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Tanzania Journal of Health Research, Vol. 12, No. 3, 2010 The knowledge and attitude towards childhood immunization
among mothers attending antenatal clinic in Lagos University Teaching Hospital,
Nigeria O. AWODELE1*, I.A. OREAGBA1, A.
AKINYEDE1, D.F. AWODELE2 and D.C. DOLAPO3 1Department of Pharmacology, College of Medicine, University of
Lagos-Nigeria Received 4 February
2010 Code Number: th10022 Abstract: Immunization
remains one of the most important public health interventions and a cost
effective strategy to reduce both the morbidity and mortality associated with
infectious diseases. Over two million deaths are delayed through immunization
each year worldwide. This present study aimed to assess the knowledge and
attitude of mothers attending antenatal clinic in Lagos University Teaching
Hospital (LUTH) in Nigeria, towards childhood immunization. This descriptive
cross-sectional study involved 274 mothers attending antenatal clinics in LUTH from
April-June 2009. The results showed that almost all (93.8%) the respondents
were aware of immunization and that immunization could prevent childhood
illness (98.1%). However, some of the respondents (28.8%) felt immunization
will make their children brilliant. While 45.5% of the respondents thought that
polio vaccines ought to be given five (5) times while only 8.6% knew it should
be given four (4) times. There were significant (P<0.05) relationships between age of respondents, ethnicity,
level of education, occupation and attitude to immunization. However, there
was no significant (P>0.05)
relationship between religion and attitude to immunization. Although majority
of the mothers were aware of the existence of immunization services, their
knowledge of immunization schedule of
vaccine preventable diseases is poor. A better understanding of routine
immunization schedule is important in the design and implementation of
immunization programmes. Educating mothers
about the vaccines and vaccine preventable diseases, and improving their
performance are recommended. Key words: mothers,
childhood, immunization, vaccine, diseases, Nigeria Introduction Epidemiological study has shown that 2.5 million deaths occurred every
year as a result of vaccine-preventable diseases, mainly in Africa and Asia
among children less than 5 years old (GIVS, 2005). Immunization is the
process of conferring increased resistance to an infectious disease by a means other than experiencing the natural infection.
Typically, this involves exposure to an agent (antigen or immunogen) designed to fortify the person's immune system against that agent or
similar infectious agents (active immunization). Immunization also can include
providing the subject with protective antibodies developed by someone else or another organism (passive
immunization).When the human immune system is exposed to a disease once, it can
develop the ability to quickly respond to a subsequent infection. Therefore, by
exposing an individual to an immunogen in a controlled way, the person's body
will then be able to protect itself from infection later on in life
(Blakemore & Jennett 2001). Medical researchers have developed diverse
immunization processes for a vast number of diseases, beginning on a large
scale about a century ago. Immunization remains one of the most important
public health interventions and a cost effective strategy to reduce both the
morbidity and mortality associated with infectious diseases. In line with the
aforementioned, the report of World Health Organization and the earlier study
of Breslow (2002) have shown that over two million deaths are delayed through
immunization each year worldwide. Childhood immunization is an act of inducing immunity to a child by
applying a vaccine that almost guarantees protection from many major diseases.
Childhood vaccination is widely considered to be ‘overwhelmingly good’ by the
scientific community (GIVS, 2005; Wright, 1995). Vaccination coverage has now
reached a plateau in many developing countries, and even where good coverage
has been attained; reaching children not yet vaccinated has proved difficult
(EPI, 1998). The dynamics of vaccination uptake
remain unclear; the critical questions that remain to be answered therefore
include to what extent is vaccination accepted by the public in response to
recommendations and pressure from health workers and community leaders? To what
extent does an informed public actively demand it? What is the level of awareness
of its benefits and importance?. Previous studies have shown that uptake of vaccination services is dependent not only
on provision of these services but also on other factors including knowledge
and attitude of mothers (Matsumura et al., 2005; Torun & Bakirci,
2006), density of health workers (Anand &
Barnighausen, 2007), accessibility to vaccination clinics, availability of safe
needles and syringes and the opportunity costs (such as lost earnings or time)
incurred by parents (mothers). A good attempt to address these factors may go a
long way to improve vaccine utilization and subsequent protection of the
children against childhood infectious diseases. Therefore, this present study was
carried out to assess the knowledge and attitude of mothers attending antenatal
clinic in Lagos University Teaching Hospital, Nigeria, towards childhood immunization
as the findings obtained may serve as the basis for effective intervention. Materials
and Methods Study area and design Lagos University Teaching
Hospital is one of the largest teaching hospitals in Nigeria. It is located in Lagos State, in south-western Nigeria. Lagos is one of
Nigeria’s most populated states. It is the chief port, principal economic and
cultural centre. The teaching hospital has 761
bed spaces and records over 9,000 patient attendances in a month out of which
there are almost 200 mothers attending antenatal clinics every month. This was
a descriptive cross-sectional survey that involved attending antenatal
clinics in LUTH for childhood immunization from April-June 2009. Study population The study population includes all the 274 mothers
attending antenatal clinics in LUTH that consented to be part of the study.
