Sign of Candiate

Remarks of the Guide Name & Designation Guide Signature Co-Guide Signature Head Of the Department Signature Remarks of Chairman & Principal Signature REGISTRATION FOR DISSERTATION BANGALORE CITY COLLEGE OF NURSING 2010 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

“ A study to assess the Knowledge regarding immunization among the mother with under-five children at the pediatric out patient department in CMCH in Tamil Nadu”.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SINDHU.B Bangalore City College of Nursing Bangalore - 43 SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate & Address : Miss Sindhu.B, 1st year M.Sc [Nursing], Bangalore City College of Nursing, 160, Chelekere Main Road, Banaswadi Outer Ring Road, Kalyanagar Post, Behind BTS Bus Depot, Bangalore - 560 043.

2. Name of the Institution : Bangalore City College of Nursing

3. Course of the Study & Subject : 1st year M.Sc [Nursing] Pediatric.

4. Date of Admission : 10-10-2009

5.Title of the Topic : “A study to assess the Knowledge regarding immunization among the mother with under-five children at the pediatric out patient department in CMCH in Tamil Nadu’’ LIST OF ABBREVATIONS USED

A Acute respiratory Infection ARI Adjusted Odds Ratio AOR Advisory Committee on Immunization Practices ACIP American Academy of Pediatrics AAP Anganwadi Workers AWWs Australisn Childhood Immunization Register ACIR

B Bacille Calmette Guerin BCG

C Christian Medical College And Hospital CMCH Centers of Disease Control CDC Confidence Interval CI

D Diphtheria-tetanus-pertusis DTP DtaP Diphtheria-tetanus DpaT DpwT DT

E Expanded Program of Immunization EPI

G Growth Monitoring, Oral dehydration therapy, Breast Feeding Immunization GOBI

H Haemophilus Influenzae B HIB Hepatitis B virus HBV Human Immuno Virus HIV

I Inactivated Polio Vaccine IPV Indian Academy of Pedeatrics IAP Infant Mortality Rate IMR Information Education and Communication IEC Integrated Child Development Services ICDS Intramuscular IM

K Knowledge Attitude Perception and Expectation KAPE

M Maternal and Child Health MCH Matlab Maternal and Child Health/ Family Planning Project MCHFP Measles / Mumps MM Measles / Mumps / Rubella MMR Months MTS

N National Family Health Survey – 11 NFHS 11 National Immunization Days NID National immunization Program NIP National Polio Surveillance Project NPSP

O Oral Polio Vaccine OPD Odds Ratio OR Oral rehydration Therapy ORT

P Probability P Pertusis and tetanus PT Pneumococcal Conjugate Vaccine PCV Primary Health Center PHC Protein Energy Malnutrion PEN Pulse Poliio Immunization PPI

R Ribonucleic Acid Virus RNA virus Rupees RS

S Sample Registration System SRS Sudden Infant Death Syndrome SIDS Standard Deviation SD

T Television TV Tetanus and Diphtheria TD Tetanus Toxoide TT Tick Borne Encephalitis TBE Trivalent Oral Polio Vaccine TOPV Tuberculosis TB

U Union Territory UT United Kingdom UK United State of America USA/US Universal Immunization Program UIP

V Vaccine Preventable Disease VPD VTS Vaccine Volume Programs VVPs Vaccine Associated Paralytic Poliomyelitis VAPP

W World Health Organization WHO

Y Years INTRODUCTION

The child shall, in all circumstances be among the first to receive protection and relief. -UN’s Rights of Child

