Assessment of Parents Knowledge, Attitude and Practice about Child

Vaccination in Selected Rural Areas of Kalaburagi District, India

Sandeep S 1*, S S Biradar 2, Veeresh 3
*1,3
Pharm.D Intern, Department of Pharmacy Practice, HKE Society’s Matoshree Taradevi Rampure Institute
of Pharmaceutical Sciences, Kalaburagi, India
2
Professor, Department of Pharmacy Practice, HKE Society’s Matoshree Taradevi Rampure Institute of
Pharmaceutical Sciences, Kalaburagi, India

Corresponding author:
Sandeep S
Pharm D Intern, HKE Society’s
Matoshree Taradevi Rampure Institute of
Pharmaceutical Sciences, Kalaburagi,
Karnataka, India - 585101
E-mail ID:sandeepsidram865@gmail.com
 Assessment of Parents Knowledge, Attitude and Practice about Child
Vaccination in Selected Rural Areas of Kalaburagi District, India
Sandeep S 1*, S S Biradar 2, Veeresh 3
*1,3
Pharm.D Intern, Department of Pharmacy Practice, HKE Society’s Matoshree Taradevi Rampure Institute
of Pharmaceutical Sciences, Kalaburagi, India
2
Professor, Department of Pharmacy Practice, HKE Society’s Matoshree Taradevi Rampure Institute of
Pharmaceutical Sciences, Kalaburagi, India

ABSTRACT:
Objective: Immunization has evolved as one of the most successful public health
interventions, reducing the incidence of infectious diseases and improving quality of life.
This study was conducted to analyze the level of knowledge, attitude and experience of
childhood vaccination among local participants from selected rural areas of Kalaburagi
District, which can be related to the immunization status of their children.
Method: The Prospective, Cross-Sectional study was conducted at selected villages of rural
areas in Kalaburagi district. Parents were enrolled into the study by considering the study
criteria. Demographic details and other relevant data were collected at pre-test and post-test
Results: A total of 631 parents from 10 selected rural areas were enrolled in the study out of
which 611 parents completed the study and 20 parents did not complete the study. It was
evident that 470(76.92%) children’s immunization was completed according to schedule,
73(11.95%) children’s immunization was not complete according to schedule and
68(11.13%) parents did not know whether child immunization was complete according to
schedule or not. The pre and post-test KAP score was assessed using SPSS software and Chi-
Square test was carried out to analyze the Statistical significance. The study was statistically
significant at p-value of <0.01.
Conclusion: The study concluded that better awareness of childhood immunization among
parents led to increased immunization experience in their children. Health workers must be
trained at the grass root level and through them the importance of childhood vaccination must
spread to all rural areas.
Keywords: Immunization, Knowledge, Attitude, Practice

INTRODUCTION:
As per WHO, ‘A vaccine is a biological preparation that improves immunity to a particular
disease. It contains an agent resembling a disease-causing microorganism, and is made from
weakened or killed forms of the microbe, its toxins or one of its surface proteins. The agent
stimulates the body's immune system to recognize the other agent as foreign, destroy it, and
"remember" it, so that the immune system can more easily recognize and destroy any of these
microorganisms that it later encounters.’1
The administration of vaccines is called vaccination. Vaccination is the most effective
method of preventing infectious diseases. 2 The WHO reports that licensed vaccines are
currently available for 25 different preventable infections.3 Vaccines are one of the most
thriving health interventions that have diminished occurrence of infectious diseases and
improved quality of life in the population along with reducing avoidable human suffering,
costs of care and treatment. Over the course of time, more and more diseases have attained
the status of being vaccine preventable, including the ones like pneumonia and diarrhoea.
Active immunization/vaccination has been named one of the “Ten Great Public Health
Achievements of the 20th Century” by CDC, United States.4 VPDs contribute significantly to
Under five mortality rates, In India under five mortality rates (U5MR) is 31.5/ 1000 in Urban
and 47.5/1000 in Rural areas.5 The main reason for this difference is due to parents' lack of
knowledge about vaccination. NFHS-5 (2019-2021) reported that only 76.4% of children in
India received basic immunization by 12-23 months. It is also reported that 84.1% of children
in Karnataka have received primary vaccination by 12-23 months and 75.3% in Kalaburagi
district.6 Expanded Program on Immunization (EPI) started in 1978 in India. In 1985, it
expanded beyond the city and became known as the Universal Immunization Program (UIP).
In 1992, it became part of the Child Survival and Safe Motherhood Programme, and in 1997,
it was included in the National Reproductive and Child Health Programme. The two main
milestones of the UIP are the eradication of polio in 2014 and the eradication of maternal and
neonatal tetanus in 2015. Parental immunization decisions are important to increase
immunization rates and parental adherence to the immunization schedule. Global research
shows that, among other factors, parents' knowledge and beliefs have a significant impact on
the initiation and continuation of childhood vaccinations. 7.8
Pharmacists are slowly creating identity as vaccination providers in the developed countries
and are those members of the healthcare team who can educate and motivate patients daily.
As per ASHP guidelines on pharmacist’s role in immunization, pharmacists can play an
important role in disease prevention by promoting awareness and administering vaccines. 9 In
India, the responsibility of promotion and administration of vaccine still rests upon the
shoulders of the nurses and social workers to a great extent. Looking at the current scenario,
it would be right to suggest that it is high time that Indian pharmacists take up the opportunity
to use their skill in the society and advocate importance of vaccination amongst the public,
thereby relieving their professional counterparts from this burden to some extent and help
improve the vaccination coverage in as many parts of the country as possible.
Therefore, the study was carried out to assess the level of knowledge, attitude and practice of
parents of Under Five years old children regarding VPDs & routine immunization & at the
same time parents were motivated by updating their level of knowledge regarding the
importance of immunization, as the parents of Under Five years old children are very
receptive to advice given by Doctors & Health Care Professionals regarding the health of the
child.

