THE KNOWLEDGE, ATTITUDES AND PRACTICES OF MOTHERS ON

IMMUNIZATION AT RUKUNYU HEALTH IV

KAMWENGE DISTRICT

BY

BINA SUNDAY ALEX

REG. NO. BMS/0010/142/DU

A RESEARCH SUBMITTED TO THE FACULTY OF CLINICAL MEDICINE AND

DENTISTRY IN PARTIAL FULFILMNET OF THE REQUIREMENTS FOR THE

AWARD OF A DEGREED OF BACHELOR OF MEDICINE AND BACHELOR

OF SURGERY (MBChB) OF KAMPALA INTERNATIONAL

UNIVERSITY

APIRL, 2019

i

DECLARATION

I, BINA SUNDAY ALEX, declare that this is my own work and has not been presented to any

other university for any award. The whole work is original, all references have been acknowledged.

NAME …………………………………………………..

TITLE ……………………………………………………..

SIGNATURE………………………………………………..

DATE……………………………………………………………..

ii

SUPERVISORS’APPROVAL.

This research has been compiled under supervision and is submitted to the faculty of clinical

medicine and dentistry of Kampala international university with approval by my supervisor.

Signed: ……………………………………………..

DR KEGERE MICHEAL (Supervisor)

Date………………………………………….

iii

ACKNOWLEDGEMENT

I give glory back to the almighty father, the God of heaven and earth for his faithfulness,

provision, favor and unfailing love to enable me complete this work that he started in me and the

study was successful due to a number of people whom I owe gratitude. Special thanks go to Dr

Kengere Micheal who kept on guiding me from the beginning of this research work up to its

completion

In a special way, I acknowledge my classmates and friends Sembeguya Simon, Mula Bushil,

Bombokka Ivan Mpanga at Kampala International university western campus. I cannot forget to

acknowledge one world health for the support given to me, whose efforts, assistance and guidance

contributed greatly to the successful completion of my studies.

All in all special acknowledgement goes to my mum Namuddu Janeffer, dad Apuuli charles and

my wife Kobugabe Annah for their support they gave me during my stay at school.

. I acknowledge the various lecturers of Kampala International University Western Campus who

endeavored to share with me so as to become what I am today

iv

ABREVIATIONS USED

EPI Expanded Program on immunization

DPT Diptheria, Pertussis, Tetanus

Hep B Hepatitis B

Hib Haemophilus influenza B

OPV Oral Polio Vaccine

BCG Bacillus Calmete Guerin

WHO World Health Organisation

PFNP Private For Non Profit

KAP Knowledge, Attitude and Practice

U.N.E.P.I Uganda National Expanded Programme on Immunisation

C.O.R.Ps Community’s Own Resource Persons

MoH Ministry of Health

HC-IV Health Centre IV

UNICEF United Nations International Children’s Emergency Fund

DPT3 Diphtheria-tetanus-pertussis 3

WHO World Health Organization

GIVS Global Immunization Vision and Strategy

CDC Centre for Disease Control

TFI Task Force on Immunization in Africa

UNEPI Uganda National Expanded Program for Immunization

HC Health Centre

v

OPERATIONAL DEFINATION

Immunization: Immunization is the process whereby a person is made immune or

Resistant to an infectious disease, typically by the administration of a

Vaccine.

Not immunised Child who didn’t receive vaccine against the 8 preventable diseases.

Defaulter Discontinued before finishing.

Fully immunised Child who received 1 dose of BCG, Measles and 3 doses of DPT HepB Hib

and Polio vaccine.

Missed opportunity When child age is eligible for immunisation and actually misses to receive

the vaccine.

Knowledge Knowing about things all that are known, the body of information.

Attitude Way of thinking or behaving on immuniztion .

Practice Action as opposed to theory.

Mothers: Mothers of under five children attending the immunization clinics

of selected hospitals

vi

TABLE OF CONTENTS

DECLARATION ........................................................................................................................................... i

SUPERVISORS’APPROVAL. .................................................................................................................... ii

ABREVIATIONS USED ............................................................................................................................. iv

OPERATIONAL DEFINATION ................................................................................................................. v

TABLE OF CONTENTS ............................................................................................................................. vi

CHAPTER ONE ........................................................................................................................................... 1

1.1 BACKGROUND ................................................................................................................................ 1

1.2 PROBLEM STATEMENT ................................................................................................................ 3

1.3 OBJECTIVES OF THE STUDY ........................................................................................................ 4

1.3.1 BROAD OBJECTIVE ................................................................................................................. 4

1.3.2 SPECIFIC OBJECTIVES ............................................................................................................ 4

1.4. RESEARCH QUESTION ................................................................................................................. 4

1.5 JUSTIFICATION OF THE STUDY .................................................................................................. 4

1.6 STUDY SCOPE .................................................................................................................................. 4

1.6.1 GEOGRAPHICAL SCOPE ......................................................................................................... 4

1.6.2.CONTENT SCOPE ..................................................................................................................... 5

1.6.3.TIME SCOPE .............................................................................................................................. 5

1.7 CONEPTUAL FRAMEWORK .......................................................................................................... 5

CHAPTER TWO .......................................................................................................................................... 7

LITERATURE REVIEW ............................................................................................................................. 7

2.0 INTRODUCTION .................................................................................................................................. 7

2.1 KNOWLEDGE ABOUT IMMUNISATION ..................................................................................... 7

2.2 ATTITUDES TOWARDS IMMUNISATION ................................................................................... 8

2.3 PRACTICES ON IMMUNISATION ................................................................................................. 8

CHAPTER THREE .................................................................................................................................... 10

vii

METHODOLOGY ..................................................................................................................................... 10

3.0 INTRODUCTION ................................................................................................................................ 10

3.1 THE STUDY DESIGN ..................................................................................................................... 10

3.2 STUDY POPULATION .................................................................................................................. 10

3.2.1 INCLUSION ............................................................................................................................. 10

3.2.2 EXCLUSION ............................................................................................................................ 10

3.3 SAMPLE SIZE DETERMINATION ............................................................................................... 10

3.4 SAMPLING TECHNIQUE .............................................................................................................. 11

3.5 DATA COLLECTION METHOD ................................................................................................... 11

