A Descriptive Study on Knowledge, Attitudes and Practices of Primary Caregivers on

Expanded Program on Immunization in

Barangay Baybay, Alubijid, Misamis Oriental

A Research Study Presented to the Faculty of Xavier University

Dr. Jose P. Rizal School of Medicine

In Partial Fulfillment of the Requirements in

Preventive and Community Medicine 4

By:
Arnado, Princess Bienvineda V. Lucman, Harissa M.
Bantuas, Sittie Nadjierah B. Pahilan, Ritzjerald Christer A.
Camacho, Kimberley P. Papelleras, Ken Jeryle M.
Centino, Tizabelle G. Si, Roselyn L.
Chio, Edrian Je B. Tan, Anna Katrina B.
Cuartero, TC Anne C. Ting, Stacy Yin M.
De la Rosa, Ralph Ryan V. Veloso, Maria Kristina M.

May 5, 2018
ABSTRACT

More than 6 million children below 5 years old die due to diseases that can be prevented
by routine vaccination. Among these diseases are pneumococcal diseases, rotavirus,
Haemophilus influenza type B, pertussis, measles and tetanus.

A study conducted by Abellera et. al. (2017) found out that Barangay Baybay had
achieved herd immunity n 2014, however, with a decreasing trend in 2015 and 2016. Several
studies were conducted to identify the factors that relate to the decreasing rate of compliance,
childhood illness being identified as the greatest barrier (Schiefele, et. al., 2011).

This is a descriptive study conducted in Barangay Baybay, Alubijid, Misamis Oriental

aimed in determining the knowledge, attitudes, and practices of the said population towards
immunization from April to May 2018. The respondents of this study included all primary
caregivers of children 12 months old and below, and utilized a questionnaire adapted from the
study of Castillo et. al. in 2014.

A total of 35 primary caregivers were included in this study. Majority of the respondents
were female, married, high school graduates and have one children in their households, earning
1500 to 3000 Php per month.

Majority of the respondents have heard of the expanded program on immunization from
the BHWs who did house-to-house visits, aside from public announcement at the barangay
health clinic. However, only half of them was able to enumerate the vaccines included in the
program. Majority was also knowledgeable on the side effects, diseases that can be prevented
by complete immunization and the schedule for immunization. Majority of them have positive
attitudes and practices regarding immunization.

In conclusion, BHU – Baybay was able educate its proponents regarding expanded
program on immunization. Nevertheless, reinforcement on the program among the primary
caregivers is recommended to make the program more sustainable and to promote more
compliance among the community.
 I. INTRODUCTION

BACKGROUND

Despite a reduction of 17,000 fewer children that die each day than in 1990, more than
six million children under five years old die due to diseases that are preventable by routine
vaccination. The leading infectious diseases include: Pneumococcal diseases (32%); Rotavirus
(30%); Haemophilus Influenzae type B (13%); Pertussis 13%; Measles (8%); and Tetanus (4%).
(WHO, 2009)

According to the World Health Organization, four out of five deaths of children under age
five occur in the Southeast Asian and Sub-Saharan African regions. In a study done by Abellera
et al in 2017 in Alubijid, Misamis Oriental, Philippines, only 45% of the eligible population were
immunized in 2014, 76% in 2015, and 53% in 2016. The Municipality of Alubijid therefore, failed
to achieve 95% herd immunity. The Municipality of Alubijid is classified as a fourth class
municipality which is home to 31,780 residents with 7,109 households.

Barangay Baybay is Xavier University – Dr. Jose P. Rizal School of Medicine’s adopted
community in Alubijid. In a study by Abellera et al in 2017, Barangay Baybay was able to
achieve herd immunity once in 2014 with a decreasing trend in coverage in 2015 and 2016.
There is no known study done to assess the compliance of primary caregivers and the factors
contributing to such failure.

Previous studies have determined four factors that contribute to the decrease adherence
rate of mothers to expanded program on immunization in their respective health centers. First,
disease related factors - Childhood illness is the greatest barrier influencing low childhood
immunization rate. According to Schiefele, et al, (2011) deferring immunization for common,
mild ailments in children resulted in missed chances for immunization.

Second, health care provider and health care system factors - Adherence is significantly
affected by health care provider’s attitudes and health care facilities. Health workers not
explaining or not providing clear information about vaccine is the strongest impediments for
vaccination compliance. Health workers in Somalia in one study did not offer instruction about
immunization side effects (La Fond 1990).

Third are social and economic factors. According to a study done by Castillo, M.A. et al
from the Lyceum of the Philippines University, financial, time/schedule and attitudes affect
compliance to immunization because some reported that they do not have enough money
allocated for their health, that no one is available in the family to bring the children for
immunization and that they forget the schedule of the immunization.

Fourth are psychological factors. Mother’s lack or inadequate knowledge about vaccines
significantly impacted their practices and behaviors which prevent vaccination compliance.
Misconceptions about vaccine safety lowered mother’s confidence in vaccines and cause them
to refuse to have their children vaccinated. The low educational level of mothers has a strong
relation with low vaccine uptake (Markland 1976, Marks 1979).

