“A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE

OF MOTHERS OF UNDER FIVE CHILDREN REGARDING

Hib VACCINATION IN SELECTED HOSPITALS AT TUMKUR
WITH A VIEW TO DEVELOP INFORMATION GUIDE SHEET”

PROFORMA FOR REGISTRATION OF SUBJECT FOR THE DISSERTATION

SUBMITTED BY:
SOWMYA.K.ANTU
FIRST YEAR MSc NURSING
CHILD HEALTH NURSING

SRI SIDDHARTHA COLLEGE OF NURSING

AGALAKOTE, B.H.ROAD
TUMKUR

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 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1 Name of the candidate MISS.SOWMYA K ANTU

And Address FIRST YEAR MSc NURSING
SRI SIDDHARTHA COLLEGE
OF NURSING, AGALAKOTE
TUMKUR 572 107

2 Name of the Institution SRI SIDDHARTHA COLLEGE

OF NURSING, B.H.ROAD,
TUMKUR

3 Course of the Study and DEGREE OF MASTER OF

Subject NURSING

CHILD HEALTH NURSING

4 Date of Admission 15TH JUNE 2008

5 Title of the Topic A STUDY TO ASSESS THE

KNOWLEDGE AND ATTITUDE
OF MOTHERS OF UNDER
FIVE CHILDREN REGARDING
Hib VACCINATION IN
SELECTED HOSPITALS AT
TUMKUR WITH A VIEW TO
DEVELOP INFORMATION
GUIDE SHEET.

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6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

“What a child doesn’t receive, he can seldom later”

-James.
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.

Haemophilus influenzae serotype [Hib] is one of the major pathogens in acute

invasive bacterial infections like pyogenic meningitis, pneumonia, epiglottitis, septic
arthritis, pericarditis and thrombophlebitis in children under five years of age. Although
safe and effective Hib vaccine exists, they are underutilized in developing countries,
especially in India.1

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.

6.1 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.
Protection from infectious diseases is 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.
Haemophilus influenzae type b [Hib] causes various bacterial infections in under five
children including meningitis and pneumonia. World Health Organization estimates that
Hib annually cause 3 million cases of serious illness and 4 lakh deaths worldwide, among
under five children.2

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 While we feel proud that India has the largest population of youths, it is also
true that our country has the dubious distinction of higher morality rate among children
less than 5 years of age. One of the reasons for these is said to be pneumonia. Experts
say that at least 4,00,000 kids die of this disease every year in India. India accounts for
almost 40% of worldwide childhood pneumonia cases. In most studies Hib is estimated
to cause over 20% of life threatening childhood pneumonia. According to latest ‘states of
world’s children report’ by UNICEF, more than 1000 children under the age of 5 die of
pneumonia every day in India. Of the 2.1million children die every year in India, 19% are
due to pneumonia. 3

It is estimated that 30% of meningitis cases are due to Hib infections.

Incidence of Hib meningitis in India is estimated to be 50-70 cases per 1 lakh population,
below the age of 5 years. Nearly 25-30% of children surviving Hib meningitis have
permanent neurological sequelae, the most serious of which are hearing loss and mental
retardation. Recent data suggests that the prevalence of Hib disease in India has been
underestimated due to a lack of adequate microbiological facilities4.

Hib vaccine is used over 120 countries would wide has been proven to be safe
and effective. After the introduction of Hib conjugate vaccine in 1990 for routine
administration to infant in United State the number of children with invasive Hib disease
decreased drastically.5 A new study from Bangladesh showed that 1/3 rd of life threatening
pneumonia cases and approximately 90% of Hib meningitis cases were prevented by Hib
immunization.6

Hib conjugate vaccine has been widely used in industrialized countries for
nearly 20 years. However, primarily because of financial constraints and lack of aware
ness among both public health officials and public regarding Hib disease burden and
benefits of the vaccine, use of these vaccine has been low in developing countries 7. In
India a large proportion of children are at a higher risk due to increasing resistance to
antibiotics as well as limited access to health care facilities. With this view IAP advocates
routine immunization against Hib for who can afford the vaccine.8

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 According to NFHS-3 report, the percentage of children who received all basic
vaccinations in Karnataka was only 55% and 6.9% receives no vaccinations. These
indicates that India still lags far behind the goal of universal immunization coverage of
children.9 All these reveals that targeted education and vaccination campaigns are
essential to achieve the elimination of childhood infections.

Studies suggest that mother’s attitude, education level, socio-demographic

characteristics as well as socioeconomic factors can influence the children’s
immunization uptake.10 After reviewing these researcher felt that there is a compelling
need to assess the knowledge and attitude regarding Hib vaccination and identifying the
learning needs, based on this specific health education module can be developed.