3.8 QUALITY CONTROL ..................................................................................................................... 11

3.9 DATA ANALYSIS ........................................................................................................................... 11

3.10 ETHICAL CONSIDERATION ...................................................................................................... 12

3.11 RESULT DISSEMINATION ......................................................................................................... 12

CHAPTER FOUR ....................................................................................................................................... 13

4.0 INTRODUCTION ............................................................................................................................ 13

4.1 SOCIAL DEMOGRAPHIC DATA .................................................................................................. 13

4.2 KNOWLEDGE ABOUT IMMUNISATION ................................................................................... 15

4.3 ATTITUDE TOWARDS IMMUNISATION ................................................................................... 18

CHAPTER FIVE ........................................................................................................................................ 22

5.1 DISCUSSION ................................................................................................................................... 22

5.1.1 INTRODUCTION ........................................................................................................................ 22

5.1.2 KNOWLEDGE ABOUT IMMUNISATION ............................................................................... 22

5.1.3 ATTITUDES TOWARDS IMMUNISATION .............................................................................. 23

5.1.4 PRACTICES ON IMMUNISATION ............................................................................................ 24

5.2.0 CONCLUSION .............................................................................................................................. 24

5.2.1 RECOMMENDATIONS ............................................................................................................... 25

viii

REFFERNCE .............................................................................................................................................. 26

APPENDICES ............................................................................................................................................ 28

APPENDIX I: QUESTIONNAIRE ............................................................................................................ 28

APPENDIX II: CONSENT FORM ............................................................................................................ 32

APPENDIX III: CONSENT FORM ........................................................................................................... 33

APPEDEX IV: MAP OF UGANDA SHOWING THE STUDY DISTRICT ........................................... 34

APPENDIX V: INTRODUCTORY LETTER ........................................................................................... 35

APPENDIX VI: CHILD HEALTH CARD ................................................................................................ 36

ix

ABSTRACT

According to UDHS (2011), a considerable proportion of childhood morbidity and mortality

caused by vaccine preventable diseases. According to MOH 2011, overall, latest coverage data

shows that routine immunization coverage remains at only 52 percent of children age 12-23

months being fully vaccinated.

It was a cross sectional discriptive study of mothers who were randomly selected from mothers

who had brought their children for immunisation during the month of febuary form Monday to

Friday.Multistage sampling technique was used in which respondents were first grouped into 5

strata according to ages of their children. Each stratum was then selected and the sum total

obtained, from this, simple random sampling was employed whereby the researcher took an

appropriate number of pieces of paper and mark them “1” or “2” and ask the participants to pick

them at random. The ones that pick “2” participated in the study 383 questionnaires were

administered by the researcher and his assistants to collect the data.Compilation, interpretation and

anlysis was done and appropriate conclusions were drawn with relevant recommendations.

Results revealed that more half mothers( 86.2%) would atleast identify of the immunisable

diseases though few(4.0%) would still identify all the eight immunisable diseases by name.More

than half of the mothers (63.4%) believed that immunisation is very useful whereas only (30.7%)

said that it is useful. Among the respondents, (96.6%) of them had immunisation cards whereas

(3.4%) had no card.

The researcher noted in conclusion that, mothers’ knowledge about immunisation is low however,

they have a positive attitude towards immunisation and they hard good practices on immunisation

.

The researcher recommended the following;that Rukunyu healthcentre should institute

programmes aimed at increasing mothers’ awareness towards immunisation through media,

mothers be encouraged to completethe immunisation schedule as per the WHO standards, mothers’

beliefs towards immunisation should be discouraged through massive sensitization.

1

CHAPTER ONE

1.0 INTRODUCTION

The World Health Organization (WHO) defined immunization as the process whereby a person is

made immune or resistant to an infectious disease, typically by the administration of a vaccine.

These vaccines help to stimulate the body’s own immune system to protect the person against

subsequent infection or disease (WHO, 2013). Immunization therefore depicts the ability to

develop immunity. Immunity being the state of having sufficient biological defenses to avoid

infection, disease, or other unwanted biological invasion (Gherardi, 1989). Immunity also depicts

the capability of the body to resist harmful microbes from gaining access into it.

1.1 Background

In response to challenges in global immunization, WHO and the UNICEF set up the Global

Immunization Vision and Strategy (GIVS) in 2003 (GIVS, 2005). The chief goal of GIVS is

primarily to reduce illness and death due to vaccine-preventable diseases by at least two-thirds by

2015 or earlier. The Task Force on Immunization in Africa (TFI) recognized from the outset the

need for high vaccination coverage to counter the disproportionate burden from vaccine-

preventable diseases in the African Region, and therefore set challenging goals for 2001–2005.

These goals aimed to ensure that the immunization performance of the African Region caught up

with other regions‟ performance.

During the last few decades, the burden of the infectious diseases has been reduced through

immunization. Also, immunization has shown major aspects of disease, disability and death

prevention. The most common vaccine preventable diseases are Rubella, measles, diphtheria,

Tetanus, pertussis and Polio (Yousif M, Albarraq 2013). Giving the child the appropriate vaccine

would significantly decrease the costs of disease treatment and rates of disease thus enhance a

good quality of life for children (Siddiqi N 2010).

Also, in a global report issued by the CDC, it was stated that the general attitude of parents was

negative among most of the mothers towards childhood vaccination programs (CDC (2009).

however, according (Falade BA(2014)some parents thought that polio immunization will decrease

the fertility rate thus the parents attitude played an important role in vaccination process as they

are the decision makers for their children and other several factors such as Low socioeconomic

status, sometimes resulting in counteractive practical circumstances such as lack of transport, may

play a role in preventing the completion of the full set of immunizations. In addition, acceptance

2

of any program is highly dependent on parental attitudes towards immunization. A fear of adverse

effects has a negative impact on paternal attitude. For example, in response to a hypothesized link

to Autism, coverage of the Measles-Mumps-Rubella (MMR) immunization in some areas of

Scotland (Friederichs V 2006) decreased significantly, reaching dangerous levels below 80%.

