Knowledge of Parents Regarding Polio Vaccination in Unvaccinated Children Less than 5 Years of Age: A Cross-sectional Study

Aim: The purpose of this study was to determine the knowledge of parents regarding polio vaccination in unvaccinated children less than 5 years of age. Study Design: Cross-sectional study. Place and Duration: Department of Pediatrics, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana Pakistan from February 2018 till August 2018 Methodology: All parents of unvaccinated children of either gender with ages from 2 months to less than 5 years of age visiting the hospital outpatient department for any reason were included in the study. Information about the OPV immunization status, demographics, education of the family earner, occupation and income, accessibility of vaccination center in terms of distance, the behavior of immunization staff, parents' views regarding vaccines were recorded. Questions were asked about the vaccination schedule. Original Research Article Larik et al.; JPRI, 34(17A): 47-51, 2022; Article no.JPRI.83229 48 Results: Mean age of the child and respondent’s age was 2.96 ±0.89 years and 31.40 ±3.96 years respectively. Male preponderance was found to be higher 146 (63.50%). Adequate knowledge about polio was found in 58 (25.20%) parents. Conclusion: The Knowledge of parents regarding polio vaccination was found unsatisfactory in unvaccinated children less than 5 years of age.


INTRODUCTION
Childhood immunization is the most costeffective way of preventing serious infectious diseases. The success of any program depends upon the coverage rate of vaccines. Many lethal diseases can be prevented by routine childhood immunization. About a million deaths are prevented all over the world due to basic routine vaccines [1]. There are a lot of issues that hinder proper immunization in children including misinformation about vaccine side effects, and disease due to vaccines. Parents' lack of knowledge regarding indications and contraindications cause poor vaccine coverage rate. Most of the parents believe that vaccines cannot be given in mild febrile illness, this is a reason behind missed vaccines in children [2].
A lot of studies done in past to determine the reasons for incomplete immunization in children.
They found that misconception about vaccines was the most common reason for vaccine program failure. The expanded program of immunization coverage in Pakistan is still low due to poor parental knowledge and beliefs regarding the vaccines. There is a need to educate parents regarding the benefits, indications, and contraindications of routine childhood vaccines. Counseling sessions should be arranged in this regard [3]. Polio is still endemic in a few countries including the African region and some other developing countries in the world. Although routine immunization coverage in these countries is improving, still it is a great need to intensify polio vaccination [4].
Poliomyelitis is still prevailing in Pakistan because in certain areas parents don't vaccinate their children. They have different myths and beliefs that should be addressed. By doing this government's goal of eradicating vaccine Preventable diseases like polio will be accomplished [5].
In Pakistan, the literature is not available regarding polio vaccination and its awareness in terms of knowledge and attitude, among parents of children under 5 years. The estimates of NGOs show very low coverage. In a study from Peshawar Pakistan, it was noted that only 64.2% of children were completely vaccinated and the most common reason behind this was lack of awareness about immunization [6]. In an Iraqi study, out of 528 parents 66.1% had adequate knowledge-practice scores. Among the knowledge questions, the lowest correct response to a statement was 10.6% [2] about 20-40% of respondents indicated insufficient knowledge regarding childhood vaccination [7]. Condition in Pakistan is alarming due to the persistence and increasing number of poliomyelitis cases in young children. The current study was planned to determine the Knowledge of parents regarding polio vaccination in unvaccinated children less than 5 years of age.

METHODOLOGY
This cross-sectional study was conducted at the Department of Pediatrics, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from February 2018 till August 2018. A Nonprobability consecutive sampling technique was used. A total of 230 parents of unvaccinated children were included in the study. The sample size was calculated by using the WHO sample size calculator taka ing Confidence level of 95% , anticipated population proportion = 10.6 % [2], and absolute precision required = 4%.
All parents of unvaccinated children of either gender with ages from 2 months to less than 5 years of age visiting the hospital outpatient department for any reason were included in the study. In this study a, total of 230 parents were interviewed for their knowledge of the polio vaccine. Parents meeting the inclusion criteria were interviewed from the outpatient department visiting along with the children for any reason. They were interviewed by trained interviewer trainee herself and by trained medical students of year 3 and above. Information about the OPV immunization status, demographics, education of the family earner, occupation and income, accessibility of vaccination center in terms of distance, the behavior of immunization staff. Questions were asked from parents regarding the immunization schedule. The whole information was recorded on especially designed proforma.
SPSS version 22.0 was used for data analysis. Descriptive statistics were used to calculate the mean and standard deviation for Quantitative Variables including the age of the child and age of the respondent. Frequencies with percentages were presented for Qualitative variables like the gender of the child, respondent (father/mother), education of parents, household income, parents' knowledge about polio vaccination. Effect modifiers like the gender of the child, parent age, gender of the parents, educational status, and family monthly income status were stratified to see the impact of these on outcomes. Poststratification Chi-square test was applied and p <0.05 was taken as significant.

DISCUSSION
The immunization coverage in Pakistan needs improvement. Factors such as knowledge, attitude, and practices of parents and patients are also known to contribute to the success or failure of the immunization program. In our study, adequate knowledge about polio was found in 58 (25.20%) parents. About 90% of respondents were in favor of vaccination.    [8]. Although vaccines are available globally but their poor coverage is alarming. This is the main hindrance to poliomyelitis eradication. In a study from Pakistan, 27.9% of parents refused to vaccinate their children. Most of the mothers were uneducated and they had the issue of food insecurity. Parents with high food insecurity were more likely to refuse vaccination of their children compared with parents with minimal food insecurity [9].
Many factors influence parents to vaccinate their children including socioeconomic status, their trust in the public health system, and the parentphysician relationship. In our study most of the families were poor, their household income in majority was 154 (67%) 15,000-30,000 rupees followed by <15,000 rupees 40 (17.40%) and >30,000 36 (15.70%). In a study from Lebanon vaccine response rate was 79.5%. Better knowledge and attitude were significantly associated with a better vaccine coverage rate [10]. Moreover a study from Peshawar Pakistan concluded that poor knowledge and negative attitude towards polio vaccine was the main reason for polio eradication failure. Although most of the parents (65.1%) had sufficient knowledge about polio disease and its vaccines their religious beliefs were the main hindrance behind the poor coverage [11,12]. The overall full basic immunization coverage in Pakistan is still low. In our study mean child age was 2.96 ±0.89 years and the majority of the child 150 (65.20%) had >2 years of age. In a current study from Sindh Pakistan, the basic immunization rates were 69.1% for under five weeks old children.
The study concluded that a child's age, number of living children, parent's education level, wealth, the source of mother and child health information, number of antenatal care, and assistance during delivery were associated with completing basic immunization.

CONCLUSION
The Knowledge of parents regarding polio vaccination was found unsatisfactory in unvaccinated children less than 5 years of age.

ETHICAL APPROVAL
Permission was taken from the ethical review committee of the university.

CONSENT
As per international standard, parental written consent has been collected and preserved by the author(s).