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A Study of the Knowledge and Attitude Towards Pulse Polio Immunization in Semi Urban Areas of South India

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A Study of the Knowledge and Attitude Towards Pulse Polio Immunization in Semi Urban Areas of South India Australasian Medical Journal AMJ 2011, 4, 2, 81-86. A study of the knowledge and attitude towards pulse polio immunization in semi urban areas of South India Joseph N1, Subba SH 2, Nelliyanil M3, Kotian SM4, Haridath AC 5, Kishor N5, Attavar S5, Poornima P 5, Rane DV 5, Chaithali H 5, Husain J5 1 Assistant Professor, 2 Associate Professor, 4 Selection Grade Lecturer, 5 M.B.B.S students, Department of Community Medicine, Kasturba Medical College, Manipal University, Light house hill road, Mangalore, India 3 Post graduate student, Department of Community Medicine, Bangalore Medical College, Bangalore, India RESEARCH transmission of polio. More than one quarter of the study population were under the misconception that polio is a curable disease. The primary source of information about Please cite this paper as: Joseph N, Subba SH, Nelliyanil M, PPI in majority of participants was the television (n = 192; Kotian SM, Haridath AC, Kishor N, Attavar S, Poornima P, 60%). Two-hundred and eighty eight (90%) participants Rane DV, Chaithali H, Husain J. A study of the knowledge knew that the purpose of PPI was to eradicate polio. Only and attitude about pulse polio immunization in semi urban 128 (40%) participants knew that polio drops can be given areas of South India. AMJ 2011, 4, 2, 81-86 Doi: to children with mild illnesses and an identical number of http://dx.doi.org/10.4066/AMJ.2011.532 participants knew that hot food stuff should not be given for at least half an hour following vaccination Corresponding Author: administration. Misconceptions such as PPI causing vaccine Dr. Nitin Joseph, MD (Community Medicine), overdose was identified among 7 (2.2%) participants, it is a Assistant Professor, Department of substitute for routine immunization was believed among 30 Community Medicine, Kasturba Medical (9.4%) participants and that oral polio vaccine prevents College, Manipal University, Light House Hill other diseases was seen among 76 (23.7%) participants. The educational status of the participants was significantly Road, Mangalore 575001 , India. associated with their awareness level (χ2 =13.668, DF=6, [email protected] P=0.033). Address] Abstract Conclusion This study identified a few important misconceptions Background associated with polio and PPI which need to be addressed The government of India launched the pulse polio by large scale awareness campaigns in order to achieve immunization (PPI) programme in 1995 with the aim of polio eradication in the near future. eradicating poliomyelitis by the end of 2000. Despite this, 733 children with polio were reported in 2009 alone. Key Words Therefore, there is a need to understand the reason Polio, PPI, Awareness, Mangalore underlying such high numbers of cases after so many years of programme implementation. This study was performed to assess the knowledge of the general population about Background poliomyelitis and PPI and their attitude and practice Poliomyelitis is a feared disease in some countries of the towards PPI. world due to its tragic legacy of paralysis and deformity. In 1988, the World Health Assembly and its members Method committed to the goal of eradication of poliomyelitis by the This cross-sectional study was undertaken in two semi- year 2000. (1) This global initiative to eradicate polio was the urban areas of Mangalore city. Only houses in which largest international disease control effort ever. Polio virus children under five lived were included in the study. Data transmission has been interrupted in most parts of the was collected by interviewing any adult member of the world except for few foci in ten countries located in South household using a pretested questionnaire. Asia and Central/Western Africa. (2) The Government of India launched the pulse polio Results immunization (PPI) programme on a country wide basis in The literacy rate of study participants was 99%. Only 1995. The term “pulse” describes the simultaneous, mass 35(10.9%) participants knew the correct mode of administration of oral polio vaccine (OPV) on a single day to 81 Australasian Medical Journal AMJ 2011, 4, 2, 81-86. all children aged below 5 years. (3) PPI consists of vaccination participants, 234(73.1%) were females. Literacy rate among of children at fixed booths on two national immunization participants was near total at 99 % (n = 317) with 134 days (NID), separated by six weeks, during the winter (41.9%) educated up to secondary school. (See Table 1) season. Table 1: Socioeconomic distribution of study participants. The main aim of PPI is to interrupt the transmission of wild (n=320) polio virus by exposing children to the vaccine virus. (3) Educational status No. Percentage However, 5-6% of children were being