Siddiqi et al., (2010)in his study he concluded that in peri–urban areas of Karachi mothers‟

knowledge about Expanded Program on immunization (EPI) vaccination was quite low and not

associated with their children’s EPI coverage. Mothers‟ educational status, however, was

significantly associated with child’s coverage. This finding showed a better health seeking

behavior in a more educated mother. Angelilioet al., (1999), They also stated that since many

factors may influence vaccination coverage, important differences should be taken into account,

such as prevalence of vaccine-preventable diseases, availability of vaccination centers, level of

knowledge and information about vaccination, and different methods used to measure

immunization status. The global Immunisation coverage has increased during the past decade to

levels of around 78 percent for Diphtheria-Tetanus and Pertusis (DTP). WHO’s African Region

has consistently been falling behind, reaching only 69 percent of DTP coverage by 2004 (Mendy

et al. 2013; Lee 2006).

World Health Organization (WHO) guidelines state that a child is considered fully immunized

when he or she has received vaccines against tuberculosis (BCG), three doses of diphtheria,

pertussis and tetanus (DPT) and polio vaccines by the age of 12 months. By 2011, the coverage of

full immunization was 51.6%, meaning that close to half of children in Uganda had not received

full immunization. This rate is far below the national target of 80% coverage of all vaccines.

When the Expanded Programme on Immunization (EPI) was launched in 1974, less than 5% of

the world’s children were immunized during their first year of life against six killer diseases; Polio,

Diphtheria, Tuberculosis, Pertussis (Whooping Cough), Measles and Tetanus.(4) From 1984

onward, the EPI has been implemented in ganda as an integral and essential element of primary

health care, was launched in Uganda as U.N.E.P.I.The Uganda National Expanded Program for

Immunization (UNEPI 2010-2014) has raised immunization coverage rates from 36.7% in 2000

to the 2011 status of 51.6% (UNEPI, Promotion of routine immunization report),and the

programme was started with the following objectives.

To reduce the high infant morbidity and mortality rate in the country resulting from the 8

immunisable diseases.

3

The most common vaccine preventable diseases are Rubella, measles, diphtheria, Tetanus,

pertussis, Polio, BCG, rotavirus, to increase the immunisation coverage, to improve and maintain

the cold chain and to create greater community awareness, mobilisation and participation in

immunisation activities.

The programme has laid a strategy for immunisation services mainly through intergration of health

services, fixed health units such as hospitals and health centres, outreach using staff of fixed static

units, mass mobilisation of communities through C.O.R.Ps.

1.2 Problem Statement

WHO (2013 ) stated that although global vaccination coverage is holding steady but an estimated

22 million infants worldwide are still missing out on basic vaccines. The report on global

vaccination coverage showed that the proportion of the world’s children who receive

recommended vaccines has remained steady for the past few years giving an instance that the

percentage of infants fully vaccinated against diphtheria-tetanus-pertussis (DTP3) was 83% in

2011, 84% in 2010 and 83% in 2009.

The latest coverage data in Uganda indicates that routine immunization coverage remains sub-

optimal, with only 52 percent of children age 12-23 months being fully vaccinated. Whereas

almost all (94 percent) receive the BCG vaccine, only 72 percent receive DPT 1-3 vaccinations,

63 percent receive polio 1-3, and 76 percent receive the measles vaccine. Four percent of children

age 12-23 months has not received any vaccinations (UDHS 2011). The disparity between the high

coverage of first vaccines (DPT1 and polio vaccine: 93 percent) and low coverage of follow on

vaccines (DPT3: 63%) reflects a high dropout rate (30%); which remains a challenge to

strengthening routine immunization services in Uganda (UDHS 2011).This rate is below the

national target of 80% coverage of all vaccines. In the last five years, coverage declined for some

of the major vaccines. In 2012, DTP3 coverage rate was estimated at 78%, meaning 22% of

children had not received the third dose of DPT3, (status of Ugandan child 2015).

(KRC 2012) in Kamwenge district Measles vaccination 81% and DPT3 coverage was 75%, thus

falling below the HSSIP target of 85%. A similar trend is noticeable for the DTP1 vaccine. The

data shows that children residing in urban areas are more likely to complete immunization

compared to their rural counterparts. Similarly, children whose mothers have secondary education

or higher are more likely to complete their immunization compared to those whose mothers have

only primary education or no education at all. There are major differences in completion of

4

immunization by gender. The major challenges with regard to immunization outreach services

have been the declining funding for operational costs, logistical challenges, irregularities of

outreaches, and lack of supportive supervision (MoH, 2010).And in 2015 measles out break

occured in kamwenge ditrict. information about knowledge, attitude and practice is lacking in

Uganda and in kamwenge district.Thus there is an urgent need to find ways to increase

immunisation coverage and particulary to encourage parents to have their children immunised.

1.3 Objectives of the Study

1.3.1 Broad Objective

To assess knowledge, attitude and practice of mothers on immunisation at Rukunyu centre IV,

Kamwenge district.

1.3.2 Specific objectives

1. To determine the knowledge of mothers towards immunisation.

2. To describe the attitude of mothers towards immunisation.

3. To assess the practice of mothers to immunise their children.

1.4. Research Question

1. What is the knowledge of mothers towards immunsation?

2. What is the attutide of mothers towards immunisation?

3. What is the practices of mothers towards immunisation?

1.5 Justification of the Study

The study about the knowledge, attitude and practice of mothers on immunisation will help the

health facility management to identify the gaps in immunisation service delivery and thus improve

the immunisation coverage through education of the beneficiary communities in Kamwenge

district. It will also be a basis of further studies to those who wish in future to carry out similar

studies for comparison. The study serves as a requirement for the partial fulfillment for the award

of a bahelor degree in Medicine and surgery.

1.6 Study Scope

1.6.1 Geographical Scope

The research study was carried out in Rukunya Health centre IV. It is found about 4km kilometres

along fort portal kamwenge road.Kamwenge District is located in Western Uganda and can be

accessed from Kampala, the Capital City of Uganda, either through Mbarara Town Via Ibanda or

Mubende - Fort Portal road via Fort Portal. This is a distance of over 400km. It borders Kasese in

5

the west, Ibanda in the south-Southeast and Bushenyi in south, Kabarole in Northwest and

Kyenjojo in the North and Northeast

1.6.2.Content Scope

The research was studying the knowledge , and practices of the mothers on immunisations , how

their knowledge affects the uptake of vaccines, as the outcome variable and their atttitude as the

predictor variable by taking into consideration other factors. Other factors which are going to be

considered are; demographic, social, health services and clinical factors however the study will

focus on KAP.