OBJECTIVES:
General Objective:
To assess the Parent’s Knowledge, Attitude and Practice and its associated factors regarding
Immunization of Children in Kalaburagi District of Karnataka.
Specific Objectives:
 To educate parents regarding Vaccination Schedule, Importance of Vaccination and
Vaccine Preventable Diseases (VPDs).
 To carryout Pharmacist mediated Patient counselling to eligible parents.

MATERIALS AND METHODS:

Study Approval: The study protocol was prepared and submitted to the Ethics Committee on
Human subject’s research for ethical clearance. The study was approved by institutional
ethics committee and ethical clearance certificate was issued.
Consent letter:
The study was initiated at Ten selected villages in Rural areas of Kalaburagi District after
obtaining a consent letter from:
 District Health Officer (DHO), Department of Health and Family Welfare, Kalaburagi,
 The Deputy Director (DD), Department of Women and Child Development, Kalaburagi,
 The Child Development Project Officer (CDPO), Department of Women and Child
Development, Kalaburagi.
Study materials:
1. Informed Consent Form.
2. Case Report Form consisting of two parts:
a) Parents Socio-Demographic details along with Child immunization status.
b) KAP Questionnaire.
3. Leaflets on Child Immunization.
4. Related Audio and Visual aids.
5. Latest National Immunization Schedule.
Study site: Study was conducted at the Anganwadi Centers in Selected Rural areas of
Kalaburagi District
Study Design: A Community-Based; Prospective, Cross-Sectional Study
Study Period: The Study was carried out for a duration of six months.
Study Criteria: The Parents were enrolled into the study by considering the following study
criteria:
a) Inclusion Criteria:
 Parents having children whose age is less than 5 years.
 Parents who are Permanent residents of selected villages.
 Pregnant women attending Anganwadi centers.
 Parents who are also working in Health care team (ANM, ASHA workers and Anganwadi
workers).
 Caretakers (or) Guardians of Children in absence of Parents.
b) Exclusion Criteria:
 Parents who are not willing to participate in study at any given time.
 Married women who have not yet conceived.
 Parents having children above 5 years of age.
 Parents residing in Urban areas.

Study Procedure:
 The study was carried out at the Anganwadi centers situated in rural areas of Kalaburagi
district, after obtaining ethical clearance. Subjects were enrolled into the study
considering the above inclusion and exclusion criteria, after obtaining written consent to
participate.
 The participants were assessed by using questionnaires on source of information
regarding Child Vaccination, Socio-demographic variables, Immunization status,
National Immunization schedule, Vaccination Preventable Diseases.
 Parents were provided with KAP questionnaire’s consisting of English and Kannada
language, were instructed how to complete the questionnaire, and each question was
explained. Sufficient time was given to complete the questionnaire.
 Parents are then taught the importance of childhood vaccinations, vaccination schedules
and vaccine preventable diseases (VPD).
 After 1 month of Pre-test, once again data was collected with the same questionnaire on
data collection form to assess the acquired Knowledge, Attitude and Perception of Parents
towards Child Vaccination.
Analysis of Data:
Each question about Knowledge, Attitude and Practice were scored to assess their KAP level
regarding child vaccination. The Data Collected from the questionnaires was analyzed by
Chi-Square test using SPSS Software was applied to find the statistical significance.
Immunization status of children was assessed based on their parent's statement.

