RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Mr. JITENDRA KUMAR GURJAR S/O
1.

Name of the candidate and

RAMBHAROSI LAL GURJAR

address (in block letters)

VPO-MAHAMADPURA TEH-BAYANA
DIST.-BHARATPUR,RAJASTHAN 321401
ACHARYA COLLEGE OF

2.

Name of the Institution

NURSING,CHOLANAGAR,RT NAGAR POST

BANGALORE-32

3.

Course of Study and Subject

M. Sc. NURSING 1st year

PAEDIATRIC NURSING

4.

Date of Admission to the Course

5.

Title of the study:

A STUDY

13,JUNE,2011

TO ASSESS THE KNOWLEDGE ON SELECTED OPTIONAL

VACCINES AMONG MOTHERS OF UNDER FIVE CHILDREN ATTENDING

IMMUNIZATION CLINIC AT BANGALORE IN VIEW TO DEVELOP
INFORMATION BOOKLET

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION
When there is prevention available, why should we take a chance? As the years go on,
it will help to reduce both physical suffering and financial costs, Dr. Chandramohan.1
World Health Organization (WHO) states that health is a state of complete
physical, mental and social well being not merely the absence of disease or illness. Health
is more than just the absence of disease. It is affected by a wide range of spectrum of
physical, mental, social and political factors. The promotion of health is social as well as
individual responsibility. It has been that 5 million children were dying each year and
another 5 million were disabled by infectious diseases2.
Immunization forms one of the most important and cost effective strategies for the
prevention of childhood sicknesses and disabilities and is thus a basic need for all
children. Parents are constantly concerned about the health and safety of their children
and they take many steps to protect them. These preventive measures range from childproof door latches to child safety seats. In the same respect, vaccines work to safeguard
children from illnesses and death caused by infectious diseases. 3
Children have an immature immune system and have no natural immunity against
conditions. Therefore they are at an increased risk for contracting infections and diseases
like mumps, rubella, typhoid and hepatitis B. Even today millions of children die each
year from vaccine preventable diseases such as measles diphtheria, tetanus and

pneumonia. Vaccines are meant to protect the child against a variety of preventable
diseases and hence it is every childs right to be vaccinated. 2
The growth and development of children is a long term contribution of country as
a whole. The key to attain the goal of health for all primary health care emphasizes on the
preventive principles one of the most cost effective health intervention is vaccine for all
infectious disease. Immunization is a high priority area in care of infants and children.
High immunization rates have almost eliminated many infectious diseases which used to
decimate sizable of the population for countries. A number of deadly and disabling
infectious diseases can be prevented by timely administration of vaccines when child is
effectively immunized at the right age, most of these diseases are either entirely
prevented or at least modified so that child suffer from a mild disease without any
disability.4
The number of vaccines has increased greatly in the last decade, and the child of
today probably feels like a pincushion by the first birthday. While combination vaccines
do reduce the number of pricks given, there is still some reluctance to subject babies to so
many injections. Apart from this, some diseases are mild and self limiting, some
vaccines are expensive, and some diseases are of uncertain importance in India.5
Vaccines are the greatest boon of modern medicine. It is hoped that paralytic
poliomyelitis would be eradicated from the world by the success of pulse polio
immunization which has been launched in India. National Immunization services now
offers protection against an additional diseases in some specific areas. Hepatitis B
Vaccine protects against serious disease of the liver. Homophiles influenza type b or

Human Influenza B Vaccines (HIB) is another vaccine which protects against pneumonia,
meningitis. Regarding Meningitis 2005 about 8357 cases were reported in India with 485
deaths. WHO (2007) each year in the world about 145 million children are born around
2.4 million deaths among children under five are still due to vaccine preventable diseases
and infections in early life. Mortality rate may be greater in developing countries,
because of low resistance of these children against infection. In the developing world
some 23% of deaths among children under five years occur in the first month. However
about 3 million babies in the developing countries die during early childhood. In recent
years however relatively low immunization levels in this age group have occasional
scattered out break of certain disease6. For this reason in spite of the national effort some
immunizations are administered optionally to improve the immunization levels of all
children. This vaccination helps to making the babies immune system stronger. People
who are duly partially immunized or not immunized at all may be at risk for the disease
that these vaccines prevent. Still the people are unaware of the immunization Schedule
and its importance. Hence the study plays an important role in spreading the awareness
on immunization among the mothers of under five children.

