“A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF MOTHERS OF TODDLER REGARDING HEPATITIS B VACCINATION IN SELECTED RURAL AREAS AT CHINTAMANI”
PROFORMA FOR REGISTRATION OF SUBJECT FOR THE
DISSERTATION
SUBMITTED BY:
NETHRAVATHI
FIRST YEAR MSc NURSING
CHILD HEALTH NURSING
S.L.E.S. COLLEGE OF NURSING
NEAR RAILWAY TRACK
CHINTAMANI
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS(IN BLOCK LETTERS) / NETHRAVATHI
1st YEAR M.Sc NURSING,
S.L.E.S COLLEGE OF NURSING,
CHINTAMANI.
2 / NAME OF THE INSTITUTION / S.L.E.S. COLLEGE OF NURSING,
CHINTAMANI
3 / COURSE FO STUDY AND SUBJECT / M.Sc. NURSING
PAEDIATRICS NURSING
4 / DATE OF ADMISSION TO THE COURSE / 30/06/2012
5 / TITLE OF THE TOPIC / “A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF MOTHERS OF TODDLERS REGARDING HEPATITIS B VACCINE IN A SELECTED RURAL AREAS AT CHINTAMANI’’
INTRODUCTION
“Healthy Children Today Make Healthy Nation Tomorrow”
-Jawaharlal Nehru
Children are major consumers of health care. In India, about 35% of total
population are children. They are not only large in number but vulnerable to
various health problems and considered as special risk group. Children always
need special care to survive and thrive. Good health of these precious members of
the society should be ensured as prime importance in all countries.
Immunisation is a process of protecting an individual from the disease
through introduction of live or killed or attenuated organisms in the individuals
system.
Vaccines are immunoboilogical substances which produce specific
protection against a given disease.
A safe and effective vaccine against hepatitis B has been available
since1982.WHO recommends that hepatitis B vaccine be included in routine
immunization schedules for all children in all countries. Hepatitis B vaccines are
availble in two forms : (a) plasma derived vaccine and (b) RDNA yeast derived
vaccine.
Plasma derived vaccine is based on the surface antigen which is harvested
and purified from plasma of human carriers of hepatitis B virus. It is formalin
inactivated sub unit viral vaccine. Each 1ml dose of the vaccine contains 20mcg of
hepatitis surface antigen formulated in an alum adjuvent. The vaccine is safe,
effective and cheapest.
A toddler is a child between the ages of one and three. The toddler years are
a time of great cognitive, emotional and social development.
One year old; physical and motor skills, sensory and cognitive development.
Two year old; weigh about 11-13kgs, height about 80-82cm.
Two and half years old; teeth full set of 20 temporary, decreased need for naps.
Major learning events of Toddlers; Toilet training, Parallel play, Squatting, Language, Emotional and self image.
Immunization is vital; it protects nearly 3/4th of children against major childhood illness. There are several diseases, which can be easily prevented by timely vaccination as a part of routine immunization. Every child has the right to benefit from the appropriate traditional and new life saving vaccinations.
All mothers wish good health for their children. Health workers desire all children immunized against vaccine preventable diseases. The government wants them protected from progressive diseases. But many vaccines do not reach a majority of infants and children. Decreased awareness, patient compliance and cost effectiveness play a major role in limiting the success of vaccine.
6 BRIEF RESUME OF THE INTENDED STUDY
6.1 NEED FOR THE STUDY
“He who cures a disease may be the ‘skill fullest’
but he that prevents it is the safest physician.”
-THOMAS FULLER.
Hepatitis B is a major public health problem. Approximately 30% of the world’spopulation, i.e. about 2 billion people, have serological evidence of infection withhepatitis B virus (HBV) (1). It is estimated that 350 million of them have chronicHBV infection, about a million of whom die each year from chronic liver disease,including cirrhosis and liver cancer. HBV is second only to tobacco as a knownhuman carcinogen.
In a study conducted by Manipal Centre for Virus Research (MCVR)
recently at Ooramana village ofErnakulam district in Kerala, 348 Hepatitis-B
patients have been identified. This is the highest Hepatitis-B
incidences in the country this year.
