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Download This PDF File IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 6:No. 3 May/June 2019 FACTORS INFLUENCING PARENTS’ AWARENESS REGARDING CHILDHOOD IMMUNIZATION: FINDINGS OF CROSS-SECTIONAL STUDY IN NORTHEAST PENANG ISLAND DISTRICT, MALAYSIA Ooi P.L.1*, Heng Z.Y.2, Boon K.Y.3 1Department of Pharmacy, Sungai Dua Health Clinic, Penang, Malaysia 2Department of Pharmacy, Jalan Perak Health Clinic, Penang, Malaysia 3Department of Pharmacy, Bandar Baru Air Itam Health Clinic, Penang, Malaysia *Corresponding author: Ooi Poh Ling Klinik Kesihatan Sungai Dua, 11700 Gelugor, Penang, Malaysia Email: [email protected] https://doi.org/10.32827/ijphcs.6.3.130 ABSTRACT Background: Vaccines play an important role in preventing serious infectious diseases in childhood. There are still existences of unvaccinated children with current immunization system in Malaysia. The aim of this study was to measure parents’ knowledge and practice regarding childhood immunization awareness and to evaluate their association with parental socio-demographic factors. Materials and Methods: A cross sectional study was conducted among parents with child aged 6 years old and below who visited public health clinics in District of Northeast Penang Island from October to December 2017. A total of 147 respondents were recruited by convenience sampling. Data was collected using a validated self-administered questionnaire. Result: The mean of knowledge score and practice score among parents were 6.40 and 6.99 respectively. Significant association was noted for knowledge score with employment status (p < 0.001), education level (p <0.001) and family income (p = 0.001). Practice score was found significantly associated with education level (p = 0.006) and family income (p = 0.014). Parents’ knowledge score was positively associated with their practice score (Spearman's correlation coefficient 0.291, p < 0.001). Conclusion: Immunization campaigns or education programs are required to improve parents’ knowledge and practice regarding childhood immunization awareness. Particular attention ought to be given to parents who were unemployed, with lower education level or family income. Keywords: Childhood immunization, Parents, Awareness, Knowledge, Practice Ooi P.L., Heng Z.Y. & Boon K.Y 130 https://doi.org/10.32827/ijphcs.6.3.130 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 6:No. 3 May/June 2019 1.0 Introduction Vaccines play an important role in preventing serious infectious diseases in childhood. Substantial achievements have been made with decline in morbidity of many vaccine- preventable diseases and their complications during the 20th century (Centers for Disease Control and Prevention, 1999). Immunization program was introduced in early 1950s in Malaysia and vaccines are provided free of charge in government health facilities. Nevertheless, there is emergence of vaccine safety concern as the incidence of vaccine- preventable diseases declined (Smith, Woods, & Marshall, 2009). The dissemination of misinformation and conflicting vaccine safety information from internet and many other resources nowadays further adversely affect parents’ decisions to immunize their children (Zimmerman et al., 2005). Underused and undervalued of vaccination have been documented in a variety of settings (Awadh et al., 2014). Low immunization level could lead to resurgence of vaccine-preventable disease (Gangarosa et al., 1998). In Malaysia, there are still existences of unvaccinated children with current immunization system and outbreaks of vaccine- preventable diseases such as measles and diphtheria still occur sporadically (Ministry of Health Malaysia, 2017). Parental knowledge and practice regarding childhood immunization awareness can affect the immunization uptake and timeliness for their children as they are main decision makers. Parental socio-demographic factors were shown to have influence on parents’ knowledge and practice regarding their children immunization (Al-lela et al., 2014). This study can provide valuable insight into parents’ knowledge and practice regarding their children immunization in Northeast Penang Island District and the associated parental socio-demographic factors. 