This study shall focus on the primary caregivers of children 12 months and below in
Barangay Baybay, Alubijid, Misamis Oriental. The proponents aim to identify the factors may
have contributed to the failure in achieving herd immunity in the said barangay.

SIGNIFICANCE OF THE STUDY

For the people of Barangay Baybay, this study evaluated the extent of the Expanded
Program of Immunization (EPI) in their locality, and determined their knowledge, attitudes, and
practices towards immunization and how these factors affect the outcome of the program.

For the Department of Health, Local Government Unit, and Barangay Health Officials,
this study provided data on the herd immunization status against vaccine-preventable diseases
among the children of Barangay Baybay, Alubijid, Misamis Oriental. This also helped them
assess the knowledge of the primary caregivers on immunization and how it affects the success
and failure of the program and whether there is a need for improvement such as health
teachings and lecture.

For the proponents, the results of this study served as a fundamental point in developing
future programs in the community towards regaining the 95% herd immunity against vaccine-
preventable diseases. This study served as a foundation for further investigation, not just in
Barangay Baybay, but in other Barangays of Alubijid with decreasing trends or those that
haven’t reached the desired herd immunity.

SCOPE AND LIMITATIONS

The study’s target population included all primary caregivers of children aged 0-12
months in Barangay Baybay, Alubijid, Misamis Oriental. Data-gathering period was from April 24
to May 4, 2018.

OBJECTIVES

GENERAL OBJECTIVE:
To determine the knowledge, attitudes, and practices of primary caregivers of children
on expanded program on immunization in Barangay Baybay, Alubijid, Misamis Oriental.

SPECIFIC OBJECTIVES:
1. To determine the demographic profile of the primary caregivers as to age, sex, marital
status, number of children, relationship to the child, educational attainment, and monthly
income.
2. To determine the extent of the primary caregiver’s knowledge on the following:
2.1 vaccines included in the EPI
 2.2 time or schedule of immunization
2.3 purpose of the immunization
2.4 effects and side effects of the different immunizations
3. To determine the primary caregiver’s attitudes as to their reasons for:
3.1 submitting their children for immunization
3.2 the incomplete immunization of their children
3.3 not submitting their children for immunization
5. To determine the primary caregiver’s practices regarding the:
5.1 timing of immunization
5.2 use of the immunization card
5.3 immunization of other children in the family

DEFINITION OF TERMS:

Fully Immunized Child (FIC) – is a child who has received all of the following antigens before
reaching one year old: one (1) dose of BCG at birth or anytime, three (3) doses of OPV, three
(3) of Pentavalent vaccines, and one (1) dose of Measles-containing Vaccine (MCV1)

(Measles containing vaccine (MCV) coverage – the number of children who received the anti-
measles vaccine from 9 months to before reaching one year old.)

Primary Caregiver - refers to a person who accompanies the child and makes decisions
regarding immunization.

Herd immunity – at least 95% of the eligible population has been fully immunized.

Eligible Population - represents the estimated number of children to be immunized which is

2.7% of the total population.

II. LITERATURE REVIEW

The Expanded Program on Immunization (EPI) aims to provide access to all relevant
vaccines for all at risk. As reported by the World Health Organization (WHO) global
immunization campaigns led to the eradication of smallpox, poliomyelitis infection dropped by
99% and between 2000 and 2008, deaths due to measles dropped by 78%. Furthermore,
maternal and neonatal tetanus has been eliminated in some countries.

The implementation encountered challenges since it’s the beginning. The Strategic
Advisory Groups of Experts (SAGE) on Immunization, an independent advisory group
established by WHO concerned with all vaccine-preventable diseases and vaccination
programs for all ages, reported in the 2017 Assessment Report of the Global Action Plan that
the year 2017 had the fewest number of cases of wild poliovirus ever reported, three more
countries including Equatorial Guinea, Indonesia and Niger, and the province of Punjab in
Pakistan were certified as having achieved maternal and neonatal tetanus elimination and nine
additional countries have introduced new vaccines. Challenges identified by the group included
signs of complacency and inadequate political commitment to immunization. Conflicts and civil
strife, global warming and natural disasters, economic uncertainties, growing vaccine hesitancy,
and multiple displaced and mobile populations are challenges identified to ensure universal
access to immunization.

A study entitled Assessment of Parent’s Knowledge, Attitude and Practice about Child
Vaccination in Rural areas in India last 2017 concluded that parental knowledge, attitude and
practice about child vaccination are important determinants of the immunization status of
children. A combined effort from the members of the health care team and social health workers
can definitely make the attainment of the targeted immunization coverage rate in the country
possible. This may hold true in the Alubijid, Misamis Oriental (Trushitkumar, P et.al, 2017).

