MOTHERS KNOWLEDGE, ATTITUDE AND PRACTICES OF VACCINATION IN CHILDREN 0-5 YEARS IN THE BOLIFAMBA COMMUNITY

Abstract

The rate of vaccination in most developing nations and Cameroon, in particular, remains unsatisfactory. This work was aimed at assessing mothers’ knowledge, attitude and practices in the vaccination of children 0-5years in the Bolifamba community. A community based cross- sectional research design was carried out on 110 mothers in the Bolifamba community and their information captured through a structured questionnaire. The data was analyzed using SPSS version 20.0 and results presented using tables.

Results revealed majority (62.7%) respondents had correct knowledge on vaccination while 37.3% had incorrect knowledge on vaccination. Also, some (88.2%) mothers had a positive attitude towards vaccination of their children and 91.3% mothers agreed they practice vaccination by ensuring their children 0-5years receive all vaccines in their vaccination cards. Majority of the mothers (97.7%) complied to their children’s vaccination schedules with the Pentavalent vaccine, Pneumo, Rota and Vit A having 100% compliance. Meanwhile oral Polio (98.2%). BCG, Measles and Rubella, Yellow fever having 94.5% respectively.

Reasons for non-compliance being insecurity issues in the community which restricted movement at times, vaccine shortages and difficulties keeping to time and respecting vaccination schedules. Also they had fears that their kids were going to be vaccinated against Covid 19 which they had heard was available in the health centre. This vaccine is for health workers who are willing to be vaccinated and NOT given to children below 18 years of age.

It is therefore recommended that frequent health campaigns should be done to vaccinate children. Also, all stakeholders of health including both government and the private sector should increase supplies of vaccines. Women in this study locality need to be educated on the importance of vaccination and the various vaccines children 0-5years of age need to take.

CHAPTER ONE
INTRODUCTION
1.0 Introduction /Background of the study.

Childhood vaccination almost guarantees protection from many major diseases. It prevents 2 million deaths per year worldwide and is widely considered to be ‘overwhelmingly good’ by the scientific community (WHO, 2005). However, 2.5 million deaths a year continue to be caused by vaccine-preventable diseases, mainly in Africa and Asia among children less than 5 years old (WHO, 2005). The prevention of diseases is important in ensuring public health and in reducing maternal and child mortality. It is widely believed among clinicians that the occurrence of disease is prevented than curing them. Vaccination is one of the best means of protection against contagious diseases. Vaccination is a way of creating immunity to certain diseases by using small amounts of a killed or weakened microorganism that causes the particular disease (Centre for Disease Control and Prevention (CDC), 2015).

Vaccination is considered as one of the biggest achievements of the twentieth century and as one of the most cost-effective measures in the prevention of childhood diseases (Davidovitch, et al., 2012). In 1974, the World Health Organization (WHO) launched a worldwide vaccination program known as the Expanded Program of Immunization (EPI), which has been considered one of the major public health interventions aimed at reducing infant morbidity and mortality (Bos & Batson, 2000). During the launching of the EPI in 1976, only about 5% of infants throughout the world were protected against six diseases (diphtheria, measles, pertussis, poliomyelitis, tetanus, and tuberculosis). By 2013, the number of protected infants was more than 80% in many countries. It is estimated that vaccination helps to prevent 2 to 3 million infant deaths each year (WHO, 2016).

Chiabi et al., (2017) stated that the Expanded Program of Immunization started in Cameroon in 1976 as a pilot project and targeted infants from 0 to 11 months. Initially it targeted 6 diseases (diphtheria, measles, pertussis, poliomyelitis, tetanus, and tuberculosis), and other vaccines were gradually introduced; the last to be introduced in the EPI was IPV in 2015. Presently, it has vaccines against the following diseases: tuberculosis, diphtheria, tetanus, poliomyelitis, pertussis, viral hepatitis B, type b Hemophilus influenza infections, pneumococcal infections, diarrhea caused by rotavirus, measles, yellow fever, and rubella. An infant is completely vaccinated when he or she has received all the vaccines in the EPI.

Ensuring that all the doses are not only administered, but given at the appropriate ages, is of crucial importance in ensuring the efficacy of the vaccine in disease prevention (Hoppenbrouwers, et al., 2014). An infant is correctly vaccinated when he or she has received all the vaccines at the recommended ages. Many infants still do not complete their vaccination schedules or are vaccinated after the recommended ages (Ba Pouth, Kazambu, Delissaint, & Kobela, 2014).

Vaccination has been regarded as the most cost-effective intervention for child health promotion by the World Health Organization. Vaccinating the children significantly decreases the percentage of treating diseases which may possibly occur in the future, thus; this will provide the children a healthy childhood and reducing poverty and suffering.