1.6.3.Time Scope

The study will commence from Feb 2019- april2019.

1.7 Conceptual Framework

Government policies on health, , healthcare system and infrastructure plus community engagement

are the modifiable variables that will affect vaccine uptake. They influence individual attributes

such as knowledge and practise. Healthcare provision factors and characteristics will also influence

uptake.The extraneous factors like demographic characteristics and provision of healthcare cover

may not only affect the individual variables but also influence vaccine uptake.

6

1. Immunization

2. Vaccine availability

1. Knowledge

2. Attitude

3. Practice of Immunization

Outbreaks of

Immunizable

diseases

Conceptual Framework

Dependent variable Independent variables

Designed by bina Sunday alex (2019)

7

CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

EPI is essential for improving infant and child survival although coverage is improved by

increasing KAP of the population.During the past decade MoH (1998), immunisation coverage in

Uganda has been as low as 30% in some districts. Poor mobilisation and insufficient community

participation hinder immunisation coverage. The MOH is in partnership with Religious Leadership

to reduce maternal and child mortality in the country. It is in this context that UNEPI in

collaboration with UNICEF, GAVIand other partners organized a National Religious Leaders

Orientation Meeting to unite over 600 religious leaders from across the country and sensitize them

on their role in promoting maternal and child health interventions

2.1 Knowledge about Immunisation

According to the CDC 2010 report, the global parental Attitude and Knowledge regarding

immunization services was low and parents have negative beliefs about measles and vaccination

programs. Hence, Parental attitudes and beliefs about vaccines are an important factor in predicting

child’s immunization status

Nighat Nisar et at(2010)in karacha pakastan his studed on mothers’knowledge about

immunisation, the knowledge of mothers towards immunisation was low and was influenced by

the mothers’ education, age, country’s economy, household size and ethnicity.Koehler et at (2001)

in Bangladesh that was majored before and after an educational programme shows that an increase

in knowledge ranges from 13-37% regarding signs and symptoms in all EPI target diseases also

noted an increase of 27 to 375 mothers’ knowledge about the vaccine. Only 1-2% of respondents

had knowledge about EPI vaccination schedule before educational interval. Before, 77% of the

parents agreed that child immunisation is necesssary but after, 100% agreed.

Dube et al 2011 states that the knowledge of mothers towards immunisation of their children

differs from individual to individual. From a total of 210 mothers who were identified and

interviewed, the number and proportion of mothers who could correctly identify the EPI diseases

are, Tuberculosis 57(27.1%), Diptheria 53(25.2%), Pertussis 71(33.8%), Tetanus 70(33.3%),

Measles 85(40.5%), Polio 91(43.3%), Hepatitis 94(44.8%).Knowledge deficit was displayed with

regard to antigen and immunization schedule. Mothers displayed limited understanding on the

8

antigen their children were supposed to receive during the next schedule. Ravhengani et al. (2010)

supported that few mothers knew the immunization schedule,

.A KAP survey in Uganda, UNEPI(2010), found that health workers were deficient in their

understanding of immunisation and that community participation in immunisation was very low,

despite willingness of communities to fully support programmes. measles out happened in

kamwenge district and 16(73%) had measles but all did not have knowledge on transmision of the

disease(Nsubuga el al (2015)

2.2 Attitudes towards Immunisation

in a global report issued by the CDC, it was stated that the general attitude of parents was negative

among most of them toward childhood vaccination programs (.CDC (2009): While immunisation

in the U.S.A has been a success, a cross sectional study by Orenstein WA et al established that

the attitude of mothers were found to have significant association with their educational and social

status. 45.6% of the mothers said immunisation was very useful, 54.1% of them said it was useful

and 0.3% said not useful. Nighat Nisar (Karacha, Pakistan, 20010)further states that the attitudes

of mothers are negative and are also influenced by their education, age, country’s economy,

household size and ethnicity. Also a study in Ghana by WHO, 2014

established that media campaign influences mothers’ attitude towards immunisation. Kalemba

(2011) in ugandastated that the media campaign has a lot to change the attitude of mothers towards

immunisation. This therefore implies that the immunisation coverage is greatly influenced by

media.

2.3 Practices on Immunisation

In Africa, WHO (2002), a 30 cluster immunisation survey was undertaken on KAP among mothers

and results showed that 90% of the population begins immunisation but 30% drop out.Bhola

Arthur et al (1997)carried out a community study in Jinma town, southwest Ethiopia to determine

reasons for defaulting from EPI using a structured questionaire, a total of 376 children aged 12-23

months and their mothers were covered. 46.5% were fully immunised, 53.5% were defaulters.

Reasons for defaulters were; inconvenience of vaccination time, child sickness and lack of

information about the need for repeated vaccine on missed appointments (48.8%) and no enough

time (25.9%) and child was sick 23.4%, maternal age, neonatal care, parity, education knowledge

9

about vaccine preventable diseases and immunisation among others were also highlighted. Stokey,

2010 found out that when immunisation coverage for individual vaccines was evaluated,

significantly lower levels of varicella coverage were observed among rural children 47.2%

compared to 58.9% urban and 60.1% sub-urban children. Bhola Arthur et al (2008)states that

there is higher acceptance of immunisation by mothers who have been educated to above grade 6

and higher education status.

He further states that the level of completing immunisation schedules has a close relationship with

occupation where government employees were first to fully immunise their children compared to

those not employed. Government employees might have had knowledge about immunisation

during their past education and daily activities, housemaids might have lack of education and

economy (illiteracy, lack of knowledge about EPI of target diseases). Currently, a greatly

consideration has been given for immunisation, the results have been under expected. The aim of

the study is to assess the obstacles in relation to the mother KAP to child immunisation.

10

CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter bears a brief explanation by the researcher of the research process from the research

area, study design, sample selection and size, research instruments, a pre-test, ethics in study , data

collection, problems expected and their solutions. It also includes the techniques that will be

employed in processing, analysing and interpreting the data into a research report with conclusions

and recommendations

.

