effectiveness of educational package on level of knowledge

195
Effectiveness of Educational Package on Level of Knowledge and Attitude Regarding Mission Indradhanush Among Mothers of Under Five Children In Selected Urban Slum Area, Bengaluru”. By Mrs. Jyotima Borgohain Handique Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka In partial fulfillment of the requirement for the degree of Master of Science in Community Health Nursing Under the guidance of Mrs. Kala. Suneetha Associate Professor and H.O.D Department of Community Health Nursing Padmashree Institute of Nursing Bengaluru-60 2018

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“Effectiveness of Educational Package on Level of Knowledge and

Attitude Regarding Mission Indradhanush Among Mothers of Under

Five Children In Selected Urban Slum Area, Bengaluru”.

By

Mrs. Jyotima Borgohain Handique

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

In partial fulf illment

of the requirement for the degree of

Master of Science

in

Community Health Nursing

Under the guidance of

Mrs. Kala. Suneetha

Associate Professor and H.O.D

Department of Community Health Nursing

Padmashree Institute of Nursing

Bengaluru-60

2018

ii

iii

iv

v

vi

ACKNOWLEDGEMENT

I owe my gratitude to my Almighty God, Gurudev who makes everything

possible in our life, for His faithfulness and countless blessing during the entire course

of the study and completion of this work.

I extend my heartfelt thanks to Chairman, Managing Trustee and Directors

of Padmashree Institute of Nursing for their constant support.

I extend my sincere gratitude to Dr. Bhima Uma Maheswari Ph.D (N),

Principal, Padmashree Institute of Nursing, for her valuable guidance, constant

encouragement and support throughout the course of the study.

Words are not enough to express gratitude to my guide Mrs. Kala. Suneetha

Associate Professor cum HOD, Community Health Nursing, Padmashree

Institute of Nursing, she is such aninspiration, her expert guidance, suggestions and

constant support throughout the study is of great value.

I also owe my gratitude to Mrs. Divyasri D.S , Associate Professor,

Community Health Nursing, Padmashree Institute of Nursingfor her guidance and

valuable suggestions throughout my study.

I am extending my sincere thanks to Prof. R. Chinnadurai, Biostatistician,

for his valuable guidance and support in statistical analysis and presentation of data.

I take this opportunity to thank the entire Teaching Faculty, Padmashree

Institute of Nursing for their contribution throughout the course.

I am thankful to all the experts who had spent their valuable time in

validating the research tool and who contributed with their valuable suggestions in

making suitable tool for my study.

I express my sincere thanks to the Medical Officer, Kengeri Upanagar

Primary Health Centre, and Gandhi Gram Urban Health Centre, Bengaluru for

granting me permission to conduct the study.

I am grateful to the Nursing staff and ASHA workers of UHC and PHC for

their help during data collection.

vii

viii

LIST OF ABBREVIATIONS USED

1. AV : Audio-visual

2. BCG : Bacille Calmette Guerin

3. Df : Degree of Freedom

4. et. Al : All others

5. F : Frequency

6. H : Hypothesis

7. H0 : Null hypothesis

8. JE : Japanese Encephalitis

9. n : Total number of sample

10. NS : Non significant

11. P : Probability

12. r : Correlation Co-efficient

13. S : Significant

14. SD : Standard Deviation

15. UIP : Universal Immunization Programme

16. VPD : Vaccine Preventable Diseases

17. WHO : World Health Organisation

18. χ2 : Chi Square

19. ≥ : Greater than or equal

20. < : Less than

21. % : Percentage

ix

LIST OF TABLES

Sl.

No Tables

Pages

1.1 Frequency and percentage distribution of demographic variable of

mothers of under five children according to age, religion, educational

status and occupation.

38

1.2 Frequency and percentage distribution of demographic variable

mothers of under five children according to family income per month,

type of family, number of children, immunization status of the mothers,

previous information about Mission Indradhanush and sources of

information.

40

2.1 Frequency and percentage distribution of pre-test level of knowledge

regarding Mission Indradhanush mothers of under five children.

47

2.2 Range, Mean, SD and Mean percentage of pre-test level of knowledge

regarding Mission Indradhanush among mothers of under five children.

47

2.3 Frequency and percentage distributionof pre-test level of attitude

regarding Mission Indradhanush among. Mothers of under five

children.

48

2.4 Range, Mean, SD and Mean percentage of pre-test level of attitude

regarding Mission Indradhanush among mothers of under five children.

48

3.1 Frequency and percentage distribution of post-test level of knowledge

regarding Mission Indradhanush among mothers of under five children.

49

3.2 Range,Mean, SD, and Mean percentage of post-test level of knowledge

regarding Mission Indradhanush among mothers of under five children.

49

3.3 Frequency and percentage distribution of post-test level of attitude

regarding Mission Indradhanush among mothers of under five children.

50

3.4 Range, Mean, SD, and Mean percentage of the post-test level of

attitude regarding Mission Indradhanush among mothers of under five

children.

50

4.1 Frequency and percentage distribution of mothers according to pre

andpost- test level of knowledge regarding Mission Indradhanush.

51

4.2 Range, mean, SD, and Mean percentage of pre and post- test level of

knowledge regarding Mission Indradhanush among mothers of under

53

x

Sl.

No Tables

Pages

five children.

4.3 Frequency and percentage distribution of mothers according to the pre

and post- test level of attitude regarding Mission Indradhanush.

53

4.4 Range, Mean, SD, and Mean percentage of pre and post- test level of

attitude regarding Mission Indradhanush among mothers of under five

children.

54

5.1 Paired t-test analysis for the significance of pre and post- test knowledge

and attitude regarding Mission Indradhanush among mothers of under

five children.

55

6.1 Correlation between the pre- test knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

56

7.1. Association between pre-test level of knowledge regarding Mission

Indradhanush among mothers of under five children with their selected

demographic variables such as age, religion and educational status.

58

7.2 Association between pre-test level of knowledge regarding Mission

Indradhanush among mothers with their selected demographic

variables such as occupation, family income, type of family, number of

children, immunization status of the children, previous information

about Mission Indradhanush and sources of information.

59

7.3 Association between pre-test level of attitude regarding Mission

Indradhanush among moters with their selected demographic variables

such as age, religion and educational status.

61

7.4 Association between pre- test level of attitude regarding Mission

Indradhanush among mothers with their selected demographic variables

such as occupation, family income, type of family, numer of children,

immunization status of the children. previous information about

Mission Indradhanush and sources of information,

62

xi

LIST OF FIGURES

Sl. No Figures Pages

1 Modified conceptual framework based on Pender’s Health

Promotion Model.

16

2 Schematic representation of Research plan of the study. 28

xii

LIST OF GRAPHS

Sl.No. Graphs Pages

1. Percentage distribution of mothers of under five children according

to age.

42

2. Percentage distribution of mothers of under five children according

to religion.

42

3. Percentage distribution of mothers of under five children according

to educational status.

43

4. Percentage distribution of mothers of under five children according

to occupation.

43

5. Percentage distribution of mothers of under five children according

to family income per month.

44

6. Percentage distribution of mothers of under five children according

to type of family.

44

7. Percentage distribution of mothers of under five children according

to number of children.

45

8. Percentage distribution of mothers of under five children according

to immunizatipn status of the children.

45

9. Percentage distribution of mothers of under five children according

to previous information about Mission Indradhanush.

46

10. Percentage distribution of mothers of under five children according

to sources of information.

46

11. Percentage distribution of mothers of under five children according

to pre and post- test level of knowledge regardingMission

Indradhanush.

52

12. Percentage distribution of mothers of under five children according

to pre andpost-test level of attitude regarding Mission Indradhanush.

54

13. Correlation between knowledge and attitude regarding among

Mission Indradhanush mothers of under five children.

57

xiii

LIST OF ANNEXURES

Annexure No.

Content Page No.

I. Letter seeking and granting permission for conducting the

research study.

112-113

II. a. Lesson plan (English)

b. Lesson plan (Kannada)

114-126

127-144

III. Criteria rating scale for content validation of thetool. 145-148

IV. Letter seeking experts’ opinion and suggestions for content

validity of tool.

149

V. List of experts who validated the tool. 150

VI. Content validity certificate. 151-159

VII. a. Certificate of English editing.

b. Certificate of Kannada editing.

160

161

VIII. A.V. Aids - Flash cards, pamphlet and leaflet (English and

Kannada)

162-180

xv

STRUCTURED ABSTRACT

Title

A quasi experimental study to assess the effectiveness of educational package

on level of knowledge and attitude regarding Mission Indradhanush among mothers

of under five children in selected urban slum area, Bengaluru.

Background

Immunization is one of the most important public health interventions to

reduce child mortality associated with infectious diseases. Mission Indradhanush

waslaunched in December 2014 and aimed to fully immunize more than 90% of

newborns and pregnant mothers by 2020 through innovative and planned approached

to reach all children.

Objectives

1. To assess the existing level of knowledge and attitude regarding Mission

Indradhanush among mothers of under five children. 2. To assess theeffectiveness of

educational package on Mission Indradhanush among mothers of under five children.

Methods

A quasi experimental study was conducted by using one group pre-test post-

test research design. Simple random sampling technique was adopted to select 60

mothers of under five children.

Results

The overall pre-test mean knowledge score was found to be 10.17 with SD of

4.49 and overall pre-test mean attitude score was found to be 30.58 with SD of 2.39.

The overall post-test mean knowledge score was found to be 17.00 with SD of 3.36

and overall post-test mean attitude score was found to be 37.21 with SD of 2.50.

Paired t-test shows that there was statistical significance at p<0.001 level. It showed,

there was an establishing impact of educational package on knowledge and attitude

regarding Mission Indradhanush among mothers of under five children and there was

significant linear correlation (r=0.486) between knowledge and attitude regarding

Mission Indradhanush among mothers of under five children at p<0.05 level.

xvi

Interpretation and Conclusion

The study concluded that the educational package was effective in improving

the level of knowledge and attitude regardingMission Indradhanushamong mothers of

under five children.

Key words

Knowledge; attitude; mothers; educational package; immunization;Mission

Indradhanush.

1

“A quasi experiental study to assess the effectiveness of educational package on level

of knowledge and attitude regarding Mission Indradhanush among mothers of under

five children in selected urban slum area, Bengaluru”

INTRODUCTION

Background of the study

Today’s healthy children are the future healthy citizen of the country.

According to 2011 census children population of 0 to 6 yrs is 158.8 million which

represents 13.12% of the total population.1

Health care of children below 5 years

should give greater importance because these age groups are vulnerable to various

health problems due to weaker immune system as compared to adults. The child needs

to be protectedfrom six infectious and vaccine preventable diseases, it includes

tuberculosis, tetanus, diphtheria, whooping cough, measles and poliomyelitis. More

than one million children and pregnant mothers can be saved from death by

immunizing them at the right age and right time and by completing the full course of

immunization.2

Immunization is a procedure in which immunobiological substances are

administered to strengthen the defense (immune) mechanism as to protect the

individual against the disease.3

Immunization remains one of the most important

public health intervention and cost effective strategies to reduce child mortality

associated with infectious diseases. It has been seen that five million children are

dying in each year and another five million were disabled by six childhood diseases in

some developing countries like India. Protecting the health and development of

children is a long term contribution to the growth and development of the country as a

whole.4

Vaccines are the antigenic substance which when administered in an

individual, stimulate the production of specific antibodies and protect the individual

against the particular diseases.5

Vaccines are among the most effective tools available

for preventing infectious diseases and their complications. Immunization is vital;

almost one third of deaths under five are prevented by vaccine. Every child has the

right to benefit from the appropriate traditional and new life saving vaccinations.

2

However, the success of an immunization programme depends on high rates of

acceptance and coverage.6

` The health of a child is basically in the hands of their mothers as children

nourish under the care of their mothers. Rearing is determined to a greater extend by

the knowledge and attitude of mothers. To meet the health needs of children, it is

impossible without mother’sinvolvement as they play a primary role in child’s life.

Most mothers know the basics of keeping their child healthy like offering them

healthy foods, making sure that they get enough sleep and ensuring safety, but it is

also very important for the mother to know the importance of immunization to

prevent from six killer diseases and its complication.

Based on the Health problems of underfive children and pregnant mothers, the

Government of India has launched many NationalHealthProgrammes to meet the

health needs of the country, such as-

• Maternal and Child Health Programme ( MCH )

• Integrated Child Development Service Scheme ( ICDS )

• Child Survival and Safe Motherhood Programme ( CSSM )

• Integrated Management of Neonatal and Childhood Illness ( IMNCI )

• National Programme on immunization

• Diarrheal disease control programme

• Vitamin A deficiency control programme

• National Rural Health Mission ( NRHM )7

Withtheongoing health programme, it is resulted in the considerable

improvement of the country’s health in general, as the children form the central part

and development and the wealth of the country depends largely on them. The

Government aims to strengthen and improve the health of children.7

Committed to improving immunization coverage and addressing the eqality agenda,

the Ministry of Health and Family Welfare, Government of India, has implemented

various intensification strategies including its flagship programme “Mission

Indradhanush” launched in December 2014, and delivery system strengthening

exercises through improved micro-plans.8

3

Mission Indradhanushin is a special drive to vaccinate all unvaccinated and

partially vaccinated children under Universal Immunization Programme. The mission

focuses on intervention to improve full immunization coverage in India from 65% in

2014 to at least 90% children in the next fiveyears.9

Mission Indradhanush aimed to

fully immunize more than 90% of newborns by 2020 through innovative and planned

approaches to reach all children. It not only aimed to rapidly increase the

immunization coverage through special drives during specified months but also

focused towards strengthening health system for addressing equality issues in access

to immunization. This initiative will eventually close immunity gap and strengthen

immunization coverage.9

In the first phase, 9.66,495 sessions were conducted and around 7.6 million

children were immunized out of which 1-9 million children were fully immunized.10

Second phase of Mission Indradhanush continued in January 2016 in 352 districts.

Phase III was implemented from April to July in 216 districts of the country. During

all the three phases, as on 1st August 2016, 2.08 crore children have been vaccinated

of which 54.5 lakh children have been fully immunized. In addition, 55.4 lakh

pregnant women were vaccinated against tetanus toxoid. According to Integrated

Child health and immunization Survey 2016, full immunization coverage has

increased by about 5-7% after the launch of Mission Indradhanush.11

This is done through special “catch-up” drives, - the aim to cover all the

children who have been left out or missed out for immunization. It is supported by

WHO,UNICEF, Rotary International and other donor partners. Medical Officer in

Charge for the Block/ Urban Planning has conducted detailed planning for additional

sessions in the planning unit. In urban areas, urban health posts, post-partum centers,

family welfare centers or local leader’s premises in urban slums are used as

immunization sites. For other areas, primary school, anganwadi centers, private

dispensaries, Non Governmental Organization sites or any other location that are

easily accessible and acceptable to community are used as immunization sites.9

There are four rounds of vaccination between April and July, with each round

having seven consecutive working days beginning of 7th

of the month. In addition to

health staff available from the same or neighboring community health center / Block

PHC, NGOs (LIONS, Rotary etc.), it is necessary to utilize retired health workers.

4

The activity are conducted from 9am to 4pm. Sessions are planned based on

availability of the targeted population to maximize the benefits achieved.9

The Government of India, in partnership with the World Health Organization,

UNICEF and other agencies, is leaving no stone unturned to ensure that there are no

children who remain unvaccinated, or partially vaccinated against these seven

preventable diseases. The World Health Organization is assisting with risk - analysis

– identifying children in underserved areas who havenot been fully immunized and

the underlying reasons, to strengthen our efforts. The WHO is also providing us

valuable technical support in micro – planning, training and monitoring the work on

the ground.12

Seeing its wider coverage, Mission Inrdadhanush has been a success till now

in order to improve the immunization coverage particularly in the under-privileged

and underserved communities and reduce mortality rate due to vaccine preventable

diseases.9

Need for the study

Each year 27 million children are born in India. Around 10 per cent of them do

not survive 5 years of age. India contributes to 25 per cent of the over 6.9 million

under five death occurring worldwide over years.13

Globally under five mortality rate

has been decreased by 53% from an estimated rate of 91 death per 1000 live births in

1990 to 43 deaths per 1000 live births in 2015. The average annual rate of reduction

of under five mortality has accelerated from 15% in a year over the period 1990 to

2000 to3.9% for 2000 to 2015; but remain insufficient to reach Millennium

Development Goal-4. About 19,000 fewer children died every day in 2015 than in

1990.14

The proposal is for all countries aiming reduce under five mortality to at least

as low as 25 per 1000 live births. The Government of India is committed to reducing

child mortality and morbidity in the country by improving full immunization coverage

through Universal Immunization programme (UIP) and introducing new and

efficacious vaccines for vaccine preventable diseases.9 India’s UIP has contributed

significantly to ensure equality to children accessing the public health system through

a variety of supply and demand side interventions,though there still remain challenges

5

of inequility. The stedy fall of infant mortality from 80 per 1000 live birth in 1991 to

37 per 1000 live birth in 2015 (SRS) does in part reflect the Govt. of India’s dedicated

efforts under UIP to reduce child mortality and morbidity.8

Attention was given to immunization programme in India after successful

eradication of smallpox in mid 1970s. India has launched Expanded Programme on

Immunization (EPI) for immunizing children against diphtheria, whooping cough and

typhoid in 1978 mainly for urban areas. Oral Polio Vaccine against polio, BCG

against tuberculosis and vaccination against measles were included in 1979-80, 1981-

82 and1985-86 respectively.15

The programme was revised in 1985 and renamed as Universal Immunization

Programme (UIP), is one of the largest health programmes of its kind in the World

catering to a birth cohort of 2.7 crore children annually. The program provides

vaccination against seven lifethreatening diseases (Diphtheria, Whooping cough,

Tetanus, Poliomyelitis, Tuberculosis, Measles and Hepatitis B) in the entire country.

In addition, vaccination against Haemophilus Influenzae type B (Hib) and Japanese

Encephalitis (JE) is provided in selected districts and states of the country.9

In spite of all positive changes, there are ongoing challenges for UIP. Despite

being operational for the past more than 30 years, only 65% children (RSOC 2013-

2014) in India receive all vaccines during their first year of life. It is estimated that

annually more than 89 lakh children majorly in hard to reach and underserved

population do not receive all vaccines that are available under Universal

Immunization programme – the highest number compared with any other country in

the World.8

Evidence shows that unimmunized and partially immunized children are most

susceptible to childhood disabilities and run a 3-6 times higher risk of death as

compared with fully immunized children. There are wide variation in the proportion

of partially immunized and unimmunized children within states and districts. Recent

evaluation have indicated that the reason for inability to reach all vaccines to children

in the country are lack of awareness among parents about the benefits of vaccination,

fear of adverse events following immunization and operational reasons such as non

availability of vaccines or vaccinators during vaccination sessions.9

6

Under Mission Indradhanush all the vaccines provided under UIP are

administered to children and pregnant women. UIP of India prevents mortality and

morbidity in children and pregnant women against 12 vaccine preventable diseases.