Hepatitis B is a potentially deadly infection of the liver that kills about
500,000 to 700,000 people each year, mostly in developing countries. The virus is
spread perinatally from an infected mother to her infant at birth, from child to
child, through unsafe injections and blood transfusions, and through sexual contact.
Currently, there is no effective treatment for the disease. Hepatitis B vaccines have
been shown to be about 95 percent protective against the disease when used
correctly.
A safe and effective vaccine against hepatitis B has been available
since1982.WHO recommends that hepatitis B vaccine be included in routine
immunization schedules for all children in all countries (2). The present manual
provides management guidelines for the introduction of hepatitis B vaccine into
childhood immunization services, with particular reference to developing
countries.one of the greatest benefits that any country can offer to its population.
Vaccination is recognized as one of the prevention strategy, which contributed to
the decreased global mortality and morbidity.
Hepatitis B vaccine is a vaccine developed for the prevention of hepatitis B
virus infection. The vaccine contains one of the viral envelope proteins, hepatitis B
surface antigen (HBsAg). It is produced by yeast cells, into which the genetic code
for HBsAg has been inserted. A course of two to three (2-3) vaccine injections are
given, the second injection at least one month after the first dose and the third
injection being administered six months after the first dose. The first and second
dose offer complete protection. The final injection (second or third depending on
number of vaccines being administered) is to prolong protection against the
hepatitis B virus. Afterward an immune system antibody to HBsAg is established
in the bloodstream. The antibody is known as anti-HBsAg. This antibody and
immune system memory then provide immunity to hepatitis B infection. The first
vaccine became available in 1981.
A range of vaccines is available in the market. Presently recombinant DNA
vaccines are available, which means they are produced by inserting the gene for
HBV into common baker's yeast where it is grown, harvested, and purified. HBV
infection cannot occur from receiving hepatitis B vaccine. The common brands
available are Engerix-B (GSK), Elovac B (Human Biologicals Institute, A division
of Indian Immunologicals Limited), Genevac B (Serum Institute), Shanvac B etc.
In 2004, an estimated 350 million individuals were infected worldwide.
National and regional prevalence ranges from over 10% in Asia to under 0.5% in
the United States and northern Europe. Routes of infection include vertical
transmission (such as through childbirth), early life horizontal transmission (bites,
lesions, and sanitary habits), and adult horizontal transmission (sexual contact,
intravenous drug use). The primary method of transmission reflects the prevalence
of chronic HBV infection in a given area. In low prevalence areas such as the
continental United States and Western Europe, injection drug abuse and
unprotected sex are the primary methods, although other factors may also be
important. In moderate prevalence areas, which include Eastern Europe, Russia,
and Japan, where 2–7% of the population is chronically infected, the disease is
predominantly spread among children. In high-prevalence areas such as China and
South East Asia, transmission during childbirth is most common, although in other
areas of high endemicity such as Africa, transmission during childhood is a
significant factor. The prevalence of chronic HBV infection in areas of high
endemicity is at least 8%. As of 2010, China has 120 million infected people,
followed by India and Indonesia with 40 million and 12 million, respectively.
According to World Health Organization (WHO), an estimated 600,000 people die
every year related to the infection.
6.2 REVIEW OF LITERATURE
According to Abdellah and Levine “the material gathered in literature review should be created as an integral part of research”
The purpose of literature review is to discover what has previously been done about the problem to be studied, what remains to be done.
1. A descriptive study was conducted to evaluate knowledge attitude, and behavior of 841 Italian mothers regarding the immunization. Respondent’s attitude towards the utility of vaccination was favourable only for 22.5%. The results of a multiple logistic regression analysis showed that the knowledge was significantly greater among mother with a higher education level and among those who were older at the time of childbirth. Study emphasized the need for health education programmes for promoting immunization of under five children.