At present there is a tremendous awareness among the people regarding health. Today, health is no longer considered as mere “absences of disease”. According to WHO definition “Health is a state of complete physical, mental and social well being and not merely an absences of diseases or infirmity”. After independence 1947 we have reached some remarkable achievements in health care like eradication of small pox and guinea worm, near eradication of poliomyelitis, reduction in diarrheal related deaths etc. In developed countries, an average 980 out of every 1000 children borne alive will celebrate their fifth birthday, whereas in India 68 out of every 1000 babies borne die in first year of life. Over the last three decades, we have had a succession of child health programs such as integrated child developmental scheme. (ICDS), maternal and child health(MCH), oral rehydration therapy(ORT) for control of diarrheal diseases, acute respiratory infectious disease control (ARI), Universal immunization program (UIP) Expanded program of immunization(EPI), Growth monitoring, oral dehydration therapy, Breast Feeding, immunization(GOBI), etc. Still a high proportional of total mortality and morbidity in the pediatric group, as high as 40 deaths per 100 live births in the country are among the children below five years of age. Above 21% of child deaths are attributed to vaccine preventable disease like tuberculosis, diphtheria, pertussis, tetanus, measles, poliomyelitis etc,. The sample registration system (SRS) bulletin issued by the office of register general in April 2001 shows the infant mortality rate as 75/1000 in rural area 44/1000 urban area and 70/1000 in the country in 1999 which was 111.8 by 1000 live births in 1983. The number of reported cases of polio, neonatal tetanus, diphtheria, tetanus, pertussis, and measles in 2003 where 225;1691;3914;4713;28985 and 44,004 respectively as per the WHO. All vaccine preventable disease can be prevented by appropriate immunization. Immunization is cost effective and can reduce the mortality rate. Still there are many factors which stand in the way of successful implementation and utilization of immunization such as age, education, illness, family type, awareness of disease and its consequences, misconception and false propaganda regarding vaccine and complication. To evaluate the achieve of the immunization program and to identify the weakness, problem of implementation and for corrective action “vaccine coverage evaluation survey” was conducted. 1985 UIP achievement of Bacilli Calmette Guerin(BCG) was 37% , diphtheria , pertussis and tetanus vaccine (DPT) was 85.7% and polio was 82.4%. The Coverage steadily increased year by year still an estimated 3 million deaths in the age group of under five will occur and it will be unfortunate that these deaths are preventable by proper immunization coverage. © UNI CEF HQ 97- 076 7/Le moy ne Immunization describes the whole process of delivery of a vaccine and the immunity it generates in an individual and population. A vaccine is a special form of a disease- causing agent (e.g., virus or bacteria) that has been developed to protect against that disease. The last 20 years have seen an explosion in the number of new vaccines. New vaccines against the leading causes of child deaths - pneumonia and diarrhoea- offer new hope. The pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RV) protect against the leading causes of pneumonia and diarrhoea, respectively. By themselves, these vaccines could save about 1 million children’s lives every year, sharply increasing the 2.5 million under-five deaths currently prevented through immunization annually. UNICEF is also working with partners so that the new vaccine momentum can enhance other interventions that help prevent deaths from these two diseases, so that the impact can be greater. The hepatitis vaccine (HepB) and Homophiles influenza type b (Hib) vaccines have gained increased adoption by national immunization programmes over the last few years. By the end of 2009, 177 of WHO's 193 Member States were using HepB, and 157 countries Hib vaccine, in their routine immunization schedule for infants.

Educating the mothers regarding the immunization causes, spread and prevention of diseases will play an important role in reducing the mortality and mobidity rate.

NEED FOR STUDY:

For the success of any program, it is imperative to create public awareness and have whole hearted participation of the people and health care personal inspite of many national programs targeting the most vulnerable group of population. i.e., mother and child, the health scenario in our country is part from satisfactory with a baby borne every 1.5 sec and 45% of our population in the age group of 1-14 years. About ¾ 0f the population was classified as unhealthy having inter related conditions like malnutrion, diarrheal disease, upper respiratory disease infections and vaccine preventable disease.

Among the infants and children admitted in the hospital 30% are of serious infections (TB, pneumonia, measles and whooping cough) there is change in the disease pattern and diseases. During the pulse polio program on several occasions, the researcher had the opportunity to interact with the parents along with general nursing students who where deputed for the program. It was found that the parents brought the children for administration of polio drops due to the propaganda and not with adequate knowledge of the disease, its spreads and after effects.

Same was true of other immunization for example: Mother were not aware of what is rubella? and why MMR was given. In the immunization clinic of CMCH “BCG” is given on Mondays and Fridays. Measles on Wednesday and Fridays. And other immunization on all working days. The facility is available on outpatient basis and neonates borne in CMCH.

In the light of above facts, this study is developed to asses knowledge of mothers regarding immunization, factors affecting immunization status of under five children. It will also help the researcher to prepare an educational module in creating awareness among the mothers regarding vaccine preventable disease.

REVIEW OF LITERATURE:

This chapter deals about the review of related literature relevant to the study. The of literature is text book, articles published in journals, studies conducted by various individuals and information leaflets provided with vaccines articles from news papers, newsletters, bulletins, magazines and websites.

One of the major function of a literature review is to ascertain what is already known in relation to a problem of interest. When the study is liked with other research findings can be better understood within the existing base of knowledge. Hence it is an important step in the development in the project work. Literature review in this study is divided into three sections.

a. Related literature on vaccine preventable disease

b. Related literature on immunization and immunization schedule.

c. Studies conducted related to vaccine preventable disease, immunization and immunization status of children foreign countries. Section-A

Related Literature on Vaccine Preventable Disease

This section is an attempt to understand and assimilate information on various vaccine preventable diseases.

PARK K 2002: stated that the health problems in a country like India are essentially linked to poverty and ove3r population which is turned lead to less satisfactory health facilities, poor sanitary environmental conditions, and malnutrition. India is still one among the country with high infant mortality rate (60 in 2000). Infant mortality rate has declined slowly from 204/1000 live births by during 1911 by 1000 live births in the year 2000. India is a vast country with widely differing population. Kerala one has low as 16/1000 live birth during the 1998.

SRS Table 1 1983-2001: infant mortality rates

S.no Year Rural Urban Country 1 1983 111.8 65.8 104.9 2 1985 107 59 97 3 1987 104 61 95 4 1988 102 62 94 5 1989 98 58 91 6 1990 86 51 80 7 1991 87 53 80 8 1992 85 53 79 9 1993 82 45 74 10 1994 80 54 74 11 1999 75 44 70 12 2000 70 40 65 1 3 2002 65 45 78 14 2005 56 43 87 15 2007 67 64 98 16 2009 45 67 89

High infant mortality rate is mainly because of dangerous infectious disease which can prevent by vaccine. WHO series on vaccine preventable disease provides adequate information regarding VPD, immunization, mortality rate, coverage etc,. Below is the description of vaccine preventable disease and the vaccine used to prevent them.

1. CHICKEN POX (Varicella): Chickenpox is a common illness among kids, particularly those under age 12. An itchy rash of spots that look like blisters can appear all over the body and be accompanied by flu-like symptoms. Symptoms usually go away without treatment, but because the infection is very contagious, an infected child should stay home and rest until the symptoms are gone.

Chickenpox is caused by the varicella-zoster virus (VZV). Kids can be protected from VZV by getting the chickenpox (varicella) vaccine, usually between the ages of 12 to 15 months. The Centers for Disease Control and Prevention (CDC) also recommends a booster shot at 4 to 6 years old for further protection. The CDC also recommends that people 13 years of age and older who have never had chickenpox or received the chickenpox vaccine get two doses of the vaccine at least 28 days apart.

A person usually has only one episode of chickenpox, but VZV can lie dormant within the body and cause a different type of skin eruption later in life called shingles (or herpes zoster). Getting the chickenpox vaccine significantly lowers kids' chances of getting chickenpox, but they might still develop shingles later in life.

Symptoms:

Chickenpox causes a red, itchy skin rash that usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals. The rash begins as multiple small red bumps that look like pimples or insect bites. They develop into thin-walled blisters filled with clear fluid, which becomes cloudy. The blister wall breaks, leaving open sores, which finally crust over to become dry, brown scabs.

Chickenpox blisters are usually less than a quarter of an inch wide, have a reddish base, and appear in crops over 2 to 4 days. The rash may be more extensive or severe in kids who have skin disorders such as eczema.

Some kids have a fever, abdominal pain, sore throat, headache, or a vague sick feeling a day or 2 before the rash appears. These symptoms may last for a few days, and fever stays in the range of 100°–102° F (37.7°–38.8° C), though in rare cases may be higher. Younger kids often have milder symptoms and fewer blisters than older children or adults.

Chickenpox is usually a mild illness, but can affect some infants, teens, adults, and people with weak immune systems more severely. Some people can develop serious bacterial infections involving the skin, lungs, bones, joints, and the brain (encephalitis). Even kids with normal immune systems can occasionally develop complications, most commonly a skin infection near the blisters.