A similar study at Libya on 2008 showed that child's gender, mother’s job, educational
attainment, and residence, either urban or rural, did not affect significantly the immunization
status. This contradicts to a study in Pakistan where mother’s high education status is
associated with better awareness about EPI (Bofarraj, 2008) Furthermore, a positive attitude
was significantly highly associated with better immunization status than negative attitude
(mothers afraid and false belief about immunization). The most often mentioned reason for
incomplete immunization was child sickness, most commonly cough, which was reported in
54%, followed by social reasons, forgetfulness and others (Borraraj, 2008).

Another study in Kinshasa, Democratic Republic of Congo was conducted in 2008. The
study population was divided into low coverage and high coverage zones basing on the BG
coverage. In this study, the father’s education and mother’s experience of an EPI disease in the
family are significant predictors of a child’s complete immunization. The mother’s vaccine-
related knowledge is a predictor of the complete immunization only in the Low coverage zone.
And the mother’s ability to cite signs of the severity of EPI-targeted diseases and the father’s
involvement are associated with the child’s vaccination status only in the high coverage zone
(Mapatano, M et.al.,2008)

A study was also conducted at Davao City which revealed that majority (68.75%) of the
mothers knew that vaccines are given at the barangay health center through BHWs. All (100%)
mothers were aware that vaccines were free. 93% claimed they knew the vaccines given but
only 75.86% were correct in identifying what the vaccines were. The source of information was
mostly through BHWs (68.75%). Parents’ response to the presence of adverse reactions was
through given antipyretics (69.2%), while some bring their child to a physician (23.10). Majority
of mothers (93.5%) were aware of their next scheduled visit for immunization. The most
common reasons why vaccines not given on scheduled dates due to child’s sickness (23.03%)
and waited for a long time before vaccine could be given (29.00%), and center ran out of
vaccines during their visit (19.35%). Also, a list of vaccines was given and mothers were asked
to choose which Non-EPI vaccines were to be given to their child, only 35.48% chose the
inappropriate vaccines for the age of the patient (Caingles and Lobo, 2011).
III. SUBJECTS AND METHODS

A. Research Design
The proponents of this study conducted a descriptive type of research on knowledge,
attitudes and practices of primary caregivers of Barangay Baybay, Alubijid, Misamis Oriental on
Expanded Program on Immunization. Data collection was done using a questionnaire adapted
from the study of Castillo et al in 2014 entitled Extent of Compliance to Immunization. It included
determination of frequency, percentage and ranking, and mean of the data that was gathered.
The inputs of the respondents on the questionnaire were the basis for analysis, interpretation
and discussion.

B. Research Setting
This study was conducted in Barangay Baybay, Alubijid, Misamis Oriental. This adapted
community of Xavier University – Dr. Jose P. Rizal School of Medicine was chosen by the
proponents because in a study by Abellera et al in 2017, the said barangay was only able to
achieve herd immunity once from 2014 to 2016 with a decreasing trend in the extent of their
immunization coverage from 2015 to 2016. Proponents of this study decided to conduct this
study to explore the compliance of primary caregivers to immunization and the factors that led to
failure in the achievement of herd immunity.

C. Population and Sample

The respondents of this study included all primary caregivers of children 12 months old
and below from Barangay Baybay, Alubijid, Misamis Oriental.

D. Methods of Data Collection

This study utilized a questionnaire adapted from the study of Castillo et al in 2014
entitled Extent of Compliance to Immunization. The proponents conducted a house-to-house
survey.

E. Data Gathering Tool

The researchers used a self-administered questionnaire adapted from a study entitled
Extent of Compliance to Immunization by Castillo et al (2014). The questionnaire was
composed of four parts. Part one was about the demographic profile of respondents including
marital status, number of children, educational attainment, and monthly income. Part two were
questions regarding knowledge of primary caregivers on expanded program in immunization.
Part three were questions regarding attitude of primary caregivers on expanded program in
immunization. Part Four were questions regarding practices of expanded program in
immunization. The questions were answerable by either Yes or No.

F. Data Gathering Procedure

The researchers submitted a letter addressed to the Municipal Health Officer to allow the
researchers to gather data from Barangay Baybay, Alubijid. A copy of the survey questionnaires
in vernacular dialect was furnished and attached for perusal. After approval of request, the
researchers personally interviewed primary caregivers of household with children 12 months old
and below.

G. Data Analysis
The researchers utilized the following descriptive statistics to ensure valid analysis and
to interpret the data.
1. Frequency: This was calculated as to how often values occur within a range of values.
2. Percentage: This was used as a descriptive statistics to denote the proportion
contributed by a part in a whole.
3. Ranking: The rank of a number is its size relative to other values in a list. If you were to
sort the list, the rank of the number would be its position.
4. Mean: The mean is the arithmetic average of a set of values to denote the perception of
primary caregivers to the Expanded Program and Immunization as well as factors
affecting their non-compliance.

IV. RESULTS AND DISCUSSION

Improving immunization coverage requires an understanding of the factors that could

influence the full immunization of children. Hence, this present study examined the possible
determinants affecting the immunization coverage in Baybay Alubijid. The study focused on
describing the sociodemographic profile, knowledge, attitudes and practices of the caregivers of
33 children currently enrolled at Baybay, Alubijid’s immunization program.