missed in the PPI. Illiterate 3 1 Therefore, during 1999-2000, in addition to booth Primary school (1 - 5 42 13.0 immunization, a house-to-house search of missed children std) was undertaken to vaccinate them over the 2-3 days Secondary school 134 41.9 following each NID. (6-10) In spite of the extensive PPI introduced by the government, Pre University (11- 45 14.1 the aim of making India a ‘polio free state’ still remains 12) (4) farfetched with 733 children with polio reported in 2009. Graduation & above 96 30 This makes India the largest polio endemic country in the Occupational status (2) world. Resistance by the general population appears to Not working 8 2.5 prevent acceptance of this programme. Misconceptions and House wife 191 59.7 myths regarding the vaccine, concern about its ill effects Unskilled 45 14.1 and lack of awareness about poliomyelitis and PPI are the Skilled 47 14.7 (5) major obstacles. Our study aims to identify these Retired 29 9.0 misconceptions to better inform future implementation of Religion this programme. This study was thus conducted to assess Hindus 265 82.8 the awareness of the target population about polio and PPI, Muslims 34 10.6 and to assess their attitude and practice towards PPI. Christians 21 6.6 Table 2: Awareness of participants about poliomyelitis Method (n=320). This cross-sectional study was undertaken in January 2009 in two semi-urban areas, Jeppinamogaru and Attavar, Characteristics No. (%) situated in Mangalore city in the Karnataka state of South Heard about poliomyelitis India. The ethical approval for conducting this study was Yes 320(100) obtained from the institutional ethical clearance committee. No 0(0) The sample size was calculated using 95% confidence limits High risk groups and 90% power. Assuming an awareness level of Children 249(77.8) poliomyelitis and PPI among people as being about 56% Adults 21(6.6) from a previous study, (6) the sample size was calculated as Don’t know 50(15.6) approximately 315 households. Only houses containing Signs & symptoms children under five years old were included in the study. A Fever 35(10.9) total of 320 such households were covered by convenience Paralysis of limbs 202(63.1) sampling during the study period. Data was collected by Others 89(27.8) interviewing any adult member (aged above 18 years) of the Don’t know 6(1.9) household using a pretested, semi-structured questionnaire Mode of transmission after taking their informed consent. Contaminated food & water 35(10.9) Participants were asked about signs and symptoms of Mosquitoes 16(5.0) poliomyelitis, the age groups most susceptible to this Don’t know 269(84.1) disease, the mode of disease transmission, the sources of information about PPI, the number of and seasons in which Preventable disease the PPI rounds are held, the benefits of PPI and reasons for Yes 288(90) non-immunization during PPI rounds. Each answer given to No 13(4.1) the questionnaire was assigned points which enabled the Don’t know 19(5.9) calculation of cumulative scores and subsequent Curable disease categorization of the level of awareness of participants into Yes 87(27.2) well, moderately and poorly. All the data collected were No 209(65.3) analysed using version 11.5 of the Statistical Package for Don’t know 24(7.5) Social Sciences software package (SPSS Inc., Chicago, IL). Awareness about the disease Chi-square was used for testing statistical significance and P All of the participants had heard about poliomyelitis. value <0.05 was considered as significant. However, only 35 (10.9%) participants knew that the disease is spread by contaminated food and water. Results Although 288 (90%) knew that poliomyelitis is a preventable disease, 87 (27.2%) were under the misconception that it is The response rate was 100 % as all the 320 participants curable. (See Table 2) agreed to be interviewed by our team. Of the total 320 82 Australasian Medical Journal AMJ 2011, 4, 2, 81-86. None of the participants knew what the term “pulse” in PPI Table 3: Awareness of participants about PPI (n=320). meant. The target age group of 0-5 years for PPI was correctly answered by 240 (75%) participants. The purpose Characteristics No. (%) of PPI being to eradicate polio was known by 288(90%) Heard about PPI participants. Seven (2.2%) participants had the Yes 320(100) misconception that repeated vaccination under PPI leads to No 0(0) over dosage and is thus harmful to children. Primary source of information about PPI Only 128(40%) participants knew that polio drops can be Television 192(60) given to children even if they were suffering from a mild Newspapers 70(21.9) illness at the time of vaccination. Another 128(40%) Radio 35(10.9) participants knew that hot food stuff should not be given Health workers 23(7.2) for at least 30 minutes following vaccination. The fact that Target age group PPI is a supplement to routine immunization and is not a 0-5 years 240(75) substitute was known to 258(80.6%) of participants.
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