2. A study was aimed to identify knowledge and perception of population regarding the pentavalent vaccine [ DPT, Hep.B and Hib]. 600 mothers were interviewed for data collection. Virtually all mothers like the idea of getting more protection with less effort, but a small group 5% are worried that 5 doses together may be dangerous and cause more side effects. The great majority of mothers already believe that meningitis is a serious disease and they want their children vaccinated against it and pneumonia.
3. 20 surveys carried out between 1991-2001 to obtain information on mother’s knowledge and attitude towards immunization, in England. More than 15,000 interviews
were conducted as part of routine programme of research. These surveys show that public wants clarity, consistency factual information and openers from those delivering immunization servces.
4. A cross sectional survey was performed to assess the knowledge, attitude and practice of mother regarding expanded programme of immunization. The study revealed that 88% of patients had knowledge about EPI programme 92% of parents had positive attitude towards EPI. The most common reason for not vaccinating their children was laziness and wrong concepts about vaccination. This study concludes that there is need for more clear and appropriate health education messages regarding vaccination of chileren.
5. A descriptive study was conducted in England to explore the parental decision-making about the ‘five in one’ vaccine. Semi-structured interviews were conducted with 22 parents if babies aged between 4 and 13 weeks old. Although parents had concerns, most of them complained with the recommended programme rather than making an informed decision. This study implies there is need for more clear information regarding the combined vaccinations.
6. A study was carried out to examine mothers practice and attitude in relation to their child’s immunization. 1295 mothers were selected and data were collected using standardized questionnaire. Four immunization types were established based on the perception of immunization knowledge and practice. The 57% mothers were complaint, 19% complaint- ambivalent, 17% moderately resistant and 7% resistant towards vaccination. Results confirm the existence of a resistance to child vaccination. It should be attributed to ignorance.
7. A cross sectional study to assess postpartum Mothers’ attitudes, 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% ofmothers 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
6.3STATEMENT OF THE PROBLEM
A Descriptive study to assess the knowledge and attitude of mothers of toddlers regarding hepatitis B vaccine in a selected rural areas at Chintamani.
6.4 THE OBJECTIVES OF STUDY ARE
1.To assess the knowledge of mothers of toddlers regarding Hepatitis B vaccination.
- To assess the attitude of mothers of toddlers regarding Hepatitis B vaccination.
- To find out the relation between knowledge and attitude of mothers of toddlers regarding Hepatitis B vaccination
- To determine the association of knowledge and attitude of mothers of toddlers with selected demographic variables.
- To develop a health education module regarding the prevention of Hepatitis B diseases.
6.5OPERATIONAL DEFINITION
Assessment:- It is the organized systematic and continuous process of collecting data from mother of under five children regarding Hepatitis B vaccination.
Knowledge: -It denotes the awareness or information that the mothers posses regarding Hepatitis B vaccination.
Attitude: - Refers to opinion of mothers towards Hepatitis B vaccination.
Mothers: - Mothers attending the immunization clinics of selected hospitals at chintamani.
Rural: -refers to the mothers of toddlers who are residing in village.
Hepatitis B Vaccination: - Vaccination against Hepatitis B virus
6.6 ASSUMPTION
The study assumes that,
- Mothers play an active role in preventing child hood infections by
immunization of their children.
- Mothers will have some knowledge regarding Hepatitis B vaccination.
- Health education module will help the mothers to gain knowledge regarding importance of Hepatitis B vaccination.
6.7 HYPOTHESIS
H1 : There will be significant relationship between knowledge and attitude of mothers of toddlers regarding Hepatitis B vaccination.
H2: There will be a significant association of the knowledge and attitude of mothers with demographic variables.
H3 :There will be a significant relationship between the level of knowledge And attitude among mothers.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
The data will be collected from mothers of toddlers who is willing to participate in the Study.
7.1.1 RESEARCH DESIGN
Non-experimental descriptive study will be used for conducting the research
7.1.2.STUDY VARIABLES
Dependent variable: Knowledge and attitude of mothers.
