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IMMUNIZATION Thesis

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A STUDY TO ASSES OF KNOWLEDGE, ATTITUDE AND PRACTICES OF PARENTS
A BOUT IMMUNIZATION ERIGAVO CITY, SOMALILAND

BY:

SUCAD SAED IBRAHIM ID

SAMIYA MOHAMOUD MOHAMED

A THESIS SUBMITTED TO THE FACULTY OF HEALTH SCIENCE IN PARTIAL

FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF BACHELOR’S
DEGREE OF QUALIFIED NURSING AT GOLIS UNIVERSITY IN ERIGAVO,
SOMALILAND

SUPERVISOR BY:

Dr. HAMZE ALI ABDILLAHI

AUGUST 2019

1
Declaration
We declare that this thesis is our original work and has never been submitted to any institution for
any award what so ever without the writers’ consent or gollis university.

SUCAD SAED IBRAHIM ID

Signature………………Date………………………

SAMIYA MOHAMOUD MOHAMED

Signature…………………Date……………………

2
APPROVAL

The undersigned certify that they have read and hereby recommend to the GOLLIS UNIVERSITY
to accept the thesis submitted by Suad Saed Ibrahim ,And Samiya Mohamoud Mohamed entitled
“A STUDY TO ASSES OF KNOWLEDGE, ATTITUDE AND PRACTICES OF PARENTS A
BOUT IMMUNIZATION ERIGAVO CITY, SOMALILAND
” in partial fulfillment of the requirements for the award of a bachelor of Health Science.

Name of supervisor……………………………… Signature……………………………....

Date………………………………….…

Name of internal Examiner…………………………. Signature…………………………………..

Date………………………………………..

Name of head of faculty…………………………… Signature…………………..............

Date………………………………….

3
 ACKNOWLEDGEMENT

Fists and foremost we started the name of Allah who gave us a good health (ALHAMDULILLAH)
and allow to us the ability to complete the research paper. Second we heartily thank full to my
supervisor Dr. HAMZE ALI ABDILLAHI whose encouragement, guidance, and supported, and
supper form the initial to the final level enable us to develop understanding of the subject. We
would like to thank to all Health Science and especially dean of faculty nursing department (Dr.
ABDIALHI ABDI DALMAR) that supported me throughout my education with patience and
knowledge at the same time as allowing me the room to wake in my own way we attribute the
level of our degree to their encouragement and effort, and without them this thesis would not have
been completed or written. We gratefully acknowledge the teacher for the teaching advice and
crucial contribution that made strong backbone of my life listening, managing, and solving the
problem, He should be acknowledged as an outstanding supervisor and we feel privileged to have
collaborated with him. Finally, I wish to thank to our classmates and all staffs at the Gollis
University.

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 Table Contents
DECLARATION...............................................................................................1
DEDICATION ...............................................................................................2
APPROVAL ...................................................................................................3

ACKNOWLEDGEMENT...............................................................................4
TABLE CONTENTS………………………………………………………...5

Chapter one
1.1Back ground: ................................................................................................... 9
1.2. Problem statement....................................................................................... …9
1.3.Objectives of the study......................................................................................11
1.4. Specific Objectives...........................................................................................11

1.5. Research question.............................................................................................11

1.7. Significance of the research............................................................................12

1.8. definitions of operational terms.....................................................................13

1.8. study area…………………………………………………………………14

1.8.2. content scope …………………………………………………………….15

1.9.conceptual frame work………………………………………………………16

CHAPTER TWO

2-LITERATURE REVIEW.....................................................................................14

2. Introduction......................................................................................................14

2.1 .Vaccination....................................................................................................14

2.2 .Determinants of full child immunization.......................................................15

2.3.characterictics of the mother ………………………………………………..15

2.4. health professional role..................................................................................15

2.5,Education .........................................................................................................16

2.6.immunization of available ..............................................................................17

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2.7.Importance of immunization……………………………………………..17

2.8-immunization of coverage ……………………………………………….17

2.9-immunization of south Africa……………………………………………18

2.10-ministery of health (MOH)disease surveillance program structure…….18

2.11- Herd immunity …………………………………………………………..19

2.12-public health perspective…………………………………………………19

2.13- in Europe…………………………………………………………………20.

2.14-sweden…………………………………………………………………….20

2.15- Vaccine safety……………………………………………………………20

2.16-vaccine efficacy and effectiveness………………………………………….21

2.17-parents knowledge and attitudes on childhood immunization……………….21

Bibliography………………………………………………………………………….22

Chapter Three: Methodology.....................................................................23

3-1-introduction
3..2. Research method and study Design...................................................................23
3.2.1.-the Research method..........................................................................................23
3.2 r.esearch population................................................................................................23
3.3-Sample size............................................................................................................24
3.3.1- Study of duration...............................................................................................24

3.4, simple of technique ..............................................................................................25

3.5,Data collection of method.....................................................................................25
3.6 .Data analysis........................................................................................................25
3.7-varriable measure by the instrument………………………………….………26
3.8-Ethical Consideration.......................................................................................26
3.9-Validity and reliability......................................................................................27

3.10- study of limitation…………………………………………………………..27

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 04. CHAPTER FOUR
4-1Presentation, Analysis And Interpretation Of Data.........................................26 -56

CHAPTER FIVE

Findings, Conclusion, Recommendation ............................................................. 57

5.1: Conclusion........................................................................................................57

5.2: Recommendations............................................................................................58

Appendix II- questionnaire…………………………………………….................59

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 CHAPTER ONE:
1. Introduction

1.1 Background

Before the era of immunizations, global morbidity and mortality from infectious disease was very
high. Many people, especially children, suffered from diseases such as smallpox, polio, measles
and influenza and other infectious diseases. Smallpox was a major infectious disease in the 20th
century causing more than 300 million deaths worldwide. Poliomyelitis is reported to have caused
over 3000 deaths and paralyzed more than 21000 people in the United States of America in 1952
and the influenza pandemic of 1918 is estimated to have resulted in more than 20 million deaths
worldwide. The modern history of immunizations dates back to the 18-th century where an English
country doctor, Edward Jenner, advanced the concept of vaccination for the world by vaccinating
patients against smallpox using pus from cowpox infected milkmaids. (Kgomotso Lovey Sehume,
2011).Vaccines are cited as one of the top ten greatest disease prevention tools of recent history
The increase in vaccines recommended specifically for adolescents is a relatively new
development; therefore, the process of vaccine delivery specifically for adolescents needs to
develop as well. Now that there are more vaccines targeted specifically for adolescents, focusing
on vaccine delivery to this population will help to improve chances of successful prevention of
disease and to meet the goals of improving vaccination rates, erasing disparities, and preventing
disease. (Richard Brendan Noggle, 12-7-2007).

Immunization is one of the public health programmers that prevent disease in society. Vaccination
is the most common technique used in immunization. It entails the administration of a vaccine into
the human body in order to stimulate an individual’s immune system against bacteria, viruses,
parasites and fungi. Vaccines are defined as biological preparation intended to produce immunity
against a disease by exciting the production of antibodies. Vaccines are safe and effective;
however, adverse reactions may develop following a vaccine and the process of immunization
itself. The World Health Organization (WHO) states that many children die all over the world
especially in developing nations due to measles, hepatitis B, Hemophilia influenza, whooping
cough (pertussis), tetanus, diphtheria and polio. Children have a low level of immunity due to an
undeveloped immune system. Therefore, children are more prone to microbial infection. Children
need to be immunized at a certain age, in order to ensure that they have a good ability to fight
against infection. (Omer Qutaiba Bader Aldeen Allela,, October, 2017). Vaccines work.
Immunization has saved the lives of more children than any other medical intervention in the last
50 years. Vaccines are safe, simple and one of the most cost-effective way to save and improve
the lives of children worldwide. However, many children in developing countries lack access to
vaccines often because they live in hard-to-reach communities and are among the most
marginalized members of the community. Vaccines ensure that all children, no matter their
circumstances, have a shot at a healthy life Children in East Africa regions continue to lose their
lives to vaccine-preventable diseases such as measles, which remains the bigger killer. Tetanus in

8
newborn also remains a problem. Diarrhea remains the second major cause of death among
children, after respiratory-tract infections. Unhygienic practices and unsafe drinking water are
some of its main causes. (Ms.Mereena,Mrs.Sujatha.R, Sep.-Oct. 2014).

1.2 Statement of the Problem

It is estimated that 1.5 million deaths occur among children less than five years of age worldwide,
which are attributed to vaccine preventable diseases. Measles accounts for 8% of such deaths
despite the fact that a safe and cost-effective vaccine is available. In 2012, there were 266,722
measles cases and 122,000 measles related deaths, with over 95% of measles-related mortality
occurring in resource-limited settings. (Doshi, Reena Hemendra, 2014).During the last few
decades, the burden of the infectious diseases has been reduced though 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. 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. The WHO estimated
a reduction in the death rate from infectious diseases between 2 and 3 million each year. Also, 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. Moreover, some parents thought that
polio immunization will decrease the fertility rate thus the parent’s attitude plays important role in
vaccination process as they are the decision makers for their children. (Ahmed Abdullah Saleh
Alenazi , October 2017)). In Somalia, there have been 7,031 suspected cases of measles reported
since the beginning of 2017. This figure exceeds the total number of cases for the whole of 2016
(5,657). More than half of the reported cases are from the central and southern regions, with
children (under-5) accounting for 65 per cent of the cases.