6.1 NEED FOR THE STUDY

Immunization is defined as the process by which individuals immune system
becomes fortified against an immogenic optional vaccine are those which are given
according to ones own choice. Access to immunization services and up to date
immunization coverage are essential for protecting every age group from debilitating and
potentially life threatening effects of infectious diseases. The risk of mortality and
morbidity is statistically high during childhood period. Prevention is ultimately the most

effective defense system in controlling infectious diseases. So the knowledge regarding

immunization in prevention of infectious disease among mothers of under five children is
important. Keeping the point of view this study was conducted to assess the knowledge
regarding optional vaccines among mothers with under five children.
India may be considered a conglomeration of many countries within a country. A
national policy must be evolved after considering many variables. One may justify
selective protection of individuals with certain vaccines on a scientific basis (such as
pneumococcal vaccine in splenectomised patients), but one must be cautious about the
routine use of optional vaccines. It is important to think beyond mere availability and
affordability. 7
An estimated 527,000 children aged <5 years die from rotavirus diarrhea each
year, with >85% of these deaths occurring in low-income countries of Africa and Asia. 6
Most (approx. 70%) cases of meningitis occur in children under the age of 5 or in people
over the age of 60.7 Out of that an annual incidence of 86 per 100,000 (95%CI 69 to 109)
in 0-4 yr old children, and 357 per 100,000 in 0-11 month infants in India.8
In India rotavirus causes 5 lacks of hospitalization annually. Usually the
hospitalization occurs within 6 months of age. The W H O estimates that the two bacteria
alone Hib and pneumococcal causes 50% of pneumonia deaths in children under five
years of age in India. In 2006, 206 polio cases were reported in India. In 2007 a total of
864 polio cases were reported. In 1988 polio was endemic in 125 countries. By mid 2009
poliovirus remained endemic in only four countries India, Pakistan, Afghanistan, and
Nigeria. The mothers play a vital role in the care of children are unaware of many
dreadful diseases its complications and its prevention.9

Chicken-pox is one more new vaccine in our armamentarium against infectious

diseases. Due to its extremely contagious nature, varicella is experienced by almost every
child or young adult in the world. Each year from 1990 to 1994, prior to availability of
varicella vaccine, about 4 million cases of varicella occurred in the United States. Of
these cases approximately 10,000 required hospitalization and 100 died. Although
varicella is not commonly perceived as an important public health problem, the
socioeconomic consequences in industrialized countries of a disease that affects
practically every child and causes the carrier absence from work should not be
underestimated.10
Hepatitis A in most developing countries is a sporadic childhood disease, but
lately focal outbreaks have been observed among children in India. A study conducted
during 2004, investigated a large-scale outbreak of hepatitis among children living in a
residential colony in Daund Taluk of District Pune in the western region of India. In total,
123 overt and 56 sub-clinical cases were detected. This report of a large-scale, explosive
outbreak of hepatitis A in Indian children once again emphasizes the need to evolve
proper public health strategies, especially for vaccination, in countries in the transitional
phase from hyperendemicity to intermediate endemicity.11
During the survey the researcher had the opportunity to interact with the parents
.It was found that the parents of the under five children were unaware of giving vaccines
and its importance in the health of their child. In the light of the above facts, it is an
essential fact that mothers of under five should bring up their knowledge about the
optional vaccines in order to bring up a new generation with less risk. This is just one
common misconception about immunizations. The truth is, most diseases that can be

prevented by vaccines still exist in the world. The reality is that vaccinations still play a
crucial role in keeping kids healthy12.