RESULTS AND DISCUSSION:

The Cross-sectional study was carried out in different villages around Kalaburagi district. A
total of 611 parents from 10 selected rural areas were enrolled in the study. The study was
carried out at the Anganwadi centers situated in rural areas of Kalaburagi district, after
obtaining ethical clearance. Parents having children whose age is less than 5 years, Parents
who are Permanent residents of selected villages and Pregnant women attending Anganwadi
centers were enrolled into the study. Parents were provided with KAP questionnaire’s
consisting of English and Kannada language, were instructed how to complete the
questionnaire, and each question was explained. Sufficient time was given to complete the
questionnaire.
Parents are then taught the importance of childhood vaccinations, vaccination schedules and
vaccine preventable diseases (VPD).It was evident that 470(76.92%) children’s immunization
was completed according to schedule, 73(11.95%) children’s immunization was not complete
according to schedule and 68(11.13%) parents did not know whether child immunization was
complete according to schedule or not.

Table 1: Demographic Profile of

Respondents among selected villages
Sociodemographic Count %
Variables (N)
Type of Attendant
Parent of a child 582 95.3
Pregnant 29 4.7
Participant’s relation
to the child 489 80.0
Mother 81 13.3
Father 41 6.7
 Guardian
Age of the Child
Below 1 year 64 10.5
1 year 100 16.4
2 years 165 27.0
3 years 121 19.8
4 years 96 15.7
5 years 65 10.7
Mother’s age
18-20 years 35 5.7
20-25 years 267 43.7
26-30 years 259 42.4
31-35 years 44 7.2
36-40 years 6 1.0
Father’s age
21-25 years 72 11.8
26-30 years 269 44.0
31-35 years 205 33.6
36-40 years 51 8.3
41-45 years 14 2.3
Mother’s
Qualification 117 19.2
Not Educated 200 32.6
Below SSLC / 10th 140 23.0
SSLC / 10th 114 18.6
PUC / 12th 1 0.2
Diploma 36 5.9
Graduate 3 0.5
Postgraduate
Father’s 19.1
Qualification 119 18.6
Not Educated 113 34.3
Below SSLC / 10th 209 13.8
SSLC / 10th 84 2.7
PUC / 12th 16 10.8
Diploma 66 0.7
Graduate 4
Postgraduate
Mother’s Occupation
Daily wages 6 1
Farmer 46 7.5
House wife 531 87
Govt. Job 3 0.4
 Kirana shop 4 0.6
Private Employee 7 1.2
Student 2 0.3
Tailor 3 0.4
Teacher 9 1.6
Father’s Occupation
Chairman 2 0.3
Daily wages 55 9
Driver 49 8
Farmer 354 58
Finance 1 0.2
Govt. Job 12 2
Kirana Shop 3 0.5
Own Business 55 9
Private Employee 55 9
Teacher 21 3.3
Unemployed 1 0.2
Watchman 3 0.5
Annual Income of
Family 399 65.3
Below 1 Lakh 57 9.3
1 -2 Lakhs 78 12.8
2-3 Lakhs 38 6.2
3-4 Lakhs 19 3.1
4-5 Lakhs 20 3.3
Above 5 Lakhs
Status
High 44 7.2
Middle 167 27.3
Low 400 65.5

Table 1 shows the Demographic profile of respondents among the selected villages. Majority
of the respondents were parents having at least one child (95.3%) and most of them were
mothers (80%). Majority of the Mothers have completed their schooling below SSLC / 10 th
(32.6%) and many of the fathers have completed at least SSLC / 10 th (34.3%). Occupation of
most of the Mothers was Housewife (87%) and Fathers was Farming (58%). Annual income
of most of the families was Below 1 Lakh (65.3%) and many of the respondents belonged to
Lower Class (65.5%).
Figure 1 depicts the parent’s Source of vaccine information in which both the parent’s
answered that Primary Health Care centers (63%), Ministry of Health – Anganawadis (14%)
were their main source of vaccine information.
 9; 1%