With regards the socio-demographic factors: maternal age, marital status, educational
level, monthly income and # of children in the household were surveyed and the profile obtained
is shown at Table 1.

Table1. Socio-demographic profile of caregivers

AGE
<18 1 3%
18-25 10 31%
26-30 5 16%
31-35 6 19%
36-40 3 9%
41-45 2 6%
>45 5 16%
MARITAL STATUS
Single 14 44%
Married 17 53%
Separated 1 3%
EDUCATIONAL LEVEL
Elementary level 2 6%
Elementary graduate 3 9%
High school level 7 22%
High school graduate 14 44%
College level 4 13%
College graduate 2 6%
Post graduate Post graduate Post graduate
None
MONTHLY INCOME
<500 3 9%
500-1500 2 7%
1500-3000 8 25%
3000-5000 7 22%
>5000 9 28%
Not disclosed 3 9%
# CHILDREN IN THE HOUSEHOLD
1 12 38%
2 7 22%
3 6 19%
4 3 9%
5 4 12%

Majority of the respondents were within the 20-45 year old age bracket. The youngest
was 18 years old and the oldest was 59 years old. About half of the respondents were married.
In terms of education, only 1 respondent (4%) finished college, 15% reached college level, 37%
finished high school, 26% attained high school level, while 18% were below highschool level. As
for income, only 26% earned more than 5000 php a month. A third of the respondents had only
1 child. The highest number of children is only 5 per household which comprise 14% of the
respondents.

In 2016, Merlene Ramnon studied the maternal characteristics and childhood

immunization series completion rates among children 2 years old using data from the Florida
Health Department of health immunization surveys. She found out that children of mothers aged
>25 years were more likely to have better immunization completion rates. In our study, the
majority of the respondents were 20-45 years old hence this could imply better immunization
completion rates. Felicitee et al studied the factors influencing routine vaccination of children of
mothers live-stock retailers in the markets of Yaounde and found that children of mothers living
alone had less chances of being completely vaccinated whereas living as a couple facilitated
the care of children. In Baybay, half of the respondents (55%) were married and the rest were
single and separated. Hence, the relatively low rate of couples could have negatively impacted
the immunization coverage. With regards education, according to Balogun et al. (2017),
complete immunization was higher in children whose mothers were educated, partly because
maternal education leads to acquisition of literacy skills and better health-seeking behaviour
which then improves immunization uptake for their children. Moreover, in the study done by
Ramnon last 2016, children of mothers who had education that is equal to or higher than
highschool have better immunization completion rates. In this research, all respondents attained
some level of formal education and only 18% were below highschool level. Those respondents
with lesser education attainment may be at risk of lesser immunization completion. In a study by
Ayaz Muhammad last 2014 entitled relationship between childhood immunization and
household socio-demographic characteristic in Pakistan they learned that people with higher
income were 1.58 times more likely to immunize their child. People with lower income are less
likely to have their children vaccinated on due dates because they have to take time off work for
timely immunization which is an added burden. Results of this study show that only 26% earned
more than 5000 php a month which is well below the minimum wage. This suggests that the low
economic status of the respondents could have lead to the decline in the immunization rate.
According to Calhoun et al, 2003, having fewer children was strongly associated with full
vaccination. Their study was a cross-sectional survey on the determinants and coverage of
vaccination in children in West Kenya. They inferred that women with fewer children may have
more time to commit to the care of an individual child. Alternatively, women with multiple
children may synchronize health visits for her children, which could influence whether each child
adheres to the recommended schedule. For example, a child may receive their vaccination in
conjunction with a sick visit for a sibling rather than on a scheduled visit for vaccination. This is
consistent with a recent study which assessed the immunization coverage and its determinants
among children in a periurban area of Kenya. They found that parents with high number of
children were less likely to immunize their children (Maina, Karanja & Kombich 2013). Based on
our data, a third of the respondents had only 1 child. The highest number of children is only 5
per household which comprise only 14% of the respondents. This low parity positively facilitates
immunization completion.

Table 2. Knowledge of respondents regarding immunization

Awareness of the Expanded program on immunization (EPI)
Yes 19 70%
No 8 30%
Source of information regarding EPI
BHC 4 21%
BHW house-house 7 37%
TV 4 21%
No answer 4 21%
Have knowledge of vaccines included in the EPI
Yes 14 52%
No 13 48%
Vaccines enumerated by respondents
BCG 11
Measles 9easles
Hep B 6ep B
OPV 5PV
Pentavalent 4
DPT 4
PCV 3V
HiB 0
IPV 0V
MMR 0MR
Knowledge on the timing of the first vaccination
At birth 18 66%
1 month 3 11%
3 months 3 11%
6 months 1 4%
1 year 1 4%
No idea 1 4%
Knowledge on vaccine preventable diseases
Measles 11
Dengue 2
Polio 4
Fever 4
Cough 5
Colds 4
Hepatitis B 3
TB 1
Diarrhea 11
Vomiting 1
Tetanus 1
Allergy 1
Chicken pox 11
Convulsion 1
Pneumonia 1
Virus 1
Knowledge on common side-effects of vaccines
Fever 20
Inflammation on 2lammation on injection site
injection site
Rashes 1ashes
Measles 1easles
Death 1eath
Numbness 1umbness
Irritability 1ritability
No answer 1o answer
Knowldege on the scheduled date of immunization
First Thursday of 18 67%
the month
Incorrect date 9 33%