6.2 REVIEW OF LITERATURE

Here the investigator has gone through previous studies and research papers which
are related to the study. It comprises of reviews about the attitude and knowledge
regarding optional vaccines.
A report is devoted to analyze the effect that compulsory vaccination has on the
compliance of the population, compared with the results obtained by massive campaigns
for optional vaccinations. The implementation of a specific software for the management
of individual schedules helps to reach a substantial complete coverage of the individuals
for the first ones, while improving but incomplete results regard the vaccines against
pertussis and measles mumps-rubella, optional in Italy. The optimization of data
management at the local health unit level improves the quality and the satisfaction of the
work performed by the personnel, but has a limited effect on the already nearly complete
coverage for the compulsory immunizations. The mounting percentage of children
immunized with optional vaccines can be explained both by the massive campaigns of
information conducted in recent years and by the better tracking of individual
immunization schedules.13
There are about 16-33 million cases of typhoid fever annually, accounting for
nearly 6 lakh deaths. An earlier surveillance study conducted by the AIIMS, in a
Delhi slum showed a peak incidence of typhoid in children between age 1 and 5
years and that the disease was as severe in children as in adults. Vaccination can

help control the increasing morbidity and mortality. Pneumococcal infections kill
more than 1.6 million people in world and thousands in India.14
An experimental study was conducted among mothers under five children regarding
Safety and immunogenicity of concurrent administration

of measles-mumps-

rubellavaricella vaccine and PedvaxHIB(R) vaccines in healthy children twelve to

eighteen months old. The Results shows that, healthy children, 12 to 18 months of age,
who received MMRV and PedvaxHIB concurrently showed immune responses similar
to those in the control group who received M-M-RII vaccine with PedvaxHIB
followed by VARIVAX 6 weeks later. Antibody titers for varicella were significantly
lower when MMRV was administered than when varicella vaccine was given separately
(0.712-fold difference, P = 0.028). The study concluded that, there were no statistically
significant differences in the seroconversion rates between the two treatment groups for
any of the antigens tested at 6 weeks and 1 year. 15.
A cross sectional study was done to assess postpartum Mothers knowledge, and trust
regarding vaccination in USA. The data collected via written survey to postpartum
mothers in a large teaching hospital in Connecticut. Results of 228 mothers who
participated in the study, 29% of mothers worried about vaccinating their infants: 23%
were worried the vaccines would not work, 11% were worried the doctor would give the
wrong vaccine, and 8% worried that they are experimenting when they give vaccines.
Mothers reported that the most important reasons to vaccinate were to prevent disease in
the baby (74%) and in society (11%). Knowledge about vaccination was poor; e.g., 33%
correctly matched chicken pox with varicella vaccine. Although 70% wanted information

about vaccines during pregnancy, only 18% reported receiving such information during
prenatal care. Mothers would benefit from additional knowledge regarding the risks and
benefits of vaccines particularly during prenatal care.16
A study to examine how maternal socio-demographic factors, together with mother's
education, knowledge, and perception of immunizations, can affect the uptake of optional
vaccinations of preschool children in Italy. Convenience samples of 1,035 mothers were
interviewed. Fifty-nine percent of the respondents reported to have had their child
immunized with the MMR vaccine and 54% reported to have had their child immunized
against pertussis. The findings suggest that mothers' attitudes, educational level, and
socio-demographic characteristics, as well as socio-economic factors and local health
policies, can influence children's immunization uptake. Health promotion, based on a
partnership between parents and health professionals, should become a priority in Italian
vaccination policies17.
A study was conducted to evaluate the effectiveness of structured teaching programme
on knowledge regarding optional vaccines among mothers of under five children in
Kovilpalayam at Coimbatore among 40 mothers selected by convenience sampling
technique. A structured interview schedule was used to assess the knowledge among
mothers under five children. Result revealed that value for knowledge was 18.91 at
(P<0.05). The results indicated that the knowledge regarding optional vaccine among
mothers with under five children was significantly improved after education.18
An experimental study was conducted on Immune responses of infants vaccinated
with serotype 6B pneumococcal polysaccharide conjugated with tetanus toxoid among