3.1 Study Design

A cross-sectional descriptive research design was used for this study. The study was descriptive in

that the researcher collected detailed descriptive information concerning the knowledge attitude

and practice of mothers with regard to immunization of children 0-24 month.

3.2 Study Population

The targeted population were children below 5 years and their mothers visiting immunisation

clinic at Rukunyu Health centre IV every Monday and Friday between the month of febuary

2019to april 2019.

3.2.1 Inclusion

Children who are less than 5 years month and their mothers who are attending immunisation clinic

at Rukunyu health centre IV in kamwenge district

3.2.2 Exclusion

Children who are above 5 years and their mothers

3.3 Sample Size Determination

Using Kish and Leslie (1965) formula for sample size estimation formula:

n = z²p (1-p) / E²

Where n = Estimated minimum sample size required

P= Proportion of a characteristic in a sample using (53.0%) found by 0liver in Uganda,

Hoima[Oliver, 2019].

11

Z=1.96 (for 95% Confidence Interval)

e = Margin of error set at 5%,

Substituting in the formula above the sample size will be gotas 383

3.4 Sampling Technique

Multistage sampling technique. Respondents were first be grouped into 5 strata according to ages

of their children. Each stratum was then selected and the sum total obtained, from this, simple

random sampling was employed whereby the researcher took an appropriate number of pieces of

paper and mark them “1” or “2” and ask the participants to pick them at random. The ones that

pick “2” participated in the study.

3.5 Data Collection Method

The pre-tested questionnaire was used to collect data on socio-economic and demographic

characteristics, as well knowledge on the immunization. Three questionnaires were used in

paediatrics ward in Rukunyu health IV in kamwenge district where three mothers were chosen at

random , and this was to help detect whether there were mistakes to be identified and corrected

such that the data collected would be rendered valid.research assistants were trained to avoid

errors A questionnaire was developed and pre-tested before actual data collection.

3.8 Quality Control

1. Research assistants were trained.

2. Pre-testing the questionnaires and checking for their completeness was done. Three

questionnaires were used in paediatrics ward in Rukunyu health IV in kamwenge district where

three mothers chosen at random , and this was to help to detect whether there are mistakes.

3. Translation and back translation of questionnaires was done in Rutooro and Rukiga languages

4. Back up of the data and filled questionnaires was stored in a safe place under lock and Key.

5. Meetings with research assistants were done to sort out data collection problems.

3.9 Data Analysis

The seleted participart was given a questionnaire to fill. Data was entered into Microsoft excel

2016 spreadsheets and analyzed using SPSS version 17.0. Descriptive statistics was performed

12

using absolute numbers, percentages, ranges and measures of central tendency accordingly. Data

presented as tables, graphs and charts using MS PowerPoint.

3.10 Ethical Consideration

An introductory letter was obtained from Faulty of Clinical Medicine and Dentistry and university

Research Ethical Committee.

Permission was got from the health Centre administration before commencing the study. Before

the study is conducted, the objectives and procedures will be explained to the legal caretakers of

legible participants in order to obtain informed consent and the information collected will be kept

confidential.

3.11 Result Dissemination

Result were disseminated to the incharge rukunyu health center IV and the faculty ofclinical

medicine and dentistry kampala university teaching hospital.

13

CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

4.0 Introduction

This chapter bears the data that has been presented in form of simple frequency tables, bar graphs

and pie charts with a brief description. A simple calculator was used in the calculations.

4.1 Social Demographic Data

Table 1: Age disribution of respondents N=383

Age in years Frequency Percentage(%)

<20yrs 50 13.0

21-30 229 59.7

31-40 69 18.0

41-50 35 9.2

>50yrs 0 0

TOTAL 383 100

More than half of the respondents 229(59.7%) were 21-30 years old while 35(9.2%)were 41-

50years old. However there were no respondents aged above 50 years.

Table 2 : Tribes of the respondents N=383

Tribe Frequency Percentage(%)

Bakiga/Banyakole 257 67.0

Bafumbira 29 7.6

Acholi 8 2.0

Batooro 50 13.5

Basoga 9 2.3

Bakoojo 20 5.1

Others 10 2.5

TOTAL 383 100

More than half of the respondents 257(67.0%) were Bakiga/Banyakole while 8(2.0%) were

Acholis.and 50(13.0%)were Batooro

14

Figure 1: Religions of respondents N=383

196(51.2%) of the respondents were Protestants while 10(3.0%)belonged to other religions

(S.D.A).

Figure 2: Education level of mothers N=383

285(67.3%) are primary levers, 63(16.4%) of the respondents had reached secondary level whereas

only 38(9.9%) had attained tertiary education.

moslema59(16%)

protestants196(52%)

catholics98(26%)

pentacostal20(5.2%

others10(3%)Sales

258(67.3%)

63(16.4%)38(9.9%)

24(6.3%)

0

10

20

30

40

50

60

70

80

primary secondary tertiary non

Series 1

15

Figure 3: Occupation of respondents N=383

288(75.2%) of the respondents were peasant farmers while the least of the respondents were

commercial farmer 7(1.8%).

Figure 4: Marital Status N=383

Most of the respondents 172(48.0%) were married, only 30(7.8%) were separatedwhile only

35(7.8%) were widow

4.2 Knowledge about Immunisation N=383

288(75.2%)

7(1.8%)

62(16.2%)13(5.9%) 9(4.1)

0

20

40

60

80

peasant farmer comercial famer house wife civil servant others

divorced49(12%)

widowed35(9%)

separeted30(7%)

singles97(24%)

married172(48%)

relative69(18.0%

health workers228(59.5%)

media38(10.0%)

friends48(12.5%)

16

228(59.5%) of the mothers got information about immunisation from healthy workers, while the

least number of respondents 38(10.0%) obtained information from a media.

Table 3: Naming immunisable diseases N=383

Number of diseases Identified Frequency Percentage(%)

Eight 15 4.0

Seven 27 7.0

Six 252 65.8

Five 51 13.3

Four 35 9.1

Below four 3 0.8

TOTAL 383 100

Most mothers 252(65.8%) were able to name only 6 of the diseases. However the least of mothers

3(0.8%) would name below 4 immunisable diseases.