The top five affected regions are: Banadir, Toghdeer, Lower Shabelle, Sool and Sahil. Measles
surveillance is constrained because of its dependence on the polio workforce. Additionally, limited
technical logistic laboratory capacities limit the timely availability of laboratory confirmation of
measles outbreaks. All outbreak countries report low first dose coverage of measles at national
level, with large disparities between regions and with pockets of low immunity. While a measles
campaign is being organized in Somalia, there are delays in rolling out similar campaigns in Kenya
and in Ethiopia, particularly in Ethiopia’s Somali region due to the rapid spread of acute watery
diarrhea. To prevent further expansion of the disease outbreak in Somalia, UNICEF and partners
are exploring ways to vaccinate children arriving into both Ethiopia and Kenya from Somalia.
However, challenges remain as some families are not being registered for fear of being sent home.
(UNICEF, 17 May 2017).

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1.3. Objectives of the study
1.3.1. Broad objective
The purpose of this study was to Assess of Knowledge and Attitude and Practice of Parents about
Immunization in Erigavo City

1.3.2. Specific objectives

The specific objectives of the study were:

1. To investigate the knowledge of caregivers regarding vaccination of children.

2. To describe the demographic of respondents in term of gender, education, marital status,
socio-economic conditions.
3. To investigate the attitudes of parents regarding vaccination of children

1.4. Research Questions

1.4.1. Main Research Question
The main research question of the study was what are the Knowledge and Attitude and Practice of
Parents about Immunization in Erigavo City

1.4.2. The specific Research Question

1. How to investigate the knowledge of caregivers regarding vaccination of children?
2. What are the demographic of respondents in term of gender, education, marital status,
socio-economic conditions?
3. How to investigate the attitudes of parents regarding vaccination of children?

1.5 (Rationale) Justification

Each year more than 330,000 children die from vaccine-preventable diseases. The top killer’s in
children under five years old include perinatal conditions (20%), respiratory infections (18%),
diarrheal diseases (17%), vaccine preventable diseases (15%), and malaria (7%).Immunization is
the most cost-effective and highest-impact health intervention which reduces hospitalization,
treatment costs and mortality. Also, the study seeks to know the Knowledge and Attitude and
Practice of Parents about Immunization in Erigavo City

1.6 SIGNIFICANCE OF STUDY

It is hoped that the findings of this study will be of use to the Ministry of Health and the
government, the findings of this study will also be important in helping National and County
governments as a whole in recognizing that vaccinations have a crucial role in addressing
economic development among populations. The findings will thus be important in helping the
government to attain its population goals enshrined in vision 2030 and the National Council for
population and Development in developing responsive programmers to address a population
needs. The findings of the study may also be of use to the pillar 2020 development frameworks in

10
immunization program by Non-Governmental Organizations, government and Community Based
organization.

1.7 Operational Definitions

There are a number of operational definitions that frame and help guide this research. These
include:

1. Immunization coverage rate: The percentage of all children between 0 to 6 years who
have received full immunization according to the South African Expanded Programmer of
Immunization during the study period.
2. Primary care giver: The person who looks after the child and is primarily responsible for
all the needs of the child including shelter, food, emotional and financial needs and is in
possession of the child’s Road to Health Card.
3. Road to Health Card: The card that belongs to a child in which his or her health record
including birth, immunizations, growth and other health matters are recorded.
4. Immunization is one of the most cost effective preventative health care interventions that is
available to communities; it has greatly reduced the burden of infectious diseases in
childhood.
5. Community: A social group of any size whose members reside in a specific locality, share
government and often have a common cultural and historical heritage.

1.8 Study area:

1.8.1 Geographical scope
The study was carried out in a Erigavo which is capital city of the largest region in
Somaliland.

1.8.2 Content scope

This study was checked finding the Knowledge and Attitude and Practice of Parents about
Immunization in Erigavo City

1.9 CONCEPTUAL FRAMEWORK

Immunization of infants and young children against serious infectious diseases is among the most
successful and cost-effective interventions in preventative health care. The success of these
programs relies on sufficiently high coverage to maintain herd immunity.

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 1.9 CONCEPTUAL FRAMEWORK
The following is a conceptual framework of the possible explanations that influence of
immunizations
Predisposing Factors Conceptual
1. Marital status
Independent Variables
2. Mother’s age
3. Sex of Child: Male, Female
4. Religion: Traditional, Muslim
5. Distance to health facility: Big
problem, no big problem
6. Antenatal care visits: No visits
7. Place of delivery: Health facility, Dependent Variable
Home
8. Frequency of watching television:
Not at all, Less frequently and
Frequently
9. Frequency of reading newspaper:
Not at all, Less frequently and
Frequently.
10. Father’s Educational level: No
education
11. Mother’s Educational level: No
education, Primary, Secondary and
higher.
12. Wealth status: Poor, Medium, Rich.

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 CHAPTER 2

LITERATURE REVIEW
INTRODUCTION:
The World Health Organization (WHO) stated that clean water and vaccines are the two public
health interventions that have greatly improved the health of people around the world The WHO
Expanded Programmer of Immunization (EPI) was launched in 1974; its aim was to reduce
mortality from six major vaccine preventable infectious diseases namely: measles, poliomyelitis,
diphtheria, pertussis, tetanus and tuberculosis. Since then, more than 20 million deaths have been
prevented worldwide and a global immunization coverage rate of more than 80 % has been
achieved There continues to be extensive scientific research to improve the safety and efficacy of
available vaccines and to develop new vaccines to target other diseases with high morbidity and
mortality such as malaria and human immunodeficiency virus infection (HIV). The disadvantage
with this great medical achievement is that immunizations are not equally available to all people
around the world and are often lacking in populations and communities that are most in need of
them. With advancing technology and research, newer, more effective and safer vaccines are being
developed and current vaccines continue to be improved upon. We now have the acellular pertussis
vaccine which has less side effects and the inactivated poliomyelitis vaccine is slowly replacing
the oral polio vaccine because it does not have the risk of causing paralysis. Routine immunization
now protects for far more than the six infectious diseases initially targeted by the WHO. Currently,
about 25 vaccines are available for disease prevention These include the hepatitis B vaccine, the
Haemophilus influenzae type B (HiB) vaccine, the pneumococcal conjugate vaccine, the rotavirus
vaccine, the meningococcal vaccine, the yellow fever vaccine, the varicella vaccine and many
others. (Onta SR., 1998).

2.1 VACCINATION
Vaccination is found out to be the best cost-effective method in public health services and saves
millions of lives, mainly children. There is some belief through an earlier manuscript that the
practice of inoculation may have originated in India and China before the 17 th century. Small pox
is considered to be the first disease, people took effort to inoculate themselves from and for which
a vaccine was discovered. Smallpox was a contagious and fatal disease which killed 300--400
million people during the 20 th century alone. (Antai, D., 2009). The British physician Edward
Jenner invented a vaccine against cowpox and designed vaccine to inoculate humans from
pathogen smallpox in 1796. Edward Jenner was extensively criticized, because it was considered
unreligious to immunize a human with some substance from an infected animal. Since he had
proved that cowpox eruption (postule) can be used for immunizing smallpox. However, the process
of vaccination began during the 18th century. After several years, following his pioneering, Louis
Pasteur invented a vaccine for protecting against Anthrax and Rabies. Consequently,
immunizations were administered for not only preventing from infection, but also to elicit an
immune response more rigorously with fewer hazards than further infection. By the end of the

13
19th century, immunization against rabies, cholera, plague and typhoid was developed and were
commonly used in practice. (Babalola, S., 2009).

2.2 DETERMINANTS OF FULL CHILD IMMUNIZATION

Determinants of childhood vaccination uptake still remain complex, and are dependent on various
socioeconomic, demographic factors and also supply and demand factors, Supply-related factors
are important however, the adequate supply of vaccines do not necessarily translate into children
being vaccinated. Several studies suggest that factors associated with vaccination demand/uptake
and acceptance are even more complex. emphasizing the need to eliminate the unnecessary
inequities associated with norms and structural factors that may hinder increased vaccination
uptake. Maternal characteristics, sex of child and birth order of the child, place of delivery and
antenatal care (ANC) follow up, wealth index, knowledge about vaccination and place of residence
could influence immunization coverage among children. (Becker, S et a, 2000).