Television
24; 4%

99; 16% Primary health care centres

Friends and relatives

83; 14%
Internet

5; 1% 386; 63% Ministry of health

5; 1% Others

None

Figure 1: Parent’s Source of Vaccine Information

Table 2 shows parents’ knowledge about vaccination. Most of the parents know the
importance of vaccination, their beneficial effects, and harmful effects. Majority of them
know that vaccines are same for both male and female children. Parents had a good
knowledge that vaccines are only given to children after a long and careful review by
scientists, doctors, and healthcare professionals. Majority of the parents had knowledge that
vaccinations reduce death and disability in the child. Parents source of information was
enquired in the knowledge section of questionnaire which is demonstrated in Figure 1.

Table 2: Parent’s Knowledge about vaccination

Questionnaire Response Count %
1. Has your child received all the Yes 551 90.18
mandatory vaccines up to date? No 19 3.11
Don’t Know 41 6.71
2. Do you know the importance of Yes 424 69.39
vaccination in children? No 139 22.75
Don’t Know 48 7.86
3. Do you know the correct age at which Yes 323 52.86
child vaccination is started? No 218 35.68
Don’t Know 70 11.46
4. Do you know that vaccinations in Yes 382 62.53
childhood prevent infectious disease? No 135 22.1
Don’t Know 94 15.38
5. Do you know that vaccinations reduce Yes 350 57.28
death and disability in children? No 129 21.12
Don’t Know 132 21.60
6. Do you know that even a healthy child Yes 329 53.85
 needs to be vaccinated? No 131 21.44
Don’t Know 151 24.71
7. Do you know that vaccines have more Yes 308 50.41
beneficial effects that harmful effects? No 124 20.29
Don’t Know 179 29.30
8. Do you know that both male and female Yes 309 50.57
children have same vaccination schedule? No 150 24.55
Don’t Know 152 24.88
9. Do you know that vaccinations are only Yes 277 45.34
given to children after a long and careful No 169 27.66
review by scientists, doctors, and healthcare Don’t Know 165 27.00
professionals?
10. Do you know that even child with cold Yes 112 18.33
and fever can be vaccinated? No 342 55.97
Don’t Know 157 25.70
11. Do you have a source of information Yes 602 98.5
about vaccination? No 9 1.5

700

551
525

350

175

41
19
0
Fully Vaccinated Partially Vaccinated Don’t Know

Figure 2: Vaccination status of child up to date

Figure 2 shows the Vaccination status of child up to date and Figure 3 shows the number of
children’s who had Adverse events following vaccination.
 450
400

300

150
116
95

0
Yes No Don’t Know
Figure 3: Adverse events following vaccination.

Table 3: Parent’s Attitude about vaccination

Questionnaire Response Count %
1. Do you feel that it is safe to have Yes 597 97.71
your child vaccinated?10 No 3 0.49
Don’t Know 11 1.80
2. Do you support the vaccination Yes 467 76.43
program designed by the ministry of No 77 12.60
health and family welfare? 10 Don’t Know 67 10.97
3. Do you advice your relatives and Yes 435 71.19
family to vaccinate their children? No 158 25.86
Don’t Know 18 2.95
4. Do you think it is important to Yes 360 59.08
follow vaccination schedule? 10 No 87 14.24
Don’t Know 163 26.68
5. Will you stop vaccination due to Yes 111 19.17
temporary side effects occurred after No 395 64.65
previous dose? Don’t Know 105 17.18
6. Did you face any reactions from Yes 51 8.35
your family members regarding your No 538 88.05
child’s vaccination? Don’t Know 22 3.6
Table 3 shows parents’ attitude regarding vaccination. Most of the parents fell safe when
their child gets vaccinated, many of them supports the vaccination programme organized by
MoHFW. Majority of the parents’ advice their relatives and family to vaccinate their children
and think it is important to follow vaccination schedule. The parents also answered that they
don’t stop vaccination due to temporary side effects occurred after the previous dose of
vaccine and the parents did not face any reactions from their family members regarding their
child’s vaccination. Figure 4 shows Parents attitude and support to vaccination program
designed by the ministry of health and family welfare.

525
467

350

175

77 67

0
Support Do not Support No Idea

Figure 4: Parents support to vaccination program designed by the ministry of

health and family welfare.