Table 4: When should immunisation start N=383

When to immunise frequency Percentage(%)

at birth 333 86.9

At 2month 31 8.1

At 6 month 10 2.6

I don’t know 9 2.4

TOTAL 383 100

More than half of the respondent 333(86.9%)knew that immunisation starts immediately from

birthand 9(2.4%)didnnot know when to start immunisation

17

Fingure 6: Do you know about immunisation N=383

a great number of participarts knew about immunisation 372(97.1%)and only 11(2.9%)did not

know

Table 5: What is immunisation for in you child

freguency Percentage(%)

prevents disease in the child 264 69.0

Helps child grow well 68 17.7

Makes child strong 34 8.9

I don’t know 17 4.4

TOTAL 383 100

More than have of the respondents knwe the importance of imunisation 264(69.0%) and 17(4.4%)

did not know

Fingure 7: Alternative mechanism to prevent infants from Vaccine Preventable Disease (PVD)

N=383

Yes372(97.1)%

No11(2.9)%

No383(94.8)%

Yes20(5.2%)

18

383((94.8%) said there was no any other mechanism to PVD while only 20(5.2%) said yes to

alternative to prevent infants from PV

4.3 Attitude Towards Immunisation

Figure 8: Place of preference to receive vaccine N=383

Half of the mothers 269(70.0%) would prefer to receive the vaccine from a static facility, while

17(5.0%) opted for other places of vaccination.

Table 6: Attitudes towards immunisation N=383

Attitude Frequency Percentage(%)

Very useful 330 86.2

Useful 42 11.0

Not useful 11 2.8

TOTAL 383 100

More than half of 330(86.2%) of the respondents said that immunisation is very useful, only11

(2.8%) said it’s not useful.

Table 7: Is Completing the immunisation schedule important N=383

resposes Frequency Percentage(%)

Yes 345 90.0

No 38 10.0

TOTAL 383 100

17(5%)

97(25%)

269(70%)

others outreach static facility

19

345(90.0%) of the mothers had fully immunised their children and only 38(10.0%) of the mothers

did not complete.

Fingure 9:immunisation important for infants N=383

360(94%) of mothers agreed that immunisation is important to infants

Table 8 vaccination side effect are dangerious N=383

Response frequency Percentage(%)

Yes 330 86.0

No 45 12.0

I don’t know 8 2.0

TOTAL 383 100

330(86.0%) said that vaccination side effects are dangerious and 8(2.0%) didn’t know

Table 9 infants taking many vacines N=383

response frequency percentage

Yes 35 9.1

No 335 87.5

I don’t know 13 3.4

TOTAL 383 100

335(87.5%) said that infants are not taking many vacines while 13(3.4%) said they didn’t know

360(94%)

23(6%0

0

20

40

60

80

100

agree disgree

20

4.4 Practices on Immunisation

Figure10: Reasons for defaulting N=383

262(69.0%) of the mother said that the child was sick and 44(11.0%) defaulted because lack of

information for the next dose.

Fingure 11: Adhering on immunisation N=383

286(74.7%) of mother said they will adhere to immunisation whlies on 97(25.3%) said no

Table 10 Conforming BCG vaccination N=383

response frequency Percentage(%)

By looking at the presence of

BCG scar

370 96.6

Don’t know 13 3.4

TOTAL 383 100

370( 96.6%) had a BCG scar while 13(3.4%) didn’t know

44(11.0%)

262(69.0%)

32(8.0%) 45(12%)

0

20

40

60

80

lack of information child was sick time inconvienance to far from home

Yes286(74.7%)

No97(25.3)%

21

Table 11 availability of immunisation card N=383

Response requency Percentage(%)

Yes 360 94

No 23 6.0

TOTAL 383 100

360(94.0%) mothers had immunisation cards while 23(6.0%) never had immunisation cards

Table12: tetanus toxoid vaccination during pregancy N=383

response frequency Percentage(%)

Yes 337 87.9

No 46 12.1

TOTAL 383 100

337(87.9%) mothers reported that they were immunised againist tetanus during pregnacy and

46(12.1%) said no

Fingure 14: know correct age of completing immunisation N=383

268(70.0%) of mother knew the practise of immunisation that it ended on 9month and 15(4.0%)

didn’t know.

9month268(70%)

6 month42(11%)

3 month58(15%)

don’t know15(4%)

22

CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.1 Discussion

5.1.1 Introduction

For successful immunisation and increased coverage of immmunisation in Uganda,and particully

at rukunyu health entre in kamwenge district the mothers’ knowledge, attitudes and practices

towards immunisation ought to be positive. In this chapter, the researcher discussed the results of

the study as presented in chapter four, drew conclusions and made recommendations.

5.1.2 Knowledge about Immunisation

Most of the mothers(59.5%) in this study got information about immunisation from healthy

workers partly because of their closeness especially at the time of giving birth and from the media.

This is not in line with Kalemba(1998)who states that media campaign have done a lot to change

mothers’ knowledge and attitude towards immunisation.in this case media had contributed to

12.5% in kamwenge district.this shows that there is a big gap that media can play to increase on

the knowledge and coverage of immunization in kamwenge district, and this indirectly will

improvve on the immunization coverage in the country.however participants included in other

study areas have got information primarily from health professionals. This is due to the fact that

vaccination information are usually given for mothers by health professional just before infants/

children taking vaccines with each immunization sessions or at the time of antenatal checkups.

More than ahalf percentageof mothers would identify only six (65.8%)of the immunisable diseases

though few would still identify all the eight immunisable diseases(4.0%) by name, this knowledge

gap affects the completion of the immunisdation schedule.13.0% of mothers where below 20years

of age this also affects there knowledge on immunisation and completion due to the effects of

stigma of having children while they are stillin either school or at their perants

homes.AnjumFazliet al did a study in India; where mothers had the knowledge that immunization

is important for the child and all of them knew that immunization is to be started at birth and should

follow vaccination sessions this was similar with this study in which (73.3%) of the mothers knew

that it was important to start immunization at birth and it was for preventing vaccine preventable

diseases. In comparison, mothers studied by Etana et al in Ambo, Ethiopia, it was found out that

only 6.7% of respondents knew the exact time when infants should begin immunization. The

discrepancy between the present study and Ambo district may be due to the difference in

23

information, education and communication (IEC) or in terms of health service accessibility in

comparison to this study since 73% of the respondents in Ambo were from rural areas. although

86/9% of respondents in this study mentioned correctly the time when infants should begin, but

only 69.0% of mothers correctly knew the objective of immunization (i.e. to prevent

diseases’).This was similar with the response of mothers in Enugu, Nigeria, 81.2% of respondents

mentioned correctly the objective of immunization Tagbo BN et al. The consistency between the

present participants and the later Nigerian participants may be due to educational status in

respondents since only 87.3% of mothers in the present study and 90% of mothers in Nigeria

attended primary, secondary school up to higher education.