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 done11.

1. A comparative study was conducted to assess the knowledge and attitude of

mothers towards Hib vaccination and Hib vaccination coverage among Amish Children in
Pennsylvania. 298 mothers were from Amish community and 136 Non Amish mothers
were selected as a comparison group. . Hib vaccination coverage was low in Amish
communities [28%] as compared with non-Amish group [95%]. Among Amish parents
who did not vaccinate their children only 25% identified either religious or philosophical
objection as factor. 51% reported that vaccinating was not priority compared with other
activities of daily life. 73% would vaccinate their children of vaccinate their children if
vaccine were offered locally. Study concluded that targeted education regarding the
vaccination is essential to achieving elimination of Hib diseases.12

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 2. A study was performed to assess current attitude of parents regarding
prevalent issues related childhood vaccination. Of 6025 participants, 95% regarded their
pediatrician as the most important source of information followed by leaflets 48%, health
magazine 44.7% and the interest 38.7%. Of currently recommended immunization against
Hib. Parents considered it is least important for their children. 22.6% of parents felt that
immunization is administered too early in life, 21% thought that it is overload and 12%
afraid of its side effects. Study concluded that there is a need for information strategies to
counteract the existing misperception. 13

3. A descriptive study was conducted to evaluate knowledge attitude, and

behavior of 841 Italian mothers regarding the immunization. Over all 28.5% of mothers
were aware about Hib vaccination. 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.14

4. 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.15

5. 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.16

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 6. A descriptive study was conducted to explore the maternal response to
addition of Hib vaccine to primary schedule. 23 mothers of babies aged 1-2 years were
interviewed. Acceptability of vaccine was principally attributable to maternal perception.
Barriers to the uptakes of the vaccine include suspicion regarding newness of the vaccine
a fear of vaccine overload in such young babies and the distress of injections.17

7. 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.18

8. 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.19

9. 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.20

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6.3 STATEMENT OF THE PROBLEM
A study to assess the knowledge and attitude of mothers of under five children
regarding Hib vaccination in selected hospitals at Tumkur, with a view to develop
information guide sheet.

6.4 OBJECTIVES OF THE STUDY

1. To assess the knowledge of mothers of under five children regarding Hib
vaccination.
2. To assess the attitude of mother of under five children regarding Hib
vaccination.
3. To find out the relation between knowledge and attitude of mothers regarding
Hib vaccination
4. To determine the association of knowledge and attitude of mothers with
selected demographic variables.
5. To develop a health education module regarding the prevention of Hib diseases.

6.5 OPERATIONAL DEFINITION

Assessment: - It is the organized systematic and continuous process of collecting

data from mother of under five children regarding Hib vaccination.

Knowledge: - It denotes the awareness or information that the mothers posses

regarding Hib vaccination.

Attitude: - Refers to opinion of mothers towards Hib vaccination.

Mothers: - Mothers of under five children attending the immunization clinics

of selected hospitals at Tumkur.

Hib Vaccination: - Vaccination against Haemophilus influenzae serotype b bacterium.

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 6.6 ASSUMPTION
The study assumes that,
i. Mothers play an active role in preventing child hood infections by
immunization of their children.
ii. Mothers will have some knowledge regarding Hib vaccination.
iii. Health education module will help the mothers to gain knowledge regarding
importance of Hib immunization.

6.7 HYPOTHESIS

H1 : There will be significant relationship between knowledge and attitude of

mothers of under five children regarding Hib vaccination.

H2 : There will be a significant association of the knowledge and attitude of

mothers with demographic variables.

7. MATERIALS AND METHOD OF THE STUDY

7.1 SOURCE OF DATA

Data will be collected from the mothers of under five children.

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 of under five

children.
Attributing variable: Demographic data of mothers include age, religion,
education, occupation, family income and number of
children.

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 7.1.3. STUDY SETTING
Study will be conducted in the immunization clinics of selected hospitals at
Tumkur

7.1.4 POPULATION
Population will be all the mothers of under five children attending the
immunization clinics of selected hospitals at Tumkur

7.2 METHOD OF DATA COLLECTION

After getting permission from concerned authorities, Researcher will

explain the purpose of the study to mothers of under five children. After obtaining their
consent the questionnaire will be distributed and data will be collected.

7.2.1. SAMPLING TECHNIQUE

The sample of mothers with under five children will be selected by using
convenient sampling technique.

7.2.2. SAMPLE SIZE

The sample size of the study constitutes 120 mothers of under five children
(n=120).

7.2.3. CRITERIA FOR SAMPLE SELECTION

INCLUSION CRITERIA
1. Mothers who are having under five children.
2. Mothers who are attending the immunization clinic of selected hospitals,
Tumkur.
3. Mothers who are willing to participate in the study.
4. Mothers who know Kannada or English.