Table 2 shows the knowledge of the caregivers regarding immunization. Majority, (70%)
of the caregivers have heard of the expanded program on immunization. 37% learned of this
from BHWs who did house to house visits while the rest learned of it from the barangay health
center and television. Half of the caregivers, 52%, were able to enumerate some of the vaccines
included in the EPI. Of the vaccines enumerated, BCG was the most frequently answered
followed by measles, Hep B, OPV, Pentavalent, DPT and PCV. However, vaccines not known
were HiB, IPV and MMR. Majority, 66% of the caregivers know that the first vaccine is given at
birth. For the rest, 11% believe it is given at 1 month, 11% at 3 months, 4% at 6 months, 4% at
1 year and another 4% have no idea when the vaccine should first be given. Regarding the
diseases that can be prevented by vaccination, the most frequently answered were measles,
diarrhea and chicken pox. This was followed by cough, polio, fever, colds, hepatitis and dengue.
The least answered were TB, vomiting, tetaus, allergy, convulsions, pneumonia and virus. Of
the side-effects, the most reported was fever. Majority, 67%, know the immunization day at their
barangay while 30% do not.

One significant issue which threatens immunization countries especially in developed

countries is the concern on vaccine safety. The memory of immunizable disease is fading - all
because of programs with the sole purpose of disease eradication. As such, a lot of the parents
nowadays feel more threatened by the side effects of vaccines, which are reported more
frequently than the actual disease itself. A study by Siddiqi et. al. focused on parental
perceptions regarding safety of vaccines and its impact on the immunization status of their
children. Those children with parents who have specific concerns with regards side effects have
a significantly lower coverage as compared to children whose parents had no such concern.
Furthermore, knowledge was found to have a positive association with immunization coverage.
Educational status of the parents also has a significant association with their children’s
vaccination status.

In a study conducted in Tacloban City, Philippines by Lledo, Q. et.al, two main reasons
for non-compliance stood out. First is the lack of knowledge and second is wrong perception
regarding immunization. This tells us that there are still primary caregivers who lack the
necessary basic information regarding the importance of their child’s immunization status which
may result to more drastic problems. The misconception of primary caregivers regarding
immunization can be accounted for their lack of knowledge of the benefits of immunization and
their beliefs that giving their children vaccinations would only threaten their health. Some are
affected by our old culture which does not rely on modern medicine and believe that this
prevention is harmful to their children. These false beliefs and wrong notions can be eradicated
by proper health education and advocacies to primary caregivers.

Esposito et al found in their study that inadequate knowledge on the advantages and
benefits of vaccinations among healthcare workers can have negative effects on vaccination
coverage. Healthcare workers are considered by parents to be the first and the most important
source of information which could affect their decision to submit their child for immunization or
not. Also, it was noted that the manner in which healthcare workers describe the characteristics
of a vaccine can also affect parents’ decision.

In a study by Negussie et al, it was noted that there is a gap in communication by health
workers and parents about common vaccine side effects which negatively affected
immunization coverage. Another study by Oku et al, stressed that lack of skilled communication
personnel especially at the lower levels of the health system may weaken the efforts to counter
negative information about vaccines and attain the support of the community for vaccination
programs. This implies that proper training and orientation of health workers is highly needed to
address and bridge this existing gap in communication in order to strongly reinforce the benefits
of immunization on a child’s health.

A study by Markland also emphasized that mothers who lack adequate knowledge about
vaccines significantly impacted their practices and behaviors towards immunization thereby
affecting compliance. Misconceptions about vaccine safety lower their confidence in vaccines,
causing mothers to refuse having their child immunized. It was also found that a low educational
level has a strong correlation with low vaccine coverage.

Siddiqi et. al. also noted that poor compliance among caregivers was due to poor
knowledge on the importance of immunization. Knowledge was found to be directly proportional
to appropriate vaccination of children. More importantly, the likelihood of proper immunization is
increased with an educated parent and significantly increased with both parents educated.
Vaccine safety was another concern to parents because of the fear of side effects that may
harm their children. For these parents, more shots of vaccine equates to lesser protection for
the child.

Shuaib, F. et al put emphasis on educational and communication channels to establish

awareness among families with lower educational levels. Caregivers who attained an
educational equivalent to some primary or completed primary education had almost three-fold of
defaulting on immunization.