There was initial solicitation of all the mothers attending antenatal clinic to
be part of this study irrespective of their level of education or social group.
This study did not coerce subjects to be part of the study without their
consent. The method used for this study is the convenience sampling technique.
This method entails recruiting all the mothers attending antenatal clinic that
desired to be part of this study within the study period. Data collection Data was
collected using a standard structured questionnaire adopted from the World
Health Organization with three (3) sections on socio-demography, knowledge on
immunization and attitude towards childhood immunization. The study subjects
were not required to write but just to tick the appropriate boxes which were
provided for each option given. Names were not used for identification but
coding numbers were used instead. The subjects that were illiterate were
assisted to complete the questionnaire. Data analysis The questionnaires obtained from the study were
analyzed using the Epi-Info 2002 software programme. The data was presented in frequency distribution tables with
percentages. Chi square statistics was used to test the significance at
p<0.05 between the socio-demographical variables and awareness and attitude
to immunization. Results The results obtained showed mothers attending
antenatal clinic in LUTH to have a mean age of about 30.7 years. A total of 268
(97.8%) respondents were married, while only 4 (1.5 %) were single. Christians
constituted the majority 223 (81.4 %) group of the population. Over 150
respondents (55.5 %) were Yorubas, while Ibos constituted 34.7% and 6.2 % were
Hausas. Table 1: Socio-demographic characteristics of respondents
About two-thirds of the respondents (64.6%) had tertiary education and larger percentages (33.2%) of them were professionals (Table 1). Table 2: Knowledge of diseases that could be prevented by immunization
Multiple responses given Almost all the respondents were aware of immunization
and that immunization could prevent childhood sickness (93.8%; 98.1%)
respectively. However, some of the respondents felt immunization will make
their children brilliant (28.8%) or grow fast (10.9%). Quite high percentages
of the respondents knew that immunization could prevent Poliomyelitis, Measles,
Diphtheria, Tuberculosis, Yellow fever and Hepatitis respectively (Table 3).