2.3 CHARACTERISTICS OF THE MOTHER

Characteristics of the Mothers are the most known determinant factors of child immunization. A
study done at southern district of Nigeria revealed that mothers with lowest education and
unemployed women were less likely to complete a child immunization. Education empowers a
woman to access relevant health services, interact effectively and assimilate information relating
to prenatal care, childhood immunizations and nutritional needs. mentioned that maternal
education is a significant determinant of child health and no other factor has such impact. observed
maternal education as the strongest independent factor for protection against childhood mortality.
In the study conducted in Ghana there was an obvious significance in children’s vaccination
pattern with mother’s education level. found that mothers who completed at least primary level of
education were 1.7 times more likely to have their children fully immunized compared to those
who had no education. (Centers for Disease Control and Prevention, 1999).

2.4 Health Professionals’ Role

To meet the growing demands for more vaccinated individuals in the United States, it is imperative
that health professionals accept their role of authority and urge the population to receive
recommended vaccines. Physicians and pharmacists hold important positions of authority in the
field of health care, and patients are more inclined to believe the education provided by physicians
and pharmacists. The specialized training that physicians and pharmacists receive places them in
a trusted position to patients who seek out their expert medical advice. Physicians and pharmacists
are professionals that use a combination of technical healthcare skill and professional skill to
successfully relate complex health information to patients in ways that are relevant and important
to patients. Physicians and pharmacists can use the trust made possible by their unique skill set to
educate patients on vaccinations so patients are able to make the right choice for their health with
the help of their physician or pharmacists’ expert recommendations. (MMWR., 2014).

14
2.5 Education
In order to improve vaccination rates, health care professionals must start at the source and begin
educating patients on vaccinations. The overwhelming amount of medical information presented
to patients can easily become confusing, and it is becoming increasingly common to come across
incorrect medical information on social media sites and various websites. Patients are now more
and more susceptible to incorrect or misleading medical information, and it is the role of physicians
and pharmacists to make sure patients are provided with correct medical information so patients
are able to make informed decisions about their healthcare. Many patients require advice when
deciding to receive a vaccination, and it is imperative that physicians and pharmacists are an
available resource for patients wishing to prevent unnecessary illness. A study published in the
Journal of Family Practice was conducted to determine various barriers that patients face when
choosing to receive an immunization, and the top three barriers were found to be lack of education,
fear of safety, and logistical issues that would limit access to vaccines. Vaccinations are an
excellent tool to ensure that children and adults are not able to contract select deadly diseases, but
there are many guidelines and recommendations that must be followed to reduce the risk of adverse
effects caused by the vaccines. Patients rely on physicians and pharmacists to educate them on
many medical decisions such as vaccinations before they make a decision regarding their
treatment. While there are many possible adverse effects associated with every vaccine, they can
be largely avoided by educating patients so they receive vaccines when it is appropriate and they
are comfortable. (Mark R, Darden P, 1999).

2.6 IMMUNIZATION IS VALUABLE

Immunization saves lives. This statement is echoed all over the world daily in immunization
campaigns because it is true. Routine immunization of children protects them from debilitating
diseases. Children can grow up healthy and reach their full intended potential in life. Even when
protection by immunization from a disease is incomplete, if a child contracts that disease the illness
is less severe and the outcome is better than if the child was not vaccinated Vaccines improve
quality of life as they can prevent diseases that can cause physical and mental disability such as
poliomyelitis and meningitis. Immunization has also helped to enable people to travel around the
world and remain protected from certain infectious diseases; immunization requirement for
travelers depend on where a person is travelling to and from where. Most common vaccines for
travelers include yellow fever, hepatitis and influenza. Life expectancy and severe outcomes of
some diseases in the elderly can be overcome by immunization; older patients who receive
vaccinations for influenza have reduced risks of suffering sequelae such as strokes and heart
attacks Immunization, due to its effect on child survival has lead to the empowerment of women
as they spend more time being more productive than looking after sick or disabled children.
Immunization has also decreased the need for women to bear more children as it leads to improved
survival. (UNICEF. , 2000.).

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2.7 Importance of immunizations
Immunization is not only valuable to individuals and families but also to communities, societies
and governments. If in a community sufficient numbers of people have been immunized against
an infectious disease, the likelihood of disease outbreaks occurring within that community is
reduced. Immunized individuals protect those that are not immunized by a phenomenon referred
to as herd immunity. Herd protection or herd immunity occurs when the level of immunity against
a particular disease is high enough in a community to prevent transmission of the particular
pathogen and thus to decrease the likelihood of the disease occurring in that community. In such
instances, the whole “herd”, or community, is protected against the disease. Immunizations can
foster the economic growth of a country in a number of ways. Firstly, the adults in a society can
spend less time looking after ill children and more time in their jobs. Children can grow up and
become productive members of society if they are immunized and don’t succumb to infectious
diseases. In a study conducted in the Philippines, Bloom and colleagues found that immunizations
not only benefit children with regard to their health but it also improved their cognitive ability in
later childhood which also translated into more productive and economically active adults. Vaccine
preventable illnesses such as Haemophilus influenzae and pneumococcal infections including
meningitis can have clinical sequelae which can result in severe long term outcomes including
seizures, mental retardation, sensorineural hearing loss and even motor abnormalities. (World
Bank,, 1990).

2.8 IMMUNIZATION COVERAGE

For different reasons immunization coverage is not optimal in both developed and developing
countries. Before the WHO EPI of 1974, routine immunization was mostly the privilege of people
in the developed world. This EPI launch was an attempt to make immunizations available to all
the world’s children. Now about 75% of the world’s children receive the required immunizations
before the age of one year and immunization continues to save millions of children’s lives all over
the globe. It is estimated that three million lives are saved by immunizations each year. The uptake
of immunizations has been generally very good in the developed world. The decline in
immunization uptake started in the late 1990‟s and it can be attributed mainly to misinformation
about vaccine effectiveness and safety. For as long as immunizations have been available, so long
have there been people who are against immunization. In recent years this anti-vaccination lobby
that claims vaccines cause cancer, learning and developmental delays, allergies and other illnesses
has gained much publicity. One of the reasons for suboptimal vaccination has been the issue of
combination vaccines. The combination vaccine against measles, mumps and rubella (MMR) has
in particular been blamed for causing inflammatory bowel disease and autism. There are many
other combination vaccines available and while some parents are skeptical about them, most prefer
them as they reduce the number of injections given to a child at a single visit. Vaccination safety
and efficacy in the developed countries has come under scrutiny due to exposure to information
and religious or cultural beliefs in general vaccines are safe and effective; most of the complaints
raised against them are incorrect and are not supported by scientific evidence. It is important for
health care workers to be well informed and educated to challenge misconceptions because

16
vaccines are beneficial. With their doubts and questions, the anti-vaccination lobbyists have
brought vaccine controversies into the public domain. Although this may have influenced the
public domain, it does not have much influence on the scientific evaluation and surveillance of
vaccinations. A vaccine for rotavirus infection was withdrawn after reports emanating from
vaccine surveillance that it was associated with the development of intussusception in vaccinated
children and this relationship was later confirmed in a study. (Oxford: Oxford University Press,
1996.).

2.9 IMMUNIZATIONS IN SOUTH AFRICA:

One of the goals of the South African national EPI goals is to achieve immunization coverage of
90% for each vaccine in the routine EPI schedule in 80% of the districts by 2005 (National
Department of Health, 2005). According to the demographic health survey of 2003 by the Medical
Research Council, the reported immunization coverage rate in children aged 12 and 23 months of
age ranged from 62 % for measles vaccine to 81 % for Bacille Calmette-Guerin (BCG) vaccination
in 2003 with the total immunization coverage rate of 79 % in that same year The immunization
coverage target in South Africa is 90% for all children under one year and it is yet to be reached.
In 2009, the South African National Department of Health added two new vaccines to the routine
immunization schedule: the pneumococcal vaccine and the rotavirus vaccine. Streptococcus
pneumoniae is an organism that is associated with a number of diseases with a high rate of
mortality and morbidity. Furthermore, the organism is associated with the challenge of antibiotic
resistance. Addition of this vaccine will not only help to reduce its associated morbidity and
mortality but it will also lead to a reduction in the antibiotic requirements for treatment of its
associated diseases. Diarrhea accounts for 18% of the under-five mortality rate in the developing
world. Rotavirus infection is one of the leading causes of diarrhea disease and the introduction of
the vaccine against Rotavirus is an important step in reducing its impact on the under-five mortality
rate. The benefits of all the healthcare changes are still to be made evident. The biggest challenge
remains for government policies to reach all the children of South Africa, especially those in poor
rural communities where service delivery still lags far behind. (WHO, 2015).