mothers of under five children. The results showed that no significant adverse reactions
were observed. Pn6B-IgG (enzyme-linked immunosorbent assay) increased to a
geometric mean of 0.62 g/ml (P = 0.367, compared with prevaccination titers) in Group
A at 7 months and 1.22 g/ml (P < 0.001) in Group B at 10 months. Total Pn6B
antibodies (radioimmunoassay) were 44 ng of antibody N/ml (P < 0.053) in Group A and
211 ng of antibody N/ml (P < 0.001) in Group B. A smaller increase in IgM and IgA antiPn6B was observed. Reinjection at 18 months elicited booster responses in total and IgG
anti-Pn6B; 62% of those in Group A and 79% of those in Group B had >300 ng of
antibody N/ml. Opsonic activity, after initial and booster vaccinations, correlated with
Pn6B-antibody titers. Three infants with nasopharyngeal cultures repeatedly positive for
serogroup 6 had poor serum IgG responses. The study concluded that, Our results
demonstrate that Pn6B-TT is safe, elicits functional antibodies and memory responses in
infants19.
A study conducted to find out the use of formative research in developing a
knowledge translation approach to rotavirus vaccine introduction in developing
countries. This paper presented the formative research results of a qualitative survey
of public health providers in five low- and middle-income countries to determine if
and to what degree rotavirus is perceived to be a problem and the priority of a
vaccine. Open-ended surveys were carried out through focus group discussions and
one-on-one interviews. Researchers discovered that in all five countries knowledge
of rotavirus was extremely low, and as a result was not considered a high priority.
However, diarrhea among young children was considered a high priority among

10

public health providers in the three poorest countries with relatively high levels of
child mortality: India, Indonesia, and Nicaragua.20
A study was done in maternal socio demographic factors, together with mothers
education, knowledge and perception of immunizations, can affect the uptake of optional
vaccinations. Interviews of mothers were performed using a structured questionnaire. The
study concludes that mothers attitudes educational level, and socio demographic
characteristics, as well as socio economic factors and local health policies, can influence
children immunization uptake. Health promotion, based on partnership between parents
and health professionals, should become a priority in vaccination policies21.

6.3 STATEMENT OF THE PROBLEM:

A study to assess the knowledge on selected optional vaccine among
mothers of under five children attending immunization clinic at Bangalore in view
to develop information booklet.
6.4 OBJECTIVES
The objectives of study are to:
asses the knowledge regarding optional vaccine among the mothers
of under five children.
associate the level of knowledge of mothers of under five children regarding the
optional vaccines with selected socio demographic variables .
To prepare an information booklet regarding selected optional vaccines.

11

6.5 OPERATIONAL DEFINITIONS:

In this study the researcher has define the following terms as:
Assess
It refers to evaluate or estimate the knowledge regarding optional vaccines.
Knowledge
Refers to the level of understanding of mothers with under five children regarding
importance, meaning, dosage frequency and side effects of optional vaccines.
Vaccines
Vaccines are the preparation used as an active immunizing agent against the diseases
which can be prevented by their timely administration.
Optional Vaccines
Refers to vaccines which are taken additionally apart from the vaccines given as per the
immunization schedule.
Under five mothers
Women in reproductive age group who are having children less than 5 years of age

6.6 RESEARCH HYPHOTHESIS

H1: There will be significant association in the level of knowledge of mothers of under
five children with selected socio demographic variable.

12

6.7 VARIABLES UNDER STUDY

Study Variables Knowledge regarding optional vaccines among mothers of under five.
Extraneous Variables- sociodemographic variables such as age, educational status,
occupation, marital status, religion and type of family.

6.8 ASSUMPTIONS
The study is based on the following assumptions
Mothers of under five children may not have adequate knowledge about optional
vaccine.
Informational booklet is an accepted guideline strategy that can enhance the
knowledge regarding optional vaccine among mothers of under five children.
6.9 DELIMITATION
Mothers of under five children who are attending immunization clinic.
6.10 PROJECTED OUTCOME
The study helps to improve the knowledge regarding optional vaccines among
mothers of under five children .
7. MATERIALS AND METHODS
7.1. SOURCE OF DATA
Data will be collected from the mothers of under five children attending immunization
clinic.
7.1.1 RESEARCH DESIGN
Non experimental descriptive design

13

7.1.2 RESEARCH SETTING

Selected immunization clinic at Bangalore
7.1.3 POPULATION
Target population: Mothers of Under five children
Accessible population: mothers of under five children attending selected immunization
clinic.
7.1.4 SAMPLE
The sample consist of mothers of under five children attending immunization clinic.
7.1.5 SAMPLE SIZE
The sample size of the present study comprises of 60 mothers of under five children.