But 48.6% of the respondents thought immunization could prevent malaria (Table
2). Although, 82.5 % and 86.4 % knew that immunization could be administered as
an injectable and mouth drop, a high percentage (55.3%) thought immunization
could be in syrup formulation. Table 3: Percentage of respondents with correct Knowledge of
immunization
Of the 257 respondents, 48.2% knew that BCG could be given
at birth while 13.2% and 4.7% thought DPT and OPV2 could be given at birth,
respectively. Also, 46.7% knew that DPT1 could be given at 6 weeks after birth
but 7.4% also thought DPT2 could be given at 6 weeks. In addition, 38.5% and
26.8% knew that measles vaccine and yellow fever vaccine could be given at 9
month after birth while 33.9% had no exact idea of when immunization could be
given (Table 3). A large percentage of the
respondents (62.6%) knew that immunization ought to be given at a specific period,
66.5% were convinced that immunization is necessary for their children, 64.2 %
of the respondents were ready to ensure their children are immunized
irrespective of the cost while 65.4% of the respondents believed they can
advise their fellow women to receive immunization for their children. Only a few
thought giving a child immunization can cause HIV/AIDS (1.5%) and it was
possible to take immunization in a community pharmacy (3.9%). A large
percentage of the respondents (45.5%) thought that polio vaccines ought to be
given five (5) times, 1.6% thought it should be given three (3) times, 7.8%
thought is should be given 6 times and 2% thought it should be given 7 times. Only
8.6% knew it should be given four (4) times, which is the standard number of times
polio vaccine should be given. Eighty-six (33.5%) of the respondents did not
know the specific number of times it should be given. The mean number of times
respondents thought a child should receive a polio vaccine was 4.9±0.9 times. Table 4: Associations between socio-demographic variables of respondents
and awareness of immunization
*Fisher exact p-value, level of significance (p<0.05) Forty-nine percent (126) of the respondents agreed
that children should be brought for immunization at the appointment time while
10.5% thought immunization should be taken at one’s convenient time; 33.5% of
the respondents did not know when their children should be brought for
immunization while 7% would bring children for immunization when they had
money. The results further showed that there were no significant relationships
between the ages of respondents and awareness of immunization and between
religion and awareness of immunization. However, significant (P<0.05) relationships were observed
between ethnicity and awareness of immunization and between level of education
and awareness of immunization (Table 4). The results showed that there were
significant (P<0.05) relationships
between age of respondents; ethnicity; level of education; occupation and
attitude to immunization however, there was no significant relationship between
religion and attitude to immunization (Table 5). Table
5: Associations between socio-demographic variables of respondents and attitude
to immunization
*Fisher exact p-value,
level of significance (p<0.05) Discussion Immunization
is an important public health interventions strategy to reduce the morbidity
and mortality associated with infectious diseases. Over two million deaths are
delayed through immunization each year worldwide (WHO, 2003). Despite this,
vaccine preventable diseases remain the most common cause of childhood
mortality with an estimated three million deaths each year (CGD,
2005). Uptake of vaccination services is dependent not only on provision of
these services but also on other factors including knowledge and attitude of
mothers (Matsumura et al., 2005;
Torun & Bakirci, 2006), density of health workers (Anand & Barnighusen,
2007), accessibility to vaccination clinics and availability of safe needles
and syringes. This present study showed that a high proportion of
the respondents had tertiary education and thus had good knowledge and
awareness of immunization. As earlier mentioned, the majority of the
respondents had good knowledge of immunization and that immunization could
prevent childhood diseases, this may be in order with the study of Freeman et al. (1992) that showed the
relationship between mothers’ education and knowledge of the diseases
immunization could prevent. However, a small proportion of the respondents felt
that immunization will make their children brilliant, more so, about half of
the respondents thought immunization will prevent malaria fever. These
proportions of incorrect responses by
the respondents is significant and it is an indication that some mothers still
have poor understanding of the concept of immunization and this may go a long
way to affect the uptake of immunization and thus cause a set back in the
millennium development goals. This present study has also shown that about half of
the respondents did not know the formulation type of vaccine. Thus, they felt
vaccine could come in syrup formulation. This may seem not important but it
could create a wrong impression especially mothers thinking their children are receiving
immunization when being given syrup medication for other purposes. The
implication of this is that such mothers may give a wrong immunization history
in the future at times when their child is ill thus complicating the physician’s
diagnosis. The findings of this present study revealed that most
mothers do not know appropriately the time schedule for vaccine administration.
These results may be consistent with the findings of Freeman et al. (1992) that showed 58% of the
respondents did not know the exact time to commence immunization and 48% did not
know the time schedule for immunization. It may be interesting to report that
this study has shown women to be interested in ensuring that their children are
immunized and more so, they could encourage their co-mothers to take
immunization for their children. A significant relationship was observed between
ethnicity and awareness of immunization, between level of education and
awareness of immunization and between age and attitude to immunization. These are
consistent with the study of Freeman et al, 1992 and Roodpeyma et al. (2007). In conclusion, although majority of the mothers had good knowledge of immunization and
that immunization could prevent childhood diseases, their knowledge of
immunization schedule as well as of vaccine preventable diseases is poor. A
better understanding of the immunization schedule is important in the design
and implementation of immunization programmes. Educating
mothers about vaccines and vaccine preventable diseases are recommended. References
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