2.10 Ministry of Health (MOH) Disease Surveillance Program Structure

National Level: Disease surveillance activities are the responsibilities of the 4 th Direction the
office for Disease Surveillance and Epidemiology. The office coordinates disease surveillance,
outbreak investigations, and epidemiological research. The reporting structure is based on WHO.
Although the relative time that vaccinations have been available is short, the impact they have had
is hard to exaggerate. The success of vaccination on reducing mortality would lead to the forming
of national vaccination programmes still in use today. For some vaccines, when the coverage in
the population is high enough the disease can be eradicated altogether. Smallpox, for example, was
a good contender for eradication as symptoms were evident and recognizable, the lag time between
exposure and disease was short (limiting transmission of disease in the population), the vaccination
provided life-long immunity to disease and only humans were affected i.e. there was no animal
reservoir, Further, not all vaccines offer life-long protection against disease with immunity waning

17
over time e.g. pertussis and diphtheria or the strain in circulation continuously changing e.g.
influenza. These factors, therefore, make eradication of some diseases nearly impossible and the
only option is to prevent and control the diseases in the population and focus on reducing the
mortality and complications associated with those diseases. (WHO , 2015).

2.11 HERD IMMUNITY

Disease prevention and control in a population requires enough individuals having immunity to a
particular disease. This concept is known as herd immunity. Herd immunity can be achieved
through natural immunity, whereby the individual has had the disease and recovered: acquired
immunity, which is when the person has been vaccinated and is no longer at risk of contracting the
disease. Herd immunity is best achieved through the use of immunization programmes, which
work by inducing long-term protection without the risk to the individual of acquiring the natural
disease. There is also an indirect effect of vaccinations or ‘herd protective’ effect, whereby the
transmission of infection (person-to-person) within a population is hindered (as the number of
individuals becomes immune from infection) and an increase in herd immunity could see a
decreased risk of an uninfected person becoming infected. This can also be thought of as protection
for persons who are unvaccinated in the population. (Ramalingaswami V, Jonsson U, Rohde J. ,
1996).

2.12 Public health perspective

Vaccination is considered to be one of the greatest achievements of public health. It has greatly
reduced the mortality and morbidity of various infectious diseases. WHO estimates that
immunization saves more than 2,5 million lives worldwide each year. Thus, maintaining high
vaccination coverage is necessary in order to control vaccine-preventable diseases. Efficacious
vaccines not only protect the immunized population, but can also reduce disease among
unimmunized individuals in the community through ―indirect effects‖ or so-called herd
immunity, when a sufficient proportion of the group is immune. In general a high level of vaccine
coverage is required to achieve elimination although due to herd immunity, some diseases can be
eliminated without 100% immunization coverage. The overall aim of the Swedish public health
policy is ‖To create social conditions to ensure good health on equal terms for the entire population,
Based on this, Sweden has identified 11 different areas of public health where "protection against
communicable diseases" constitutes a specific target. It is also stated that vulnerable groups such
as children, elderly and immigrants are particularly important target groups for preventive health
care. (Prislin R, Dyer JA, Blakely CH, Johnson CD, 1998).

2.13 In Europe
Estimated current immunization coverage rates in the WHO European Region are not sufficient to
ensure herd immunity and stop the spread of VPDs in the Region. In some countries with
previously high coverage, the rates have now fallen well below the 95% threshold recommended
by WHO. In general, at the European level there is little information on vaccination coverage
among hard-to-reach/serve populations. The reported data is commonly based on surveys or data

18
collected during outbreaks. A recent report from ECDC shows that vaccination coverage for
different underserved groups is in general low with great variability: 7- 46% among religious
groups, 0.6-65% among anthroposophic communities and 0-82% for nomadic groups (Travellers
and Roma) (5). Further, the report suggests that in some countries the childhood vaccine uptake is
lower among migrants than in the indigenous population One of the general findings was that the
majority of the countries lack specific national laws and regulations on migrant immunization. In
addition, there is no body assigned with the mission of monitoring immunization in the migrant
population. (Ramalingaswami V, Jonsson U, Rohde J. The Asian enigma. , 2006).

2.14 In Sweden
The Public Health Agency of Sweden is responsible for surveillance and prevention of
communicable diseases. The agency works closely with regional health agencies and County
Medical Officers to improve and sustain high immunization coverage of VPDs. The Swedish
national immunization program (NIP) is offered free of charge and the county councils and
municipalities are responsible for implementing the NIP through, despite a good vaccination
coverage rate, during the last years there have been several outbreaks of imported measles and
rubella. In 2012, there were 30 cases of measles and 50 cases of rubella reported in Sweden. These
outbreaks point to the presence of pockets of susceptible populations. Local immunization
statistics show areas of low MMR coverage in Sweden, within specific communities. Migrant
communities, particularly undocumented groups, are also potential pockets of susceptibility, due
to their vulnerable situation and limited access to health care. In 2011 Sweden reported its first
case of congenital rubella since 1985. It was an unvaccinated migrant woman from Vietnam, who
arrived in Sweden at the age of 17 years and was not reached by complementary vaccination
against rubella. Later during a visit to Vietnam she contracted rubella in early pregnancy. (Mark
R, Darden P, 2010).

2.15 VACCINE SAFETY

The introduction of new vaccines (or medicines) follows extensive safety monitoring and for most
vaccines included in the national programmers, there is data on the longer-term safety of these
vaccines in the population. However, for annual vaccines like influenza – that alter each year
depending on the circulating strains, longer-term information on their safety in a population is
generally not available In these instances, very rare outcomes from the vaccination will only be
discovered from post- vaccination surveillance in a larger population A challenge with adverse
events following vaccination (particularly for those that are rare) is identifying whether it was the
vaccine itself that caused the outcome or just something that randomly occurred in that population.
(WHO, 1999; ).

2.16 VACCINE EFFICACY AND EFFECTIVENESS

Vaccine efficacy is a measure of the difference in disease risk between vaccinated and
unvaccinated individuals under ideal conditions. Randomised control trials (RCTs) are used to
ascertain efficacy outcomes, whereby optimal conditions are maintained throughout the trial

19
period. This means that the efficacy outcomes are not directly generalisable to the general
population. Vaccine effectiveness (VE) is a term used to reflect outcomes in a non-controlled
environment and from a public health perspective, collecting data on vaccination individuals in
the population is preferable to RCTs, as outcomes are more reflective of what is happening in the
population where the environment is not controlled The Swedish healthcare registers provide the
means for us to assess effectiveness in real-life settings and factor in access, distribution and detect
changes in herd immunity. (WHO, 2016).

2.17 Parents′ Knowledge and Attitudes on Childhood Immunization

Immunization has greatly reduced the burden of infectious diseases Immunization prevents illness,
disability and death from vaccine-preventable diseases including diphtheria, measles, pertussis,
pneumonia, polio, rotavirus diarrhoea, rubella and tetanus Parents’ knowledge about immunization
and their attitudes towards them are likely influence uptake. Previous studies revealed
misconceptions on parents’ knowledge and negative attitudes towards childhood immunization.
Mothers’ knowledge about vaccination was found to be quite low and their educational status was
significantly associated with child’s coverage. Negative attitude, for example mothers fear from
vaccination, was found to be significantly affected the immunization status of their children
assessed parents’ knowledge on immunization and noted that most of the respondents can be
characterized as having a positive opinion about vaccination, although 20-40% of respondents
indicated insufficient knowledge on this issue. Greater concern about the safety of vaccines was
expressed by older parents, residents of towns and highly educated individuals On the other hand
researchers in developed world found parents’ attitudes and beliefs had little effect on their
children’s immunization level. Despite the fact that local and systemic reactions to vaccines are
identified, but they were found to be one of the barriers to childhood immunization among other
factors. (Yousif MA, Ahmed Abdulrahman Albarraq, , 2013).

20
 CHAPTER 3
METHODOLOGY
3.1 INTRODUCTION
This methodology of the study is present in this chapter The section discussed in the chapter
include: a description of the study area data collection instrument and procedures sample size
determination simple procedure study variable data.

3.2 RESEARCH METHOD AND STUDY DESIGN

3.2.1. The Research method

cross sectional study was used especially descriptive and The quantitative research method was
used in order to answer the research questions of this study. Research study to Assess of
Knowledge and Attitude and Practice of Parents about Immunization in Erigavo City,

3.2 Research population

The target population of this study was 130 the estimated study population selected of Parents
about Immunization conceptual in Erigavo city.

3.3 Sample size

To determine the sample size, the researcher was guided by the Slovene’s sample selection
formula, which is:
N
n=
1 + N(e2 )

130
n=
1 + 130(0.052 )

130
n=
1 + 130(0.0025)

130
n= = 98.1132075472
1.325

n = 99

21
N: Population size
n: Sample size
e: Level of Significance = e=0.05=e2 = (0.05)2= 0.0025

3.3.1 Study duration

The study duration was from May to October, 2019.

3.4. The Sampling technique

The technique that we selected the sample was systemic random sampling which we used the
interval number of 2 according to the result we obtained from the formula below.

Where this indicates for:

K- CLASS INTERVAL
N -TOTAL NUMBER OF POPULATION
N- SAMPLE POPULATION

N 130
K= =K =2
N 99
3.5. The Data collection method
Data was collected through face-to-face interviews using a structured questionnaire. The research
instrument used was a structured questionnaire which collected data on knowledge attitude and
practice towards among parents about immunizations.