The Government has identified 201 high focus districts across the country that have

50% of all unvaccinated or partially vaccinated children in the country. A total of 528

districts covered during the various phases of Mission Indradhanush and more than

2.47 crore children and 67 lakh pregnant women have been vaccinated. With the

launch of Mission Indradhanush, the Government aims at

• Generally high demand for immunization services by addressing

communication challenges.

• Enhancing political, administrative and financial commitment through

advocacy with key stakeholders and

• Ensuring that the partially immunized and unimmunized children are fully

immunized as per National Immunization schedule.9

The Union Health Ministry plans to achieve full immunization coverage under

its “Mission Indradhanush” by 2018. States conduct Mission Indradhanush drives for

seven working days from 7th

of every month, for four consecutive months, excluding

Sundays, holidays and routine immunization days.8

Mission Indradhanush contributed to an increase in Full Immunization

Coverage by 6.7%, as evidenced by Integrated Child Health and Immunization

Survey (INCHIS). This increase would not be sufficient to achieve Full Immunization

Coverage of more than 90% of new-borns by 2020 as aimed under Mission

Indradhanush.Further, Full Immunization Coverage in selected disticts/cities that have

shown slow progress in spite of repeated phases of Mission Indradhanush.8

There are several reasons why India has so many unlimited and party

immunised children–vast pools of illiteracy, lack of awareness about the benefits of

immunization and lack of access to healthcare facilities. Reaching every child who

missed out on immunization is not an easy task. The vulnerable are not just in the

rural hinterland. Many live on the margins of urban India.It is children of migrant

workers often miss out on routine and supplementary immunization.Others at equal

risk include those belonging to populations that are nomadic, living around brick

kilns, urban slums, fishermens’ villages, living in riverine areas with shifting

7

populations and other traditionally underserved and hard- to- reach groups like tribal

communities and those living in forested areas.Those at risk also include populations

which have a health facility exists but lack health workers.12

With the aim to accelerating the full immunization coverage and provide

greater focus on urban areas and other pockets of low immunization coverage, the

Ministry of Health and Family Welfare has drawn up an aggressive action plan to

achieve the target by 2018 and it was launched on 8th

October,2017 as Intensifies

Mission Indradhanush.8

Hon’ble Prime Minister emphasized the need of a supplemental aggressive

action plan to cover all left outs and drop outs in selected districts and urban cities

with low routine immunization coverage in a specific time frame(December 2018).

These districts should focus on improving immunization coverage through need based

interventions in Intensified Mission Indradhanush drives, based on a comprehensive

gap analysis, with strengthened involvement of relevent non- health departments and

enhanced accountability frameworks.8

Inter-ministerial and inter- departmental coordination, action- based review

mechanism and intensified monitoring and accountability framework are the key for

effective implementation of targeted rapid interventions to improve the routine

immunization coverage which will ensure that life saving vaccines reach every child.8

Under the intensified drive, due attention must be given to:

• Urban slum areas and districts where there is maximum scope of

improvement in immunization

• Due- listing of beneficiaries on the basis of robust head- count surveys which

will be validated by supervisors; and

• Improving mobilization of beneficiaries.8

This Intensified Mission will hence be steered based on the information

received from gap assessment, concurrent monitoring by partners, and end- line

surveys. States and districts need to device coverage improvement plans based on gap

self assessment,which will be reviewed at all levels for adherence to achieving goal of

reaching 90% evaluated coverage/ concurrent monitoing by December 2018.8

8

Over half (54%) of the world’s population lived in urban areas and by 2050

this population is expected to increase 66 per cent, adding approximately 2.5 billion

new urban dwellers. Around 90% of the projected increase will occur in Asia and

Africa, which currently have the lowest level of urban dwelling population (48% and

40% respectively). This increasing trends towards urbanization is closely linked

withincreasing population living in slum environment, particularly in low and middle

income countries in Asia and Africa.16

Significant disparities in health outcomes exist in urban areas, with the urban

poor most affected. These disparities are driven by demographic, geographic and

socio- economic factors. The coverage of basic health services, including vaccination,

is usually lower among urban poor communities, increasing their vulnerability to

vaccine preventable diseases. Factors associating with immunization uptake in urban

slums are

• Socio-economic characteristics

The socio-economic circumstances are having low level of income and

education; poor provision ofpublic infrastructure such as water and sanitation;

insecure legal status resulting in exclusion from public health systems; and reduced

or absent provision of basic health services.

• Information, beliefs and behavior

Health services are not acceptable due to lack of information and distrust in

the government. Some parents are unaware of the need of vaccines; either the mother

or both parents being too busy to take their child to be vaccinated; parents travelled to

village or place of origin; parents or caretakers unaware of the location or timing of

the vaccine clinic.

• Health services

The provision of health services are different when compared to the rest of an

urban area, which may have an effect on immunization coverage and lead to

inequalities in coverage among the urban poor in slums. The quality of the services

provided also plays a role: higher patient satisfaction and provision of accurate

information leads to increased attendance for repeat vaccine doses.

9

• Migration status

An Indian slum cited the following reasons for under-immunization for

migrant population: mother or both parents being too busy; parents returned to home

village; parents unaware of place or time of immunization; and lack of awareness for

the need for immunization.16

A study conducted among 731 Saudi parents of 0-12 years old children during

April 2013 in Taif, Saudi Arabia shows that parents had good knowledge on general

role of vaccination in prevention of some infectious diseases 672 (91.9%), timing of

the first dose in vaccination schedule 635 (86.8%). Parents had poor knowledge on

importance of administration of multiple doses of same vaccine 304(41.6%).Parents

attitudes towards immunization was positive except in some aspects related to

vaccination side effects 316 (34.2%) and the probability of occurrence of diseases

against which the child was vaccinated 288 (39.4%). It indicates that although parents

had good knowledge and positive attitudes on some aspects related childhood

immunization, gaps in both studied domains were identified. Educational

interventions are needed to upgrade parents’ knowledge with special emphasis on less

educated and residents of rural areas.17

A study conducted among 500 families having children between 0-5 years in

rural areas of Punjab, India from March 2014-march 2015 revealed that maximum

coverage to BCG vaccination (77.2%) and minimum for measles vaccine (56.2%) was

observed. 55% of children were completely immunized, 28.8% were partially

immunized and 16.2 were not immunized. It is concluded that the main reason for

partial/non immunization was lack of knowledge of families about vaccination.

Considering incomplete knowledge and inappropriate practices the policy makers and

medical profession require to put in much more efforts to sensitive families about

importance regarding immunization in preventing diseases and their consequent

morbidity and mortality.18

A survey study conducted among 60 migrant mothers of under five children in

selected construction sites at Bangalore Urban showed that 55.0% were between 20-

23 years of age, 38.3% had only 1 child, 45% of the children belonged to the ages

below 1 year, 91.7% had no formal education, 68.3% of migrant mothers speak

Kannada, 71.7% of them had inadequate knowledge, whereas 28.3% of them had

10

moderate knowledge while 0% of them had adequate knowledge. The post-test score

showed that (38)63.3% had adequate knowledge and (22)36.6% had moderate

knowledge while none had inadequate knowledge. There is no association between

knowledge scores and demographic variables.19

A study conducted in the urban slums of Bijapur, Karnataka in 2012among

155 mothers/ responsible guardian of children in the age group of 12 to 23 months

revealed that 54 out of 155 respondents (34.84%) where fully immunized, 97

(62.58%) were partially immunized and 4 (2.58%) were unimmunized. It indicates

that the immunization coverage in the urban slum of Bijapur is still way short of the

85% coverage mark due to a lack of information and motivation among the parents.20

A community based cross-sectional study conducted among 150 parents in

slums of Mangalore taluk during August –November 2015shows that 88(57.7%) of

under five children were fully immunized, 62(41.3%) were partially immunized. It

indicates that the immunization coverage was found to be very bad. There is an urgent

need to ensure that regular health education sessions are conducted. Slum areas

should be the target of RCH programme with special focus on immunization related

activities e.g. ensuring that all households with children should have immunization

cards.21

A study conducted among 143 mothers from socioeconomically backward part

of Bangalore, Karnataka. in a teaching hospital in South India shows that even though

most of the mothers had satisfactory knowledge, attitude and practice, almost 25%

children were identified as un-immunized or partially immunized. The study indicated

that there is an urgent need to increase the coverage of Universal Immunization

programme vaccines and there is a direct need to arrange for health education

program sessions for all the parents regarding the importance of complete adherence

of vaccination among children. TV, newspaper and other media can be also promoted

as most important sousces which can be used for spreading educational messages

regarding vaccination.22

From the above studies it shows that the magnitude of unimmunization and

incomplete immunization is huge among under five children specially in urban slum

area. It is important to to create awareness among parents about immunization and its

11

benefits. Mothers are the primary care giver and the decision makers in upbringing of

their children. So, the investigator assumes that the mothers should have depth

knowledge and attitude regarding immunization and Mission Indradhanush. The

investigator choose the mothers of urban slum as her sample to create awareness

about Mission Indradhanush to ensure that they are adequately informed about the

programme and it would help to cover all the children who have been left out or

missed out for immunization.

12

OBJECTIVES

Statement of the problem

A quasi experimental study to assess the effectiveness of educational package

on level of knowledge and attitude regarding Mission Indradhanush among mothers

of under five children in selected urban slum area, Bengaluru.

Objectives of the study

1.To assess the existing level of knowledge and attitude regarding Mission

Indradhanush among mothers of under five children.

2. To assess the posttest level of knowledge and attitude regarding Mission

Indradhanush among mothers of under five children.

3. To assess the effectiveness of educational package on knowledge and attitude

regarding Mission Indradhanush among mothers of under five children.

4. To determine the correlation between knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

5. To associate the pretest level of knowledge and attitude regarding Mission

Indradhanush among mothers of under five children with their selected

demographic variables.

Operational definitions

1. Effectivenes

It refers to the extent to which the educational package will improve

the knowledge and attitude regarding Mission Indradhanush among mothers

of under five children.

2. Educational package

It refers to the systematically developed educational strategy to teach

the mothers of under five children regarding importance of Mission

Indradhanush, who are all beneficiaries, about the seven life threatening

diseases, Universal immunization schedule by using A.V. aids such as flash

cards, pamphlets and leaflets for a duration of 45 minutes to 1 hour.

13

3. Knowledge

It refers to the level of understanding regarding Mission Indradhanush

among mothers of underfive children which is assessed by structured

questionnaire.

4. Attitude

It refers to belief and opinion regarding Mission Indradhanush among

mothers of under five childrenwhich is elicited by Likert scale.

5. Mission Indradhanush

It is a health programme launched by the Union Government to ensure

immunization of children and pregnant women. This is a focused and

systematic drive to be implemented through a “catch up” campaign mode. The

aim of the “catch up” mode is to cover all the children who have been left out

for immunization.

6. Mothers of under five children

It refers to the mothers who are having children below five years of

age and are residing in selected urban slum.

Assumptions

1. Mothers of under five children may have low knowledge regarding Mission

Indradhanush.

2. Mothers of under five children may have poor attitude towards Mission

Indradhanush.

3. Educational package may improve the knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

4. Knowledge and attitude of mothers of under five children may vary with

their selected demographic variables.

Research Hypotheses

H1- There is a significant difference between the mean pre-test and post-test score of

knowledge and attitude regarding Mission Indradhanush among mothers of under

fivechildren.

14

H2- There is a significant correlation between pre-test knowledge and attitude

regarding Mission Indradhanush among mothers of under five children.

H3- There is a significant association between pre-test level of knowledge and attitude

regarding Mission Indradhanush among mothers of under five childrenwith

theirselected demographic variables.

Delimitations

1. The study was delimited to mothers having children below five years.

2. The data collection was dilimited to 4 weeks

Conceptual framework

Concepts are basically vehicles of thought that involve images. Concepts are

words that describe objects, properties or eventsthatare basic componentsof theory. It

is an idea of an object, property or events which can be empirical or concrete,

inferential or abstract, that is derived from individual perceptual experience. Concept

is defined as a complex mental formulation of an object, property or an event that is

derived from the individual’s perception and experience.23

Conceptualization is the process of forming ideas, which are utilized and

forms the conceptual framework for development of research design. It helps the

researcher to know that data need to be collected and gives direction to an entire

research process.Theories and conceptual models are the primary means of providing

a conceptual context for a study.24

The present study is intended to assess the effectiveness of educational

package regarding Mission Indradhanush among mothers of under five children.

The conceptual model selected for this study is based on “Pender’s Health

Promotion Model” (1996). The Health Promotion Model proposed by Nola Pender

and was designed to be a complementary counterpart to model of health protection.

Health promotion is directed at increasing the well level of wellbeing and human

Health potential.

The model focused on following three areas

1. Individual characteristics and experiences

2. Behavior specific cognition and affect

15

3. Behavioral outcomes.

Individual characteristics

In this study, individual characteristics refers to the demographic variables of

mothers of under five children consisting of age, religion, educational status,

occupation,family income per month,type of family, number of

children,immunization status of the children, previous knowledge and sources of

information.

Behavior specific cognition and affect

Here, it refers to the existing knowledge and attitude regarding Mission

Indradhanush among mothers of under five children. The investigator targeted that the

administration of educational package will improve the level of knowledge and

attitude of mothers of under five children regarding Mission Indradhanush .Structured

interview schedule was developed to assess the knowledge and three point Likert

scale was developed to assess the attitude regarding Mission Indradhanush among the

mothers of under five children.

Perceived barrier to actions such as lack of awareness and lack of the sources

of information were identified. Effort was taken to overcome the perceived barriers

and effective working environment was created in order to fulfill the expectation of

the mothers to achieve the targeted goals.

Educational package regarding Mission Indradhanush was administered to all

the selected mothers of under five children with the help of flash cards, pamphlets and

leaflets for a duration of 45 minutes.

Behavioral outcome

It is the end result of behavior and helps to identify and assess short term and

long term outcomes. In the present study, behavioral outcome refers to the

comparison of pre -test and post-test level of knowledge and attitude scores of

mothers of under five children regarding Mission Indradhanush. Assessment of

improvement in knowledge and attitude of parents was done by statistical

computation. The targeted outcome was met through the administration of educational

package on Mission Indradhanush among mothers of under five children.

16

17

REVIEW OF LITERATURE

Literature review is defined as a broad, comprehensive, in depth, systematic

and critical review of scholarly publication, unpublished printed or audio visual

materials and personal communications. Before starting any research whether it is

single study or an extended project, a literature review of previous study and

experience related to the purpose investigation should be done. One of the most

satisfying purposeof the literature review is the contribution to make the new

knowledge insight and general scholarship of the research. A researcher analyses

existing knowledge before dwelling into a new area of the study, while conducting a

study, when interpreting the results of the study and when making the judgement

about application of new knowledge in nursing practice.

The received related literature has been organized under the following headings:

1. Literature related to knowledge regarding immunization.

2. Literature related to knowledge and attitude regarding immunization.

3. Literature related to effectiveness of educational programme on immunization.

4. Literature related to immunization programme.

Literature related to knowledge regarding immunization

A non-experimental survey was conducted to assess the level of knowledge

regarding immunization among mothers of under five children and associate the

findings with the selected demographic variables in selected area of Pune city. 200

mothers who were having under five children were selected by non-probability

convenient sampling technique. The study results shows that majority of mothers was

having average knowledge 140 (70%), poor 50 (20%) and good 10 (5%). There is also

association between education of mothers and knowledge regarding immunization at

p <0.05 level. The chi square test result indicates that as the standard of education is

higher, the knowledge of immunization was more. The study concluded that mothers

knows the importance of immunization, but they have knowledge deficiency about

some vaccine like BCG,DPT, doses of hepatitis B and vitamin A vaccination.25

A community based cross sectional survey study was done to assess the

immunization status and knowledge regarding newer vaccines among mothers in a

rural area of Rangareddy District, Telangana, India. Fifty children and their mothers

18

were selected for the study by convenient sampling technique. A pre designed, pre

tested questionnaire was used by adapting interview technique. The study result

shows that about three fourth (74%) children were completely immunized and 26%

were partially immunized. About one third of mothers were aware about pentavalent

vaccination, one fourth were aware about IPV and extreme low level of awareness

(2%) was seen regarding Rota virus vaccine. The study concluded that one fourth of

the children were partially immunized with majority missing the booster doses and a

very low level of awareness was seen among mothers regarding various newer

vaccines.26

A hospital based cross-sectional descriptive study was conducted to assess the

maternal knowledge about immunization, vaccines used, vaccination centres and

advantages at tertiary care centre in Maharastra. The study was conducted among the

mothers at pediatric OPD of Government Medical College and hospital, Akola. The

results show that majority of mothers had poor knowledge of vaccine used in

Universal Immunization programme. BCG and OPV were comparatively known to

many. Also the most of the mothers were not aware of advantages of immunization.27

A non experimental researchexploratory study was conducted to assess the

knowledge among mothers of under five children regarding immunization in selected

villages of Moga, Punjab. 100 mothers of under five children were selected from

anganwadis by using simple random sampling method. The finding of the study

revealed that 12% of mothers had good knowledge, 40% of mothers had average

knowledge and 48% of mothers had below average knowledge regarding

immunization. The total mean percentage of mothers knowledge regarding

immunization is (69.12%). There was statistically significant effect of age,

qualification, occupation of mother, family income in rupees, religion, number of

children and source of information on knowledge regarding immunization. So the

study concluded that the level of knowledge vary according to different demographic

variables.28

A non experimental study was conducted to assess the knowledge regarding

immunization among mothers of under five children and prepare health education

programme regarding immunization at Kunderki U.P. India. The mothers of under

five children were selected as sample by using convenient sampling technique. The

19

sample size was 30. The result shows that good knowledge score is 10%, average

knowledge score is 23.34% and poor knowledge score is 66.66%. The study

concluded that the mothers of under five having poor knowledge of immunization.29

A descriptive and non experimental study was conducted to assess the

knowledge regarding immunization among mothers of under five children admitted in

pediatric ward of Prabhakar Kore Hospital, Belagavi, Belgaum with the aim to

develop educational pamphlet. The study was conducted on 50 mothers of under five

children and they were selected by convenient sampling technique. The results

showed that majority of 34 (68%) of mothers of under five children had an average

knowledge regarding immunization, 9 (18%) of mothers had good knowledge and

minimal 7(14%) had poor knowledge. The study concluded that mothers knowledge

regarding immunization is essential for timely utilization of immunization services as

it isthe most cost effective measure to prevent vaccine preventable diseases.30

A non-experimental exploratory study was conducted to assess the knowledge

of mothers of under five children on immunization with a view to develop a

information booklet. The sample comprised of 30 mothers of under five children, who

visited Yenepoya hospital, Mangalore. The study result shows that 30% of mothers

had poor knowledge, 43.4% of mothers had average knowledge, 23.4% of mothers

had good knowledge and 3.33% mothers had excellent knowledge. There is no

significant association between knowledge score and selected demographic variables.