In general, in this study 372(97.1%) of mothers had good knowledge and this was lower than the

study finding by Nnamdi Azikiwe University hospital in Nigeria which revealed that, 215(70.0%)

of mothers had good knowledge. The discrepancy may be due to the sample size difference or

educational back grounds of the participants. While in a study conducted in Connecticut (north

eastern United States) showed that both fresh and experienced mothers Scored poor knowledge

about vaccination. The probable cause of poor knowledge of mothers in developing and developed

countries is different. For example, the major health problem in developed countries is not

communicable disease and mothers may not focus on vaccine preventable diseases and may not

develop good knowledge on communicable diseases, while poor knowledge in developing

countries may be due to social, economic and political will.

5.1.3 Attitudes towards Immunisation

Most mothers would prefer to immunise their children from a static health facility (70.0%) as

compared to outreach and other places. This is because of reliability and good facilitation of static

stations.With an increased awareness, the greatest percentage 86.2% of mothers believed that

immunisation is very useful.which is conciding with Night Nisa(karaha pakistani 2007)

As it is seen in this study, 98.0% and 97.5% of participates in this study had favorable attitude

towards immunization of infants, and health personnel, respectively. This was similar to the study

that was done Kinshasa, Congo; which showed that 93.8% of respondents had positive attitude

about their children being immunized and 93.5% of them had positive attitude toward the health

personnel Mapatono et al. Although these respondents in this study had positive attitude towards

the EPI program and vaccine providers in general, a large proportion 91% of mothers believed that

infants took too many vaccines and . This type of perception was described by other scholars in

24

Texas health science center at Fort Worth (America) with two consistent belief/attitudes of mothers

such as vaccines could harm child, children receive too many vaccinations Anna E. et al .This

similarity should not be seen from the same angle of reference as in Uganda and basically rural

Kamwenge. For example, mothers found in developed countries may develop this type of attitude

because they pay attention more on vaccines safety while mothers found in developing countries

like Uganda may be due to lack of knowledge or social influences.

5.1.4 Practices on Immunisation

As far as their practice is concerned on infant immunization, about 96.6% of mothers had and

showed EPI card on the spot of immunization. This contradicted, with 67% of mothers Uganda

state of nation report of 2011 and with 41.8% of respondents in Ambo district Etana B et al had

showed EPI cards for their children, respectively. Moreover, immunization practice in the present

study (98.5%) greater than UDHS 2011 and Ethiopia ministry of health 2011 annual health and

health related indicator reports which represent 51.6% and 84.4% of infants were fully vaccinated,

respectively. The variation is due to a study design difference (institution in this study and national

based survey in comparison studies).Almost 74.7%% of respondents in this study brought their

infants for immunization according to the scheduled time. 98.0% of infants were fully vaccinated.

This is consistent with a cross sectional study done in India, that 98% and 93% of children

completely immunized and had been immunized on the schedule, time, respectively. In the

contrary, inconsistencies had been seen with other findings. For instance, according to Mapattono

et al in Congo, mothers’ immunization practice based on immunization card showed about 37%

while in Ethiopia, Ambo only 35.6% of infants completed all the recommended vaccines this

according to Etan B et al. The discrepancy may be due to social or cultural reasons, and study

setting differences

5.2.0 Conclusion

In this study, the generally50.2% and 57.3% knowledge and attitude of respondents toward

towards immunization of infants was good, respectively. Despite inadequate knowledge and

Attitude of mothers towards infant immunization, the majority 86.1% of mothers had good practice

of INFANT immunization. From this point of view, it is possible to conclude that mothers’

immunization practice was not really based on their knowledge and attitude regarding

immunization of infants. Maternal education and health profession association were significantly

25

Associated with good knowledge. Similarly, Mothers’ education, infants’ aged from 1week was

significantly associated with favorable attitude towards immunization of infants. Good infant

immunization practice was significantly associated with mothers who have ever heard information

about vaccination, who knew correctly the number of sessions needed, who knew the time when

infants should complete immunization and who knew correctly the time when infants should begin

immunization.

5.2.1 Recommendations

The health centre incharge of Rukunyu health centre IV should institute programmes aimed at

increasing mothers awareness towards immunisation. This could be through media such as radios,

televisions, newspapers and dramma.Encourage mothers to complete the immunisation schedule

as per the WHO standards.Discourage mothers’ beliefs towards immunisation through masssive

sensitization of the communities.

26

REFFERNCE

Angelillo I.F., Ricciardi G., Rossi P., Pantisano P., Langiano E. & Pavia M.(1999) Mothers and

vaccination: knowledge, attitudes, and behaviour in Italy. Bulletin of the World Health

Organization, 77 (3): 225-228

AnjumFazli, RohulJabeen, and Dr. Syed ArshadHussainAndrabi. Immunization of Children in a

Rural Area of North Kashmir, India: A KAP Study. Journal of Health and Allied

Antai, D., (2009) Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of

individual and contextual determinants. BMC Infectious Diseases, 9: 181

Awosika D. (2012) Access to immunization and other public health interventions through the

pharmacists. West African Journal of Pharmacy 23 (1): 3 –11

Bedford H. Approaches for the unimmunized – one size does not fit all. J Fam Health Care 2008;

18:201-3. Centers for Disease Control and Prevention (CDC) (2008). "Measles--United

States, January 1 - April 25, 2008". Morbidity Mortality Weekly Report(MMWR) 57 (18):

494–8.