3.6 DATA ANALYSIS

Prior to data analysis, data editing was performed to identify errors and strange values and to
compare them to the questionnaire for correction. Then the data was captured and analyzed using
Statistical Package for Social Sciences (SPSS) software version 22. Data Analysis is the process
of evaluating data using analytical and logical reasoning to examine each component of the data
provided.

22
3.7. Variables measured by the instrument
The dependent variables measured are knowledge and attitude and practice related immunizations
the independent variables include the knowledge attitude and practice status of the respondent and
demographic characteristics such as age, sex, and education.

3.8. ETHICAL CONSIDERATIONS

The following ethical issues were observed during the process of conducting this study: Ethical
clearance was obtained from our supervisor and also the academic dean and the dean of health
science Gollis University – Erigavo Campus.

3.9 Validity and Reliability

3.9.1 Validity
Validity is arguably the most important criteria for the quality of a test. The term validity refers to
whether or not the test measures what it claims to measure. On a test with high validity the items
will be closely linked to the test's intended focus

V= RQ/ TQ
V= validity
RQ= relevant questions
TQ= total questions

3.9.2 Reliability
Test-retest reliability is a measure of reliability obtained by administering the same test twice
over a period of time to a group of individuals.

𝑅= 𝑇𝐷/𝑇𝑄
TD= total difference
TQ=total questionnaire
R= reliability

3.10. STUDY LIMITATIONS

Although it was expected that participants would answer honestly and with integrity, it is also
possible that some of them might hide the truth when giving answers. Also Language barrier: some
respondents don’t understand the English language which causes to translate to Somali language
this problem becomes obstacle to get response easily.

23
 CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND INTERPRETATION

4.1 Introduction
During this chapter in deeply present the analysis of data, and their interpretations. The data
analysis and interpretation was based on the research questions as well as research objectives, this
presentation is divided in to two parts. The first part presents the respondents‟ demographic
information such as, age, gender, education and marital status while the second part of
the presentation deals with, interpretation and analysis of the research questions and
objectives by using SPSS and sometimes in excel software. The following pages are the
data presentations and analysis of research findings

4.2: Characteristics of respondents

Table: 4.2.1Gender of the Respondents

Respondents were also asked to identify their gender and below are the responses:

Frequency Percent Valid Percent Cumulative Percent

Valid Male 21 23.3 23.3 23.3

Female 69 76.7 76.7 100.0

Total 90 100.0 100.0

50
21%
69%
0
male
female

According to the above table 4.2.1 majority of the respondents were female at 76.7%
while 23.3% were male. Therefore this analysis suggested that most of the
Respondents were female.

24
Table: 4.2.2 Marital status of Respondents

Martial

Frequency Percent Valid Percent Cumulative Percent

Valid Single 20 22.2% 22.2 22.2

Married
66 73.3 95.6
73.3%

Divorced 4 4.4% 4.4 100.0

Total 90 100.0 100.0

martial status

married 73.3%
60
50
40 single , 22.2%
30
20
10
0 divorced, 4.4%

single
married
divorced

2-Table 4.2.2 shows that the majorities’ respondents of the study were single which 22.2% is,
This represents to 33 respondents while married are 73.3% which represents to 20 respondents and
the others (divorced and widowers) are 4.4% that indicates the most of married responded the
questions are single.

25
Table 4.2.3 level of education

Cumulative
Frequency Percent Valid Percent Percent

Valid Certificate 45 50.0 50.0 50.0

Degree 5 5.6 5.6 55.6

un able to read and write 40 44.4 44.4 100.0

Total 90 100.0 100.0

50%
5.6% 4.4%

Certificate unable to read/write

degree

3-The above table 4.2.3 shows us most of the respondents 50.0% are attended or hold
at certificate; the respondents are attended bachelor degree , 5.6% of respondents
were un able to read and write are represents 4.4% . That clarifies most people who
takes part to the questioner was certificate holder.

26
Table 4.2.4 Current occupations status

Current occupations status

Cumulative
Frequency Percent Valid Percent Percent

Valid Unemployed 3 3.3 3.3 3.3

Student 5 5.6 5.6 8.9

House wife 50 55.6 55.6 64.4

House Servant 18 20.0 20.0 84.4

Government employ 4 4.4 4.4 88.9

Private employ 10 11.1 11.1 100.0

Total 90 100.0 100.0

100 Student, 92.9

90
80
70 private
house servant employee
60 20.0% govermental 11.1%
50 employee
40 4.4%
30 student
5.6%
20
10 Self-employed, 5.4
house wife unemployed Employed, 1.8%
0 50% 3.3%
Student Self-employed Employed

4-The above figure 4.2.4 shows us most of the respondents 50.0 % are house wife ; while
20.0% of respondents are house servants respondents and 11.1% of the respondents are
private employed , 5.6% are student , 4.4% are governmental employee, 3.3% are
unemployed . That clarifies most people who takes part to the answer was housewife womens.

27
Table 4.2.5 Total Monthly Income

Cumulative
Frequency Percent Valid Percent Percent

Valid Less than $ 100 58 64.4 64.4 64.4

$100-$300 19 21.1 21.1 85.6

$300-$600 10 11.1 11.1 96.7

$600-$900 3 3.3 3.3 100.0

Total 90 100.0 100.0

100
90 90
80
70 58
60
50
40 frequency
30 19 percentage
20
10 10 Cumulative Percent
0 3

5-The above figure 4.2.5 shows us most of the respondents 64.4 % are less then ;
while 21.1% of respondents are 100-300 respondents and 11.1% are respondent 300-
600 , 3.3% are 600-900. That clarifies most people who takes part to the answer was
less than 100$

28
What is the Number of your family members (including yourself)?

Cumulative
Frequency Percent Valid Percent Percent

Valid 1-3 20 22.2 22.2 22.2

4-7 60 66.7 66.7 88.9

More than 7 10 11.1 11.1 100.0

Total 90 100.0 100.0

100%
90%
80%
70%
Cumulative Percent2
60%
percentage2
50%
percentage
40%
Frequency
30%
20 60 10 90
20%
10%
0%
valid 3-Jan 7-Apr More than 7
.

The above figure 4.2.6 shows us most of the respondents 66.7 % are 4-7 ; while
22.2% of respondents are 1-3 , respondents and 11.1% are respondent More than 7
,. That clarifies most people who takes part to the answer was 4-7

29
How far do you live from the nearest health Clinic or Hospital?

Cumulative
Frequency Percent Valid Percent Percent

Valid less than 2 Kilometers 70 77.8 77.8 77.8

3-5 Kilometers 12 13.3 13.3 91.1

6-10 Kilometers 5 5.6 5.6 96.7

More than 10 Kilometers 3 3.3 3.3 100.0

Total 90 100.0 100.0

77.8%
80
70
60
50
Frequency
40
Percent
30
Cumulative Percent
20 13.3%
10 5.6% 3.3.%
0
less than 2 3-5 Kilometers 6-10 More than 10
Kilometers Kilometers Kilometers

Table 4.2.7 shows that the majorities’ respondents of the study were =less than
2kilometers 77.8% is, this represents to 12 respondents while3-5 Kilometers are 13.3%
which represents to 5 respondents and the respondents while36-10 Kilometers are 5.6%
% which represents to 3 respondents More than 10 Kilometers 3.3%.

30
 With whom do you live?

Cumulative
Frequency Percent Valid Percent Percent

Valid Parents 35 38.9 38.9 38.9

Family 45 50.0 50.0 88.9

Friends 2 2.2 2.2 91.1

By Myself 8 8.9 8.9 100.0

Total 90 100.0 100.0

60

50
50

38.9
40

Cumulative Percent
30
Percen
Frequency
20

8.9
10
2.2
0
Parents Family Friends By Myself

Table 4.2.8 shows that the majorities’ respondents of the study were Family 50.0% is,
this represents to 35 respondents while are Parents 38.9% which represents to 45
respondents while are Family 50.0% which represents to 2 respondents while are Friends
2.2% which represents to 8 respondents Myself 8.9 %.

31
 Have you ever heard about immunization?

frequency Cumulative
Percent Valid Percent Percent

valid Yes 63 70.% 70.0 70.0

No 27 30.% 30.0 100.0

Total 90 100.% 100.0 Total

160

140

120

100 70
Cumulative Percent
80
Percent
60 frequency

40 30

20

0
Yes No

Table 4.2.9 shows that the majorities’ respondents of the study were yes 70.0% is, this
represents to 63 respondents while are yes 70.0% which represents to 27 respondents
while are 30% .

32
 Have you radio or television at home?

Cumulative
Frequency Percent Valid Percent Percent

Valid Yes 80 88.9 88.9 88.9

No 10 11.1 11.1 100.0

Total 90 100.0 100.0

100
88.9
90

80

70

60
Frequency
50
Percent
40 Series 3
30

20
11.1
10

0
Yes No

Table 4.2.10 shows that the majorities’ respondents of the study were Yes 88.9% is, this
represents to 80 respondents while are Yes 88.9% which represents to 10 respondents
while are no 11.1%.