There was a significant association between knowledge and exposure to mass media

in relation to immunization among mothers of under five children.31

Literature related to knowledge and attitude regarding immunization

A survey study was conducted to assess the knowledge and attitude of mothers

towards childhood immunization in Bauchi Local Government, Nizeria.Data was

collected from 322 mothers by in-depth interview schedule. The finding of the study

revealed that the level of mothers’ education relates to their knowledge and tend to

encourage childhood immunization. The study recommends that Government should

employ more health officials, such as nurses to meet the WHO health staff ratio of

one nurse for four patients. There is need to remove all cultural impediments that

prevent women from immunization by empowering them with decision making at

20

home. The study believed that there is the need to encourage women or girl child

education as well as to educating husbands, parents and community leaders on the

dangers associated with lack of immunization especially of the mentioned five killer

diseases.32

A qualitative study was conducted to assess the knowledge, attitude and

perception about routine childhood vaccination among Jewish Ultra-Orthodox

mothers residing in communities with low vaccination coverage in the Jerusalem

district. The study was conducted among mothers and sampling technique used was

focus groups and semi-structured interview. The sample size was 87. The study result

shows that vaccination delay was very common and timeliness was considered

insignificant. Overall there was a sense of self-responsibility accompanied by inability

to influence others. The study concluded that investigating maternal knowledge and

attitudes on childhood immunization provides insights that may insist in planning

tailored intervention programs aimed to increase both vaccination coverage and

timeliness. 33

An institutional based cross sectional study was conducted from March 1st to

April 1st, 2013 to assess knowledge, attitude, and practice of mothers towards

immunization of infants and their associated factors in immunization clinic in health

centers at Addis Ababa, Ethiopia. The study results revealed that only 55.0%, 53.8%

and 84% of respondents had good knowledge, positive attitude and good practice

towards immunization of infants. Good immunization practice was significantly

associated with mothers who heard information about vaccination, mothers who know

the time of starting and completion of immunization, know the number of sessions

needed and place of delivery. The study concluded that knowledge and attitude of

mothers’ about infant vaccination was not adequate. Despite of inadequate knowledge

and attitude of mothers towards infant immunization, 84.0%of mothers found to have

good practice of immunization.34

A cross-sectional survey study was conducted to assess the knowledge,

attitude and practice of mothers’ towards children obligatory vaccination at Damietta

Governorate, Egypt. The sample size was 1050 mothers (210 from 5 districts) and

they were selected randomly according to availability of household list. Four

structured interviewing sheets were used to assess the data. The results revealed that

21

there was a statistically significant correlation between knowledge and practice of the

studied mothers. The study concluded that less than half of the studied mothers had

poor knowledge score while less than one third had good score, more than two thirds

of the studied mothers had good attitude score while the minority had poor attitude

score and more than one third of mothers had good practice while one quarter had

poor practice.35

A study was conducted to assess the knowledge, attitude and practice of

mothers as regards immunization and the influence of socio demographic

characteristics on immunizable children in Jos North, Nigeria. The study was

conducted among 232mothers with children born between 26th

September 2011 and

26th

September 2012 .The study showed only 2.6% had excellent knowledge on

vaccine preventable diseases, 89.6% had an overall good knowledge while5.2% each

had fair and poor knowledge. The education of mother, marital status, religion,

geographical zone and her and/ of the father of the child been immunized as children

significantly influenced their knowledge (p<0.05). The study concluded that proper

health education and health promotion intervention has to be taken as measures to

improve knowledge, attitude and practice of mothers towards immunization.36

A mixed method study was conducted to evaluate the correlation between

parental knowledge-practices and children’s immunization completeness in Mosul,

Iraq. A retrospective cohort study and a prospective cross sectional study was used.

528 children born between 1 January 2003 and 31June 2008 were randomly selected

from public health clinic. Immunization history of each child was collected

retrospectively from their immunization record/card. The results of study indicate that

about half of studied 286 (56.3%) were immunized with all vaccination doses; these

children were considered as having had complete immunization. 66.1% of the parents

was found to have adequate knowledge and practice scores. A significant association

of immunization completeness with total knowledge and practice groups (p<0.05) was

found. The study concluded that future efforts are required to improve immunization

rate and parents’ knowledge and practice.37

A study was conducted to determine the knowledge, attitude and practice of

mothers regarding their understanding of immunization in rural areas in and around

Pondicherry. The study was conducted among 501 mothers of children from 0-5 years

22

of age. The results shows that majority of children (62.6%) included in the study were

born at Aarupadai Veedu Medical College and Hospital and 100% immunization

coverage upto 18 months were recorded for all those children. The knowledge and

awareness of antenatal vaccination is approximately 70-80% of the mothers, 30% of

mothers are not aware that immunization can be done during minor ailments and after

minor adverse reactions. The study concluded that health professional play a major

role in creating both immunization awareness and administration in prescribed date to

mothers.38

A descriptive cross sectional study was conducted to assess the knowledge and

practice of mothers regarding childhood immunization compliant with immunization

completeness in Aurangabad, Maharashtra, India. The study was conducted among

364 mothers attending immunization OPD in Government Medical College during

September to December2015. The results shows that 78.5% children were completely

immunized as per date. 57.97% of the study population was found to have adequate

knowledge-practice scores. A significant association of immunization completeness

with knowledge-practice scores of mothers (p<0.05) was found. It is concluded that

future efforts are required to improve immunization rate and parents’knowledge and

practice.39

A cross-sectional study was conducted to assess the knowledge, attitude and

practice of mothers of under five children regarding immunization in a selected

community, Rishikesh, Uttarakhand. Total 50 subjects were assessed by using semi

structured questionnaire. The result revealed majority 40 (80%) of the under five

children are partially immunized. Majority 25(50%) had moderately adequate

knowledge and 45(90%) have favorable attitude towards immunization. Majority

44(88%) had poor practice whereas 6(12%) demonstrated good practice. There was

significant association between subjectslevel’ of knowledge and attitude while no

association was found between knowledge and practice of mothers of under five

children. The study concluded that it is very clear that the partial vaccination among

under five children in Uttarakhant, India warrant special attention.40

A cross-sectional survey study was conducted to survey mothers’ knowledge

and attitude towards childhood immunization and then determine if these variables

correlate with the timely vaccination coverage of their children in Rural Uganda from

23

September to December 2013. The sample size was 302 women having one child

between 1 month and 5 years from rural Sheema district. The study finding shows that

88% of the children received age-appropriate on time immunization, 93.5%of the

women were able to state that childhood immunizations protect children from

diseases. The study concluded that the factors influencing caregivers’ demand for

childhood immunization vary widely between, and also within, developing

countries.41

A prospective cross-sectional study was carried out for assessment of parents’

knowledge, attitude and practice about child vaccination in Rural areas of Bangalore.

110 parents of under five children were selected and data was collected by using

structured questionnaire. The results shows that a majority of them (72.7%) had good,

(21.8%) had average and (5.4%) had poor knowledge whereas 85.4% of the

respondent were found to have good attitude towards child immunization. 68.1%

children were completely immunized, 7.2% receive incomplete immunization and

remaining 24.5% was uncertain. A very significant correlation was seen between the

parental knowledge and attitude score with p<_0.0001. The study concluded that the

parental knowledge, attitude and practice about child vaccination are important

determinants of the immunization status of their child.42

A descriptive study was conducted to assess the knowledge and attitude on

immunization among the mothers of under five children, Halaga village, Belgaum,

Karnataka. 50 mothers of under five children were selected by convenient and

purposive sampling. The result reveals that mean knowledge value on immunization

of mothers of under five children was 58.1 and attitude score was 41.4. The

correlation between knowledge on immunization and attitude of mothers showed that

there is a positive correlation between knowledge on immunization and attitude

(r=0.483). The study concluded that the mothers of under five children of rural

community area had moderately adequate knowledge on immunization and moderate

positive attitude towards immunization. These findings reveal that the community

health nurses should make little efforts in educating the mothers so as to achieve

100% immunization.43

A cross-sectional survey was conducted to determine the knowledge,

attitude and practice of parents regarding childhood immunization in immunization

24

clinic at Vanivilas hospital, attached to Bangalore Medical College and Research

Institute and a private pediatric clinic in Bengaluru. Data were collected from 200

parents/ guardians (100 from each set up) using structured questionnaire. The result

showed that 172(86%) children were fully immunized. Knowledge (p<0.004) and

practice (p<0.001) of parents opting for optional vaccines were significantly higher in

private setting compared to the government setting. The study concluded that

although childhood immunization practices and attitudes are satisfactory, majority

donot have specific knowledge on vaccines and the duration of protection they offer.

Socio-demographic factors had a significant influence on the immunization status.44

A cross sectional descriptive study was carried out to assess the knowledge,

attitude and perception of mothers with children under five years of age about

vaccination in Mangalore, India. 200 mothers of under five children were selected

from Urban Health centre (74) and a peripheral Health Centre in Bengre (126) and a

semi structured pre validated questionnaire was used to collect data. The results

revealed that around 8 (10.8%) from urban area and 78 (61.9%) from rural area were

illiterate. On a net analysis, 64(86.5%) mothers in the urban area and only 64(50.8%)

mothers in the rural area are found to have favorable knowledge, attitudes,

perceptions and practices towards vaccination. The study concluded that a significant

number of mothers in rural areas were unaware about the vaccination and its

implications and even in the urban areas, there was lacunae in the knowledge, attitude

and perception of mothers towards childhood vaccination.45

Literature related to effectiveness of educational progrommeon immunization

A cross-sectional study was conducted to assess parents’ knowledge and to

evaluate the effect of a short educational intervention on improving parents’

knowledge of childhood immunization. 73 Malaysian parents were enrolled in this

study and changes in total knowledge score before and after the intervention were

measured using a validated questionnaire. The result shows that the majority were

mothers (n=64, 8.7%).Parents’ knowledge about childhood immunization increased

significantly after the intervention compared to the baseline results (p<0.001). There

were significant differences between parents’ knowledge and their educational level

and monthly income (p<0.001 and p=0.005), respectively. The study concluded that a

25

short educational intervention desiagned for parents’ had a positive effect on their

knowledge about immunization.46

A quasi experimental study was conducted to assess the effectiveness of health

teaching programme on knowledge regarding immunization among mothers of under

five children in selected communitysetting, Aurangabad. 40 mothers of under five

children were selected by purposive sampling technique. The study result shows that

the overall pre-test mean knowledge score was found to be14.675 and SD as 4.226.

And the overall post-test mean knowledge score was found to be 21.800 and SD as

4.207. Paired t-test shows statistical significance at 5 per cent level (p<0.05)

establishing the impact of planned teaching on knowledge regarding immunization

among mothers of under five children. The study concluded that post-test mean

knowledge score of mothers indicated significant difference which is a net benefit to

the mothers due to the effectiveness of health teaching program.47

Literature related to immunization programme.

A study was carried out to assess the awareness of mothers about the new

vaccines introduced in the childhood vaccination programme in Delhi State. Total

samples of 388 mothers were interviewed in the immunization clinic of a tertiary care

hospital. The result shows that only 18.3% of the participants were aware that newer

vaccines have been introduced into the programme. 48. 2% of the respondents were

unaware about the same, while 33.5% claimed to have heard about it but were not

sure whether newer vaccines had been introduced. It was observed that as the

education status of mothers improved, their awareness regarding newer vaccines in

the programme also increased. The study concluded that there is a requirement of

focused publicity campaign to increase the awareness and thereby uptake of the new

vaccine among caregiver.48

An one year prospective cross sectional study was carried out to study the

knowledge regarding immunization schedule among parents and the source of

information regarding vaccination. Data were collected from parents of 240 children

admitted in Pediatric ward of Kamla Nehru hospital, Gandhi Medical College,

Bhopal. The study results shows that the highest incidence was of TB 47.92%

followed by tetanus, measles, diphtheria and neotetanus. The incidences of vaccine

preventable diseases were higher among unvaccinated child as compared to

26

vaccinated child except tuberculosis where vaccination rate was higher (52.17). All

vaccine preventable diseases were much common in illiterate fathers and mothers.

The study concluded that there is need to increase awareness and knowledge about the

benefits and importance of vaccination, as well as the harmful consequences of non

complete immunization.49

A descriptive studywas conducted to assess the knowledge and attitude

regarding national vaccine programme among mothers of under five in selected

hospital Mangalore. The sample size consists of 300 mothers. The study result shows

that 289 (96.33%) mothers knew that BCG vaccine prevents Tuberculosis .Only

26(8.66%) mothers were knowledgeable about the measures that can be done if the

child has not given DPT. 11 (3.66%) mothers knew that chicken pox can be prevented

by varicella vaccine. The study concluded that even though the mothers had good

attitude regarding vaccines but they were unaware of Hib vaccine and rotavirus

vaccine and awareness should be created among mothers.50

27

METHODOLOGY

Research methodology is a systematic way to solve the research problems. It

is of vital importance which consists of the various steps that are generally adopted by

a researcher in studying the problem along with the logic behind them. The

methodology of the researcher indicates the general pattern of organizing the

procedure for gathering valid and reliable data for the purpose of the study.

This chapter deals with research approach, research designs, variables, setting

of study, population, sample, criteria for sample selection, sampling technique,

sampling criteria, tool for data collection, validity and reliability, pilot study, method

of data analysis, interpretation and ethical consideration.

Research approach

Research approachindicates the basic procedure for conductingthe research.

Quantitative research approach was used to assess the effectiveness of educational

package on level of knowledge and attitude regarding Mission Indradhanush among

mothers of under five children .

Research design

Quasi experimental one group pre- test and post- test design.23

Pre- test (O1) Intervention (X) Post- test (O2)

Assess pre-test level of

knowledge and attitude

regarding Mission

Indradhanush among

mothers of under five

children through

structured interview

schedule and Likert scale.

Educational package

regardingMission

Indradhanush among

mothers of under five

children by using flash

cards, pamphlets and

leaflets for duration of 45

minutes.

Assess post-test level of

knowledge and attitude

regarding Mission

Indradhanush among

mothers of under five

children through

structured interview

schedule and Likert scale.

28

Figure No. 2: Schematic representation of research plan.

Research design: Quasi experimental one group pre- test post- test design.

Study setting: Kengeri Upanagar urban slum area, Bengaluru.

Population: All the mothers having under five years children in Kengeri Upanagar urban slum area.

Sample size: 60 mothers.

Sampling technique: Simple Random Sampling technique.

Independent variables:

Educational package regarding

Mission Indradhanush

Dependent variables Knowledge

and attitude regarding Mission

Indradhanush

Tool for data collection:

Structured interview schedule and Likert scale

Method of data collection:

1.Informed consent 2. Pre test 3. Educational package 4. Post- test

Data analysis: Descriptive and Inferential statistics

Findings and conclusion

Statement of the problem: A quasi experimental study to assess the effectiveness of

educational package on level of knowledge and attitude regarding Mission Indradhanush

among mothers of under five children in selected urban slum area, Bengaluru.

29

Research variables

Variables are an attributes of a person that varies and takes on different values.

Independent variables

Educational Package on level of knowledge and attitude regarding Mission

Indradhanush.

Dependent variables

Knowledge and attitude regarding Mission Indradhanush among mothers of

under five children.

Demographic variables

Baseline information of motherssuch as age,religion, educational status, occupation,

family income per month, type of family, number of children, immunization status

of children, previous knowledge regarding Mission Indradhanushand sources of

information.

Setting

The study was conducted in Kengeri Upanagar urban slum area, Bengaluru

and the setting was selected according to geographic proximity, feasibility and

availability of the sample.

Population

In this study, population comprised of all the mothers of under five children in

Kengeri Upanagar urban slum area, Bengaluru.

Sample

Mothers of under five children who fulfilled the inclusion criteria were the

samples and the sample size was 60.

Criteria for sample collection

Inclusion criteria

The study includes

1. Mothers having children below five years.

2. Mothers of under five children who can understand Kannada or English.

3. Mothers who are residing in Kengeri Upanagar urban slum area, Bengaluru.

30

Exclusion criteria

The study excludes

1. Mothers of under five children who are not available at the time of data

collection.

2. Mothers of under five children who are not willing to participate in the study.

Sampling technique

The sampling technique adopted for the study was Simple Random Sampling

technique.

Development and description of tool

The tools were prepared on the basis of objectives of the study, by taking

suggestion from the guide, by consulting 6 nursing experts, one biostatistician and one

medical officer. Under the guidance of the guide, final tools were prepared. The tools

consist of 3 sections, Section A consists of structured interview schedule regarding

demographic variables, Section B cons ists of structured interview schedule to assess

the knowledge regarding Mission Indradhanush and Section C consists of 3 points

Likert attitude scale to assess the attitude of mothers regarding Mission Indradhanush.

The following steps were carried out while preparing the tool

1. Review of literature

2. Based on experts opinion

3. Researcher’s personal opinion.

Tools for data collection

The tool consists of the following sections:

Section A

It includes demographic variables which give base line information of mothers

such as age, religion, educational status, occupation, family income per month, type

of family, number of children, immunization status of children, previous

informatiomregarding Mission Indradhanush and sources of information.

31

Section B

Structured interview schedule was used to assess the level of knowledge

regarding Mission Indradhanush among mothers of under five children.

Scoring interpretation

Scoring key was prepared for section B, score ‘1’ was awarded to correct

response and ‘0’ for wrong response in all items. Thus a score of 22 were allotted to

interpret the level of knowledge among mothers of under five children, the scores

were categorized as

1. Inadequate knowledge -<50%

2. Moderate knowledge-50-75%

3. Adequate knowledge- > 75%

Section C

3 points Likert attitude scale was used to assess the attitude of mothers of

under five children regarding Mission Indradhanush.

