Indian J. Prev. Soc. Med. Vol. 44 No.3-4, 2013
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1 ISSN Indian J. Prev. Soc. Med. Vol. 44 No.3-4, 2013 A STUDY ON FAQ s OF THE MOTHERS ATTENDING AN IMMUNIZATION CLINIC IN G.R.MEDICAL COLLEGE, GWALIOR AK Agarwal 1, RN Mahore 2 ABSTRACT This study was carried out in an immunization clinic in a Medical College to know about the questions raised by the, about any difference in the types of queries with their educational level and suggest for future IEC. Question were about types, time and number of doses of vaccines to be given, care of the reaction after immunization, the body s weight and its improvement. Group A questioned about Immunization schedule/ next visit and contraindications of immunization significantly more than by Group B (P<0.01). However, question about adverse reactions following immunization, treatment/care of the reaction after immunization, other vaccines than schedule, present weight of the baby and how to improve it and family planning practices was significantly raised more by the Group B than by Group A and illiterates (P<0.01). Key words: Immunization, Inquisitive, Educational level the INTRODUCTION Government of India launched UIP in 1985 with much dynamism to attain the objective of the progressive i.e, to cover at least 85% of all infants against the six vaccine-preventable diseases viz diphtheria, pertussis, tetanus, poliomyelitis, measles and tuberculosis by Lot of energy and money has been spent on the UIP but it does not reap the much hyped outcome. Unmistakably, various survey results show the glaring gap between the target and achievement even after several years 1. It had been found by the end of 2002 that the coverage level for BCG was about 81% and that of DPT and OPV was 70% in India. 2 Estimated full immunization rates in Madhya Pradesh was 48%, 30%, 50%, and 67% for 1999, 2000, 2001, and 2002, respectively. Dropout is an important contributor to low coverage, as shown by the BGC to measles dropout rate of 23%, 31%, 26%, and 15% for 1999, 2000, 2001, and 2002, respectively. However, access is the major contributor to low coverage as indicated by BCG coverage rate of 71%, 69%, 78%, and 95% for 1999, 2000, 2001, and 2002, respectively. The coverage survey data show moderately poor access and dropout, with marked improvement of both in the 2002 survey 3. Ann Veneman, UNICEF Executive Director and Chairperson GAVI, also pointed out that India s routine immunization rates are just 64% 4. One of the causes of low coverage is lack of information and ignorance of the about the immunization. 5,6,7 The vaccines are available, vaccines and vaccinators are present but the target of 85% coverage had not been achieved. 1. Associate Professor, Deptt of Community Medicine, GR Medical College, Gwalior (M.P.) 2. Demonstrator, Deptt of Community Medicine, GR Medical College, Gwalior (M.P.) Address Correspondence: Medical College Campus, G. R. Medical College, Gwalior (MP) Ph ; anilanjuindia@rediffmail.com Indexed in : Index Medicus (IMSEAR), INSDOC, NCI Current Content, Database of Alcohol and Drug Abuse, National Database in TB and Allied Diseases, IndMED, Entered in WHO CD ROM for South East Asia.
2 The children s hospital of Philadelphia published in their Parents Pack the topic Question Parents frequently ask about Vaccines ; in this topic the parents asked questions about schedule and adverse reaction of Hepatitis-B vaccine, complications of mumps, measles, rubella vaccine, new variety of Meningococcus vaccine and administration of the present dose of DTaP vaccine despite side effects after the previous dose 8. In this country also ask questions to the health functionaries on different aspects of immunization, child care etc. in an immunization clinic. With this background the present study was conducted among the attending the immunization clinic in the Department of Community Medicine, GR Medical College, Gwalior with the following objectives: 1. To know about the queries raised spontaneously by the attending 2. To find out if there is any difference in the types of queries with the educational level of the 3. To suggest the areas of future IEC thrust. MATERIALS AND METHODS This study was conducted from Jan to April, 2009 in the Immunization Clinic the Department of Community Medicine, GRMC, Gwalior, among 1345 attending the clinic 587 (43.64% of total ) asked questions regarding different aspects of immunization to the ANM. These 587 were considered as study population. The asked their questions spontaneously without any interrogation or interference by the functionaries. The 2 demonstrators under the supervision of 2 senior teachers, used to record the questions raised by the in the clinic during the immunization session without any interference. More than one question was asked by a mother on many occasions; so total number of questions did not corroborate with the n that is 587. The spontaneous questions of the were recorded first as heard when they were asking and then they were called in separately to give their personal details viz. age, rural/urban residence, number of children, literacy status, and occupation along with the age, sex, immunization status of their children for