33
Where did you first learn about immunization or vaccination?

Cumulative
Frequency Percent Valid Percent Percent

Valid Radio 15 16.7 16.7 16.7

TV 45 50.0 50.0 66.7

Health workers 25 27.8 27.8 94.4

Family, Friends, Neighbours

5 5.6 5.6 100.0
and colleagues

Total 90 100.0 100.0

60

50

40

30 Frequency

20 Percent
Cumulative Percent
10

0
Radio TV Health workers Family, Friends,
Neighbours and
colleagues

Table 4.2.11 shows that the majorities’ respondents of the study were TV 50.0% is, this represents
to 45 respondents while are radio 16.7% which represents to 45 respondents while are TV 50.0% which
represents to 25 respondents while are Health workers 27.8% and which represents to 5 respondents
Family, Friends, Neighbours and colleagues 5.6%.

34
 Who is responsible for making sure a child has their immunization?

Frequency Percent Valid Percent Cumulative Percent

Valid Mother 53 58.9 58.9 58.9

Father 1 1.1 1.1 60.0

Other relative 6 6.7 6.7 66.7

Other Medical professions 30 33.3 33.3 100.0

Total 90 100.0 100.0

70

60

50

40
Frequency
30 Percent
Cumulative Percent
20

10

0
Mother Father Other relative Other Medical
professions

Table 4.2.12 shows that the majorities’ respondents of the study were Mather 58.9% is, this
represents to 53 respondents while are Father 1.1% which represents to 53 respondents while are
Mather 58.9% which represents to 6 respondents while are Other relative 6.7% and which represents to
30 respondents Other Medical professional 33.3%.

35
 How many Children do you have alive

Frequency Percent Valid Percent Cumulative Percent

Valid I dont have children at all 6 6.7 6.7 6.7

I have alive children 70 77.8 77.8 84.4

No Response 14 15.6 15.6 100.0

Total 90 100.0 100.0

90

80

70

60

50
Frequency
40 Percent

30 Cumulative Percent

20

10

0
I dont have children at I have alive children No Response
all

Table 4.2.13 shows that the majorities’ respondents of the study were I have alive children 77.8% is,
this represents to 70 respondents, which represents to 6 respondents while are I don’t have children at
all 6.7% which represents to 70 respondents while are I have alive children 77.8% which represents to
14 respondents while are No Response15.6 % .

36
According to you, is vaccination important?

Frequency Percent Valid Percent Cumulative Percent

Valid Yes 79 87.8 87.8 87.8

No 6 6.7 6.7 94.4

Don't know 5 5.6 5.6 100.0

Total 90 100.0 100.0

100

90

80

70

60
Frequency
50
Percent
40 Cumulative Percent
30

20

10

0
Yes No Don't know

Table 4.2.14 shows that the majorities’ respondents of the study were yes 87.8% is, this represents
to 79 respondents, which represents to 6 respondents while are No 6.7% which represents to 79
respondents while are yes 87.8 % which represents to 5 respondents while are Don't know 5.6 % .

37
 At which age should start a child vaccination

Frequency Percent Valid Percent Cumulative Percent

Valid Month 61 67.8 67.8 67.8

Year 29 32.2 32.2 100.0

Total 90 100.0 100.0

70
61
60

50
Frequency
40
Percent
30 29
Cumulative Percent
20 Cumulative Percent
10 Percent
0
Frequency
Month
Year

Table 4.2.15 shows that the majorities’ respondents of the study were Month 67.8 % is, this
represents to 61 respondents, which represents to 29 respondents while are Year 32.2% which
represents to 61 respondents while are Month 67.8 % which represents to 29 respondents while are
Year 32.2%.

38
 How do you evaluate the immunization services in your area?

c Percent Valid Percent Cumulative Percent

Valid It is good 20 22.2 22.2 22.2

It is not too bad 22 24.4 24.4 46.7

It is bad 18 20.0 20.0 66.7

No idea 30 33.3 33.3 100.0

Total 90 100.0 100.0

33.3
35

30
24.4
25 22.2
20
20 Frequency

15 Percent
Cumulative Percent
10

0
It is good It is not too It is bad No idea
bad

Table 4.2.16 shows that the majorities’ respondents of the study were No idea 33.3% is, this
represents to 30 respondents, which represents to 20 respondents while are It is good 24.4% which
represents to 18 respondents while are It is bad 20.0% which represents to 30 respondents while are
No idea 33.3%.

39
 Where did you get the immunization services in your area?

Frequency Percent Valid Percent Cumulative Percent

Valid Health centres 84 93.3 93.3 93.3

Elsewhere 4 4.4 4.4 97.8

I have no Idea 2 2.2 2.2 100.0

Total 90 100.0 100.0

100
90
80
70
60 Percent
50 Valid Percent
40 Cumulative Percent

30
20
10
0
Health centres Elsewhere I have no Idea
Table
4.2.17 shows that the majorities’ respondents of the study were Health centers 93.3% is, this
represents to 84 respondents, which represents to 4 respondents while are It is Elsewhere 4.4% which
represents to 2 respondents while are It is bad 2.2% which represents to84 respondents while are
Health centre’s 93.3%.

40
 What do you think the immunizations can protect many disease?

Frequency Percent Valid Percent Cumulative Percent

Valid Agreed 32 35.6 35.6 35.6

Strong Agreed 30 33.3 33.3 68.9

Disagreed 17 17 18.9 87.8

Strong Disagreed 11 12.2 12.2 100.0

Total 90 100.0 100.0

90
80
70
60
50
Frequency
40
30 Percent
20 Cumulative Percent Valid Percent
10 Valid Percent
Cumulative Percent
0 Percent
Frequency

Table 4.2.18 shows that the majorities’ respondents of the study were Agreed 35.6% is, this
represents to 32 respondents, which represents to 30 respondents while are Strong Agreed 33.3%
which represents to 17respondents while are Disagreed 18.9% which represents to11 respondents
while are No idea 12.2%.

41
 What is your attitude toward immunization?

Frequency Percent Valid Percent Cumulative Percent

Valid Very serious 45 50.0 50.0 50.0

Somewhat serious 20 22.2 22.2 72.2

Not very serious 6 6.7 6.7 78.9

I have no idea 19 21.1 21.1 100.0

Total 90 100.0 100.0

100%

80%

60% Cumulative Percent

50 22.2 6.7 21.1
Percent
40%
Frequency
20%

0%
Very serious Somewhat Not very I have no idea
serious serious

Table 4.2.19 shows that the majorities’ respondents of the study were Very serious 50.0% is, this
represents to 45 respondents, which represents to 20 respondents while are Somewhat serious 22.2%
which represents to 6 respondents while are Not very serious 6.7% which represents to19 respondents
while are No idea 21.1%..

42
 What is your attitude toward vaccination prevent infectious diseases?

Frequency Percent Valid Percent Cumulative Percent

Valid Yes 30 33.3 33.3 33.3

No 52 57.8 57.8 91.1

Don't know 8 8.9 8.9 100.0

Total 90 100.0 100.0

180

160

140 57.8

120

100 Cumulative Percent

80 Percent
33.3
Frequency
60

40

20 8.9

0
Yes No Don't know

Table 4.2.20 shows that the majorities’ respondents of the study were yes 57.8% is, this represents
to 30 respondents, which represents to 52 respondents while are no 57.8% which represents to 8
respondents while are Don't know 8.9% .

43
 do you think vaccination could maintain child health?

Frequency Percent Valid Percent Cumulative Percent

Valid Yes 44 48.9 48.9 48.9

No 39 43.3 43.3 92.2

Don't know 7 7.8 7.8 100.0

Total 90 100.0 100.0

50
44
45
39
40
35
30 Frequency
25 Percent

20 Cumulative Percent

15
10 7

5
0
Yes No Don't know

Table 4.2.21 shows that the majorities’ respondents of the study were yes 48.9% is, this represents
to 44 respondents, which represents to 39 respondents while are no 43.3% which represents to 8
respondents while are Don't know 7.8% .

44
 Hepatitis measles virus could be prevented by vaccination

Frequency Percent Valid Percent Cumulative Percent

Valid Yes 59 65.6 65.6 65.6

No 21 23.3 23.3 88.9

Don't know 10 11.1 11.1 100.0

Total 90 100.0 100.0

70
59
60

50

40 Frequency
Percent
30
21 Cumulative Percent
20

10 10 Cumulative Percent
Percent
0
Frequency
Yes
No
Don't know

Table 4.2.22 shows that the majorities’ respondents of the study were yes 65.6% is, this represents
to 59 respondents, which represents to 21 respondents while are no 23.3% which represents to 10
respondents while are Don't know 7.811.1%

45
 What do you think about vaccination benefits?

Frequency Percent Valid Percent Cumulative Percent

Valid Beneficial 48 53.3 53.3 53.3

Not Beneficial 25 27.8 27.8 81.1

I don't know 17 18.9 18.9 100.0

Total 90 100.0 100.0

60
53.3

50

40

Frequency
30 27.8
Percent

18.9 Cumulative Percent

20

10
5

0
Beneficial Not Beneficial I don't know Category 4

Table 4.2.23 shows that the majorities’ respondents of the study were Beneficial 53.3% is, this
represents to 48 respondents, which represents to 25 respondents while are Not Beneficial 27.8%
which represents to 17 respondents while are Don't know 18.9%.