In section C, for positive questions, score of 3 for agree, score of 2 for

uncertain and score of 1 for disagree, for negative questions, score of 3 for disagree,

score of 2 for uncertain and score of 1 for agree. Thus a total score of 42 were allotted

to interpret the level of attitude among mothers of under five children, the scores were

categorized as

1. Unfavorable attitude -<50%

2. Neutral attitude -50-75%

3. Favorable attitude- >%75%

Development of educational package

The first draft of educational package was developed on the basis of

information obtained during extensive literature review and objectives in the blue

print. The entire content was prepared as a lesson plan. The content was given to 8

experts and modifications were made according to their suggestions and the content

was finalized.

32

Preparation of final draft of educational package

Preparation of final draft was done after incorporating the expert’s opinion and

suggestions. The content was prepared in English and Kannada in the form of lesson

plan and A.V aids. The average time taken to teach on Mission Indradhanush among

mothers of under five children by using A.V aids was 45 minutes duration.

Content validity

The first draft of educational package was based on the objective of the study

and was given to 6 nursing expert in the field of community health nursing, 1 expert

in the field of community medicine and 1 expert in the field of Statistics. The experts

were requested to give their opinion and suggestions regarding the relevance of the

tool for medications to improve the clarity and contents of the items. The tool

consisted of 22 items on knowledge and 14 statements on attitude, comprehension and

application domain, in all items were agreed upon with the suggestions. The final tool

was incorporated with the expert suggestions and opinion.

Reliability

In order to establish reliability of the tool, the test split half method was used.

The calculated “r” value was 0.87 for knowledge and 0.95 for the attitude and the

developed tool was found to be reliable.

Formula

r =� �� ∑���������

∑�� ���∑�� ���

r1

= 2r/1-r

Pilot study

Pilot study is a small version or trial run done in preparation for major study.

The pilot study was conducted in the month of January,2018 for 1 week in Gandhi

gram urban slum area Bengaluru. An administrative approval was obtained from the

Medical Officer of Health and Family Welfare,Gandhi Gram urban health centre,

BMP, Bengaluruto conduct the study. On the first day, the existing level of

knowledge and attitude regarding Mission Indradhanush was assessed with the help of

structured interview schedule and Likert scale respectively. On the same day the

educational package was administered by using flash cards, pamphlets and leaflets for

33

45 minutes. After a period of 7 days of educational package, post-test knowledge and

attitude was assessed by using same structured Interview schedule and Likert scale.

The purpose of the pilot study was to find out the feasibility of conducting the study.

There was significant improvement in the post-test knowledge and attitude

regarding Mission Indradhanush among mothers of under five children. The subjects

expressed their desire to learn and the pilot study revealed that tool was feasible and

appropriate to conduct the main study.

Procedure for data collection

After obtaining the official permission from Medical Officer of Kengeri

Upanagar urban health centre, and written consent obtained from the samples, the

investigator conducted the main study among 60 mothers of under five children who

were selected by simple random sampling technique method and the data was

collected in the month of February 2018 for 4 weeks. The investigator personally

collected the data in the following phase.

Phase I

On the first day, the existing knowledge and attitude regarding Mission

Indradhanush among mothers of under five children was assessed with the help of

structured interview schedule and 3 point Likert scale.

Phase II

On the same day, educational package was given to mothers of under five

children regarding Mission Indradhanush by using flash cards, pamphlets and leaflets

for 45minutes.

Phase III

After a period of 7 days of educational package, post- test level of knowledge

and attitude regarding Mission Indradhanush was assessed by using the same

structured interview schedule and 3 point Likert scale.

Data Analysis

The data was collected and analysed by using descriptive and inferential statistics:

34

Descriptive statistics

1. Frequency and Percentage distribution are used to assess the demographic

variables.

2. Range, Mean and Standard deviation were used to describe pre- test and post-

test level of knowledge and attitude regarding Mission Indradhanush among

mothres of under five children.

3. Correlation co-efficient was used to correlate the correlation between

knowledge and attitude regarding Mission Indradhanush.

Inferential statistics

1. Paired t-test was used to compare pre and post -test knowledge and attitude

regarding Mission Indradhanush amongmothres of under five children.

2. Chi-square test was used to determine the association between the pre- test

level of knowledge and attitude regarding Mission Indradhanush with their

selected demographic variables.

Ethical consideration

1. Formal permission was obtained from the Medical Officer Kengeri Upanagar

Urban Health Centre, Bengaluru.

2. Written consent was obtained from the study samples.

3. The subjects were informed that confidentiality of the data will be maintained

4. The subjects were informed that their participation was on voluntary basis

and can withdraw from the study anytime

5. No ethical issues arose during the study.

35

RESULTS

Organization of study findings

Analysis is the process of evaluating data using analytical and logical

reasoning to examine each component of the data provided.51

This chapter provides

the analysis and interpretation of data collected from the mothers of under five

children in Kengeri Upanagar Urban Slum area, Bengaluru. The data was analysed by

using descriptive and inferential statistics.

The substantive summary of the analysis was under the following sections

Section 1: Description of demographic variables of mothers of under five

children.

Table1.1: Frequency and percentage distribution of demographic variables of the

mothers of under five children according to age, religion, educational

status and occupation.

Table 1.2: Frequency and percentage distribution of demographic variables of the

mothers of under five children according to family income per month in

rupees, type of family, number of children, immunization status of children,

previous information regarding Misssion Indradhanush and the sources of

information.

Section 2: Assessment of pre -test level of knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

Table 2.1: Frequency and percentage distribution of pre-test level of knowledge

regarding Mission Indradhanush among mothers of under five children.

Table 2.2: Range, Mean, Standard deviation and Mean percentage of pre-test level of

knowledge regarding Mission Indradhanush among mothers of under five

children.

Table 2.3: Frequency and percentage distribution of pre-test level of attitude regarding

Mission Indradhanush among mothers of under five children.

Table 2.4: Range, Mean, Standard deviation and Mean percentage of pre-test level

of attitude regarding Mission Indradhanush among mothers of under five

children.

36

Section 3: Assessment of post- test level of knowledge and attitude regarding

Mission Indradhanush amongmothers of under five children.

Table 3.1: Frequency and percentage distribution of post- test level of knowledge

regarding Mission Indradhanush among mothers of under five children.

Table 3.2: Range, Mean, Standard Deviation and Mean percentage of post- test level

of knowledge regarding Mission Indradhanush among mothers of under

five children.

Table 3.3: Frequency and percentage distribution of post- test level of attitude

regarding Mission Indradhanush among mothers of under five children.

Table 3.4: Range, Mean, Standard deviation and Mean percentage of post-test level of

attitude regarding Mission Indradhanush among mothers of under five

children.

Section 4: Assessment of pre and post-test knowledge and attitude regarding

Mission Indradhanush amongmothers of under five children.

Table 4.1: Frequency and percentage distribution of mothers according to pre and

post- test knowledge regarding Mission Indradhanush.

Table 4.2: Range, Mean, Standard deviation and Mean percentage of pre and post-test

knowledge regarding Mission Indradhanush among mothers of under five

children.

Table 4.3: Frequency and percentage distribution of mothers according to pre and

post-test attitude regarding Mission Indradhanush.

Table 4.4: Range, Mean, Standard Deviation and Mean percentage of pre and post-

test attitude regarding Mission Indradhanush among mothers of under five

children.

Section 5: Effectiveness of educational package on level of knowledge and

attitude regarding Mission Indradhanush among mothers of under

five children.

37

Table 5.1: Paired t-test analysis for the significance of pre and post-test knowledge

and attituderegarding Mission Indradhanush among mothers of under five

children.

Section 6: Assessment of correlation between the pre-test level of knowledge and

attitude regarding Mission Indradhanush among mothers of under

five children.

Table 6.1: Correlation between the pre-test knowledge and attitude regarding Mission

Indradhanush among mothers of under five children.

Section 7: Association between pre- test level of knowledge and attitude

regarding Mission Indradhanush with selected demographic

variables.

Table 7.1: Association between pre- test level of knowledge regarding Mission

Indradhanush among mothers of under five children with their selected

demographic variables such as age in years, religion and educational status.

Table 7.2: Association between pre- test level of knowledge regarding Mission

Indradhanush among mothers of under five children with their selected

demographic variables such as occupation, family income per month, type

of family, number of children, immunization status of children, previous

information regarding Mission Indradhanush and sources of information.

Table 7.3: Association between pre-test level of attitude regarding Mission

Indradhanush among mothers of under five children with their selected

demographic variables such as age in years, religion and educational

status.

Table 7.4: Association between pre-test level of attitude regarding Mission

Indradhanush among mothers of under five children with their selected

demographic variables such as family income per month, type of family,

number of children, immunization status of children, previous

information regarding Mission Indradhanush and sources of information.

38

Section 1: Description of demographic variables of mothers of under five

children

Table1.1: Frequency and percentage distribution of demographic variables of

mothers according to age, religion, educational status and

occupation.

n=60

SL.NO DemographicVariables Frequency Percentage

1 Age in years

a. 20 years and below 6 10.0

b.21-25 years 28 46.7

c. 26-30 years 18 30.0

d. 31years and above 8 13.3

2 Religion

a.Hindu 42 70.0

b. Christian 3 5.0

c.Muslim 12 20.0

d.Others 3 5.0

3 Educational status

a. No formal education 2 3.3

b. Primary education 15 25.0

c. Secondary education 11 18.3

d. Higher secondary education 21 35.0

e. Graduation and above 11 18.3

4

Occupation

a.Home maker 23 38.3

b.Daily wager 17 28.3

c.Self employed 11 18.3

d.Government employee 2 3.3

e.Private employee 6 10.0

f.Others 1 1.7

Table 1.1 shows the frequency and percentage distribution of selected

demographic variables of mothers of under five children as age in years, religion,

educational status and occupation.

With regards to age, 10.0% (6) mothers were 20 years and below, 46.7% (28)

were 21 -25 years, 30.0% (18) were 26-30 years and 13.3% (8) were 31 years and

above. With respect to religion, 70.0% (42) mothers belong to Hindu religion, 5.0%

39

(3) mothers belong to Christian religion, 20.0% (12) belong to Muslim religion and

5.0% (3) belong to other religion. With regards to educational status of mothers, 3.3%

(2) had no formal education, 25.0% (15) had primary education, 18.3% (11) had

secondary education, 35.0% (21) had higher secondary education and 18.3% (11) had

graduation and above level of education. With regards to occupation of mothers,

38.3% (23) were homemaker, 28.3% (17) were daily wager, 18.3% (11) were self-

employed, 3.3% (2) were government employee, 10% (6) were private employee and

1.7% (1) was other occupations.

40

Table1.2: Frequency and percentage distribution of demographic variables of

the mothers according to occupation, family income per month in

rupees, type of family, number of children, immunization status of the

children, previous information about Mission Indradhanush and the

sources of information.

n=60

Sl. No DemographicVariables Frequency Percentage

5 Family income (rupees/month)

a.≤10,000 37 61.7

b.10,001-15,000 16 26.7

c.15001 and above 7 11.7

6 Type of family

a. Nuclear family 17 28.3

b. Joint family 38 63.3

c. Extended family 5 8.3

7 Number of children

a. 1 27 45.0

b. 2 22 36.7

c. 3 or more 11 18.3

8 Immunization status of children

a. Fully immunized 42 70.0

b. Partially immunized 15 25.0

c. Drop out 3 5.0

9 Have you heard about Mission Indradhanush?

a. Yes 24 40.0

b. No 36 60.0

If yes, specify the sources of information (n=24)

a. Health personal 13 54.2

b. Family member 5 20.8

c. Friends - -

d. Mass media 6 25.0

The above table shows the frequency and percentage distribution of selected

demographic variables of mothers of under five children according to family income

per month in rupees, type of family, number of children, immunization status of

children, knowledge about Mission Indradhanush and sources of information.

With regards to family income per month in rupees, 61.7.% (37) had an

income of ≤ 10,000 per month, 26.7% (16) had an income of 10,001-15,000 per

month, and 11.7 % (7) had an income of 15,001 and above per month .With regards

41

to type of family, 28.3% (17) belongs to nuclear family, 63.3% (38) belongs to joint

family and 8.3% (5) belongs to extended family.With regards to number of children

45% (27) had one child, 36.7% (22) had two children and 18.3% (11) had three or

more children. With regards to immunization status of the children 70.0% (42) were

fully immunized, 25.0% (15) were partially immunized and 5.0% (3) were drop out.

With regards to previous knowledge about Mission Indradhanush 40.0% (24) have

heard about Mission Indradhanush and 60.0% (36) have not heard about Mission

Indradhanush. With regards to source of information, 54.2% (13) heard about Mission

Indradhanush through health personnel, 20.8% (5) heard from family members and

25% (6) heard through mass media.

42

Graph 1: Percentage distribution of mothers of under five children according to

age

Graph 2: Percentage distribution of mothers of under five children according to

religion.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Below 20

years

21-25 years 26-30 years 31 and

above

10.0%

46.7%

30.0%

13.3%

Per

cen

tage

Age in years

0%

10%

20%

30%

40%

50%

60%

70%

80%

Hindu Christian Muslim Others

70.0%

5.0%

20.0%

5.0%

Per

cen

tage

Religion

43

Graph 3: Percentage distribution of mothers of under five children according to

educational status.

Graph 4: Percentage distribution of mothers of under five children according to

occupation

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

No formal

Education

Primary

Education

Secondary

Education

Higher

Secondary Education

Graduation

and Above

3.3%

25.0%

18.3%

35.0%

18.3%

Per

cen

tage

Educational status

0%5%

10%15%20%25%30%35%40%

38.3%

28.3%

18.3%

3.3%

10.0%

1.7%

Per

cen

tage

Occupation

44

Graph 5: Percentage distribution of mothers of under five children according to

family income per month in rupees.

Graph 6: Percentage distribution of mothers of under five children according to

type of family.

0%

10%

20%

30%

40%

50%

60%

70%

61.7%

26.7%

11.7%

Per

cen

tage

Family income per month

0%

10%

20%

30%

40%

50%

60%

70%

Nuclear Joint Extended

28.3%

63.3%

8.3%Per

cen

tage

Type of family

45

Graph 7: Percentage distribution of mothers of under five children according to

number of children.

Graph 8: Percentage distribution of mothers of under five children according to

immunization status of children.

0%

10%

20%

30%

40%

50%

1 2 3 or above

45.0%

36.7%

18.3%

Per

cen

tage

Number of children

0%

10%

20%

30%

40%

50%

60%

70%

80%

Fully

Immunized

Partially

immunized

Drop out

70.0%

25.0%

5.0%

Per

cen

tage

Immunization status of children

46

Graph 9: Percentage distribution of mothers of under five children according to

previous information about Mission Indradhanush.

Graph 10: Percentage distribution of mothers of under five children according to

sources of information.

40.0%

60.0%

Have you heard about Mission Indradhanush?

Yes

No

0%

10%

20%

30%

40%

50%

60%

Health

personnel

Family

members

Friends Mass media

54.2%

20.8%

0%

25.0%

Per

cen

tage

Sources of information

47

Section 2: Assessment of pre- test level of knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

Table 2.1: Frequency and percentage distribution of pre-test level of knowledge

regarding Mission Indradhanush among mothers of under five

children.

n=60

SI. No

Pre-test level of knowledge Frequency Percentage

1. Inadequate knowledge (<50%) 45 75.0

2. Moderate knowledge (50-75%) 11 18.3

3. Adequate knowledge (>75%) 4 6.7

Total 60 100

The above table shows that in the pre- test, 75.0% (45) of mothers had

inadequate knowledge, 18.3% (11) had moderate knowledge and 6.7% (4) had

adequate knowledge.

Table 2.2: Range, Mean, Standard Deviation and Mean Percentage of pre- test

level of knowledge regarding Mission Indradhanush among mothers

of under five children.

n=60

Pre-test

knowledge Max. Score Range Mean SD Mean%

Over all 22 3-19 10.17 4.49 46.2%

The above table shows that in the pre-test, the range was 3- 19, mean was

10.17, SD was 4.49 and mean percentage was 46.2.

48

Table 2.3: Frequency and percentage distribution of pre-test level of attitude

regarding Mission Indradhanush among mothers of under five

children.

n=60

SI. No Post-test level of knowledge Frequency Percentage

1. Unfavorable attitude (<50%) - -

2. Neutral attitude (50-75%) 40 66.7

3. Favorable attitude (>75%) 20 33.3

Total 60 100

The above table shows that in the pre-test, 66.7% (40) of mothers had neutral

attitude and 33.3% (20) had favorable attitude.

Table 2.4: Range, Mean, Standard Deviation and Mean Percentage of pre-test

level of attitude regarding Mission Indradhanush among mothers of under five

children.

n=60

Pre-test

knowledge Max. Score Range Mean SD Mean%

Over all 42 27-36 30.58 2.39 72.8%

The above table shows that in the pre-test range was 27-36, mean was 30.58,

SD was 2.39 and mean percentage was 72.8%.

49

Section 3: Assessment of post- test level of knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

Table 3.1: Frequency and percentage distribution of the post-test level of

knowledge regarding Mission Indradhanush among mothers of

under five children.

n=60

SI. No Post-test level of knowledge F %

1. Inadequate knowledge (<50%) - -

2. Moderate knowledge (50-75%) 26 43.3

3. Adequate knowledge (>75%) 34 56.7

Total 60 100

The above table shows that in the post- test, 43.3% (26) of mothers had

developed moderate knowledge and 56.7% (34) of mothers developed adequate

knowledge.

Table 3.2: Range, Mean, Standard deviation and Mean percentage of the post-

test level of knowledge regarding Mission Indradhanush among

mothers of under five children.

n=60

Post-test

knowledge Max. Score Range Mean SD Mean%

Over all 22 11-22 17.00 3.36 77.3%

The above table shows that in the post- test, the range was 11-22, mean was

17.00, SD was 3.36 and mean percentage was 77.3%.

50

Table 3.3: Frequency and Percentage distribution of the post- test level of

attitude regarding Mission Indradhanush among mothers of under

five children.

n=60

SI.

No. Post-test level of attitude Frequency Percentage

1. Unfavorable attitude (<50%) - -

2. Neutral attitude (50-75%) - -

3. Favorable attitude (>75%) 60 100

Total 60 100

The above table shows that in the post test, 100% (60) have developed

favorable attitude.

Table 3.4: Range, Mean, Standard deviation and Mean percentageof post- test

level of attitude regarding Mission Indradhanush among mothers of

under five children.

n=60

Post-test

Attitude

Max.

