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Background: Misconceptions and inadequate knowledge about vaccination represent an important barrier against adherence to vaccination schedules.
Objectives: To assess the knowledge and attitude of mothers of children under five years of age with regard to standard childhood vaccination.
Subjects and methods: A cross-sectional study was conducted at Taif Children’s Hospital (a subsidiary of the Ministry of Health), Saudi Arabia, among a sample of mothers of children aged below five years attending the hospital’s outpatient clinics during the study period of May-July 2021. A valid questionnaire was utilised for data collection, comprising demographic questions as well as an assessment of respondents’ knowledge and attitude towards childhood vaccination.
Results: The study included 397 mothers, more than half of whom (53.9%) were aged between 20 and 30 years. Overall, the total knowledge score ranged between 5 and 10, with an arithmetic mean of 9.03 and standard deviation of (± 1.25). Higher-educated mothers (university or above) were more knowledgeable about childhood vaccination than lesser-educated mothers (mean ranks were 200.44 and 123.35, respectively), p=0.020. Overall, the total score for attitude towards childhood vaccination ranged between 5 and 10, with an arithmetic mean of 9.15 and standard deviation of (± 0.48). Married mothers expressed a more positive attitude towards childhood vaccination than divorced mothers (mean ranks were 200.83 and 144.81, respectively), p=0.014.
Conclusion: The knowledge about, and attitude towards, childhood vaccination among mothers in Taif, Saudi Arabia are excellent. However, some misconceptions require correction
Keywords: Childhood immunization, Vaccination
According to the World Health Organization (WHO), the administration of vaccines stimulates the human immune system to protect the individual against infectious diseases through a process called immunisation [1]. Immunisation is the most cost-effective intervention; it prevents nearly 3 million deaths per year and can save the lives of about 1.5 million children per year, globally [1,2]. Furthermore, it has been documented that successful immunisation reduces hospitalisation, cost of treatment, and mortality [3]. Misconceptions and inadequate knowledge about vaccination represent an important barrier against adherence to vaccination schedules. These misconceptions and inadequate knowledge cover aspects including the definition of a vaccine, its adverse effects, vaccine-preventable diseases, and development of diseases after the administration of vaccines [4].
Low rates of complete childhood vaccination still exist in many developing countries. This represents a public health problem; the United Nations Children’s Fund (UNICEF) has reported that nearly one third of mortality in children under five years can be prevented by vaccination [5]. The success of childhood immunisation programmes depends on many factors, some emphasis, you could say on the improvement of parents’ knowledge regarding vaccines [6]. Since parents are the primary health decision-makers for their children, their knowledge and attitude towards immunisation significantly impact the immunisation status of their children [7]. Mothers’ understanding of the reasons for childhood vaccination, as well as barriers against vaccination, is crucial when it comes to designing campaigns to improve vaccination uptake in Saudi Arabia; the present study therefore aims to investigate the knowledge and attitude of mothers of children under five years towards standard childhood vaccination.
This cross-sectional study was conducted at Taif Children’s Hospital (a subsidiary of the Ministry of Health) located in the centre of Makkah Region, in the western part of Saudi Arabia. It is the fourth-largest city in the region, with an area of approximately 13,840 km 2. The population of Taif Governorate was estimated at 993 800 people in the year 1435H corresponding to the Gregorian year 2013, representing 12.8% of the region’s total population [8]. Participants eligible for inclusion in this study were mothers of children aged below five years who attended the outpatient clinics of Taif Children’s Hospital (MOH) during the study period of May- July 2021. Mothers who did not have children below the age of five, and severely ill mothers who could not cooperate properly with the researcher, were excluded from the study. The sample size was computed using the statistical formula for a cross-sectional survey: n=Z 2 XPXQ/D 2 based on the following values: n: Calculated sample size Z: The z-value for the selected level of confidence = 1.96 P: Estimated prevalence of lowest level of good knowledge about childhood vaccination =37.1% (0.37), based on a previous Saudi study carried out in Riyadh [8] Q: (1 – P) = 62.9% (0.63) D: Maximum acceptable error = 0.05 Thus, a total of 394 mothers were invited to participate in the study, giving a sample of 358 mothers with 10% was added to the total sample size for the non-respondents. We used non-probability convenience sampling to collect data from all mothers who fulfilled the inclusion criteria, until the sample size was attained. An interview questionnaire was used in this study, which was used previously in another Saudi study carried out in Arar [9]. It includes three main parts: - Demographic data of participants (age, current marital status, number of children, education, job status and residence, and parent’s age, education and job status). - Knowledge assessment questions, with “yes” and “no” responses, covering various aspects of awareness and knowledge of childhood vaccination (10 questions). - Questions regarding attitude towards vaccination (9 questions). Before giving the questionnaires to the mothers, informed consent was requested from each of them; everyone had the right not to participate in the study or to withdraw from the study prior to completion. The researcher explained the purpose of the study to all of the respondents, and the respondents’ confidentiality and privacy were guaranteed.