2.0 Materials and Methods A cross-sectional study was conducted from 1st October 2017 to 31th December 2017. Parents with child not more than 6 years old who were visiting public health clinics in District of Northeast Penang Island during the study period were included. Estimated sample size was calculated using one sample, continuous outcome formula (LaMorte, 2016). Convenience sampling method was used and 147 parents were participated in this study. Validated questionnaire adopted from Awadh et al. (2014) (with author permission) which consisted of two parts was used in data collection. The first part contained parents’ socio- demographic data while the second part contained the knowledge and practice questionnaire regarding childhood immunization awareness. There were 10 questions on knowledge and 10 questions on practice. For scoring of questions, one point will be given for each correct answer and zero for wrong answers or no response. Data were collected from eight public health clinics in the District of Northeast Penang Island (Jalan Perak, Bandar Baru Air Itam, Sungai Dua, Jalan Macalister, Air Itam, Tanjung Bungah, Bukit Jambul and Lebuh Muntri). Cover letter describing the study objectives was explained and informed consent was obtained from the parents who agreed to participate in this study. Ooi P.L., Heng Z.Y. & Boon K.Y 131 https://doi.org/10.32827/ijphcs.6.3.130 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 6:No. 3 May/June 2019 Subject confidentiality was ensured by utilizing identification code numbers on the questionnaire. This study was approved by the Medical Research Ethics Committee (MREC), Ministry of Health Malaysia. Data were analyzed using Microsoft Excel 2007 and SPSS version 20 software. Descriptive statistical analysis was used to assess parents’ socio-demographic data, knowledge and practice scores. All data were tested for normality and were not normally distributed. Mann- Whitney test was used to evaluate the association between parents’ gender, marital status, place of living and employment status with their knowledge score as well as practice score. Kruskal-Wallis test was used to assess the association between parents’ age, number of preschool children, family size, race, religion, education level and family income with their knowledge score and practice score. Spearman correlation was used to find association relationship between parents’ knowledge score and practice score. P-value<0.05 was considered to be statistically significant. 3.0 Result 3.1 Parents’ Socio-demographic Characteristics A total of 147 parents were participated in this study. The vast majority of the respondents were female (72.1%). Majority were aged between 30 and 40 years (55.8%). Most of the respondents were Malays (69.4%). Majority of the respondents attained educational level of secondary school and above (52.4%) (Table 1). Table 1 Socio-demographic characteristics of respondents Parameter Frequency (n=147) Percentage (%) Gender Male 41 27.9 Female 106 72.1 Age (years) <20 2 1.4 20-30 53 36.1 30-40 82 55.8 >40 10 6.8 Marital Status Married 146 99.3 Single 1 0.7 No. of preschool children 1-2 129 87.8 3-4 16 10.9 >4 2 1.4 Family size <4 79 53.7 4-6 60 40.8 >6 8 5.4 Ooi P.L., Heng Z.Y. & Boon K.Y 132 https://doi.org/10.32827/ijphcs.6.3.130 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 6:No. 3 May/June 2019 Race Malay 102 69.4 Chinese 33 22.4 Indian 11 7.5 Others 1 0.7 Religion Islam 105 71.4 Buddhism 27 18.4 Hinduism 10 6.8 Others 5 3.4 Place of living Rural 16 10.9 Urban 131 89.1 Employment status Employed 114 77.6 Unemployed 33 22.4 Education level No formal education 1 0.7 Primary 1 0.7 Secondary 77 52.4 Tertiary education 68 46.3 Family income <RM1000 5 3.4 RM1001-RM2000 28 19.0 RM2001-RM3000 44 29.9 RM3001-RM4000 38 25.9 RM4001 and above 32 21.8 3.2 Parents’ Knowledge and Practice regarding Childhood Immunization The mean of the knowledge score and practice score were 6.40 and 6.99, respectively (Table 2). Table 2 Knowledge score and practice score of respondents Score Mean Median Knowledge 6.40 7.00 Practice 6.99 8.00 Ooi P.L., Heng Z.Y. & Boon K.Y 133 https://doi.org/10.32827/ijphcs.6.3.130 IJPHCS International Journal of Public Health and Clinical Sciences Open Access: e-Journal e-ISSN : 2289-7577. Vol. 6:No. 3 May/June 2019 3.3 Knowledge and Practice regarding Childhood Immunization between Different Socio- demographic Characteristics of Parents Table 3 Knowledge score across different socio-demographic parameters Parameter Knowledge Score Mean Median Za /χ2b value p-value Gender -0.188a 0.851a Male 6.49 7.00 Female 6.37 7.00 Age (years) 1.692b 0.639b <20 7.00 7.00 20-30 6.58 7.00 30-40 6.30 7.00 >40 6.10 5.50 Marital Status -0.346a 0.803a Married 6.40 7.00 Single 6.00 6.00 No. of preschool 0.098b 0.952b children 1-2 6.42 7.00 3-4 6.31 7.00 >4 6.00 6.00 Family size 0.537b 0.765b <4 6.42 7.00 4-6 6.31 6.50 >6 6.00 5.50 Race 6.642b 0.084b Malay 6.61 7.00 Chinese 6.21 6.00 Indian 5.36 5.00 Others 3.00 3.00 Religion 4.324b 0.229b Islam 6.54 7.00 Buddhism 6.22 6.00 Hinduism 5.36 5.00 Others 3.00 7.00 Place of living -1.881a 0.060a Rural 5.19 5.00 Urban 6.55 7.00 Employment status -4.157a <0.001a,* Employed 6.82 7.00 Unemployed 4.97 5.00 Education level 26.654b <0.001b,* No formal education 3.00 3.00 Primary 5.00 5.00 Secondary 5.65 6.00 Ooi P.L., Heng Z.Y.
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