Score Range Mean SD Mean%

Over all 42 33-42 37.21 2.50 88.6%

The above table shows that in the post test, the range was 33- 42, mean was

37.21, SD was 2.50 and mean percentage was 88.6%.

51

Section 4: Assessment of pre and post-test knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

Table 4.1: Frequency and Percentage distribution of mothers according to pre

and post- test level of knowledge regarding Mission Indradhanush.

n=60

SI.

No. Level of knowledge Pre-test Post-test

F % F %

1. Inadequate knowledge (<50%) 45 75.0 - -

2. Moderate knowledge (50-75%) 11 18.3 26 43.3

3. Adequate knowledge (>75%) 4 6.7 34 56.7

Total 60 100 60 100

The above table 4.1 presents the frequency and percentage distribution of

mothers according to level of knowledge before and after the educational package.

Majority of 75.0% (45) of the mothers had inadequate knowledge, 18.3% (11) had

moderate knowledge and 6.7% (4) had adequate knowledge before the educational

package but after educational package was administered, majority of 56.7% (34) of

mothers had developed adequate knowledge and 43.3% (26) developed moderate

knowledge.

Mothers of under five children according to level of knowledge before educational

package were within inadequate, moderate and adequate but after the educational

package, majority of them had developed adequate knowledge.

It evidenced that the educational package had shown the effect on improving

the level of knowledge regarding Mission Indradhanush among mothers of under five

children.

52

Graph 11: Percentage distribution of Mothers of under five children according

to pre and post-test level of knowledge regarding Mission

Indradhanush.

0.0%

20.0%

40.0%

60.0%

80.0%

Inadequate

knowledge

Moderate

knowledge

Adequate

knowledge

75.0%

18.3%

6.7%0%

43.3%

56.7%P

erce

nta

ge

Level of knowledge

Before

educational

package

After

awareness

package

53

Table 4.2: Range, Mean, SD and Mean percentage of pre and post -test level of

knowledge regarding Mission Indradhanush among mothers of under

five children n=60

SI.

No. Knowledge Max. Score Range Mean SD

Mean%

1. Pre test 22 3-19 10.17 4.49 46.2

2. Post test 22 11-22 17.00 3.36 77.3

The above table shows that in the pre- test range was 3-19, mean was 10.17,

SD was 4.49 and mean percentage was 46.2%. In the post- test, range was 11-22,

mean was 17.00, SD was 3.36 and mean percentage was 77.3%.

Table 4.3: Frequency and Percentage distribution of mothers of under five

children according to the pre and post-test level of attitude regarding

Mission Indradhanush.

n=60

SI. No.

Level of attitude Pre-test Post-test

F % F %

1. Unfavorable attitude (<50%) - - - -

2. Neutral attitude (50-75%) 40 66.7 - -

3. Favorable attitude (>75%) 20 33.3 60 100

Total 60 100 60 100

The above table presents the frequency and percentage distribution of mothers of

under five children according to level of attitude before and after the educational

package. 66.7% (40) of mothers had neutral attitude and 33.3% (20) had favorable

attitude before the educational package, but after the educational package, 100% (60)

of them had developed favorable attitude.

Mothers of under five children according to level of attitude before educational

package were within neutral attitude but after the educational package 100% of have

developed favorable attitude.

It evidenced that the educational package had shown the effect on improving

the level of attitude among mothers of under five children.

54

Graph 12: Percentage distribution of mothers of under five children according to

pre and post-test level of attitude regarding Mission Indradhanush.

Table 4.4: Range, Mean, SD and Mean percentage of pre and post -test level of

attitude regarding Mission Indradhanush among mothers of under

five children.

n=60

SI. No Attitude Max.

Score Range Mean SD Mean%

1. Pre-test 42 27-36 30.58 2.39 72.8%

2. Post-test 42 33-42 37.21 2.50 88.6%

The above table shows that in the pre- test, range was 27-36, mean was 30.58,

SD was 2.39 and mean percentage was 72.8%. In the post test, range was 33-42, mean

was 37.21, SD was 2.50 and mean percentage was 88.6%.

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Unfavourable

attitude

Moderate

attitude

Favourable

attitude

0.0%

66.7%

33.3%

0% .0%

100%

Per

cen

tage

Level of attitude

Before

educational

package

After

educational

package

55

Section 5: Effectiveness of educational package on level of knowledge and

attitude regarding Mission Indradhanush among mothers of under

five children.

Table 5.1: Paired t-test analysis for the significance of pre and post- test

knowledge and attitude regarding Mission Indradhanush among

mothers of under five children.

n=60

Sl.

no.

Variables

Max

score

Pre and post knowledge

difference Paired

t-value P-value

Mean

difference

SD of

difference

% of

increase

1. Knowledge 22 6.83 1.13 31.0 14.45* p<0.001

2. Attitude 42 6.63 0.11 15.7 11.16* p<0.001

Note: *- denotes significant ( p<0.001) for df = 59.

The above table depicts the outcome of paired t-test analysis carried over to

assess the significance of pre and post-test mean score of knowledge and attitude

regarding Mission Indradhanush among mothers of under five children. The paired t-

test was found to be significant to overall knowledge and attitude regarding Mission

Indradhanush.

It evidenced that there is a significant difference in knowledge and attitude

after the intervention of educational package.

Testing of hypothesis

H1-: There is a significant difference between the mean pre- test and post- test score

of knowledge and attitude regarding Mission Indradhanush among mothers of

under five children.

H01: There is no significant difference between the mean pre -test and post- test score

of knowledge and attitude regarding Mission Indradhanush among mothers of

under five children.

The table 5.1 represents the mean pre-test and post-test knowledge and attitude

regarding Mission Indradhanush among mothers of under five children respectively.

The paired t- test was carried out and it was found out significant at P<0.001 level,

hence reseaech hypothesis (H1) was accepted and the null hypothesis (H0) was

rejected. It provides evidence that the educational package was significantly effective

in improving the knowledge and attitude regarding Mission Indradhanush among

mothers of under five children.

56

Section 6: Assessment of correlation between pre-test knowledge and attitude

regarding Mission Indradhanush among mothers of under five

children.

Table 6.1: Correlation between the pre-test knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

n=60

Variables Mean SD r p-value

Knowledge 10.17 4.49 0.486*

p<0.05

Attitude 30.58 2.39

Note: *- Significant at 5% level (i.e., p<0.05)/NS-not significant at 5% level

(i.e,>0.05)

The above table 6.1 presents the correlation between knowledge and attitude

regarding Mission Indradhanush among mothers of under five children. The Karl

Pearson’s correlation was found to be (r=0.486) and it was found to be statistically

significant at p<0.05. It was evidenced that there was significant linear correlation

between knowledge and attitude ie., increase in knowledge bears the further increase

in attitude regarding Mission Indradhanush among mothers of under five children.

There was significant trend in increase of attitude with the increase in knowledge

through the regression model (Attitude = 27.29 +0.34 x Knowledge ). The R-square

was 0.24, which implied that chance of increase in attitude was by the influence of

24.0% increase of knowledge and remaining influence was due to other factors.

Testing of Hypothesis

In order to evaluate the correlation between knowledge and attitude regarding

Mission Indradhanush among mothers of under five children, the following

hypothesis were tested.

H2: There is a significant correlation between knowledge and attitude regarding

Mission Indradhanush among mothers of under five children

H02: There is no significant correlation between knowledge and attitude regarding

Mission Indradhanush among mothers of under five children

57

The above table 6.1 indicates that there positive correlation between

knowledge and attitude regarding Mission Indradhanush among mothers of under five

children at p<0.05 level hence, research hypothesis was accepted and null

hypothesis was rejected.

Graph 13: Assessment of correlation between knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

58

Section 7: Association between pre-test level of knowledge and attitude with their

selected demographic variables.

Table 7.1: Association between pre- test level of knowledge regarding Mission

Indradhanush among mothers of under five children with their

selected demographic variables such as age in years, religion and

educational status

n=60

Sl.

No

Demographic

variables

Sample

(n=60)

Level of knowledge Chi-

square

value

p-value ≤ Median >Median

F % F % F %

1 Age in years

a. 20 years and below 6 10.0 5 14.3 1 4.0

8.759,

df=3,

S

p<0.05 b. 21-25 years 28 46.7 19 54.3 9 36.0

c. 26-30 years 18 30.0 9 25.7 9 36.0

d. 31 and above 8 13.3 2 5.7 6 24.0

2 Religion

a. Hindu 42 70.0 19 54.3 23 92.0

10.676,

df=3,

S

p<0.05 b. Christian 3 5.0 3 8.6 0 0

c. Muslim 12 20.0 11 31.4 1 4.0

d. Others 3 5.0 2 5.7 1 4.0

3 Educational status

a.Noformal education 2 3.3 2 5.7 0 0

18.801,

df=4, S p<0.05

b. Primary education 15 25.0 13 37.1 2 8.0

c.Secondary.education 11 18.3 8 22.9 3 12.0

d.Higher Secondary

education 21 35.0 11 31.4 10 40.0

e.Graduation

and above 11 18.3 1 2.9 10 40.0

Note: S-significant (p<0.05); NS-Not significant (p>0.05).

59

Table 7.2 Association between pre - test level of knowledge regarding Mission

Indradhanush among mothers of under five children with their

selected demographic variables such as occupation, family income,

type of family, number of children, immunization status of children,

previous knowledge about Mission Indradhanush and sources of

information.

n=60

SL.

NO

Demographic

variables

Sample no

(60)

Level of knowledge Chi

square

value

p-value

≤Median >Median

F % F % F %

4 Occupation

a. Home maker 23 38.3 10 28.6 13 52.0

21.839,

df=5,

S

p<0.05

b. Daily wager 17 28.3 16 45.7 1 4.0

c. Self employed 11 18.3 8 22.9 3 12.0

d.Government

employee 2 3.3

1 2.9 1 4.0

e. Private employee 6 10.0 0 0 6 24.0

f. Others 1 1.7 0 0 1 4.0

5 Family income(Rupees/month)

a. ≤10,000 37 61.7 25 71.4 12 48.0 4.306,

df=2, NS

p>0.05 b. 10001-15,000 16 26.7 8 22.9 8 32.0

c. Above 15,001 7 11.7 2 5.7 5 20.0

6 Type of family

a. Nuclear family 17 28.3 9 25.7 8 32.0 0.284,

df=2,

NS

p>0.05 b. Joint family 38 63.3 23 65.7 15 60.0

c. Extended family 5 8.3 3 8.6 2 8.0

7 Number of children

a. 1 27 45.0 15 42.9 12 48.0 10.691,

df=2, S

p<0.05 b. 2 22 36.7 9 25.7 13 52.0

c. 3 or more 11 18.3 11 31.4 0 0

8 Immunization status of children

a. Fully immunized 42 70.0 3 65.7 19 76.0 2.386,

df=2,

NS

p>0.05 b. Partially immunized 15 25.0 9 25.7 6 24.0

c. Drop out 3 5.0 3 8.6 0 0

9

a.

Have you heard about Mission Indradhanush?

a. Yes 24 40.0 9 25.7 15 60.0 7.143,

df=2, S p<0.05

b. No 36 60.0 26 74.3 10 40.0

b. If yes, specify the sources of information (n=24)

a. Health personal 13 54.2 6 66.7 7 46.7 1.546,

df=2,

NS

p>0.05 b. Family member 5 20.8 2 22.2 3 20.0

c. Friends 0 0 0 0 0 0

d. Mass media 6 25.0 1 11.1 5 33.3

Note: S-significant (p<0.05); NS-Not significant (p>0.05).

60

The table 7.1 and 7.2 envisages the outcome of chi square analysis being

carried out to bring out the association between the pre-test level of knowledge

regarding Mission Indradhanush among mothers of under five children with their

demographic variables. The categories such as age, religion, educational status,

occupation, family income, number of children, immunization status of the children,

previous information about Mission Indradhanush and the sources of information

were accounted for determining the association with knowledge. Out of which, age,

religion, education and occupation of mothers, family income, number of children and

previous information of the demographic variables of the mothers of under five

children were found significant with level of knowledge regarding Mission

Indradhanush.

61

Table 7.3: Association between pre- test level of attitude regarding Mission

Indradhanush among mothers of under five children with their

selected demographic variables such as age in years,

religion,educational status and occupation.

n =60

Sl.

No

Demographic

variables

Sample

(n=60)

Level of attitude Chi-

square

value

P-value ≤ Median >Median

F % F % F %

1 Age in years

a. 20 yearsand below 6 10.0 3 8.1 3 13.0 3.252,

df=3,

NS

p>0.05 b.21-25 years 28 46.7 18 40.6 10 43.5

c. 26-30 years 18 30.0 13 35.1 5 21.7

d.31 and above 8 13.3 3 8.1 5 21.7

2 Religion

a. Hindu 42 70.0 24 64.9 18 78.3 3.797,

df=3,

NS

p>0.05 b. Christian 3 5.0 2 5.4 1 4.3

c. Muslim 12 20.0 10 27.0 2 8.7

d. Others 3 5.0 1 2.7 2 8.7

3 Educational status

a. No formal education 2 3.3 2 5.4 0 0

16.076,

df=4, S

p<0.05

b. Primary education 15 25.0 13 35.1 2 8.7

c. Secondary education 11 18.3 5 13.5 6 26.1

d.Higher Secondary

education 21 35.0 15 40.5 6 26.1

e. Graduation and above 11 18.3 2 5.4 9 39.1

4 Occupation

a.Home maker 23 38.3 13 35.1 10 43.5

9.331,

df=5,

S

p<0.05

b. Daily wager 17 28.3 15 40.5 2 8.7

c. Self employed 11 18.3 6 16.2 5 21.7

d.Government

employee 2 3.3

1 2.7 1 4.3

e. Private employee 6 10.0 2 5.4 4 17.4

f. Others 1 1.7 0 0 1 4.3

Note: S-significant (p<0.05); NS-Not significant (p>0.05).

62

Table 7.4: Association between pre- test level of attitude regarding Mission

Indradhanusamong mothers of under five children with their

selected demographic variables such as family income, type of

family, number of children, immunization status, previous

information regarding Mission Indradhanush and sources of

information.

n=60

Note: S-significant (p<0.05); NS-Not significant (p>0.05).

The table 7.3 and 7.4 envisages the outcome of chi square analysis being

carried out to bring out the association between the pre- test level of attitude regarding

Mission Indradhanush among mothers of under five children with their demographic

SL.

NO

Demographic

variables

Sample no

(60)

Level of knowledge Chi

square

value

p-value ≤Median >Median

F % F % F %

5 Family income(Rupees/month)

a. ≤10,000 37 61.7 25 67.6 12 52.2 1.791,

df=2,

NS

p>0.05 b.10001-15,000 16 26.7 9 24.3 7 30.4

c. Above 15,001 7 11.7 3 8.1 4 17.4

6 Type of family

a. Nuclear family 17 28.3 11 29.7 6 26.1 1.696,

df=2,

NS

p>0.05 b. Joint family 38 63.3 24 64.9 14 60.9

c. Extended family 5 8.3 2 5.4 3 13.0

7 Number of children

a. 1 27 45.0 14 37.8 13 56.5 8.410,

df=2,

S

p<0.05 b. 2 22 36.7 12 32.4 10 43.5

c. 3 or more 11 18.3 11 29.7 0 0

8 Immunization status of children

a. Fully immunized 42 70.0 25 67.6 17 73.9 0.272,

df=2,

NS

p>0.05 b.Partially immunized 15 25.0 10 27.0 5 21.7

c. Drop out 3 5.0 2 5.4 1 4.3

9

a.

Have you heard about Mission Indradhanush?

a.Yes 24 40.0

13 35.1 11 47.8 0.952,

df=2,

NS

p>0.05

b.No 36 60.0 24 64.9 12 52.2

b. If yes, specify the sources of information (n=24)

a.Health personal 13 54.2 6 46.2 7 63.6 6.616,

df=2,

S

p<0.05 b. Family member 5 20.8 5 38.5 0 0

c.Friends 0 0 0 0 0 0

d.Mass media 6 25.0 2 15.4 4 36.4

63

variables. The categories such as age, religion, educational status, occupation, family

income, type of family, number of children, immunization status of children, previous

information about Mission Indradhanush and the sources of information were

accounted for determining the association with attitude. Out of which, education,

occupation, number of children and source of information of the demographic

variables of the mothers of under five children were found significant with level of

attitude regarding Mission Indradhanush.

Testing of hypothesis

H3: There is a significant association between the pre- test level of knowledge and

attitude regarding Mission Indradhanush among mothers of under five children

with their selected demographic variables.

H03: There is no significant association between the pre- test level of knowledge and

attitude regarding Mission Indradhanush among mothers of under five children

with their selected demographic variables.

The table 7.1 and 7.2, shows the chi-square value at the level of p<0.05 for

knowledge and prove that there was association between the pre-test level of

knowledge regarding Mission Indradhanush among mothers of under five children

with their selected demographic variables such as age, religion, education,

occupation, number of children and previous information. Hence,research hypothesis

(H3) was accepted and null hypothesis (H03) was rejected.

The table 7.3 and 7.4shows the chi-square value at the level of p<0.05 for

attitude and prove that there was association between the pre-test level of attitude

regarding Mission Indradhanush among mothers of under five children with their

selected demographic variables such as education, number of children and source of

information. Hence null hypothesis (H03) was rejected and research hypothesis (H3)

was accepted.

64

DISCUSSION

This chapter deals with discussion part according to the result obtained from

the statistical analysis based on the data of the study, review of literature and

hypothesis which was formulated to this study. The present study was conducted to

assess the effectiveness of educational package on level of knowledge and

attituderegarding Mission Indradhanush among mothers of under five children in

Kengeri Upanagar urban slum area, Bengaluru.

In order to achieve the objective of the study, a quasi experimental one group

pre-test post-test design was adopted. The samples were selected by random sampling

technique. The data was collected from 60 respondents before and after providing the

educational package regarding Mission Indradhanush. The findings of the study has

been discussed with reference to the objectives, hypothesis and with the findings of

the other studies.

Demographic variables of the subjects

Regarding the frequency and percentage distribution on demographic variables

of mothers of under five children according to the age, religion, educational status,

occupation, family income per month in rupees, type of family, number of children,

immunization status of children, previous information about Mission Indradhanush

and the sources of information.

With regards to age, majority of the mothers of under five children 46.7% (28)

belongs 21-25 years, 30.0% (18) mothers belongs to below 26-30 years, 13.3% (8)

belong to 31 years and above and 10.0% (6) belongs to 20 years and below .

With regards to religion, majority of the mothers 70.0% (42) belongs to Hindu

religion 20.0% (12) belongs to Muslim religion, 5.0% (3) belongs to Christian and

5.0% (3) belongs to other religion.