Table 3. Attitudes of respondents regarding immunization

INTEREST OF RESPONDENTS IN HAVING THEIR CHILDREN IMMUNIZED
Yes 27
No 0
FEELINGS OF LAZINESS IN HAVING THEIR CHILDREN IMMUNIZED
Yes 1
No 260
FORGETFUL OF THE SCHEDULED IMMUNIZATION DATE
Yes 0
No 27
FEEL MOTIVATED TO HAVE THEIR CHILDREN IMMUNIZED
Yes 13
No 14
AFFECTED WHEN CHILDREN ARE IMMUNIZED
Yes 13
No 14

The attitudes of the caregivers regarding immunization are shown in Table 3. All
caregivers were interested in having their children get immunized. Almost all caregivers don’t
feel lazy in going to the barangay health center (97%) while only 3% feel lazy. All caregivers
don’t forget the immunization schedule. 52% of caregivers are motivated enough to continue
immunization of their children, while 48% are not motivated enough. 52% of the caregivers feel
affected in seeing their child(ren) cry every time she/he gets vaccinated while 48% are not
affected in seeing their child(ren) cry when he/she gets vaccinated.

These findings were similar to a study by Castillo, M.A. et. al. of Lyceum of the
Philippines University in which family's beliefs and attitude towards immunization are not totally
factors that affect compliance to immunization. However these factors partially affect
compliance because some reported that they forget the schedule of the immunization.

Table 4. Immunization practices of caregivers

OTHER CHILDREN WERE FULLY IMMUNIZED
Yes 17
No 2
No answer 8
DOES REGULAR CHECK-UP ON IMMUNIZATION CARD
Yes 26
No 1
WHEN THE RESPONDENTS BRING THEIR CHILDREN FOR IMMUNIZATION
During scheduled date 26
Anytime 1
When I’m not busy 0
Never 0
ASKS HEALTH CARE WORKERS REGARDING CONCERNS OF IMMUNIZATION
Yes 23
No 4
HEALTHWORKERS PROVIDE IEC ON IMMUNIZATION
Yes 26
No 1

The practices of the primary caregivers towards immunization are shown in Table 4.
62.96% claimed that their children were fully immunized, while 7.4% claimed to have incomplete
immunization. Majority (96.30%) of the primary caregivers in Barangay Baybay regularly
checked on their children’s immunization card, and follows their scheduled date of
immunization. Apart from following the appropriate schedule, 85.18% of the primary caregivers
raise their concerns about immunization, while 14% of which does not. There were 96.30% who
claimed that the Barangay Health Workers provide Information Education Campaign through
lectures on immunization.

A study published in IOSR Journal of Pharmacy in Nigeria last 2015 entitled Assessment
of Knowledge, Attitudes and Practices of Mothers in Jos North Regarding Immunization involved
a questionnaire study design in 232 households with children born between September 26,
2011 and September 26, 2012. It was aimed to assess the relationship of socio demographic
characteristics and the knowledge, attitude and practices of mothers regarding immunization.
Eighty nine percent of the respondents had good knowledge regarding immunization. Less than
60% went for the scheduled vaccination and less than 3% had negative attitude towards
immunization. Socio demographic characteristics – education of the mother, marital status,
religion, geopolitical zone and parents of the child had been immunized as children had a
significant influence on the respondent’s knowledge. The researchers then suggested that
measures such as proper health education and health promotion interventions be taken to
improve the knowledge, attitude and practice of mothers towards immunization. (Chris-Otubor,
G.O., Dangiwa, D.A., Ior, L.D, Anukam, N.C., 2015).
 M.M. Angadi, Arun Pulikkottil Jose, Rekha Udgiri, K.A. Masali, and Vijaya Sorganvi
published “A Study of Knowledge, Attitude and Practices on Immunization of Children in Urban
Slums of Bijapur City, Karnataka, India” in 2013. The study was “to determine the knowledge,
attitude and practices of respondents among guardians of children aged 12-23 months with
respect to immunization.” There were a total of 155 respondents. Majority, about sixty-three
percent, of the children were partially immunized and about three percent were unimmunized.
Reasons for these were lack of information and motivation among the mothers/guardians. And
based on this study, the mother’s educational status, socio-economic status and sex of the child
were not statistically significant.

Our study showed that 96.30 % followed the immunization schedule and that the health
workers provided lectures and information regarding the Expanded Program on Immunization.
And eighty-five percent of the respondents raised concerns regarding vaccination. Immunization
coverage was below the target despite these results.

CONCLUSION

Upon completion of this research study, the knowledge, attitudes and practices of the
subjects regarding the EPI were determined using an adapted questionnaire.

Based on the results, the subjects of this study were mostly married, able to finish high
school, with a monthly income of 1500 to 3000 pesos, and had only 1 child in their household.

In terms of caregivers’ knowledge on EPI, majority had knowledge on the existence of

the said program, the vaccines given at birth, the monthly schedule of administration, and the
side effects that are expected after administration. Knowledge on the vaccines given and their
corresponding purpose may need further reinforcement.

In terms of the caregivers’ attitude to EPI, it was found out that nearly all of the subjects
were willing and able to send their children to immunization. Factors resulting to not submitting
and incomplete immunization of children include lack of motivation on the caregivers’ part to
finish the entire course of immunization and seeing their children cry during the vaccination.