Table 4: Parent’s Practice about vaccination

Questionnaire Response Count %
1. Whether your child received Yes 551 90.18
mandatory childhood vaccination? No 19 3.11
Don’t Know 41 6.71
2. Do you look for vaccines other than Yes 137 22.42
those recommended by the government? No 374 61.21
Don’t Know 100 16.37
3. Do you use pain relievers to relieve Yes 304 49.75
swelling and pain after having your child No 289 47.30
vaccination? [10] Don’t Know 18 3.95
4. Did the health care workers inform Yes 467 76.43
you about the dose of vaccine and your No 89 14.57
next vaccine schedule while receiving Don’t Know 55 9
the vaccine?
5. Did your child develop any problems Yes 116 18.99
after vaccination? No 400 45.47
Don’t Know 95 15.54
 6. Whether your child immunization is Yes 470 76.92
complete according to the schedule? No 73 11.95
Don’t Know 68 11.13
7. Did you inform the doctor or health Yes 306 50.08
care workers about any side effects seen No 251 41.08
in your child after vaccination? 11 Don’t Know 54 8.84
8. Do you have any instance of missed Yes 19 3.11
dose? No 551 90.18
Don’t Know 41 6.71

Table 4 shows parents Practice about vaccination. Most of the parents give free vaccines
provided by Government to their child. Majority of them use pain relievers like Paracetamol
to their children after vaccination. Most of the children did not develop any reactions after
vaccination and majority of the parents informed the doctors or health care workers regarding
the side effects. There were only few instances of missed dose. Figure 5 shows Parents
practice about importance to follow vaccination schedule.

525
Important Not Important Don’t Know

360
350

175 163

87

0
Figure 5: Parents practice about importance to follow vaccination schedule

Each question answered by the parents under the Knowledge, Attitude and Practice section of
the questionnaire was scored. A score of 1 was given for correct answer and negative and
uncertain answer was scored 0. The score was tabulated to calculate the level of significance
using Pearson Chi-Square test.
The data was analyzed and Interpreted by using descriptive and inferential statistics using
latest version of SPSS software according to the objectives of the study. A thorough
statistical study using SPSS version 22 was done and by applying statistical tools like Pearson
Chi-Square test with 5% significance it was inferred that the objectives of the study were
fulfilled. The Knowledge, Attitude and Practice of parents was significant at 5% significance
and at p-value <0.001

CONCLUSION:
In our study we conclude that a most of the parents in the selected rural areas were not aware
about the vaccination and its uses. The knowledge of parents regarding vaccination was
59.11%, the attitude score was 76.54%, the practice score was 78.49%. Which signifies that
the parents in the selected rural areas had a poor knowledge regarding vaccination, the
attitude of parents regarding vaccination was average and the practice of vaccination was
improved only because of the good efforts done by the MoHFW and Universal Immunization
Programme through Anganawadis.
Parents believe that their decisions only affect their family, but in broad sense these
individual decisions are affecting their community. Some of the roles which pharmacists play
in improving the vaccination coverage are: Improving both the quality and quantity of the
delivery of vaccination services, increasing community awareness, participation, and
education, improving disease monitoring and vaccination coverage, developing new or
improved vaccines, and improving the use of vaccines.
Lower literacy rates of parents in rural areas is a matter to worry. Some of them do not know
about the disease for which the child is being immunized. Although many parents do not
know the timing of vaccination but some of them follow the immunization card and come
accordingly to the vaccination centers.

ACKNOWLEDGMENTS:
The authors would like to thank Dr. S. S. Biradar (Professor, Department of Pharmacy
Practice, HKES’s MTRIPS, Kalaburagi) for guiding us throughout the research work. We
also would like to thank Dr. Rajeshwari K (Assistant Professor, Department of
Pharmacology, HKES’s MTRIPS, Kalaburagi) for their constant motivation, timely support,
and guidance. The authors would like to thank Parents of under five children of Kalaburagi
District who enthusiastically participated in the study.

CONFLICT OF INTEREST:
The authors declare No Conflict of Interest.

ETHICS STATEMENT:
The study was initiated after obtaining Ethical clearance from the concerned Institutional
Ethics Committee.

LIMITATIONS:
This study provides the extent of Parents KAP towards vaccination in Kalaburagi district of
Karnataka, India and cannot be correlated with other parts of rural India.

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Abhijna Soori2, Pradhum Ram2,

Basavaprabhu Achappa3, Mukta
Chowta4,