Etana B. and Deressa W. Factors associated with complete immunization coverage in children

aged 12–23 months in Ambo Woreda, Central Ethiopia. BMC Public Health 2012;

Friederichs V, Cameron JC, Robertson C. Impact of adverse publicity on MMR vaccine uptake:

apopulation based analysis of vaccine uptake records for one million children, born 1987-

2004. Arch Dis Child 2006; 91: 465-8.

Gherardi E. The Concept of Immunity.History and Applications. Immunology course Medical

School, University of Pavia. http://en.wikipedia.org/wiki/Immunity_(medical)Global

Immunization Vision and Strategy (GIVS). Facts and figures April 2005.Geneva: WHO;

2005. Global immunization vision and strategy 2006-2015. Geneva: WHO; 2005

Kapoor R. and Vyas S., (2010) Awareness and knowledge of mothers of under five children

regarding immunization in Ahmedabad, Healthline1(1): 12 – 15. KRC survey report on

service delivery in Rwenzori region 2009.

Lee J.W., (2003) Child survival: a global health challenge. Lancet 362: 262

27

Mapatano MA. Immunization-related knowledge, attitudes and practices of mothers in Kinshasa,

Democratic Republic of the Congo. Original Research, available at www.safpj.co.za

MoH (2014).Annual Health Sector Performance Report 2013/14.Republic of Uganda, Kampala,

Uganda.National Primary Health Care Development Agency (NPHCDA) (2009) National

Immunization Policy.

Oliver Ombeva M, Munube D, Rachael Nakatugga Afaayo Kisakye Annet; Barriers of effective

uptake and provision of immunization in rural district in Uganda

Odusanya O.O., Alufohai E.F., Meurice P.F. &Ahonkhai V.I., (2008).Determinants of vaccination

coverage in rural Nigeria.BMC Public Health.8: 381. Published online 2008 November 5

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587468/

Orenstein W.A., Papania M.J., Wharton M.E., (2004)."Measles elimination in the United

States".Journal of infectious Diseases 189 (Suppl 1): S1–3 SAFamPract 2008; 50

(2):61.Sciences 2012; 11(1).

28

APPENDICES

APPENDIX I: QUESTIONNAIRE

THE KNOWLEDGE, ATTITUDE AND PRACTICE OF MOTHERS TOWARDS

IMMUNIZATION OF THEIR CHILDREN AT RUKUNYU HEALTH CENTRE IV IN

KAMWENGE DISTRICT.

SOCIAL DEMOGRAPHIC DATA

1a.Age<20yrs 21-30yrs 31-40yrs

41-50yrs 51-60yrs >60yrs

1b.Tribe

Mutooro Mukiga munyakole Mutagwenda Others specify………………

1c.Religion

Catholic Protestant Moslem Others specify…………

2.Education Standard

None Primary O-level A-leve University Others specify …………

3.Occupation

Peasant farmer Commercial farmer Self employed Civil servant

Others …….

4.Marital Status

Married Single Divorced Widowed saperated ………….

KNOWLEDGE ABOUT IMMUNIZATION

1. Do you know about immunisation? Yes or No

If yes what is the benefit of immunisation ?

29

1 Injection that prevents diseases in children

2. Injection that helps child grow well

3. Injection that makes child strong

4.How did you get to know about immunisation?

Friend Media Relative None

5.Can you name the childhood illnesses that are prevented?

Polio Measles T.B Hib

Pertussis Hep B Diptheria TetanusMeningococcal

Pneumococcal Don’t know

6.Is immunization good?

Yes NO I don’t know

7. What are the benefits of immunization?

Makes child grow Makes child smart Makes child bright

Prevents diseases don’t know

8. Do you know any side effects of immunisation? If yes, what happens.

i.Paralysed ii.Become deaf iii.Can't breathe iv.Dead vi.Others specify..........9.Do

you any other alternative mechanism to prevent infants from VPD?

Yes No

ATTITUDE TOWARDS IMMUNIZATION

1.How did you think or feel about immunisation?

i.Very useful ii.Useful iii.Not useful iv.Others specify ………………

30

2.Do you think completing immunisation according to schedule is important?

Yes No Give a reason………………………

3.Where do you prefer to receive vaccines?

i.Static facility ii.Out reach iii.Others specify………………

4. Immunisation important for the infant?

Yes……………………….No………………………………….

5,Will the vaccination not work?

Yes ……………….No…………………………….

6. Do you have a positve attitude toward the health works who deliver the vaccines to your infant?

Yes ……………. No………………………………

PRACTICE ABOUT IMMUNISATION

1. Have you ever got tetanus toxoid during pregnacy? Yes No

2 .what are you reason for missing immunisation days

-too far from vaccination site

-lack of information-child was sick

-mother was sick

-time inconveniences -others specify

3. are you will to adhere on completing the schedule?

Yes No

4. Do you have of immunization card (see the card)

Yes No

31

4. check the infant for BCG scar

Yes…………………………………….No……………………..

Thank you.

32

APPENDIX II: CONSENT FORM

My name is BINA SUNDAY ALEX. Iam medical student from KAMPALA UNIVESITY

TEACHING HOSPITAL and the purpose of this interview is to assess knowledge,attitude and

practice of mothers towards immunisation of their children also to provide useful information for

programme managers and providers to enable them improve the service provision.

Your information is very useful to this study.

All information taken will be kept confidential. You have the right not to participate in the

interview or to refuse at any stage of interviewing.

I agree to continue …………………………………………………..

I disagree to continue……………………………………………….

33

APPENDIX III: CONSENT FORM

NdiBINA SUNDAY ALEX, omwegi wa KIU enshonga ahabwenki nikubuuza ebibuzo ebi

nokwenda kumanya oku ebeyi ye’byokurya erikuteganisa omu enkozesa yebyokuryakandi

nokutaho emihanda ningasi emiringo eyakubasa kuyamba abantu abari kukurira entebekanisa

zebyokushubura embyokurya kuhwerwa kutaho engyenderwaho ekyakuyamba kubutura

ahakatare kebyokurya.

Entekateka nobuhabuzi bwawe ni bikuru munonga omukushoma oku.

Nikiriza ………………………………………………………

Tina’yikiriza…………………………………………………..

34

APPEDEX IV: MAP OF UGANDA SHOWING THE STUDY DISTRICT

STUDY

AREA

35

APPENDIX V: INTRODUCTORY LETTER

36

APPENDIX VI: CHILD HEALTH CARD