Attributing variable: Demographicdata of mothersinclude age, religion, education, occupation, family income and number of children
7.1.3. STUDY SETTING
Study will be conducted in the selected rural areas of PHC at chintamani
7.1.4 POPULATION
Population will be the mothers of toddlers
7.2 METHOD OF DATA COLLECTION
After getting permission from concerned authorities, Researcher will explain the purpose of the study to mothers of toddlers. After obtaining their consent the questionnaire will be distributed and data will be collected.
7.2.1. SAMPLING TECHNIQUE
The sample of mothers with toddlers will be selected by using convenient sampling technique.
7.2.2. SAMPLE SIZE
The sample size of the study constitutes 120 mothers of toddlers (n=120).
7.2.3. CRITERIA FOR SAMPLE SELECTION
INCLUSION CRITERIA
1. Mothers who are having toddlers.
- Mothers who are attending the immunization clinic of selected hospitals, chintamani.
- Mothers who are willing to participate in the study.
- Mothers who know Kannada or English
EXCLUSION CRITERIA
1. Mothers who are unable to understand and read Kannada and English.
- Mothers who are not willing to participate in the study.
3. Mothers who are not available at the time of data collection.
7.2.4. INSTRUMENT
A structured questionnaire will be prepared for data collection.
The tool will have 3 parts.
Part I: Proforma for collecting demographic data.
Part II: Consist of questions to assess the knowledge of mothers of toddlers regarding Hepatitis B vaccination
Part III: Consists of attitude scale to assess the attitude of mothers of toddlers regarding Hepatitis B vaccination
7.2.5. METHOD OF DATA ANALYSIS AND PRESENTATION
Data will be analyzed according to the objectives of the study using descriptive and inferential statistics and will be presented in the form of graphs, tables and diagrams.
a. Descriptive statistics.
- Frequency and Percentage will be used to describe the distribution of mothers according to demographic characteristics.
- Mean, Mean score percentage and Standard deviation will be used to assess the knowledge and attitude scoring of mothers.
- Linear correlation will be worked out to find the relation between knowledge and attitude of mothers of under five children.
- Inferential Statistics
- Chi-Square test will be used to determine the association of knowledge and attitude of mothers with demographic characteristics.
7.2.6. PILOT STUDY
A pilot study will be conducted by selecting 12 mothers of toddlers to assess the feasibility of the main study.
7.2.7. PROJECTED OUTCOME
The mothers may have inadequate knowledge regarding Hepatitis B vaccination of toddlers. Based on the outcome of the study a health education module will be prepared, which will help to create awareness among mothers regarding the importance of Hepatitis B vaccination.
7.2.8. DURATION OF THE STUDY
The study is planned to conduct with the time duration at about 8-10 weeks.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMANS OR ANIMALS?
No, since the study is non-experimental type descriptive study, it doesn’t involve any intervention.
7.4HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION?
Ethical clearance will be obtained from the Institution’s Ethical Committee. The purpose and the details of the study will be explained to the mothers of under five children and informed consent will be obtained from them.
8. LIST OF REFERANCES
1. http;/en.wikipedia.org/wiki/Toddlers
2.Parul Datta ; Pediatric Nursing ; 2nd edition- 2009, Jaypee Publishers,Page No;1-2,37.
3. Centers for Disease Control and prevention (CDC); “Progress towards introduction of Hib vaccine in low income countries world wide”; MMWR Morb Mortal Wkly Rep. Feb.57(6); 2008. Pp: 148-51.
4. UNICEF ; “The state of world’s children Report”.July. 2008.
5. National Family Health Survey(NFHS-3). 2006
6.Patric.J, Leman, Ticker.S, Woodcock.A; “Factors underlying sub optimal childhood immunization”. Vaccine; Nov. 24(49); 2006. Pg: 7030-36.
7. Makheja.N; “The purpose and need of research study and review of literature.”Nursing Times ; Apr. 1(12); 2006. Pp: 45-7.
8. Heininger.U; “An internet based survey on parental attitude towards immunization”. Vaccine; Sep. 24(37-38); 2006. Pp: 6351-55.
9. Angelillo.I. F. etal; “Mothers and vaccination : Knowledge, attitude and behaviour in Italy”. Bull. World health organization.77(3);1999. Pp: 224-9.