46
 What do you feel when vaccinating your child?

Frequency Percent Valid Percent Cumulative Percent

Valid Save 76 84.4 84.4 84.4

Fear 14 15.6 15.6 100.0

Total 90 100.0 100.0

90 84.4

80

70

60

50 Frequency

40 Percent
Cumulative Percent
30

20 15.6

10

0
Save Fear
Table
4.2.24 shows that the majorities’ respondents of the study were save 84.4% is, this represents to 76
respondents, which represents to 14 respondents while are fear.15.6%.

47
 Will you advice your relatives and family to immunize their children?

Frequency Percent Valid Percent Cumulative Percent

Valid Yes 40 44.4 44.4 44.4

No 50 55.6 55.6 100.0

Total 90 100.0 100.0

100
90
80
70
55.6
60 Frequency
44.4 Percent
50
40 Cumulative Percent

30
20
10
0
Yes No

Table 4.2.25 shows that the majorities’ respondents of the study were no 55.6% is, this represents
to 50 respondents, which represents to 40 respondents while are yes44.4%.

48
 Will you search for other available vaccines for your children?

Frequency Percent Valid Percent Cumulative Percent

Valid Yes 50 55.6 55.6 55.6

No 40 44.4 44.4 44.4

Total 90 100.0 100.0

60 55.6

50 44.4

40
Frequency

30 Percent
Cumulative Percent
20

10

0
Yes No

Table 4.2.26 shows that the majorities’ respondents of the study were yes 55.6% is, this represents
to 50 respondents, which represents to 40 respondents while are fear.44.4%

49
 Do you follow the obligatory vaccination programs?

Frequency Percent Valid Percent Cumulative Percent

Valid Yes 40 44.4 44.4 0.44.4.

No 50 55.6 55.6 0.55.6

Total 90 100.0 100.0 100.00

120

100

80 55.6

Cumulative Percent
60 44.4
Percent
Frequency
40

20

0
Yes No
Table
4.2.27 shows that the majorities’ respondents of the study were no 55.6% is, this represents to 50
respondents, which represents to 40respondents while are yes44.4%.

50
 Do you think vaccination decreases the rates of mortality and disabilities?

Frequency Percent Valid Percent Cumulative Percent

Valid Yes 10 11.1 11.1 11.1

No 80 88.9 88.9 100.0

Total 90 100.0 100.0

100
80
88.9
60
11.1 Frequency
40
80 Percent Percent
20 10
0
Frequency
Yes

No

Table 4.2.28 shows that the majorities’ respondents of the study were no 88.9% is, this represents
to 80 respondents, which represents to 10 respondents while are yes.11.1%.

51
 Do you think immunization prevents childhood disease?

Frequency Percent Valid Percent Cumulative Percent

Valid Yes 30 33.3 33.3 33.3

No 40 44.4 44.4 44.4

Don't know 20 22.2 22.2 22.2

Total 90 100.0 100.0 100.0

50
44.4%
45

40

35 33.3%

30
Frequency
25 22.2% Percent
20 Cumulative Percent
15

10

0
Yes No Don't know

Table 4.2.29 shows that the majorities’ respondents of the study were no 44.4% is, this represents
to 40 respondents, which represents to 20 respondents while are don’t know 22.2%. And which
represents to 30 respondents while are don’t know 33.3%.

52
 Importance of vaccination?

Frequency Percent Valid Percent Cumulative Percent

Valid Prevent infectious diseases 15 16.7 16.7 16.7

Maintain child health 40 44.4 44.4 61.1

reduce child mortality rate 15 16.7 16.7 77.8

Protect children from complication 20 22.2 22.2 100.0

Total 90 100.0 100.0

44.4
45
40
35
30
25 22.2
Frequency
20 16.7 16.7
precentage
15
10
5
0
Prevent Maintain child reduce child Protect children
infectious health mortality rate from
diseases complication

Table 4.2.30 shows that the majorities’ respondents of the study were Maintain child health 44.4% is,
this represents to 40 respondents, which represents to 15 respondents while are Prevent infectious
diseases 16.7%. Which represents to 40 respondents while are Maintain child health 44.4%. Which
represents to 15 respondents while are 16.7%. Which represents to 20 respondents while are 22.2%.

53
 Vaccination important for boy than girls

Frequency Percent Valid Percent Cumulative Percent

Valid Agreed 40 44.4 44.4 44.4

Strong agreed 30 33.3 33.3 77.8

Disagreed 20 22.2 22.2 100.0

Total 90 100.0 100.0

50
44.4
45

40

35 33.3

30
Frequency
25 22.2 Percent
20 Cumulative Percent
15

10

0
Agreed Strong agreed Disagreed

Table 4.2.31 shows that the majorities’ respondents of the study were agree 44.4% is, this represents

to 40 respondents, which represents to 30 respondents while are strong agree 33.3%. Which represents
to 20 respondents while are Disagreed 22.2%.

54
 CHAPTER FIVE

CONCLUSIONS AND RECOMMENDATIONS

5.1 Conclusion

There is no exaggeration to assert that vaccination is one of the greatest scientific discoveries ever
made. It protects many children from getting sick and dead from dreadful diseases, thereby
reducing the agony of many parents. So, there is necessity for the parents to develop unequivocal
knowledge and perceptions about vaccinations. Because unequivocal knowledge and practices
helps to develop positive attitude towards vaccination and thus their contribution to vaccination.
It helps to reduce the burden of dreadful infectious diseases, which are best controlled by
vaccination.

Vaccines are cited as one of the top ten greatest disease prevention tools of recent history, the
increase in vaccines recommended specifically for adolescents is a relatively new development;
therefore, the process of vaccine delivery specifically for adolescents needs to develop as well.
Now that there are more vaccines targeted specifically for adolescents, focusing on vaccine
delivery to this population will help to improve chances of successful prevention of disease and to
meet the goals of improving vaccination rates, erasing disparities, and preventing disease.

Vaccination is frequently cited as one of the most efficient, low-cost and high-impact
public health measures for preventing disease. Although many of the vaccine- preventable diseases
(VPD) have the potential to be eliminated, globally they still represent a major cause of illness and
mortality among children, adolescents and adults.

An estimated 2.1 million people around the world died in 2002 of diseases that are
otherwise preventable by widely use of vaccines, among these, 1.4 million children were under the
age of five, and over 500 000 of these childhood deaths were caused by measles. In Europe more
than 100 000 cases of measles. And 30 000 cases of rubella have been reported in the last four
years. Vaccination is considered to be one of the greatest achievements of public health. It has
greatly reduced the mortality and morbidity of various infectious diseases. Efficacious vaccines
not only protect the immunized population, but can also reduce disease among unimmunized
individuals in the community through ―indirect effects‖ or so-called herd immunity, when a
sufficient proportion of the group is immune. In general, a high level of vaccine coverage is
required to achieve elimination although due to herd immunity, some diseases can be eliminated
without 100% immunization coverage. (The study informs that undocumented parents are aware
of their child‘s rights to receive vaccinations but fear of revealing their illegal status overrides their
willingness to vaccinate their child. Thus, additional and specific efforts to restore trust in the
health care system are needed.

55
 5.2 RECOMMENDATIONS
Based on the findings from the study some recommendations are

1. It would be much helpful if awareness creation activities like disseminating important

information on immunizations programs in the community.
2. Counseling and education tailored according to different target group needs.
3. Healthcare practitioners should inform parents of the need for adolescent visits.
4. Recommend vaccination for adolescents to every adolescent and their parents
5. Discuss vaccination for adolescents with every adolescent and their parents at every
healthcare visit to improve perceived prevention benefits of vaccination.
6. Be prepared to discuss possible vaccine side effects and misconceptions effectively with
poor populations.
7. Consider schools as an environment to deliver vaccination related messages to students.
8. Consider the perceptions of adolescents, in addition to their parents, when designing pro-
vaccine interventions.
9. The district administration should engage local leaders in their attempt to operationalize
the district health plan. Local community involvement is critical to any vaccination
prevention plans whether national or local in scope.
10. The Ministry of Health and Social Services should build the capacity of health workers by
providing them with skills for better client education.
11. Lastly, government and other institutions such as non-governmental agencies should make
it their ultimate aim of publicizing the awareness of vaccinations.

56
Bibliography
Ahmed Abdullah Saleh Alenazi . (October 2017)). Assessment of Knowledge and Attitude and Practice of
Parents about Immunization in Jeddah City, 2017. Imam Abdulrahman bin Faisal University,King
Khalid University,Batterjee medical college,Ibn sina National college., 2939-2943page.

Antai, D. (2009). Faith and child survival: the role of religion in childhood immunization in Nigeria.religion
in childhood immunization in Nigeria. Journal of Biosocial Science, , 57-76page.