recording in predisigned and pretested proforma. Only their presence in the clinic was counted in number to determine the percentage of inquisitive. The questions were clustered in groups and statistical analysis was carried out. The were divided according to their level of education into illiterate, primary (I- V), secondary (VI-X), Higher Secondary (XI-XII), Graduate, Postgraduate. Illiterate should feel free in asking any question as the written message would fail to reach them. These were to depend solely on their ears and pictures for getting information. So the literate were divided in 2 groups one group included Primary and secondary i.e., school educated group (Group A) and the other group consisted of Higher Secondary, graduate and postgraduate (Group B). The chi-square test was applied to find out the significant differences on various questions asked by the two groups of. RESULTS 587 (43.64%) out of total 1345 attending the clinic 587 (43.64%) asked questions. So these 587 were included in the study as study population. Table-1 reveals that majority of were from the age group of (75.8%) while 6.64% were in their teens and 17.55% were aged 30 years and above. Illiterate were 19.42%; and 50.08% were educated up to secondary level (Group A). The higher educated (30.48%) also had queries. Table-1:Age wise distribution of the inquisitive (n=587) Age (yrs) No. % < Total Indian J. Prev. Soc. Med Vol. 44 No
3 Majority of the inquisitive were housewives (81.94%). The study population had one twin. 446 (75.97%) had children up to 2; the rest had more than 2 children. Male children were 369 (62.86%) and female ones were 218 (37.14%). Infants constituted 68.99% of the total children provided vaccines followed by months (12.95%), months (7.14%), and months (4.63%). However the children aged months and 5-11 years were 2.38% and 3.91%, respectively. Table-2: Distribution of the inquisitive according to the educational level (n=266) Educational level of the No. of Illiterate Primary (I-V) Secondary (VI-X) Higher Secondary Graduate Postgraduate % Total It was noted from Table 3 that asked questions on immunization schedule/next visit, contraindications of immunization, adverse reactions following immunization, treatment/care of the reaction after immunization, vaccine during fever & illness, feeding after vaccination, other vaccines than schedule, present weight of the baby and how to improve it and family planning practices However, Group A questioned about immunization schedule/next visit and contraindications of immunization significantly more than by Group B (P<0.01). However, the question about adverse reactions following immunization, treatment/care of the reaction after immunization, other vaccines than schedule, present weight of the baby and how to improve it and family planning practices was significantly raised more by the Group B than by Group A and illiterates (P<0.01). Similarly the question about vaccine during fever & illness, feeding after vaccination was asked significantly more by Group A than those by Group B and illiterates (P<0.01, P<0.02). Table-3: Distribution of the questions according to the educational levels of the (n=265) Questions asked about Illiterate (n=114) Group A (n=294) Group B (n=179) No. % No. % No. % 2 value Indian J. Prev. Soc. Med Vol. 44 No df P value Immunization schedule/ next visit Contraindications of immunization Adverse reactions following immunization Treatment/care of the reaction (fever) after immunization Vaccine during fever & illness Drop out asked about completion of schedule Feeding after vaccination Other vaccines then schedule Present weight of the baby and how to improve it Family Planning practices Many asked more than one question. No statistically significant difference was found between Group A and Group B and illiterates so far questions on drop out asked about completion of schedule (P>0.05). The illiterate were more interested only in knowing about
4 immunization schedule/next visit (63.16%) and contraindications of immunization (39.47%) while they asked about the other questions less than that by the educated. DISCUSSION In this study 6.64% in their teens and 17.55% aged 30 years and above were outside the ideal childbearing age of years 2. These are the who would require more interpersonal communication as some socio-economic problems led them to remain outside the ideal childbearing age. The educated asked questions apart from illiterate ones. So furtherance of IEC is required for irrespective of educational level setting aside the feeling of complacency on the part of the health functionaries considering the educational status of the. Majority of the inquisitive were housewives (83.94%). This ignorance might be due to their less scope of going outside their homes for attending any Mahilla Mandal (community group) meeting or exposure to any mass media could also be limited as that would not answer all the questions of individual mother. Here interpersonal communication or Focus Group Discussion (FGD) would be helpful where the participants could have intimate discussion. Two-thirds of the inquisitive (66.54%) came from the Lashkar town suggesting that urban ladies also require further clarification through