With regards to educational status of mothers majority of them 35.0% (21) had

secondary education, 25.0% (15) had primary education, 18.3% (11) had graduation

and above, 18.3% (11) had secondary education, and 3.3 % (2) had no formal

education.

65

With regards to occupation of mothers, majority of mothers 38.3% (23) were

home maker, 28.3% (17) were daily wager, 18.3% (11) were self employed, 10.0%

(6) were private employee, 3.3% (2) were government employee and 1.7% (1) were

from others occupation,

With regards to family income per month in rupees, majority of mothers

61.7% (37) had an income of 10,000 and below, 26.7% (16) had an income of

10,001-15.000 and 11.7 % (7) had an income of 15.001 and above.

With regards to type of family, majority of mothers 63.3% (38) belongs to

joint family, 28.3% (17) belongs to nuclear family and 8.3% (5) belongs to extended

family.

With regards to number of children, majority of mothers 45.0% (27) had one

child, 36.7% (22) had two children and 18.3% (11) had three or more children.

With regards to immunization status of the children, majority of children

70.0% (42) were fully immunized, 25.0% (15) were partially immunized and 5.0% (3)

were drop out.

With regards to previous knowledge about Mission Indradhanush, majority

of mothers 60.0% (36) had not heard about Mission Indradhanush and 40.0% (24) had

heard about Mission Indradhanush.

With regards to sources of information, majority of mothers 54.2% (13) had

heard about Mission Indradhanush from health personnel, 25.0% (6) had heard from

mass media, 20.8% (5) had heard from family members and no mothers had heard

from friends.

The first objective was to assess the existing level of knowledge and attitude

regarding Mission Indradhanush among mothers of under five children.

With regards to the pre- test level of knowledge regarding Mission

Indradhanush among mothers of under five children from table 2.1 and 2.2 it is

evident that 75.0% ( 45) of mothers had inadequate knowledge ,18.3% (11) had

moderate knowledge and 6.7% (4) had adequate knowledge from table 2.2. All the

66

pre-test knowledge scores were ranging within 3- 19, mean was 10.17, SD was 4.49

and mean percentage was 46.2%

With regards to the pre- test level of attitude regarding Mission Indradhanush

among mothers of under five children from table 2.3 and 2.4, it is evident that 66.7%

(40) of mothers had neutral attitude and 33.3% (20) had favorable attitude. The

attitude scores were ranging between 27-36, mean 30.58, SD was 2.39 and mean

percentage 72.8%.

The findings of the study was supported by a non experimental study which

was conducted to assess the knowledge regarding immunization among mothers of

under five children and prepare health education programme regarding immunization

at Kunderki U.P. India. The mothers of under five children were selected as sample

by using convenient sampling technique. The sample size was 30. The finding of the

study shows that good knowledge score is 10%, average knowledge score is 23.34%

and poor knowledge score is 66.66%. The study concluded that the mothers of under

five having poor knowledge of immunization.

A descriptive study was conducted to assess the knowledge and attitude

regarding national vaccine programme among mothers of under five in selected

hospital Mangalore. The sample size consists of 300 mothers. The study result shows

that 289 (96.33%) mothers knew that BCG vaccine prevents Tuberculosis .Only

26(8.66%) mothers were knowledgeable about the measures that can be done if the

child has not given DPT. 11 (3.66%) mothers knew that chicken pox can be prevented

by varicella vaccine. The study concluded that even though the mothers had good

attitude regarding vaccines but they were unaware of Hib vaccine and rotavirus

vaccine and awareness shoul d be created among mothers.50

The second objective was to assess post-test level of knowledge and attitude

regarding Mission Indradhanush among among mothers of under five children.

With regards to the post- test level of knowledge and attitude regarding

Mission Indradhanush among mothers of under five children, from table 3.1 and 3.2,

it is evident that 43.3% (26) had moderate knowledge and 56.7%(34) had adequate

knowledge and post- test knowledge scores were ranging between 11-22 with a mean

17.00 and mean percentage 77.3 where SD was 3.36.

67

With regards to post- test level of attitude, all 100% (60) had developed

favorable attitude regarding Mission Indradhanush and all the post- test attitude scores

were ranging between 33-42 with a mean 37.21 and mean percentage 88.6 where SD

was 2.50.

The third objective was to assess the effectiveness of educational package on level

of knowledge and attitude regarding Mission Indradhanush among mothers of

under five children.

With regards to the pre -test and post- test level of knowledge and attitude

regarding Mission Indradhanush among mothers of under five children, from the table

5.1, the ‘t’ value were found to be 14.45 for knowledge and 11.16 for attitude which

was statistically significant at p< 0.001 level.

The findings of the study was supported by a quasi experimental study

conducted to assess the effectiveness of health teaching programme on knowledge

regarding immunization among mothers of under five children in selected community

setting, Aurangabad. 40 mothers of under five children were selected by purposive

sampling technique. The study result shows that the overall pre-test mean knowledge

score was found to be14.675 and SD as 4.226. And the overall post-test mean

knowledge score was found to be 21.800 and SD as 4.207. Paired t-test shows

statistical significance at 5 per cent level (p<0.05) establishing the impact of planned

teaching on knowledge regarding immunization among mothers of under five

children. The study concluded that post-test mean knowledge score of mothers

indicated significant difference which is a net benefit to the mothers due to the

effectiveness of health teaching program.47

The fourth objective was to correlate the pre-test level of knowledge and attitude

regarding Mission Indradhanush among mothers of under five children.

The table 6.1 revealed that there was significant linear correlation (r=0.486)

between knowledge and attitude regarding Mission Indradhanush among mothers of

under five children which is significant at p<0.05 level.

The findings of the study was supported by a descriptive study which was

conducted to assess the knowledge and attitude on immunization among the mothers

of under five children, Halaga village, Belgaum, Karnataka. 50 mothers of under five

68

children were selected by convenient and purposive sampling. The result reveals that

mean knowledge value on immunization of mothers of under five children was 58.1

and attitude score was 41.4. The correlation between knowledge on immunization and

attitude of mothers showed that there is a positive correlation between knowledge on

immunization and attitude (r=0.483). The study concluded that the mothers of under

five children of rural community area had moderately adequate knowledge on

immunization and moderate positive attitude towards immunization.44

A survey study was conducted to assess the knowledge and attitude of mothers

towards childhood immunization in Bauchi Local Government, Bauchi State- Nizeria.

The total sample size was 322 mothers and data was collected by in-depth interview

schedule. The finding of the study revealed that the level of mothers’ education relates

to their knowledge and tend to encourage childhood immunization. The study also

believed that there is the need to encourage women or girl child education as well as

to educating husbands, parents and community leaders on the dangers associated with

lack of immunization especially of the mentioned five killer diseases.32

The fifth objective was to associate between the pre- test level of knowledge and

attitude regarding Mission Indradhanush among mothers of under five children

with their selected demographic variables.

The table 7.1 and 7.2 shows that there was a significant association between

the pre-test level of knowledge regarding Mission Indradhanush among mothers of

under five children with their selected demographic variables such as age, religion,

education and occupation of mothers, number of children and information regarding

Mission Indradhanush.

The table 7.3 and 7.4 shows that there was a significant association between

the pre-test level of attitude regarding Mission Indradhanush among mothers of under

five children with their selected demographic variables such as educational status

of mothers, number of children and sources of information.

The findings is supported by a non-experimental survey was conducted to

assess the level of knowledge regarding immunization among mothers of under five

children and associate the findings with the selected demographic variables in

selected area of Pune city. 200 mothers who were having under five children were

69

selected from selected area by non-probability convenient sampling technique. The

study results shows that majority of mothers was having average knowledge 140

(70%), poor 50 (20%) and good 10 (5%). There is also association between education

of mothers and knowledge regarding immunization at p <0.05 level. The chi square

test result indicates that as the standard of education is higher, the knowledge of

immunization was more. The study concluded that mothers knows the importance of

immunization, but they have knowledge deficiency about some vaccine like

BCG,DPT, doses of hepatitis B and vitamin A vaccination.25

A non experimental research exploratory study was conducted to assess the

knowledge among mothers of under five children regarding immunization in selected

villages of Moga, Punjab. 100 mothers of under five children were selected from

anganwadis by using simple random sampling method. The finding of the study

revealed that 12% of mothers had good knowledge, 40% of mothers had average

knowledge and 48% of mothers had below average knowledge regarding

immunization. The total mean percentage of mothers knowledge regarding

immunization is (69.12%). There was statistically significant effect of age,

qualification, occupation of mother, family income in rupees, religion, numbersof

children and source of information on knowledge regarding immunization. So the

study concluded that the level of knowledge vary according to different demographic

variables.28

70

CONCLUSION

This chapter presents a brief summary of the study with limitation, nursing

implications and recommendations for future research and conclusion

The present study assessed the effectiveness of educational package on level

of knowledge and attitude regarding Mission Indradhanush among mothers of under

five children in Kengeri Upanagara Urban slum area, Bengaluru.

In the pre- test level of knowledge, 45 (75.0%) of mothers had inadequate

knowledge, 11 (18.3%) had moderate knowledge and 4 (6.7%) had adequate

knowledge whereas in post-test, 26(43.3%) of mothers had moderate knowledge and

34 (56.7%) of them had developed adequate knowledge. On the assessment of level of

attitude in pre-test, 40 (66.7%) had neutral attitude and 20 (33.3%) had favorable

attitude and none of them had unfavorable attitude whereas in the post-test, 60 (100%)

had developed favorable attitude. The paired t-test was carried out and it was found to

be significant at p<0.05 level. Hence, research hypothesis was accepted and null

hypothesis was rejected.

The study concluded that educational package is significantly effective in

improving the level of knowledge and attitude regarding Mission Indradhanush

among mothers of under five children.

Nursing Implications

The investigator has drawn the following implications from the studies which

are of vital concern to the field of nursing practice, nursing administration, nursing

education and nursing research.

Nursing Practice

1. Educational package can be effective in improving the knowledge and attitude of

mothers regarding Mission Indradhanush.

2. The community health nurse should identify the various factors which affects the

immunization of children and pregnant mothers, create awareness about

importance of immunization.

71

3. Regular health education programme can be conducted by the nursing personnel

in community setting which helps the mothers to be aware about the ongoing

immunization Programme for children and pregnant mothers, the optional

vaccines, benefits of immunization and about the killer or vaccine preventable

diseases.

4. The study carries an implication that community health nurse plays an important

role in imparting knowledge and helping the mothers regarding Mission

Indradhanush and help the Government to achieve the goals and objectives.

Nursing Education

1. Nurse should equip themselves by reading more books, recent advances and

current health related issues to keep themselves updated.

2. The nursing curriculum should include more on the recent National Health

Programme for effective utilization of the ongoing health programme

including immunization programme so that the public can benefit from various

Health schemes.

Nursing Administration

1. Nurse administrator should collaborate and co-ordinate with the community

leaders in creating awareness in the community for effective utilization of

Universal Immunization Programme including Mission Indradhanush.

2. Nurse administrator should arrange in-service education, training and staff

development programme to nursing personnel regarding latest and ongoing

National health programme including Universal Immunization Programme

and Mission Indradhanush.

3. Nurse administrator should arrange special training to School Teachers,

Anganwadi workers and social workers about Mission Indradhanush and

Universal Immunization Programme, its importance and about vaccine

preventable diseases or killer diseases.

72

Nursing Research

1. The study should be generalized and conducted in a larger population so it can

be used for Evidenced Based Studies .

2. The study should be disseminated through research journals and scientific

papers.

3. The study should be utilized for future studies and references.

Recommendations

1. The study may be replicated using larger population.

2. A similar kind of study can be undertaken in different settings (eg. Tribal and

hilly areas, construction sites etc.)

3. Educational programme may be designed for mothers, Anganwadi workers,

health workers, school teachers, Panchayat members and social workers to

disseminate knowledge regarding Mission Indradhanush.

Limitations

• The study was limited to mothers who were having children below five

years in Kengeri Upanagara urban slum area, Bengaluru .

• The sample size of the study was limited to 60 mothers of under five

children.

73

SUMMARY

The Ministry of Health and Family Welfare, Government of India launched

Mission Indradhanushin December 2014 as a special drive to vaccinate all

unvaccinated and partially vaccinated children under Universal Immunization

Programme. Mission Indradhanush aims to fully immunize more than 90% of

newborns by 2020 through innovative and planned approaches to reach all children as

well as pregnant women, against twelve vaccine preventable diseases. It not only

aimed to rapidly increase the immunization coverage through special drives during

specified months but also focused towards strengthening health systems for

addressing equity issues in access to immunization.

With the aim to accelerating the full immunization coverage and provide

greater focus on urban areas and other pockets of low immunization coverage, the

Ministry of Health and Family Welfare has drawn up an aggressive action plan to

achieve the target by 2018 and it was launched on 8th

October,2017 as Intensified

Mission Indradhanush.

The investigator conducted the present study to assess the effectiveness of

educational package on level of knowledge and attitude regarding Mission

Indradhanush among mothers of under five children. This study reveals that there is

substantial increase in knowledge and attitude of mothers after administration of

educational package on Mission Indradhanush.

The above study suggested that the immunization and health of the child is

impossible withoutmothers involvement as they play a primary role in child’s life.

Objectives of the study were

1. To assess the existing level of knowledge and attitude regardingMission

Indradhanush among mothers of under five children.

2. To assess the post-test level of knowledge and attitude regardingMission

Indradhanush among mothers of under five children.

3. To assess the effectiveness of educational package on knowledge and attitude

regardingMission Indradhanush among mothers of under five children.

74

4. To correlate the pre-test knowledge and attitude regardingMission

Indradhanush among mothers of under five children.

5. To associate between the pre-test level of knowledge and attitude regarding

Mission Indradhanush among mothers of under five children with their

selected demographic variables.

The Assumptions of the study were

1. Mothers of under five children may have low knowledge regarding Mission

Indradhanush.

2. Mothers of under five children may have poor attitude towards Mission

Indradhanush.

3. Educational package may improve the knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

4. Knowledge and attitude of mothers of under five children may vary with

their selected demographic variables.

The research hypotheses were stated as follows:

H1- There is a significant difference between the mean pre-test and post-test score

of knowledge and attitude regardingMission Indradhanush among mothers of

under five children.

H2- There is a significant correlation between knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

H3- There is a significant association between pre-test level of knowledge and

attitude regardingMission Indradhanush among mothers of under five

children.with their selected demographic variables.

The conceptual framework of this study was based on Pender’s health

promotion model (1996).

An extensive review of literature was done which enabled the investigator to

study the selected problem in depth, to develop conceptual framework, to construct

the tool, analyze and interpret the data.

75

The investigator selected quasi-experimental one group pre-test and post-test

design to assess the effectiveness of educational package on level of knowledge and

attitude regarding Mission Indradhanush among mothers of under five children. 60

mothers were selected through simple random sampling technique.

A structured interview schedule was developed by the investigator which

comprised of three sections: Section A consist of demographic data which gives

baseline information of mothers of under five children such as age, religion,

educational status, occupation, family income, type of family, number of children,

immunization status of the children, previous information about Mission

Indradhanush and sources of information, Section B on Structured interview schedule

to assess the level of knowledge of mothers of under five children regarding

Mission Indradhanush and Section C on 3 point Likert scale to assess the level of

attitude of mothers regarding Mission Indradhanush.

The content validity was obtained from experts and reliability was obtained by

split half method using Spearmen Brown’s prophecy formula method. Feasibility of

the study was confirmed by pilot study. The level of knowledge was assessed under

three categories: adequate knowledge, moderate knowledge and inadequate

knowledge. The level of attitude was assessed under three categories favorable

attitude, neutral attitude and unfavorable attitude.

The data obtained was analyzed and interpreted in terms of the objectives and the

hypotheses of the study. Descriptive and inferential statistics were used for data

analysis.

Major findings of the study

• With regards to age, majority of the mothers of under five children 46.7% (28)

belongs 21-25 years, 30.0% (18) mothers belongs to below 26-30 years,

13.3% (8) belongs to 31 years and above and 10.0% (6) belongs to 20 years

and below .

• With respect to religion, majority of the mothers 70.0% (42) belongs to Hindu

religion 20.0% (12) belongs to Muslim religion, 5.0% (3) belongs to Christian

and 5.0% (3) belongs to other religion.

76

• With regards to educational status of mothers, majority of them 35.0% (21)

had secondary education, 25.0% (15) had primary education, 18.3% (11) had

graduation and above, 18.3% (11) had secondary education, and 3.3 % (2) had

no formal education.

• With regards to occupation of mothers, majority of mothers 38.3% (23) were

home maker, 28.3% (17) were daily wager, 18.3% (11) were self employed,

10.0% (6) were private employee, 3.3% (2) were government employee and

1.7% (1) were from others occupation.

• With regards to family income per month in rupees, majority of mothers

61.7% (37) had an income of 10,000 and below, 26.7% (16) had an income of

10.001-15,000 and 11.7 % (7) had an income of 15,001 and above.

• With regards to type of family, majority of mothers 63.3% (38) belongs to

joint family, 28.3% (17) belongs to nuclear family and 8.3% (5) belongs to

extended family.

• With regards to number of children, majority of mothers 45.0% (27) had one

child, 36.7% (22) had two children and 18.3% (11) had three or more children.

• With regards to immunization status of the children, majority of children

70.0% (42) were fully immunized, 25.0% (15) were partially immunized and

5.0% (3) were drop out.

• With regards to previous knowledge about Mission Indradhanush, majority of

mothers 60.0% (36) had not heard about Mission Indradhanush and 40.0%

(24) had heard about Mission Indradhanush.

• With reference to sources of information, majority of mothers 54.2% (13) had

heard about Mission Indradhanush from health personnel, 25.0% (6) had heard

from mass media, 20.8% (5) had heard from family members and no mothers

had heard from friends.

• In the pre-test, majority75.0% (45) of mothers had inadequate

knowledge,18.3% (11) had moderately adequate knowledge and 6.7% (4) had

77

adequate knowledge and 66.7% (40) of mothers had neutral attitude and

33.3% (20) had favorable attitude.

• After administration of educational package (post-test) majority of mothers

56.7 (34) had adequate knowledge, 43.3% had moderate knowledge and pre-

test Mean (10.17) was lower than the post-test mean (17.00), pre-test Mean

percentage ( 46.2%) was lower than the post- test mean percentage 77.3%) and

pre-test SD (4.49) was higher than the post-test SD (3.36). In the post-test

level of attitude, all 60 (100%) had developed favorable attitude and pre-test

mean (30.58 ) was lower than the post-test mean (37.21), pre-test mean

percentage (72.8%) was lower than the post-test mean percentage (88.6%) and

pre-test SD was (2.39) SD was lower than the post-test SD ( 2.50).

