2010 Jan 8;28(3):604-13.
Szilagyi PG, Bordley C, Vann JC, Chelminski A, Kraus RM, Margolis PA, Rodewald LE. Effect of patient reminder/recall interventions on immunization rates: a review. Jama. 2000 Oct 11;284(14):1820-7.
Prislin R, Dyer JA, Blakely CH, Johnson CD. Immunization status and sociodemographic characteristics: the mediating role of beliefs, attitudes, and perceived control. American Journal of Public Health. 1998 Dec;88(12):1821-6.
Lang P. Vaccination status of children in Switzerland (Doctoral dissertation, University_of_Basel).
Hull B, Dey A, Beard F, Hendry A, Brotherton J, McIntyre P. Written by.
O'Connor PM, Liyanage JB, Mach O, Anand A, Ramamurty N, Balakrishnan MR, Singh S. South-East Asia Regional update on measles mortality reduction and elimination, 2003â€“2008. The Journal of infectious diseases. 2011 Jul 1;204(suppl_1):S396-402.
Tao W, Petzold M, Forsberg BC. Routine vaccination coverage in low-and middle-income countries: further arguments for accelerating support to child vaccination services. Global health action. 2013 Dec 1;6(1):20343.
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