IEC. The rural used to get the immunizing agents from Peripheral Health centers; so their attendance in immunization clinic was lesser than those coming from Lashkar town. But these attending immunization clinic might be considered as tip of the iceberg favouring the scope of further strengthening of IEC even in urban areas. It was found that Group A questioned about immunization schedule/next visit significantly more than that by Group B (Table 3). These questions were related to BCG, OPV, DPT and Measles vaccines due to their inclusion in UIP in India; so these could not be compared with the questions raised by the parents in Philadelphia study where questions centred round the schedule and adverse reaction of Hepatitis-B vaccine, complications of Mumps, Measles Rubella Vaccine, new variety of Meningococcus vaccine and administration of the present dose of DTaP vaccine despite side effects after the previous dose. However the types of the questions like schedule, adverse reaction and complications of the vaccine asked by the in the present study and the parents in the Philadelphia study were similar though types of vaccines were not exactly similar 8. When the contraindications of immunization was considered, no statistically significant difference was found between the illiterate and group A ( 2 = 0.78, df 1, P>0.05)) but the difference between illiterate, group A and group B was found significant ( 2 = 25.99, df= 2, P>0.001 (table 3). No statistically significant difference was found between the 2 groups, when the drop out asked about completion of schedule was considered. The question about treatment/ care of the reaction after immunization was significantly raised more by Group B than by Group A ( 2 = 34.47, df= 2, P<0.001 (Table-3). This might be due to more concern of the literate with the higher educational level than those up to school levels. Similarly the present weight of the baby and how to improve it was asked significantly more by Group B than that by Group A ( 2 = 24.67, df= 2, P<0.001) (table 3). It would indicate that the in higher education bracket were more inquisitive about the growth and development of their babies. Regarding Feeding after vaccination no statistical significance was found between the 2 groups A and B (P=0.374) (Table 3). The illiterate asked about the treatment of other medical problems of the babies less than that by the educated ; probably majority of the former group did not think of putting this question in this clinic. Indian J. Prev. Soc. Med Vol. 44 No
5 This study revealed that questions raised by the were not only associated with immunization only but also with other problems of the children; so it differs from The Children s Hospital of Philadelphia study 8 where questions of parents were confined to vaccines only. CONCLUSION This study indicates that health functionaries will have take up the Health education aspects of the more enthusiastically through personal Interpersonal communication and FGD in different set ups e.g., clinics, community group meetings or wherever the mother could be met either singly or in groups and incorporate vaccine information in the curricula. This would remove their different confusion and improve their confidence about the programme and that would help in reaching the target of the vaccine coverage of the children. In an immunization clinic the attending nurses and trained paramedics should be encouraged to treat common ailments with proper advice and to answer the questions raised by the. Inquisitive pointed out the deficiencies of the health functionaries. Acknowledgement: Authors being a part of the system are grateful to participants of the study, so that steps in future could be taken up more effectively. REFERENCES 1. Adorna Cecilo L. Immunize ALL of India s children: Job One for NRHM (National Rural Health Mission) Newsletter. February-March 2006, Vol. 1 (3), CDC. (July 2, 2004) Progress towards Sustainable Measles Mortality reduction South-East Asia Region, Routine Vaccination, table 1, Morbidity & Mortality Weekly Report (MMWR) CDC, 53 (25); Dasgupta S, Pal D, Sinha RN, Mandal NK, Roy Karmakar P, Saha I, Mandal AK. Decline Trend in Routine UIP Coverage. Indian Journal of Public Health. 2001, Vol. XXXXV, No. 1, p Desai VK, Kapadia SJ, Kumar P, Nirupam S. Study of Measles incidence and vaccination coverage in slums of Surat city; Indian Journal of Community Medicine; January -March 2003, Vol. 28. No. 1, p Parents PACK Questions Parents Frequently Ask About Vaccines. The Children s Hospital of Philadelphia. 6. Park K. Universal Immunization Programme. Park s Text Book of Preventive & Social Medicine, Banarsidas Bhanot, Jabalpur, India, 18 th Edition, January 2005, p Veneman A. Immunization an excellent Investment. NRHM (National Rural Health Mission) Newsletter. 2006, 1(3), Yadav RJ and Singh P. Immunization status of children and in the state of Madhya Pradesh; Indian Journal of Community Medicine, 2004; 29: Yadav S, Mangal S, Padhiyar N, Mehta JP, Yadav BS. Evaluation of Immunization coverage in an urban slum of Jamnagar city; Indian Journal of Community Medicine, 2006; Vol. 31 (4), Indian J. Prev. Soc. Med Vol. 44 No
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