• The paired t-test was carried out and it was found to be significant at p<0.001

level. Hence, research hypothesis (H1) was accepted and null hypothesis (H01)

was rejected. It was evident that the educational package was significantly

effective in improving the level of knowledge and attitude regarding Mission

Indradhanush among mothers of under five children.

• There was significant linear correlation (r=0.486) between knowledge and

attitude regarding Mission Indradhanush among mothers of under five

children which is significant at p<0.05 level. Hence, research hypothesis (H2)

was accepted and null hypothesis (H02) was rejected. It was evident that there

is positive linear correlation between knowledge and attitude regarding

Mission Indradhanush among mothers of under five children.

• Chi square analysis being carried out to bring out the association between the

pre-test level of knowledge regarding Mission Indradhanush among mothers

of under five children with their demographic variables. The result of the

study indicated that age, religion, education and occupation of mothers,

number of children and previous information of the demographic variables of

the mothers of under five children had significant association with level of

knowledge regarding Mission Indradhanush, where as education, number of

children and source of information of the demographic variables of the

mothers of under five children had significant association with level of

78

attitude regarding Mission Indradhanush. Hence, research hypothesis (H3) was

accepted and null hypothesis (H03) was rejected. It was evident that there is

association of pre- test level of knowledge and attitude regarding Mission

Indradhanush among mothers of under five children with their selected

demographic variables.

79

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85

CONSENT FORM

LETTER SEEKING CONSENT FROM THE SUBJECTS FOR

PARTICIPATION IN STUDY

Dear participant,

I am a post graduate nursing student at the Padmashree Institute of Nursing,

Bangalore, and conducting “A study to assess the effective of educational package on

level of knowledge and attitude regarding Mission Indradhanush among mothers of

under five children in selected urban slum area, Bengaluru. Hope you will co-operate

with me for the same.

I request you to answer the given interview questionnaire with the most

appropriate responses. Kindly do not leave any question unattended. The information

given by you will be kept confidential and used only for the study purpose. Kindly

sign the consent form given below.

Thanking You.

Yours faithfully,

Mrs Jyotima Borgohain Handique

86

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DwäÃAiÀÄ ¥Á ÉÆμÀÄîªÀªÀgÉÃ, £Á£ÀÄ ¥ÀzÀä²æà E£ïìnlÆåmï D¥sï £À¹ðAUï, ¨ÉAUÀ¼ÀÆgÀÄ ¸ÁßvÀPÉÆÃvÀÛgÀ £À¹ðAUï «zÁåyð¤AiÀiÁVzÉÝÃ£É ªÀÄvÀÄÛ ¨ÉAUÀ¼ÀÆj£À DAiÀÄÝ £ÀUÀgÀ PÉƼÀZÉ ¥ÀæzÉñÀzÀ°è “LzÀÄ ªÀµÀðQÌAvÀ aPÀÌ ªÀÄPÀ̼À vÁAiÀÄA¢gÀ°è «Ä±À£ï EAzÀæzsÀ£ÀĵïUÉ ÀA§A¢ü¹zÀAvÉ w¼ÀĪÀ½PÉ ªÀÄvÀÄÛ ªÀÄ£ÉÆèsÁªÀzÀ ªÀÄlÖzÀ §UÉÎ ±ÉÊPÀëtÂPÀ ¥ÁåPÉÃeï£À ¥ÀjuÁªÀĪÀ£ÀÄß ¤zsÁðgÀuÉ ªÀiÁqÀ®Ä CzsÀåAiÀÄ£À”-ªÀ£ÀÄß PÉÊUÉÆArzÉÝãÉ. EzÀPÁÌV ¤ÃªÀÅ £À£ÀUÉ ¸ÀºÀPÁgÀ ¤ÃqÀÄ«gÉAzÀÄ §AiÀĹzÉÝãÉ.

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87

CONSENT FORM

I here with consent for the above said study knowing

that all the information provided by me will be treated with utmost confidentiality by

the investigator which will be helpful to update knowledge and attitude regarding

Mission Indradhanush among mothers of under five chidren.

Date: Name and Signature of the participant

Place: Address:

88

M¦àUÉ ¥ÀvÀæ

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89

ETHICAL COMMITTEE CLEARANCE CERTIFICATE

90

PROFORMA RORMAT

BLUEPRINT OF KNOWLEDGE AND ATTITUDE

STRUCTURED INTERVIEW SCHEDULE

Section A: Demographic Variables of Mothers of under five childrens

SN TYPE OF QUESTION QUESTION NO.

1 MCQ (Multiple Choice Questions) 1,2,3,4,5,6,7,8,9A,9B,1

Total 11

Section B:Structured Interview Schedule

S

N

TYPE

OF

QUEST

ION

QUESTION NO. MARKS WEIT

AGE

1 MCQ

(Multipl

e Choice

Questio

ns)

1,2,3,4,5,6,7,8,9,10,11,12,13,

14,15,16,17,18,19,20,21,22

1+1+1+1+1+1+1+1+1+1+1+

1+1+1+1+1+1+1+1+1

+1+1=22

Every question consists of:

• 4 options

• Each answer being

scored as 1

100%

Total 22 22 100%

Section C: 3 point Likert Scale

SN TYP

E OF

QUE

STI

ON

QUESTION NO. MARKS WEIT

AGE

1 3

point

Liker

t

Scale

1,2,3,4,5,6,7,8,9,10,11,12,13,14 3+3+3+3+3+3+3+3+3+3+3

+3+3+3 =42

Every question consists of:

• 3 options

• Each answer being

scored on a scale

value of 1-3

100%

Total 14 42 100%

91

SECTION A

DEMOGRAPHIC VARIABLES OF MOTHERS OF UNDER FIVE

CHILDREN

Instruction:

(Please read each statement carefully and give appropriate response)

Please answer the entire question.

1. Age in years

a) 20 years and below

b) 21-25years

c) 26 -30 years

d) 31years and above

2. Religion

a) Hindu

b) Christian

c) Muslim

d) Others

3. Educational status of Mother

a) No formal education

b) Primary education

c) Secondary education

d) Higher secondary education

e) Graduation and above

4. Occupation of Mother

a) Home maker

b) Daily wager

c) Self employed

d) Government employee

e) Private employee

f) Others

92

5. Family income per month

a) Rs. 10,000 and below

b) Rs. 10,001-15,000

c) Above Rs.15,001

6. Type of family

a) Nuclear family

b) Joint family

c) Extended family

7. Number of Children

a) 1

b) 2

c) More than 3

8. Immunization status of children

a) Fully Immunized

b) Partially Immunized

c) Drop out

9. Have you heard about Mission Indradhanush?

a) Yes

b) No

If yes, specify the source of information

i. Health personnel

ii. Family members

iii. Friends

iv. Mass media

93

SECTION B

Structured interview schedule to assess the knowledge of mothers of under five

children regarding Mission Indradhanush

1. What is meant by Mission Indradhanush?

a) Health promotion programme.

b) Health screening and early intervention programme

c) Re-habilitation programme

d) Immunization programme

2. Which Ministry launched Mission Indradhanush?

a) Ministry of Education

b) Ministry of Social Welfare

c) Ministry of Health and Family Welfare

d) NRHM

3. What is the main objective of Mission Indradhanush?

a) To cover all non immunized children

b) To cover all partially immunized children

c) To cover all pregnant mothers

d) To cover all drop out children and pregnant mothers

4. Where are the Mission Indradhanush services available?

a) Areas with high routine immunization coverage

b) Areas with low routine immunization coverage

c) All the government hospitals

d) All the private hospital

5. How to identify the beneficiaries for Mission Indradhanush services ?

a) By survey

b) By screening

c) By blood testing

d) By checking height and weight

6. Which age group of children are beneficiaries of this programme?

a) 0 – 1 year, pregnant mothers

b) 0 – 6 years, pregnant mothers

c) 0 – 5 years, pregnant mothers

94

d) 0 – 10 years, pregnant mothers

7. Mission Indradhanush is mainly for which group of children?

a) Fully immunized

b) Malnourished

c) Partially immunized

d) Sick

8. What may be the reasons for partial immunization?

a) Lack of awareness about benefits of vaccination

b) Fear of adverse effects following immunization

c) Non availability of health services

d) All of the above

9. Who conducts survey for Mission Indradhanush?

a) Health personnels

b) Panchayat members

c) Political leaders

d) NGO

10. Which of the following health personnels are involved in conducting survey

for Mission Indradhanush?

a) Doctors

b) ANMs

c) Laboratory technicians

d) Physiotherapists

11. How many rounds of immunization are conducted under this programme?

a) 2 rounds

b) 3 rounds

c) 4 rounds

d) 5 rounds

12. What is the duration of each round?

a) 3 days

b) 7 days

c) 5 days

d) 6 days

95

13. How many vaccine preventable diseases are covered by Mission

Indradhanush?

a) Seven

b) Six

c) Eight

d) Five

14. What is the working time for Mission Indradhanush?

a) 9 am – 6 pm

b) 9 am– 12 noon

c) 9 am– 4 pm

d) 9 am– 2 pm

15. What are the areas forvaccination under Mission Indradhanush ?

a) Primary School, Post partum centre

b) Anganwadi Centre, NGO sites

c) PHC, local leader’s premises

d) All of the above

16. Which card is given to the beneficiaries under Mission Indradhanush?

a) Adhaar card

b) Vaccination card

c) Ration card

d) Voter ID card

17. What are all the vaccines provided by Mission Indradhanush?

a) Pentavalent,BCG

b) Measles, OPV

c) TT, Hepatitis -B

d) All of the above

18. Which type of vaccine is given to pregnant mothers?

a) DPT

b) TT

c) MMR

d) OPV

96

19. In Karnataka, which day of the week is immunization clinic conducted?

a) Thursday

b) Wednesday

c) Tuesday

d) Monday

20. How the information about Mission Indradhanush is conveyed to the public?

a) Health personnel

b) Mass media

c) Members of panchayat

d) All of the above

21. Which of the following activity will be helpful for awareness for Mission

Indradhanush?

a) Mothers meeting

b) Home visit

c) Community meeting

d) All of the above

22. Which of the following indicates the success of Mission Indradhanush ?

a) Decreased number of partially immunized children and pregnant mothers

b) Increased number of partially immunized children and pregnant mothers

c) Decreased number of sick children

d) Increased number of sick children

97

SECTION C

LIKERT SCALE TO ASSESS THE ATTITUDE OF MOTHERS OF UNDER

FIVE CHILDREN REGARDING MISSION INDRADHANUSH

(3 POINT LIKERT SCALE)

KEYS

A- Agree

B- Undecided

C- Disagree

SL

NO

ITEMS

RESPONSE

Score A U D

1. Mission Indradhanush is helpful programme

for children and pregnant mothers.

2. Mission Indradhanush can help to reduce the

children disease and death rate.

3. It is difficult to receive the services of Mission

Indradhanush

4. Mission Indradhanush will help to cover 100%

full immunization.

5. Mission Indradhanush is beneficial for fully

immunized children.

6. Unimmunized and partially immunized

children are susceptible to childhood diseases

and disability.

7. Unawareness of parents on benefits of

immunization cause partial immunization.

8. All the vaccinations are not necessary for

98

SL

NO

ITEMS

RESPONSE

Score A U D

children.

9. There are fix and mobile sessions of

vaccination.

10. Mission Indradhanush services are provided

free of cost.

11. Mission Indradhanush covers only the less

immunization coverage area.

12. Mission Indradhanush services cover whole

Karnataka.

13. Services of Mission Indradhanush are available

for only few selected months.

14. Mass media has no role in Mission

Indradhanush.

99

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106

SCORING FOR STRUCTURED KNOWLEDGE QUESTIONNAIRE

Item no. Correct response score

1 d 1

2 c 1

3 d 1

4 b 1

5 a 1

6 b 1

7 c 1

8 d 1

9 a 1

10 b 1

11 c 1

12 b 1

13 a 1

14 c 1

15 d 1

16 b 1

17 d 1

18 b 1

19 a 1

20 d 1

21 d 1

22 a 1

107

SCORING FOR 3 POINT LIKERT SCALE

ITEM

NO

DIRECTION

OF

SCORING

AGREE UNDECIDED DISAGREE

1 + 3 2 1

2 + 3 2 1

3 - 1 2 3

4 - 1 2 3

5 - 1 2 3

6 + 3 2 1

7 + 3 2 1

8 - 1 2 3

9 + 3 2 1

10 + 3 2 1

11 + 3 2 1

12 - 1 2 3

13 + 3 2 1

14 - 1 2 3

Maximum score=42

SCORING

1. Unfavorable attitude:< 50%

2. Neutral attitude :50-75%

3. Favorable attitude:>75%

108

MASTER CHART

Sl.

No

Demographic variables of mothers of under 5 children Pre test Post test

1 2 3 4 5 6 7 8 9 A 9B Knowledge

Total

Attitude

Total

Knowledge

Total

Attitude

Total

1. c A d a a b a a b

11 30 17 38

2. c A c a a b b a b

10 32 15 37

3. c a b e b a a a a b 10 29 14 33

4. c a b b a a c a b

7 30 12 32

5. c a d a b a b b a b 10 30 18 36

6. b a b a a a b b b

10 30 14 34

7. c a d b a b b a a b 9 28 18 37

8. b a a b a c a a a a 4 30 12 34

9. d a d a a a b a a a 10 29 18 37

10. b a e d b b a a a a 14 32 19 37

11. d a b a a a a a b

7 31 13 33

12. b a d a b a a b b

12 35 18 38

13. b a e a c b a a b

12 34 19 39

14. b a e a b b a a b

8 33 18 35

15. a a d a a a a a b

8 28 17 35

16. b a d a b b a a b

8 28 17 35

17. c a e c a a a b b

12 32 20 37

18. b a c a c c a b a d 8 27 16 36

19. b c d a a b b a b

5 30 18 38

109

Sl.

No

Demographic variables of mothers of under 5 children Pre test Post test

1 2 3 4 5 6 7 8 9 A 9B Knowledge

Total

Attitude

Total

Knowledge

Total

Attitude

Total

20. d a d a a a b a a d 12 34 17 34

21. c c b a a b b a b

8 27 13 34

22. c c b a a b c a b

6 26 12 33

23. c c b b b b c a a b 3 29 12 33

24. b a c b a b c b b

7 29 14 36

25. b c b c b b a a b

6 29 13 35

26. c c c c b b b c a a 6 29 15 35

27. c a c c a b c b b

8 29 16 37

28. c a b b a b c b a a 5 29 12 34

29. a b c b b b a c a a 5 31 14 38

30. a b b a a b c c b

5 28 13 36

31. d c d c a b c b a a 7 27 18 39

32. a c d f a b b a a a 12 33 19 39

33. b c c b a c b a a a 7 32 14 37

34. b c b b a b c a b

3 30 12 35

35. b a c a a b b a a a 12 33 17 38

36. b a d b b a b a b

8 28 19 38

37. b a d a b b a a a d 9 32 18 38

38. d a e a c c b b b

14 33 20 40

39. d a e a c b a a a d 9 29 19 40

40. b c a b a b a b a b 7 29 11 37

110

Sl.

No

Demographic variables of mothers of under 5 children Pre test Post test

1 2 3 4 5 6 7 8 9 A 9B Knowledge

Total

Attitude

Total

Knowledge

Total

Attitude

Total

41. c a d a b b b b b

12 35 20 39

42. c a e e a b a a a a 19 32 22 42

43. c a d e a b b a a a 17 32 22 38

44. d a e e a b b a a d 15 34 22 40

45. b a e e b b a a a a 17 28 20 41

46. d a e e c c a a a d 17 36 21 40

47. b a c c b b a a b

9 34 15 38

48. b a b b a a a a b

6 26 13 36

49. c a b b a a c a b

7 24 13 35

50. c a d b a a b a b

7 29 18 42

51. b a d b a b c b b

6 30 18 40

52. a a b c a a a b b

6 32 14 38

53. b a d c b b b a b

5 28 18 38

54. b d d c a b b a b

4 29 18 40

55. b b c b a a b a b

7 29 16 36

56. b c b b a b a a b

3 29 14 36

57. b d c c a b a a b

5 35 17 40

58. b d e c c a b a b

10 31 22 42

59. a a d a a b a b b

7 26 18 38

60. b a d d c b a a b

5 30 17 38

111

112

ANNEXURE I

LETTER SEEKING AND GRANTING PERMISSION FOR COUNDUCTING

RESEARCH STUDY

113

114

ANNEXURE II (a)

EDUCATIONAL PLAN ON MISSION INDRADHANUSH

Name of the researcher : Mrs. Jyotima Borgohain Handique

Name of the topic : Mission Indradhanush

Group : Mothers of under five children

Method of teaching : Lecture and group discussion

Date and time :--/--/2018

Place : Kengeri Upanagar

Duration : 45 minutes -1 hour

Medium of instruction : Kannada

AV aids : Flash cards, pamphlets and leaflets

115

OBJECTIVES

General objective: At the end of the educational package session, the mothers ofunder five children will gain knowledge regarding Mission

Indradhanush.

Specific objectives: At the end of the educational package, the learner will be able to

1. introduce the concept of Mission Indradhanush

2. enumerate the objectives of Mission Indradhanush

3. explain the strategy of Mission Indradhanush

4. describe about the operational planning Mission Indradhanush

5. explain about the life threatening diseases of children

6. describe about Universal immunization schedule

7. discuss the success of Mission Indradhanush

116

Time Specific

O bjectives Content

Researcher activities

Learning activities

A.V Aids

Evaluation

5 min To

introducethe

concept of

Mission

Indradhanush

Introduction and concept of Mission Indradhanush

� Mission Indradhanush was launched by the

Government of India under Ministry of Health and

Family Welfare, on 25th December 2014.

� Immunization forms the major focus of child survival programme throughout the world.

� It depicts the seven colour of rainbow, target seven

killer diseases such as diphtheria, pertusis or

whooping cough, tetanus, poliomyelitis,

tuberculosis, measles and hepatitis B. Also vaccine to guard against Japanese encephalitis and

haemophilus influenza type B are provided in

selected districts.

� The mission focuses on interventions to improve

full immunization coverage in India from 65% in 2014 to at least 90% children in the next five

years. This is done through special catch-up

drives.

� Under Mission Indradhanush, the government has

identified 201 high focus districts across the country that have nearly 50% of all unvaccinated

or partially vaccinated children in the country.