Babalola, S. (2009). Determinants of the Uptake of the Full Dose of Diphtheria-Pertussis-Tetanus Vaccines
(DPT3) in Northern Nigeria:. Maternal Child Health Journal, 550-558pahe.

Becker, S et a. (2000). The determinants of use of maternal and child health services in Metro Cebu,the
Philippines. Health Transition Review, , 77-89page.

Centers for Disease Control and Prevention. (1999). impact of vaccines universally recommended for
children— United States, 1990–1998. 238–243page.

Doshi, Reena Hemendra. (2014). Assessing trends in measles epidemiology, immunization coverage,
vaccine efficacy, cost-effectiveness to identify practical strategies for measles elimination.
University of California, 1-106page.

Kgomotso Lovey Sehume. (2011). CHILDHOOD IMMUNIZATION IN MMAKAUNYANE VILLAGE IN THE

NORTH WEST PROVINCE OF SOUTH AFRICA. UNIVERSITY OF LIMPOPO, 1-79page.

Mark R, Darden P. (1999). Children’s immunizations: The gap between parents andproviders. Health Mark
Quarterly, . 700-714page.

Mark R, Darden P. (2010). Children’s immunizations: The gap between parents and providers. . 1-
714.page.

MMWR. (2014). National, state, and urban area vaccination coverage levels among childrenaged19-35
months in the United States. 585-589page.

Ms.Mereena,Mrs.Sujatha.R. (Sep.-Oct. 2014). A Study on Knowledge and Attitude Regarding Vaccines

among Mothers of Under Five Children. IOSR Journal of Nursing and Health Science , 2320–
1959page.

Omer Qutaiba Bader Aldeen Allela,. (October, 2017). Knowledge and Attitude of Immunization among
IIUM Pharmacy Students. College of Pharmacy, University of Duhok, Duhok, Kurdistan Region,
Iraq-Journal of Basic and Clinical Pharmacy,, 65-69page.

Onta SR. (1998). The quality of immunization data from routine primary heath care reports. Health Policy
and Planning., 131-139.page.

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Oxford: Oxford University Press. ( 1996.). Human Development Report. . Published for the United Nations
Development Program., 221-345page.

Prislin R, Dyer JA, Blakely CH, Johnson CD. (1998). Immunization status and sociodemographic
characteristics: the mediating role of beliefs, attitudes, and perceived control . Public Health. ,
1821-1826page.

Ramalingaswami V, Jonsson U, Rohde J. . (1996). The Asian enigma. The progress of nations.New York:
Unicef, 1. 11-17page.

Ramalingaswami V, Jonsson U, Rohde J. The Asian enigma. . (2006). The progress of nations Published for
the United Nations Development Program. The Health Belief Model, 1-64page.

Richard Brendan Noggle. (12-7-2007). Adolescent Knowledge, Attitudes, and Beliefs toward Vaccination.
Georgia State University,School of Public Health, 1-83page.

UNICEF. (17 May 2017). Humanitarian Situation Report Horn of Africa Measles Outbreak Response.
Ethiopia, Kenya, Somalia, 1-5page.

UNICEF. . (2000.). The state of the world’s children New York: Unicef, . 1-18page.

WHO. ( 1999; ). Global control of vaccine-preventable diseases: how progress can be evaluated. . Reviews
of Infectious Diseases., 49-54.page.

WHO . (2015). Health report east african region. 1-19page.

WHO. (2015). Health report. 1-17page.

WHO. (2016). 1-8page.

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Research for Development, Health Research:, 1-55page.

Yousif MA, Ahmed Abdulrahman Albarraq, . (2013). Parents′ Knowledge and Attitudes on Childhood
Immunization, Taif, Saudi Arabia. Journal of Vaccines & Vaccination , 1-5page.

58
Appendix II
Questionnaire

Gollis University
Erigavo Campus
Faculty of nursing

Dear of respondent

We are the students from Gollis University doing Bachelor degree in nursing, we are conducting
a study whose objective is to generate, Information of the knowledge attitude and prevention
regarding hepatitis B among medical students in erigavo district. We kindly requested you to fill
in this questionnaire with a lot of sincerely and to the best of your knowledge, the data you provide
will be only used for academic purpose and the information you offer will be treated with most
confidently, your contribution of answering these questions will be highly appreciated.

Thanks a lot.

Part one: Profile of the Respondents

1. Gender
A) Male B) Female

2. Marital status
A) Single B) Married C) divorced

3. Level of education attained

59
A) Certificate B) diploma C) degree D) master’s degree

E un able to read and write

4. Age of the respondent (years)

A. 18- 21
B. 22- 25
C. 26- 29
D. 32-35

5. Total monthly income

1. Less than $100

2. $100 – $300
3. $300 – $600
4. $600 – $900

6. What is your current Occupation?

1. Unemployed
2. Student
3. House wife
4. House servant
5. Government employ
6. Private employ

7. Size of House hold/ family members in the household

1. One ( )
2. Two ( )
3. Three ( )
4. Four ( )
5. Five ( )
6. Above five ( )

8. What is the number of your family members (including yourself)?

1. 1 – 3

60
 2. 4-7
3. More than 7

9. How far do you live from the nearest health clinic or hospital?
1. Less than 2 kilometres
2. 3–5 kilometres
3. 6–10 kilometres
4. More than 10 kilometres

10. With whom do you live?

1. Parents
2. Family
3. Friends
4. By myself
5. My hand band and me
6. Other/others (please specify) ……………………

11. What is your Husband’s level of education?

A. No education
B. Graduated from Primary school
C. Graduated from Secondary school
D. Graduated from high school
E. Graduated from university
F. Other (specify) ……………………………………………

Part two: information about immunizations

1. Have you ever heard about immunization?
A. Yes
B. No

2. Do you have radio or television at home?

61
 A. Yes
B. No

3. Where did you first learn about immunization or vaccination?

A. Newspapers and magazines
B. Radio
C. TV
D. Brochures, posters and other printed materials
E. Health workers
F. Family, friends, neighbours and colleagues
G. Religious leaders
H. Teachers
I. Other (please explain)
4. Who is responsible for making sure a child has their immunizations?

A. Mather
B. Father
C. Parents
D. Other relative
E. Other medical professional
5. How many children do you have alive?

A. I do not have children at al

B. I have alive children
C. No response
D. Other (specify) -------
6.According to you, is vaccination important?

A. Yes
B. No
C. Don’t know
7. At which age should start a child vaccination? At …………………….. ……Month

8. At which age should finish a child vaccination? At ………………….. Months

9. How do you evaluate the immunization services in your area?

A. It is good
B. It is not too bad
C. It is bad
D. No idea

62
 E. Other (specify) ………………………………………………

10. Where did you get the immunizations services in your area?
A. Governmental hospital
B. Health centres
C. Private hospitals
D. Private clinic
E. Non-governmental organization clinic,
F. Elsewhere
G. I have no idea
12. What do you think the immunizations can protect many disease?
A. Agreed
B. Strong agreed
C. Disagreed
D. Strong disagreed
13. What is your attitude toward immunizations?
A. Very serious
B. Somewhat serious
C. Not very serious
D. I have no idea
14. What is your attitude toward Vaccination prevent infectious disease?
A. Yes
B. No
C. Don’t know
15. do you think Vaccination could maintain child health?
A. Yes
B. No
C. Don’t know
16. Hepatitis Measles virus could be prevented by vaccination
A. Yes
B. No
C. don’t know
17. What do you think about vaccination benefits?
A. Beneficial
B. Not beneficial
C. I don’t know
18. What do you feel when vaccinating your child?
A. Save
B. Fear

63
19. Will your advice your relatives and family to immunize their children?

A. Yes
B. No

20. Will you search for other available vaccines for your children?

A. Yes
B. No
22. Do you follow the obligatory vaccination programs?
A. Yes
B. No

23. Do you think Vaccination decreases the rates of mortality and disabilities?
A. Yes
B. No

24.do you think Immunization prevents childhood disease?

A. Yes
B. No
C. don’t know

25. Importance of vaccination?

A. Prevent infectious diseases
B. Maintain Child health
C. Reduce child mortality rate
D. Protect children from complication

26. Vaccination important for boy than girls?

A. Agreed
B. Strong agreed
C. Disagreed

Date of interview------------------------------- Name

of interviewer----------------------------

Signature of interviewer-----------------------

Name of person________________

64
 Appendix III

Time frame
No Duration Activity

1 25 April 2019 Title approval

2 4 May 2019 Chapter one

3 23 May 2019 Chapter two

4 1 June 2019 Questionnaire

5 22 June 2019 Chapter three

6 20 July 2019 Chapter four

7 23 July 2019 Chapter five

8 23 July 2019 Primarily pages

9 25 July 2019 Copy and printing

Appendix IV

BUDGET FRAME
NO Description Amount

1 Transportation cost $ 16

2 Internet excess $ 36

3 Printing and copy cost $ 15

5 Total $ 67

65

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