In terms on the caregivers’ practices towards immunization, only more than half of the
subjects claimed that other children in the household were fully immunized. Nearly all of the
subjects use their immunization card and follow their immunization date as indicated in the card.

RECOMMENDATION

The key to achieve herd immunity and put an end to misinformation with regards
immunization is for the community to be actively engaged. As such, it is highly recommended
that each member of the community, most especially the primary caregivers, attend Primary
caregivers’ class to enhance their knowledge and adherence to the immunization program.
Primary caregivers are encouraged to strictly adhere to the immunization schedule and
cooperate in the REB strategy for easy and accurate reporting of immunization status of
children and vaccine-preventable diseases. Organized community groups including but not
limited to health volunteers, teachers, religious groups, and youth groups can be particularly
useful in helping raise awareness and remind community members with regards immunization
sessions as well as mobilize families whose children are due or overdue for vaccinations.

Barangay Health Workers are integral to the success of the implementation of the REB
strategy. Actively seeking out families in far flung areas of the community in order to immunize
children is one way to get them involved in the immunization program. Aside from this, door-to-
door monitoring of vaccination status within the barangay is also recommended in order to
monitor the progress and identify high risk puroks for corrective action. They can conduct a
regular Mother’s Class set by the RHU with as many catchment area communities as
possible.By doing so, this will respond to continued significant immunity gaps among
disadvantaged puroks in a barangay. They can work hand in hand with XUJPRSM, local
leaders, primary caregivers, religious organizations and ethnic minorities to facilitate unity and
exchange information. This can be a venue to provide updates and importance of the
immunization program, to ask for honest feedback and suggestions, and to raise any questions
or concerns about immunization.

The Rural Health Midwives play a very important role in educating primary caregivers about
the availability and benefits of the immunization program. Being in the frontline of their
respective health centers, they are recommended to empower and lead the barangay health
workers in carrying out the REB strategy.

The Public Health Nurses are recommended to assess immunization status and update
the weight of children at every visit, ensure proper documentation of immunization history,
proper computation of medications to be given in anticipation of the vaccine’s side effects based
on the children’s weight, and complete collection of data from the BHW for fast and easy
retrieval of records for future research purposes.

The Municipal Health Officer is recommended to strengthen the awareness and

advocacy of protection against vaccine-preventable diseases, reinforce the motivation and
compliance of mothers of children registered to the program, and ensure that there is timely
submission of complete and updated immunization reports. The completeness and accuracy of
these reports will ensure that the immunization supplies and equipment are promptly
requisitioned, well maintained, kept and accounted for.

The LGU is recommended to attend or even assist in educating and providing refresher
courses for health workers to equip them in conducting information drive about the immunization
program, vaccine-preventable diseases, vaccine-related complications, common side effects
associated with vaccines, age-appropriate vaccine administration, and the importance of such.
Resources should be efficiently distributed to the different barangays with the system of
distribution explained clearly to avoid wastage of resources.
 APPENDIX
A Descriptive Study on Knowledge, Attitude and Practices of Primary
Caregivers on Expanded Program on Immunization in
Barangay Baybay, Alubijid, Misamis Oriental

INTRODUKSIYON

Ang mga estudyante sa Xavier University - Dr. Jose P. Rizal School of Medicine kay
magpahigayon ug survey sa mga ginikanan/ guardian bahin sa bakuna sa mga bata edad ubos
12 ka buwan pinaagi sa pagtubag ug mga pangutana gamit ang isa ka questionnaire.
Ang tumong ani nga research kay ang pagsusi sa Expanded Program of Immunization
(EPI), bahin sa mga nahibal-an, pamatasan, ug binuhatan sa mga ginikanan sa bakuna.
Ang inyong mga tubag mamahimong kompidensyal lamang ug dili pagagamiton sa uban
pang katuyoan.
Daghang Salamat!

PAGTUGOT

Gatugot ko nga muapil ani nga research.

Nasabtan nako ang research nga gipahigayon ug ang tumong niini.

Nasayod ko nga ang impormasyong makuha mamahimong kompidensyal lamang ug dili

pagagamiton sa uban pang katuyuan.

OO DILI

__________________________________
Pangalan sa Ginikanan/Guardian ug Pirma
 SURVEY QUESTIONNAIRE

Date: _____________ Barangay Baybay, Purok: ___

Name: __________________ Age:_____ Sex:____ Relationship: ___________

1. What is your marital status? (Unsa imung marital status? Sulati ug check (√) ang imong tubag.)
___ Single (ulitawo o dalaga)
___ Married (minyo)
___ Widow/Widower (balo)
___ Separated (buwag)
___ Live in

2. What is the highest level of education that you achieved? (Kinatas-an nga naabtan sa eskwela.
Sulati ug check (√) ang imong tubag)
Elementary level ___ College level ___
Elementary Graduate ___ College Graduate ___
High School level ___ Post Graduate ___
High School Graduate ___ None ___