Researcher

introduce the

concept of

Mission

Indradhanush

Learners

listen

attentively

Flash card What is the

concept of

Mission

Indradhanush?

5 min To enumerate

the objectives

of Mission

Objectives of Mission Indradhanush

General objective

Researcher

enumerate the

Learners

listen

Flash card What are the

objectives of

Mission

117

Indradhanush

The objective is to ensure high coverage of children and pregnant women with all available vaccines

throughout the country, with emphasis on the identified

201 high focus districts.

Specific objectives

With the launch of Mission Indradhanush, the

Government aims at

1. Generating high demand for immunization

services by addressing communication challenges.

2. Enhancing political, administrative and financial commitment through advocacy with key

stakeholders;

3. Ensuring that partially immunized and

unimmunized children are fully immunized as per

National Immunization schedule.

objectives of Mission

Indradhanush

carefully Indradhanush?

3 min To explain

strategy of Mission

Indradhanush

Strategy of Mission Indradhanush

The Government has planned to conduct four special vaccination campaigns between January and June 2015.

All vaccines are already available free of cost under

Universal Immunization programme in India. Under this

mission, Government plans to intensify its efforts and thus

increase accessibility of these vaccines to all the children of India.

Researcher

explains the strategy of

Mission

Indradhanush

Learner

listen carefully

Flash

card

Whatis the

strategy of Mission

Indradhanush?

118

9 min To describe

about the operational

planning of

Mission

Indradhanush

Describe about the operational planning of Mission

Indradhanush The following two operational mechanisms will be

utilized to reach out to the unreached or poorly reached

beneficiaries:

a) Fixed and outreach sessions

Sites for vaccination

In urban areas, urban health posts, post-partum

(PP) centers, family welfare centres or local

leader’s premises in urban slums can also be used

immunization sites. For other areas, primary

schools, anganwadi centers, private dispensaries, non-governmental organization (NGO) sites or any

other locations that are easily accessible and

acceptable to community can be used as

immunization sites.

Availability of human resources

In addition to health staff available from the same

or neighboring community health center

(CHC)/Block PHC, NGOs (LIONS, Rotary etc.), it

is necessary to utilize retired health workers, and

staff available from other government agencies such as Employee’s State Insurance Corporation,

Ventral Government Health Scheme, armed forces,

Researcher

describes about the

operational

planning of

Mission

Indradhanus

Learners

listen attentively

Pamphlets What arethe

operational planning of

Mission

Indradhanush?

119

railways, District Urban Development Agency (DUDA)/State Urban Development agency

(SUDA) and community based organizations to

reach large number of children.

Timing:The activity will be conducted from 9 am to 4 pm. However, sessions should be planned

based on availability of the targeted population to

maximize the benefits achieved.

Team: A team will comprise one vaccinator and

up to two mobilizers (at least one should be from local mohallas/locality). An additional vaccinator

will be included in the team if the estimated

injection load is more than 60-70.

b) Mobile sessions

Mobile sessions should be planned at places where routine immunization coverage is weak and the

small number of beneficiaries does not warrant an

independent session. These areas include peri-

urban areas, scattered slums, brick kilns and

construction sites.

10min To explain

about the life

threatening diseases of

children

Explain about the life threatening diseases of children

The seven vaccine preventable diseases are diphtheria,

whooping cough, tetanus, polio, TB, measles and Hepatitis B.

These seven diseases are common in children and they

can be prevented by immunization. Immunizations are

given to young children starting at birth.

Researcher

explain about

the life threatening

diseases of

children

Learner

listen

carefully

Flash card Explain about

the life

threatening diseases of

children.

120

Children who are not immunized at all or not fully immunized they get these diseases, are often very sick and

many of them die. A number of them remain with

permanent damage (handicap) from the disease.

Tuberculosis - It is spread to other through the air. Sign and symptoms are chronic cough and loss of weight; if the

disease is not treated the child becomes very sick and dies.

But children who have been immunized will not get

tuberculosis.

Whooping cough - It causes cough which occurs continuously and ends with a whoop. The child also has

fever and a running nose. At the end of each whoop the

child may vomit. If the disease is not treated early the

child may die, and those who survive many develop

malnutrition. If the child receives 3 doses of vaccination he is protected against whooping cough.

Diphtheria- Children with diphtheria have fever, and a

membrane which covers the throat causing difficulty in

breathing. This membrane may suffocate the child to

death. It is prevented by 3 doses of immunization.

Tetanus- The germ enter the body through cuts or bruises.

They may enter through a thorn prick or umbilical cord of

new born child. Who have tetanus cannot open their

mouth and they are rigid. And often die if they receive

treatment. Immunization against tetanus is given starting from 6 weeks of age, and to pregnant mothers.

121

Measles- This is a common infection in children and can attack many children at once. It spread from one person to

another through the air during coughing, sneezing or

talking.

The child become very sick with fever skin rash, sticky red eyes and coughing. The cough is like the

barking of a dog. Some develop dehydration due to

diarrhea and vomiting. Some recover but many dies.

There is no medicine to cure measles and it can be

prevented by immunization.

Polio -It is a dangerous disease that causes paralysis of the

body. The germ is passed in faces and many spread from

one person to another by mean of unwashed hands, flues,

contaminated food. If the child does not die from polio, he

remains with permanent paralysis. There is no treatment for polio.

Hepatitis B- It is the inflammation of liver due to the

Hepatitis B virus. People with chronic hepatitis may have

no symptom, but gradual liver damage may be occurring.

They may have symptom of acute hepatitis like loss of appetite, fatigue, low grade fever, muscle & joint ache,

nausea & vomiting, yellow skin &dark urine due to

jaundice

122

5 min To describe about

Universal

immunization

schedule

Describe about Universal immunization schedule

Researcher Describe

about

Universal

immunization schedule

Learner listen

carefully

Leaflet Describe about

Universal

immunization

schedule

123

4 min To discuss the success of

Mission

Discuss the success of Mission Indradhanush

Government of India partnering with WHO, UNICEF and

other partners to leverage the knowledge and

Researcher discuss the

success of

Mission

Learner listen

carefully

Flash card Discuss about the success of

Mission

124

Indradhanush infrastructure built during the polio campaign to step this mission around 2000 doctors and field monitors who were

working with the WHO on the Polio eradication

programme are now part of this nationwide initiative of

vaccinate all unvaccinated and partially vaccinated children.

Under the mission, the Government has indentified 201

high focus districts across the country. These districts

have been identified based on a composite indicator,

considering full immunization coverage, number of partially vaccinated. And unvaccinated children and

whether the district is an identified High Priority Districts

(HPD). Nearly 50% of all unvaccinated or partially

vaccinated children in India are in these 201 districts.

A total in the first phase 9, 66495 sessions were held and around 7.6 million children were immunized .The second

phase 352 districts were selected including 279 mid

priority districts.

But this increase would not be sufficient to achieve

Full Immunization Coverage in selected districts/cities that have been shown slow progress in spite of repeated

phages of Mission Indradhanush, so Government has

modified the mission to Intensified Mission Indradhanush

for low coverage areas.

Seeing its wider coverage mission Indradhanush has been a success till now in order to improve the immunization

coverage particularly in the underprivileged and

Indradhanush Indradhanush

125

underserved communities and reduce childhood mortality due to vaccine preventable disease.

4 min To summarize

and conclude

the topic

Summary and Conclusion

Mission Indradhanush depicting 7 colours of rainbow

provides vaccination to 7 vaccine preventable disease

which includes diphtheria, whooping cough, tetanus,

polio, TB, measles, hepatitis-B. The new vaccines

rotavirus, measles rubella, inactivated polio vaccine, Japanese encephalitis for adults are also included.

With these now 11 vaccines have been covered under this

programme. In one year time 1.62 crores children have

been additionally brought under ambit of immunization an

about 45 lacks have been totally immunized additionally. Mission Indradhanush aims at covering all children by

2020 who are either unvaccinated or are partially

vaccinated against these vaccine preventable diseases.

Researcher summarize

the topic.

Learner listen

carefully

126

Bibliography

1. Mission Indradhanush. Operational Guidelines. Available from http://www.tripuranrhn.gov.in/guidelines/0701201701.pdf

2. Mission Indradhanush phase 1: Final coverage report. Accessed fromhttp://www.missionindradhanush.in/about

3. Md Abu Bashar, Success story of Mission Indradhanush: A road to achieve universal immunization, National Journal of Community

medicine, May 2016; Issue - 5 Volume - 7,

4. Mission Indradhanush Immunization Program, Accessed from http://www.civilsdaily.com/story/mission-indradhanush-immunization-program/

5. Akhilesh Kumar Singh, Research scholar, Department of Economics, Lucknow University, Lucknow, Mission Indradhanush: The Art of

Health and Healing, Indian Streams Research Journal, April 2016; Issue – 3 volume – 6

6. Mission Indradhanush to get a new name as four new vaccines have been added into it accessed from http://www.newsbharati.com/Encyc/2016/5/31/Mission-/indradhanush-programme-vaccination

7. CHAPTER 8. The Six Immunisable Diseases accessed from http://www.nzdl.org/gsdlmod?e=d-00000-00---off-0cdl--00-0----0-10-0---0-

--0direct-10---4-------0-1l--11-en-50---20-about---00-0-1-00-0--4----0-0-11-10-0utfZz-8-

00&cl=CL1.68&d=HASH01221928a8ae1bc2f8253cba.13&gt=1

127

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145

ANNEXURE III

CRITERIA RATING SCALE FOR VALIDATION OF THE TOOL

EVALUTION CRITERIA CHECKLIST

Dear Sir/ Madam

Kindly go through the evaluation criteria checklist for the validation of tool.

There are two columns given for your responses and a column for remarks. Kindly

place a tick in the appropriate column your remarks.

SL.NO CONTENT YES NO REMARKS

1. Demographic variables:

All characteristics necessary for the study are

included.

2.

Structured interview

schedule :

• Language is

simple and easy to follow.

• Covers adequate

content.

• All items necessary to

achieve the

objective of the

study are included.

3. Likert scale:

All the items necessary to

achieve the objective of the

study are included.

146

Dear Sir/Madam,

Kindly go through the content and place right mark against the questionnaire in the

following columns ranging from relevant to not relevant, when found to be needs modification, kindly give your opinion in the remark column.

Section A

Demographic variables

Sl .No Items Relevant Needs

modification Not relevant Remarks

1.

2.

3.

4.

5.

6.

7.

8.

9. A

9. B

147

SECTION B

STRUCTURED INTERVIEW QUESTIONNAIRE

Sl.No Items Relevant Needs

modification Not relevant Remarks

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

Maximum score = 22

148

SECTION C

3 POINT LIKERT SCALE TO ASSESS THE ATTITUDE REGARDING

MISSION INDRADHANUSH

Sl .No Items Relevant Needs

modification Not relevant Remarks

1.

2.

3.

4.

5.

6.

7.

8.

10.

11.

12.

13.

14.

Suggestion if any:

1.

2.

Date: Signature and seal of the expert

Place: Name and designation

149

ANNEXURE IV

LETTER SEEKING EXPERT’S OPINION AND SUGGESTIONS FOR

CONTENT VALIDITY OF TOOL

From,

Mrs. Jyotima Borgohain Handique

II Year M.Sc. nursing Student.

Padmashree Institute of Nursing

To,

Forwarded Through

Principal

Padmashree Institute of Nursing

Sub: Seeking permission for content validation of the research tool

Respected Sir/Madam,

I, Mrs. Jyotima Borgohain Handique, IInd

year M.Sc. Nursing (community

health nursing) student of Padmashree institute of nursing, request your good self, if

you would kindly accept to validate my research tool on “A study to assess the

effectiveness of educational package on level of knowledge and attitude

regarding Mission Indradhanush among mothers of under five children in

selected urban slum area, Bengaluru” I would be obliged if you would kindly

affirm your acceptance to the undersigned with your valuable suggestion on the topic.

I have attached the details of my study along with the research tool.

Thanking you in anticipation

Yours sincerely,

Mrs. Jyotima Borgohain Handique

Enclosures:

Problem statement and objectives of the study

Structured interview questionnaire andAttitude scale.

Validity certificate

150

ANNEXURE V

LIST OF EXPERTS

1. Dr. B.T Basavanthappa

Principal, Raja Rajeshwari College of Nursing

Bengaluru.

2. Dr. Lukima Saikia

Lecturer,Community Health Nursing

Regional College of Nursing,

Guwahati,Assam.

3. Dr. Lakshmi A.

Principal, HOD,Community Health Nursing

Sarvodaya College of Nursing, Bangalore.

4. Kathyayini N.B.

Associate Professor, Community Health Nursing

Kempegowda College of Nursing, Bangalore.

5. Prof. Prasanna Kuar

HOD, Department of Community Health Nursing

Government College of Nursing

Bangalore.

6. Dr. G. Nagarathana

Professor, Department of Community Health Nursing

Government College of Nursing

Bangalore.

7. Dr. Himashree Bhattacharya

AssistantProfessor, Department of Community Medicine

NEIGRIHMS,Shillong, Meghalaya.

8. Prof . R. Chinnadurai

M.sc,M.Phil.PGDCA

Biostatitician, Padmashree Group Of Institution

Bangalore.

151

ANNEXURE VI

CERTIFICATE OF CONTENT VALIDITY

I hereby certify that I have validated the tool of Mrs. Jyotima Borgohain

Handique, M.Sc. Nursing Student who is undertaking, “A study to assess the

effectiveness of educational package on level of knowledge and attitude

regarding Mission Indradhanush among mothers of under five children in

selected urban slum area, Bengaluru.”

Place: Signature and seal of expert

Date: Name and Designation

152

153

154

155

156

157

158

159

160

ANNEXURE VII (a)

CERTIFICATE OF ENGLISH EDITING

161

ANNEXURE VII (b)

CERTIFICATE OF KANNADA EDITING

162

ANNEXURE VIII

EDUCATIONAL PACKAGE

ON

MISSION INDRADHANSH

163

FLASH CARDS (ENGLISH)

MISSION INDRADHANUSH

INTRODUCTION

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

164

GOALS AND OBJECTIVES

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

STRATEGY

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

165

LIFE THREATENING DISEASES OF CHILDREN

BCG VACCINE WHOOPING COUGH

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

BCG VACCINE WHOOPING COUGH

DIPHTHERIA MEASLES

TETANUS

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

166

POLIOMYELITIS HEPATITIS-B

HEPATITIS-B

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

167

SUCCESS OF MISSION INDRADHANUSH

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

SUMMARY AND CONCLUSION

PADMASHREE INSTITUTE OF NURSING, BANGALORE-60

168

FLASH CARDS (KANNADA)

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173

OPERATIONS L PLANNING OF

MISS ION INDRADHANUSH

Prepared by:

Jyotima Borgohain Handique

2nd year M.Sc. Nursing

Community Health Nursing

PION

PAMPHLET (ENGLIS H)

174

OPERATIONAL PLANNING O F MISSION

INDRADHANUSH:

The two operat ional mechanisms are ut ilized

to reach out to the unreached or poorly reached

beneficiaries:

a) Fixed and outreach sessions

b) Mobile sessions

a) Fixed and outreach sessions

SITES FOR VACCINAT ION

In urban areas,

• Urban health posts

• Post-partum centers

• Family welfare centers

• Local leader’s premises in urban slums

Other areas,

• Primary schools

• Anganwadi centers

• Private dispensaries

• Non- Government organizat ion

• Any other locat ion that are easily

accessible and acceptable to the

community

AVAILABILIT Y OF HUMAN RESOURCES

• All the health staff from the same or

neighboring community health centre/

• Block PHC,

• NGOs (LIONS, Rotary etc)

• Retired health workers

• Staff available from other Government

• Agencies such as

� Employee’s State Insurance

Corporat ion,

� Central Government Health

Scheme,

� Armed forces

� Railways

� District Urban Development

Agency (DUDA)/

� State Urban Development

Agency (SUDA)

� Community based organizat ions

TIMING:

The activit ies are conducted from 9am to

4pm. However, sessions are planned based on

availability of the targeted populat ion to

maximize the benefits achieved.

TEAM:

A team comprises one vaccinator and up to

two mobilizers (at least one should be from local

mohallas/locality). An additional vaccinator is

included in the team if the est imated injection

load is more than 60-70.

b) Mobile sessions

Mobile sessions are planned at places where

routine immunizat ion coverage is weak and the

small number of beneficiaries does not warrant

an independent session. These areas include

• Peri –urban areas

• Scattered slums

• Brick kilns and

• Construct ion sites.

175

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• CAUÀ£ÀªÁr PÉÃAzÀæUÀ¼ÀÄ,

• SÁ ÀV D¸ÀàvÉæUÀ¼ÀÄ,

• ¸ÀPÁðgÉÃvÀgÀ ÀA¸ÉÜUÀ¼À (NGO)

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EvÁÛ¢)® sÀ å«gÀĪÀ DgÉÆÃUÀå ¹§âA¢AiÀÄ eÉÆvÉUÉ

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• PÉÃAzÀæ ¸ÀPÁðgÀzÀ DgÉÆÃUÀå AiÉÆÃd£É,

• ¸Éå£Àå ¥ÀqÉ, • gÉà ÉéÃ

• f¯Áè £ÀUÀgÀ C©üªÀÈ¢Ý Keɤì (DUDA)/

• gÁdå £ÀUÀgÀ C©üªÀÈ¢Ý Keɤì (SUDA)

• ¸ÀªÀÄÄzÁAiÀÄ DzsÁjvÀ ¸ÀA ÉÜ

• ÀªÀÄAiÀÄ:F ZÀlĪÀnPÉAiÀÄ ¨É½îUÉ 9 UÀAmÉ ¬ÄAzÀ

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• ÀAZÁj C¢üªÉñÀ£ÀUÀ¼À£ÀÄß AiÉÆÃd¸À ÁUÀÄvÀÛzÉ.

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• ZÀzÀÄjzÀ PÉƼÀZÉ¥ÀæzÉñÀUÀ¼À°è EnÖU É §nÖUÀ¼ÀÄ

• ªÀÄvÀÄÛ PÀlÖqÀ ¤ªÀiÁðt vÁtUÀ¼ÀÄ M¼ÀUÉÆüÀîvÀÛªÉ

177

LEAFLET (ENGLIS H)

NATIONAL I MMUNI ZATION SEHEDULE

Prepared by:

Jyotima Borgohain Handique

2nd

year M.Sc. Nursing

Community Health Nursing

PION

178

NATIONAL IMMUNI ZATION SEHEDULE

179

LEAFLET (KANNADA)

c

180