7.1.6. SAMPLING TECHNIQUE

Nonprobability convenient sampling technique will be used to select the sample.
7.1.7 SAMPLING CRITERIA
Inclusion Criteria
Study includes mothers of under five children who are
1. are willing to participate in the study
2. present at the time of data collection.
3.are able to speak and communicate in Kannada or English.

Exclusion Criteria
1. Mothers with critically ill children
2. Health care professionals

14

7.2 Methods of data collection:

Instrument need to be used:
The tool for data collection:
Section A: Socio demographic data of the study participants which includes age,
educational status, occupation, marital status, religion and type of family.
Section B: Structured questionnaire to assess the knowledge on optional vaccines among
mothers of under five children.
7.2.1 Plan for data collection procedure:
A formal administrative permission will be obtained from the respective authority. The
investigator would introduce self,explain to the subjects the purpose of study,assure
confidentiality and obtain written informed consent from the subjects.The investigator
will collect data using validated structured questionnaire related to demographic variables
and on knowledge regarding optional vaccine

Information booklet regarding optional vaccine will be developed by the investigator and
distributed to the participants which contains all information in both English and Canada.
7.2.2 PLAN FOR DATA ANALYSIS
DESCRIPTIVES STATISTICS
1. Frequencty and percentage distribution will be used to interprete demographic
variables of mothers of under five children
INFERENTIAL STATISTCS.
2. Association of knowledge of mothers of under five on optional vaccines with selected
socio demographic variables using chi square.

15

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION

TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMALS? IF SO
PLEASE DESCRIBE.
Yes. Structured knowledge questionnaire will be used to collect data from
mothers of under five children on optional vaccines is selected immunization cinics at
Bangalore.

7.4

HAS

ETHICAL

CLEARANCE

BEEN

OBTAINED

FROM

YOUR

INSTITUTION IN CASE OF 7.3?

YES.

8. LIST OF REFERENCES
1. Dr. K. Chandramohan.The Hindu. Online edition of India's National Newspaper.
Tamil Nadu - Chennai Monday, Sep 29, 2008
Avaliable from URL :
http://www.thehindu.com/2008/09/29/stories/2008092958290200.htm
2. K.Park. Text Book of Preventive and social medicine. 20th edition. Banarsidas Banot
Publication, Jabalpur. PP 603-610.
3.

Vaccines recommended for Indian children Available from URL:

http://www.bolohealth.com/expertspeak/Indukhosla/healthy-skin-and-hair/82
vaccines-recommended-for-indian-children

16

4.

Vaccinations

for

infants

and

children

Available

from

URL:

http://www.bolohealth.com/expertspeak/Indukhosla/healthy-skin-and-hair/82vaccines-recommended-for-indian-children
5. Y K Amdekar. Optional vaccines: a critical appraisal. Issues Med Ethics.2000 JanMar;8(1) .
Available from URL: http://www.issuesinmedicalethics.org/081mi007.html
6. Dr. Parang Mehta. Optional Childhood Vaccines. September 30, 2006.
Avaliable from URL: http://www.mehtachildcare.com/vaccines/optvacs.htm
7. CDC Weekly. November 21, 2008 / 57(46); 1255-1257
Available from URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5746a3.htm
8. Stanley J. Swierzewski, III, M.D.
Available from URL:

http://www.neurologychannel.com/meningitis/in

9. Minz S, Balraj V, Lalitha MK, Murali N, Cherian T. Incidence of Haemophilus

influenzae type b meningitis in India. Indian J Med Res. 2008 Jul;128(1):57-64.
10. Patel MM, Parashar UD. Assessing the effectiveness and public health impact of
rotavirus vaccines after introduction in immunization programs. J Infect Dis. 2009
Nov 1;200 Suppl 1:S291-9 Available URL from:
http://www.ncbi.nlm.nih.gov/pubmed/19817612?
itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel

17

11. Bhave SY. Indraprastha Apollo Hospital & Max Health Care, New Delhi, India.
Controversies in chicken-pox immunization. Indian J Pediatr. 2003 Jun;70(6):503-7.
Available from URL:http://www.ncbi.nlm.nih.gov/pubmed/12921321?
itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalp
os=5

12. Chadha M. S, Lole K. S, Bora M. H,Arankalle V. A. Transactions of the

Society of Tropical Medicine and Hygiene ISSN 0035-9203.

Royal

Available from

URL: http://cat.inist.fr/?aModele=afficheN&cpsidt=21980430
13. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information
Centre). Summary report on HPV and cervical cancer statistics in India. 2007.
Available from URL: www.who.int/hpvcentre.com
14. Sharma VK, Khandpur S. Transmitted infectious disease. India.Nat Med J India 2004;
17: 310-319.

15. Adis, a Wolters Kluwer. Mothers' Knowledge about Vaccine Preventable

Diseases and Immunization Coverage of

a Population with High Rate of

Illiteracy. Journal of Tropical Pediatrics. Vol 10.

16. Rengaswamy Sankaranarayanan, Neerja Bhatla. ICO Monograph Series on HPV and
Cervical Cancer: Asia Pacific Regional Report.
Available from URL: http://www.sciencedirect.com/science?
_ob=ArticleURL&_udi=B6TD4-4TD5VXV9&_user=8780669&_coverDate=08%2F19%2F2008

18

17.

Giorgio Serafini,Stefano Caramello

and

Secondo Vaudetto.

Compliance

to

compulsory vaccination: Strategies and results. Volume 11, Number 3 / June, 1995.
Pages: 349-350.
Available from URL : http://www.springerlink.com/content/j538440m15608226/
18. S.Selvakumari. Knowledge of optional vaccines among mothers of under five
children .Journal of Management and Science, Vol. 1, No.1, Sep 2011, pp. 30-35.
19. Lazcano-Ponce E, Rivera L, Arillo-Santilln E. Acceptability of a human
papillomavirus (HPV) trial vaccine among mothers of adolescents in Cuernavaca,
Mexico. Arch Med Res. 2001 May-Jun;32(3):243-7.
Avaliable from URL: http://www.ncbi.nlm.nih.gov/pubmed/11395192
20.Evan Simpson, Scott Wittet, Josefina Bonilla. Use of formative research in developing
a knowledge translation approach to rotavirus vaccine introduction in developing
countries. BMC Public Health 2007, 7:281doi:10.1186/1471-2458-7-281
Available from URL: http://www.biomedcentral.com/1471-2458/7/281/abstract/
21. Journal of Tropical Pediatrics 1995 41(6):376-378; doi:10.1093/tropej/41.6.376
1995 by Oxford University Press.
Avaliable from URL : http://tropej.oxfordjournals.org/cgi/content/abstract/41/6/376
9.

SIGNATURE OF THE
CANDIDATE

19

10. REMARKS OF THE GUIDE

THE

STUDY

IS

SIGNIFICANT

OF

RELEVANT AND HELP MOTHER TO

IMMUNIZE
THEREBY
MORBIDITY

CHILDREN
REDUCE

AND

UNDER

AND

FIVE

MORTALITY

RATES .

11. NAME AND DESIGNATION OF

GUIDE(IN BLOCK LETTER)
11.1. GUIDE

MRS. BINDU S. KUMAR

(HOD) CHILD HEALTH NURSING
MRS. BINDU S. KUMAR

11.2. SIGNATURE
11.3. CO-GUIDE (IF ANY)

MRS. BABY KALYANI

11.4. SIGNATURE
11.5.HEAD

OF

THE

DEPARTMENT
11.6. SIGNATURE
12. REMARK OF THE PRINCIPAL

THE

STUDY

IS

MORE

SIGNIFICANT AND RELAVENT TO

THE FIELD OF CHILD HEALTH
NURSING.

12.1. SIGNATURE

20