Anyone who has had chickenpox (or the chickenpox vaccine) as a child is at risk for developing shingles later in life, and up to 20% do. After an infection, VZV can remain inactive in nerve cells near the spinal cord and reactivate later as shingles, which can cause tingling, itching, or pain followed by a rash with red bumps and blisters. Shingles is sometimes treated with antiviral drugs, steroids, and pain medications, and there's now a shingles vaccine for people 60 and older

2. Diphtheria: is an infectious disease caused by the bacterium Corynebacterium diphtheriae. This disease primarily affects the mucous membranes of the respiratory tract (respiratory diphtheria), although it may also affect the skin (cutaneous diphtheria) and lining tissues in the ear, eye, and the genital areas.

Signs and symptoms of diphtheria The symptoms of respiratory diphtheria usually begin after a two- to five-day incubation period. Symptoms of respiratory diphtheria may include the following:  Sore throat,  Fever,  Malaise,  Hoarseness,  Difficulty swallowing, or  Difficulty breathing. With the progression of respiratory diphtheria, the infected individual may also develop an adherent gray membrane (pseudomembrane) forming over the lining tissues of the tonsils and/or nasopharynx. Individuals with severe disease may also develop neck swelling and enlarged neck lymph nodes, leading to a "bull-neck" appearance. Extension of the pseudomembrane into the larynx and trachea can lead to obstruction of the airway with subsequent suffocation and death. The dissemination of diphtheria toxin can also lead to systemic disease, causing complications such as inflammation of the heart (myocarditis) and neurologic problems such as paralysis of the soft palate, vision problems, and muscle weakness. VACCINE: There are four combination vaccines used to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults. Children should get 5 doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. DT does not contain pertussis, and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine. Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also containing protection against pertussis. A single dose of Tdap is recommended for adolescents 11 or 12 years of age, or in place of one Td booster in older adolescents and adults age 19 through 64. (Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism.) FLU (Influenza): Influenza is a highly infectious viral illness symptoms include fever, chills, dry cough, running nose, body ache, headache and sore throat. Flu is transmitted by contact with an infected person or airborne virus. VACCINE:

The Influenza vaccine, also known as a Flu Shot, is an annual vaccine to protect against the highly variable influenza virus. Each injected seasonal influenza vaccine contains three influenza viruses: one A (H3N2) virus, one regular seasonal A (H1N1) virus (not the 2009 pandemic H1N1 virus), and one B virus. Purpose and benefits of annual flu vaccination "Influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications."An influenza epidemic emerges during each winter's flu season. Each year there are two flu seasons due to the occurrence of influenza at different times in the Northern and Southern Hemispheres. It is frequently estimated that 36,000 people die each year from influenza and accompanying opportunistic infections and complications in the United States alone. Worldwide, seasonal influenza kills an estimated 250,000 to 500,000 people each year. The majority of deaths in the industrialized

Hepatitis A:

Hepatitis A is inflammation (irritation and swelling) of the liver caused by the hepatitis A virus. Symptoms : Symptoms will usually show up 2 - 6 weeks after being exposed to the hepatitis A virus. They are usually mild, but may last for up to several months, especially in adults. Symptoms include:  Dark urine  Fatigue  Itching  Loss of appetite  Low-grade fever  Nausea and vomiting  Pale or clay-colored stools  Yellow skin (jaundice) Treatment:

There is no specific treatment for hepatitis A. Rest is recommended during the acute phase of the disease when the symptoms are most severe. People with acute hepatitis should avoid alcohol and any substances that are toxic to the liver, including acetaminophen (Tylenol). Fatty foods may cause vomiting, because secretions from the liver are needed to digest fats. Fatty foods are best avoided during the acute phase. Hepatitis A vaccine was licensed in 1995. Children receive a two doses of the vaccine given at six months interval. Hepatitis B:

Hepatitis B is inflammation (irritation and swelling) of the liver due to the hepatitis B virus (HBV). Symptoms:

Many people who have chronic hepatitis B have few or no symptoms. They may not even look sick. As a result, they may not know they are infected. However, they can still spread the virus to other people. Symptoms may not appear for up to 6 months after the time of infection. Early symptoms may include:  Appetite loss  Fatigue  Low-grade fever  Muscle and joint aches  Nausea and vomiting  Yellow skin and dark urine due to jaundice People with chronic hepatitis may have no symptoms, even though gradual liver damage may be occurring. They may have some or all of the symptoms of acute hepatitis.The hepatitis B vaccine is recommended specifically for all infants and children The following list is a general guide for vaccination, but since every person is at some risk for infection, these guidelines should be individualized for each situation.  All infants at birth and all children up to 18 years.  Health care professionals and emergency personnel.  Sexually active teens and adults  Men who have sex with men.  Sex partners or close family/household members living with an infected person.  Families considering adoption, either domestic or international.  Travelers to countries where hepatitis B is common (Asia, Africa, South America, the Pacific Islands, Eastern Europe, and the Middle East).  Patients with kidney disease or undergoing dialysis.  Residents and staff of correctional facilities and group homes.  Any person who may fall into a high risk group due to occupation or lifestyle choices.

Vaccine Schedule

The vaccine is readily available at your doctor's office or local health clinic. Three doses are generally required to complete the hepatitis B vaccine series, although there is an accelerated two-dose series for adolescents.  First Injection - At any given time  Second Injection - At least one month after the first dose  Third Injection - Six months after the first HAEMOPHILUS INFLUENZA [HIB VACCINE]; Hib bacteria resides in the nose and throat of many people with out making them ill but it can cause serious illness especially in preschool children .before vaccine was available, Hib disease was the most common cause of meningitis in children under the age of five, and often led to pneumonia, skin infections hearing loss, permanent brain injury death. The disease is spread through air by sneezing and coughing symptoms of illness include a high fever, severe headache, stiff neck, quiet or with drawn behavior, sensitivity to light, vomiting, ear infection and convulsion. VACCINE; the routine schedule is 2-3 doses before the first birthday MEASLES; Measles is a potentially serious and highly contagious childhood disease. It can lead to ear infection, pneumonia seizures, brain damage and death. Measles begin with cold-like symptoms- fever, red runny eyes, cough, runny nose and tiredness. Small white spots appear on the inside of the mouth and rash begins, usually on the face.it spreads over the arm, chest, back abdomen, thighs, legs and feet. The illness last 7 to 10 days, VACCINE; one dose of MMR vaccine is between 12 and 15 months of age MENINGOCCAL [BACTERIAL] MENINGITIS; Bacterial meningitis is an acute disease caused by bacteria which infects the meninges a thick lining covering the brain and spinal cord. It is characterized by sudden onset of fever, intense headache, nausea and often vomiting and a stiff neck. VACCINE; meningococcal vaccine can prevent 4 types of meningococcal disease MUMPS; Mumps is caused by a virus it usually causes painful swelling of the glands that lie just above the back of the angle of jaw but other glands may be affected. It can cause fever, headache and mild respiratory symptoms .after puberty, mumps can swollen tests or ovaries. Rarely mumps causes deafness. Mumps is transmitted through air or by direct contact with the saliva of an infected person. VACCINE; One dose of MMR vaccine is routinely given between 12and15 months of age. PERTUSIS; pertussis is a highly contagious bacterial respiratory infection spread by coughing or sneezing. It starts like a common cold but within a few days cough come in exhausting bursts, often followed by a whooping sound as the children breath. Vomiting can also follow a long coughing spell. The disease is most serious in small infants. VACCINE: a four short series of the combination vaccine DTaP, in the first 18 months of life and a fifth dose before entering kindergarten. PNEUMOCCOAL DIESEASE-children; pneumoccal disease are infections caused by the bacteria streptococcus pneumonia, blood stream infections. Sinus infection and meningitis. Young children are much more likely to get pneumoccoal disease. VACCINE; pneumoccoal conjugate vaccine[PCV7] is recommended for all children less than 23 months of age the normal schedule for vaccination is 2,4 and 6 months of age and a booster dose at 12-15 months of age. POLIO: Polio is a viral infection transmitted by a fecal oral contact. Milder cases may last only a few days, causing fever, sore throat, stomachache and headache if the disease worsens. It cause severe muscle pain, paralysis, breathing difficulty and if death. VACCINE; oral polio vaccine[opv] contains three strains of live. But considerably weakened polio virus. The first three doses are given at 2, 4, and 6-9 months. A fourth booster dose is given at school entry. RUBELLA: Rubella is a relatively mild viral illness that may go undiagnosed because of its mild symptoms. Although its seldom poses a major risk to children rubella does put unborn infant at considerable risk [miscarriage or severe birth defects. VACCINE; One dose of MMR Vaccine is between 12 and 15 months of age. XIV.TETANUS: Tetanus is a bacterial disease usually transmitted through a cut or puncture wound contaminated with soil. The bacterium produces a powerful toxin that poisons nerves and causes muscle spasms or death. Spasms or death spasm of neck muscle known as lockjaw. VACCINE; a four short series of dtap, in the first 18 months of life, and booster dose at 3rd and 5th year. Section B Related literature on immunization and immunization schedule Section B deals with review of related literature and information collected on immunization and immunization schedule. Since the chance discovery of cow pox vaccine by Edward jenner, many vaccine have been discovered for different diseases. The mile stone is presented below: Mile Stones in Vaccination:

Years Vaccination

1798 Small pox vaccine

1885 Rabies vaccine

1892 Cholera vaccine

1913 Toxin / Anti Toxin against Diphtheria

1921 BCG

1923 Diphtheria Toxiod and pertsusis vaccine

1927 Tetanus Toxoid

1937 Influenza Vaccine and yellow Fever Vaccine

1949 Mumps Vaccine

1954 Salks polio vaccine

1957 Sabin live oral polio vaccine 1960 Measles Vaccine

1962 Rubella Vaccine

1968 Type C Meningococcal vaccine

1971 Type A Meningococcal vaccine

1976 Hepatitis B Vaccine

In our country also there is varied schedule in use like National Immunization schedule, IAP schedule and WHO EPI schedule which are given below. NATIONAL IMMUNIZATION SCHEDULE

Vaccine Age

14 9-12 Birth 6 weeks 10 weeks weeks months

Primary vaccination

BCG X

Oral polio X X X X

DPT X X X

Hepatitis B* X X X

Measles X

Booster Doses

DPT + Oral polio 16 to 24 months

DT 5 years

Tetanus toxoid (TT) At 10 years and again at 16 years

Vitamin A 9, 18, 24, 30 and 36 months

Pregnant women

Tetanus toxoid (PW): 1st dose As early as possible during pregnancy (first contact) 2nd dose 1 month after 1st dose Booster If previously vaccinated, within 3 years Section C Studies conducted related to vaccine preventable disease immunization, and immunization status of children in India. The results and studies regarding immunization – Conducted a study to asses the utilization of immunization servives among under five children in selected area of vellore district. The results of the study was: 1) Utilization of six vaccines were compared it was found that utilization of polio is complete than other vaccines. 2) Utilization of immunization service if far better in rural area than urban area. Under took a study on factors affecting immunization and its relationship to immunization status of under children living in Manchampalyam PHC, Tamil Nadu. Result: 50 – 60% of the mother was unaware of immunization, only 40 – 50% of mother was able to say science and Symptoms of one or two diseases. But achievement was 83.3%. there is no relationship between mothers age, religion, education and type of family and knowledge regarding immunization status of under five children STATEMENT OF THE PROBLEM

A study to asses the knowledge regarding immunization among mother with under five children at the pediatric outpatient department, CMCH, Vellore city Objectives:

 Asses the knowledge of mothers regarding immunization.  Asses the immunization status of the children.  Identify the factors Affecting immunization.  Find out the Association between the factors affecting the immunization and immunization status of children.  Development instructional on vaccine preventable disease based on study findings. HYPOTHESIS:

 There is no significant association between selected Socio-demographic variables and mothers knowledge regarding immunization.  There is no significant association between mother knowledge regarding immunization status of under-five children.