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 EXCLUSION CRITERIA
1. Mothers who are unable to understand and read Kannada and English.
2. 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 regarding
Hib vaccination.
Part III: Consists of attitude scale to assess the attitude of mothers regarding
Hib 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.
b. Inferential Statistics
 Chi-Square test will be used to determine the association of
knowledge and attitude of mothers with demographic characteristics.

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 7.2.6. PILOT STUDY
A pilot study will be conducted by selecting 12 mothers of under five
children to assess the feasibility of the main study.

7.2.7. PROJECTED OUTCOME

The mothers may have inadequate knowledge regarding Hib vaccination
of under five children. 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 Hib vaccination.

7.2.8. DURATION OF THE STUDY

The study is planned to conduct with the time duration at about 6-8 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.

7.4 HAS 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.

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8. LIST OF REFERANCES
1. Swingler.G, Fransman.D, Hussey.G; “Conjugate vaccine for preventing Hib
infections”; Cocharane Database Sys Rev. Dec. 18(2); 2007. Pp: 172-9.
2. 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.
3. UNICEF ; “The state of world’s children Report”.July. 2008.
4. Minz.S, Bairaj .V, Lalitha.M.K, Murali.N, Joseph.A, Steinhoff. M.C; “Incidence
of Haemophilus influenzae type b meningitis in India”. Indian Journal of Med. Res .
July.128(1); 2008 . Pp: 57-64.
5. Luis.A, Sastagnine.M.D, Federico.R, Laham.M; “Haemophilus influenzae type
b disease”. Clinical Paediatrics .Apr .47(1); 2008. Pp: 507-9.
6. Rahman.M, Hossain.S, Baqui.A.H, Shoma.S, Rashid H; “Haemophilus influenzae
type b disease in urban children (<5years) of Bangladesh: implications for therapy
and vaccination.” Infect. Mar. 56(3); 2008. Pp: 191-96.
7. Morris.S. K, Moss.W.J, Halsey. N “Haemophilus influenzae type b conjugate
vaccine use and effectiveness”. Lacet Infect Dis .July. 8(7); 2008. Pp: 435-43.
8. Invasive Bacterial Infection Surveillance (IBIS); “Are Haemophilus influenzae
infections a significant problem in India A prospective study review.” Clin Infe Dis;
Apr. 34(7); 2002. Pp: 949-57.
9. National Family Health Survey(NFHS-3). 2006
10. Patric.J, Leman, Ticker.S, Woodcock.A; “Factors underlying sub optimal
childhood immunization”. Vaccine; Nov. 24(49); 2006. Pp: 7030-36.
11.Makheja.N; “The purpose and need of research study and review of
literature.”Nursing Times ; Apr. 1(12); 2006. Pp: 45-7.
12. Lurie.P .etal; “Haemophilus influenzae type b Disease Among Amish children in
Pennsylvania: Reason for Persistent Disease”. Pediatrics; Oct. 108(4); 2001. Pp:60.
13. Heininger.U; “An internet based survey on parental attitude towards
immunization”. Vaccine; Sep. 24(37-38); 2006. Pp: 6351-55.
14. Angelillo.I. F. etal; “Mothers and vaccination : Knowledge, attitude and behaviour
in Italy”. Bull. World health organization.77(3);1999. Pp: 224-9.

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15. Boulianne.N. etal; “Why some children are in completely vaccinated”. Can J
Public Health; May. 94(3); 2003. Pp: 218-23.
16. Yarwood .J , Noakes.K, Kennedy.D, Campell.H , Salisbury.D; “Tracking mothers
knowledge and attitude to childhood immunization”. Vaccine; Dec. 23(48); 2005. Pp:
5670-87.
17. Harrington.P.M, Woodma.C, Shannon.W.F; “Vaccine,Yes:Injection,No: Maternal
responses to introduction of Hib vaccine”. British Journal of general practice; Nov.
49(448); 1999. Pp: 401-2.
18. Ticker.S, Leman.P.J;“Its just the normal thing to do:exploring parentaldecision
making about the ‘five in one’ vaccine.” Vaccine; Oct. 25(42); 2007; Pp: 409.
19. Sultana.A, Jahan.s, Ahmad.I; “Knowledge attitude and practice of Immunization”;
Pak Armed Forces Med J; Dec. 51(2); 2001. Pp: 177-81.
20. Burton J.C, Golay.M, Sudre.P; “Compliance and resistance to child vaccination:
A study among Swiss mothers”.Rev Epidemol; Sep. 53(4); 2005. Pp: 341-50.

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