3. What is your monthly income? (Pila imung kita kada-bulan? Sulati ug check (√) ang imong tubag.)
Below 500 Php ___
500 – 1500 Php ___
1500 – 3000 Php ___
3000 – 5000 Php ___
More than 5000 Php___

4. How many children are in your household? (Pila ka bata sa inyong panimalay? Isulat ang imong
tubag) ______
KNOWLEDGE

1. Have you ever heard about Expanded Program on Immunization? (Nakadungog na ba ka bahin
sa Expanded Program on Immunization? Sulati ug check (√) ang imong tubag.)
___ Yes (oo)
___ No (wala)
If yes, where did you hear about it? (Kung oo, asa nimo nadunggan? Isulat ang imong tubag)
__________________________________________________________

2. Do you know the vaccines that are included in the Expanded Program on Immunization? (Kabalo
ba ka sa mga bakuna nga apil sa Expanded Program on Immunization? Sulati ug check (√) ang
imong tubag.)
___ Yes (oo)
___ No (wala)
If yes, list down all the vaccines included. (Kung oo, ilista tanan bakuna nga imong nahibal-
an)_____________________________________________________

3. When do the child ideally given his/her first vaccine? (Kanus-a pinaka-una ginabakunahan ang
bata? Sulati ug check (√) ang imong tubag.)

___ At birth (sa pagka-tao)

___ 3 months (3 ka bulan)
___ 6 months (6 ka bulan)
___ 1 year (1 ka tuig)
___ No idea (wala ko kahibalo)

4. Do you know the illnesses that can be prevented with completed immunization among children?
(Nakabalo ba ka kung unsa ang mga sakit nga malikayan sa kumpleto nga bakuna sa mga bata?
Sulati ug check (√) ang imong tubag.)
___ Yes (oo)
___ No (wala)
If yes, list down all the illnesses included. (Kung oo, ilista tanan sakit nga imong nahibal-
an)_____________________________________________________

5. What are the common side effects of immunization? (Unsa ang mga kasagaran nga side effects
sa pagpa-bakuna? Ilista ang imong tubag.)
______________
______________
______________

6. In your barangay, what day is Immunization Day? (Sa inyong barangay, unsa nga adlaw ang
Pagbakuna? Isulat ang imong tubag.)
______________
ATTITUDE

1. I am interested to have my child/children to be immunized. (Interesado ko nga akong anak

mabakunahan. Sulati ug check (√) ang imong tubag.)
___ Yes (oo)
___ No (dili)

2. I’m too lazy to go to the barangay health center. (Gatapulan ko muadto sa barangay health
center. Sulati ug check (√) ang imong tubag.)
___ Yes (oo)
___ No (dili)

3. I always forget the immunization schedule. (Permi ko makalimut sa schedule sa pagpabakuna.

Sulati ug check (√) ang imong tubag.)
___ Yes (oo)
___ No (dili)

4. I’m not motivated enough to continue the immunization of my child/children. (Wala kaayo koy
gana nga padayunon pa ang pagpa-bakuna sa akong anak/mga anak. Sulati ug check (√) ang
imong tubag.)
___ Yes (oo)
___ No (dili)

5. I feel affected to see my child/children cry every time he/she gets vaccinated. (Ma-apektuhan ko
kada makita nako akong anak nga muhilak inig tupok sa bakuna. Sulati ug check (√) ang imong
tubag.)
___ Yes (oo)
___ No (dili)
PRACTICES

1. My other children were fully immunized. (Ang uban nakong anak kay kompleto ug bakuna. Sulati
ug check (√) ang imong tubag.)
___ Yes (oo)
___ No (dili)

2. I regularly check on my child’s immunization card. (Regular nako nga gina-lantaw ang
immunization card sa akong anak. Sulati ug check (√) ang imong tubag.)
___ Yes (oo)
___ No (dili)

3. When do you bring your child at the barangay health center for immunization? (Kanus-a nimu
ginadala imung anak sa barangay health center para magbakuna? Sulati ug check (√) ang imong
tubag.)
___ During scheduled date (sa schedule nga adlaw)
___ Anytime (Maski kanus-a)
___ When I’m not busy (Pag dili ko busy)
___ Never (Dili gyud)

4. I ask the barangay health workers/doctors regarding matters that are not clear to me regarding
immunization. (Mangutana ko sa mga BHW/doctor sa mga butang nga dili klaro sa ako
mahitungod sa pagpa-bakuna. Sulati ug check (√) ang imong tubag.)
___ Yes (oo)
___ No (dili)

5. (Barangay health workers/doctors educate me regarding the benefits and side effects of the
vaccines and instruct me on when to follow up. (Ang mga BHW/ doctor gatudluan ko bahin sa mga
benepisyo ug side effects sa bakuna ug kung kanus-a mag follow up. Sulati ug check (√) ang
imong tubag.)
___ Yes (oo)
___ No (dili)
 #5 is on knowledge and not part of the practices of the primary health caregiver.

DAGHANG SALAMAT!
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