Operational Definition:

Operational definition means the definition of a concept are variable in terms of the operation or procedure by which it is to be measured in this study the following terms are operationally defined to suit to the particular context. IMMUNIZATION:

 Immunization: Vaccination. Immunizations work by stimulating the immune system, the natural disease-fighting system of the body. The healthy immune system is able to recognize invading bacteria and viruses and produce substances (antibodies) to destroy or disable them. Immunizations prepare the immune system to ward off a disease. To immunize against viral diseases, the virus used in the vaccine has been weakened or killed. To immunize against bacterial diseases, it is generally possible to use only a small portion of the dead bacteria to stimulate the formation of antibodies against the whole bacteria. In addition to the initial immunization process, it has been found that the effectiveness of immunizations can be improved by periodic repeat injections or "boosters." Also see Immunizations (in the plural) and Immunization of a specific type (such Immunization, Polio).  Knowledge: Refer to the facts and information that mother has acquired regarding immunization through education as ascertained by interviewing the mothers by using semi structured questioner.  Mothers: Refer to the woman who are having children in the age group of 0-5 years attending the pediatric outpatient department of CMCH in Vellore city. ASSUMPTION:

Mothers’ knowledge about vaccine preventable disease and immunization schedule is not adequate. Even though the immunization status of the children is satisfactory.

Delimitations:

This study is delimited to mothers of under-five children attending CMCH in Vellore primarily to urban dwellers.

Projected Outcome:

The mother should gain knowledge regarding vaccine preventable disease and immunization schedule.

METHODS: A descriptive survey research design was adopted to conduct the study target population was mother with under five children attending the pediatrics outpatient department of CMCH in Vellore and the Sample size was 100 mothers. A semi structure validated interview schedule that was divided in three parts was used to collect the data.

 Socio demographic factors  Knowledge factors  Immunization status of under five children Expert opinion pretest and pilot study were conducted for the purpose of validity and reliability of the tool. The redefined tool had 39 items and was translated into tamil and retranslated with English. Data was collected / analyzed using mean, percentage, standard deviation, square and t-test and presented in the form of tables and graphs.

VARIABLES

DEPENDENT VARIABLE; knowledge scores of mothers in OPD

INDEPENDENT VARIABLE; structured teaching programme.

MATERIALS AND METHODS

SOURCE OF DATA; Mothers at hospital in CMCH at Vellore

METHODS OF DATA COLLECTION:

Research method ; Non experimental method

Research design ; Experimental design[1 group pre test and post test]

Sampling technique ; a sample comprised of 100 mothers in selected hospital.

Sample size ; 100

Population ; Mothers and under five children.

Setting ; CMCH at Vellore

TOOL OF DATA COLLECTION: Pre testing of the tool was done by administrating it on 10 mothers of under five children attending the outpatient department of CMCH Vellore. A pilot study was done in a small scale version or trial run down preparation will be done on study.

Prior permission was obtained from the authorities of CMCH. The period of data collection was schedule for one month from March 10 - April 10 of 2010. The investigator explain to the mothers regarding the study individually, request the co- operation and personally interviewed the mothers consent for participation in the study was taken on the interview schedule itself.

The investigator spent on an average 15 – 25 mins with eah participant depending upon the mother tongue, education level and understanding capacity of the mother. Purpose of the study was explained to both parents whenever accompanied by the father on an average, 5 – 7 mothers were interviewed daily.

DATA ANALYSIS AND INTERPRETATION:

Data will be analyzed using both descriptive and inferential statistics, mean standard deviation and percentage will be used to describe the knowledge of mothers regarding assessing the knowledge of immunization with under five children.

The raw data obtained was organized in a master sheet it was analysed according to the objectives of the study using differential statistical method. i.e mean standard deviation, percentage, Chi-square and t-test. The findings were expressed in tables and graphs.

INTERPRETATION & CONCLUSION

The study revealed the significant association between mothers, age, education, family income & source of information to mothers knowledge on vaccine preventable disease (p<0.05). It was found that there is no significant association between type of family, religion source of information and distance from immunization center to immunization status of under five children(p>0.05). The T-test revealed a significant relation between the immunization status versus knowledge regarding control of disease, purpose of immunization & immunization schedule. The need for providing knowledge regarding vaccine preventable disease, immunization & immunization schedule is important & health personal should be educated and motivated for providing constant health information specifically to mothers. The strategies used for pulse polio immunization can be effectively applied for the other vaccines also. REFERENCES

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