The Millennium Development project 2009 emphasizes that, reducing child morbidity in a nation ensures a healthy and robust generation contributing to society. In an international project’s report, Sub-Saharan Africa is the lowest performing region in terms of Millennium Development Goal (MDG) 4 – reducing child mortality and, Ethiopia is one of the lowest performers in all MDGs.

The Expanded Programmed on Immunization (EPI) was created with the purpose of expanding immunization services beyond smallpox to the following six preventable diseases: diphtheria, measles, pertussis, poliomyelitis, tetanus and tuberculosis. The EPI was introduced in Cameroon in 1976 (Ministry of Public Health of Cameroon, 2002). According to the 2011 Cameroonian Demographic Health Survey (DHS) (Institut National de la Statistique (Yaoundé, Cameroun) et ICF International (Calverton, Maryland, USA), 2011), the coverage of the nine EPI vaccines in children aged 12–23 months was 57 % at the national level, and 59.3 % in the West Region.

When it became clear in the late 1990s that this goal would not be achieved globally, some supportive initiatives arose, including the Global Alliance for Vaccines and Immunization (GAVI), which contributes to an impressive increase in new funding for immunization. GAVI is a public-private partnership committed to improving access to routine vaccines and to introducing new vaccines for children in low-income countries (Martin & Marshal, 2003).

Vaccine-preventable diseases outbreaks are linked to inadequate levels of vaccination coverage (WHO, 2013). Several factors are associated with poor vaccination coverage in resource-limited countries. A multilevel analysis involving 24 African countries (International Federation of Red Cross and Red Crescent Societies, 2013) showed that breaks in childhood vaccination are linked, at the contextual level. High community illiteracy rates, high country fertility rates, and living in urban areas, while, at the individual level, they are linked to the poorest households, uneducated parents, parents with no access to media and/or with low health-seeking behaviours.

The relative effect of the above factors may significantly vary according to the geographical area (International Federation of Red Cross and Red Crescent Societies, 2013). The uptake of vaccination services is dependent not only on provision of the services but also on other factors including knowledge and attitude of mothers and density of health workers (Anand & Bärnighausen, 2017). The opportunity costs (such as lost earnings or time) incurred by parents may also have an important impact on uptake (Nath et al 2018).

Cultural receptivity to perceived modernity and education, as well as trust in health workers, were considered to be the most important factors influencing attitudes (Mull, Anderson & Mull, 2011). In short, knowing little about vaccination does not necessarily translate into negative attitudes towards it. factors such as trust (e.g., in healthcare providers) and culture may be more influential. The impact of high levels of knowledge on subsequent attitudes towards vaccination is unknown. The fundamental question is whether or not resources should be invested in improving parents’ knowledge of and attitudes towards vaccination. Although the evidence is unclear, it is commonly believed, though some disagree, that strengthening advocacy, communication and social mobilization will enhance informed and willing participation in vaccination programme and that vaccination strategies are likely to be more successful if they are based on an understanding of sociocultural behaviour (Streefland, 2015).

This study benefits from the Health Promotion Model (HPM) Nola J. Pender (2012). This theory focused on health promotion directed at increasing a client’s level of well-being. It also describes the multi-dimensional nature of persons as they interact within their environment to pursue health. The model focuses on the following three areas: (1) Individual characteristics and experiences, (2) Behavior – specific cognitions and affect, and (3) Behavioral Outcomes (Pender, 2012). The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions.

1.2 Problem Statement
In Africa, more detailed and comprehensive information at the district level is necessary in order to develop and implement appropriate strategies for improving vaccination coverage. In Cameroon, there are few studies, conducted at the primary level on, assessing mothers’ knowledge, attitude, and practices on the vaccination of children 0-5years. With the growing importance of vaccination to fight against diseases by preventing the diseases yet they are recurring traces of common epidemic diseases found within the communities.

It is against this backdrop that the researcher seeks to embark on the research study in order to assess the knowledge, attitude, and practices of vaccination in children 0-5years in the Bolifamba community of Muea Health Area of Buea Municipality in the South West Region of Cameroon.

1.3 General Objective
To assess mothers’ knowledge, attitude, practices and challenges in vaccination of children 0-5years in the Bolifamba Community.

1.3.1 Specific Objective
To assess the knowledge of mothers living in Bolifamba of vaccination in children 0-5years.
To assess the attitude of mothers living in Bolifamba towards vaccination in children 0-5years.
To find out if mothers in the Bolifamba community comply with the vaccination of their children 0-5 years.
To determine the challenges faced by mothers in Bolifamba in the vaccination of children 0-5years.