The data were collected and verified by hand, and then coded prior to computerised data entry. The Statistical Package for Social Sciences (SPSS) software, version 26.0, was used for data entry and analysis. We applied descriptive statistics (e.g. number and percentage) and analytic statistics using non-parametric statistical tests for non-normally distributed data, as evidenced by significant Shapiro- Wilk test. The Mann-Whitney test was applied to compare two groups, while the Kruskal-Wallis test was applied to compare more than two groups; a p- value ≤ 0.05 was considered statistically significant.
Demographic characteristics
The study included 397 mothers. Their demographic characteristics are summarised in Table 1. More than half of them (53.9%) were aged between 20 and 30 years, and their husbands were in the same age group (57.4%). The majority (96.7%) were currently married and 47.3% had two children, including the index one. The majority of the mothers (97.5%) and their husbands (93.7%) were university graduates or above, and living in Taif City (95.7%). Approximately half of them (50.9%) were house-wives. Knowledge about childhood vaccination All of the surveyed mothers could recognise that vaccinations play a role in child health. The vast majority were sure that vaccinations are important for their children (99.7%), were aware that even healthy children require vaccination (99.7%), Vaccination is a method proven to control and eliminate life-threatening infectious diseases, particularly among vulnerable groups such as children, One (n=55)
(Yes) influenza vaccine? (Yes) sufficient? (Yes) life? (Yes) (Yes) Housewife (n=202) The present survey revealed that more educated mothers (university or above) were more knowledgeable about childhood vaccination than the lesser-educated groups. In a similar study carried out in Riyadh, factors associated with parents’
In Sudan, more than half of the respondents (55%) had negative attitudes towards vaccination of children in vaccination campaigns [16]. In Jerusalem- Palestine, the majority of mothers (94%) considered vaccination to be the main activity in maternal and children’s clinics [17]. In Georgia, the majority of mothers (97%) had a positive attitude toward immunisation and believed that vaccination plays an important role in preventing infectious diseases [18]. Again, comparison of these studies, including the present one, is not always practical, mainly due to demographic differences and the use of different tools to assess attitudes towards childhood vaccination. The current study showed that married mothers expressed a more positive attitude towards childhood vaccination than their divorced counterparts. In a study conducted in Riyadh [13], factors associated with parents’ attitudes towards immunisation were gender, residence and education level. In Malaysia, mothers’ education, age and job status were significantly associated with their attitude towards childhood vaccination [19] while in Georgia, mothers’ education was significantly associated with their attitude regarding immunisation [18].
The present study has some limitations that bear mentioning. First, it is a single-centre study, which could affect the generalisability of the results. Being a cross-sectional study is also considered a limitation, as this can prove only association, and not causality, between exposure factors and outcomes. Finally, the use of an interview questionnaire in this study renders it subject to bias. Despite these limitations, the study addresses a topic of public health importance and its assessment could assist decision-makers in Taif City, Saudi Arabia.
The knowledge of, and attitude towards, childhood vaccination among mothers in Taif, Saudi Arabia, are excellent. However, there are some misconceptions that need correction. More educated mothers (university or above) were more knowledgeable about childhood vaccination thanthe lesser-educated groups, and married mothers expressed a more positive attitude towards childhood vaccination than their divorced counterparts. Based on the findings of the present study, our recommendations are as follows: