Assessment of Measles Immunization in Children 1-2 Year Age in District Peshawar, Khyber Pakhtunkhwa Pakistan

1. Habib-ur-Rehman 2. Abdul Latif Mahesar 3. Shahid Nisar Khalid 4. Muhammad Ishaq

1. Assoc. Prof. of Medicine, JMC, Peshawar 2. Assoc. Prof. of Pharmacology, JMC, Peshawar 3. District Specialist, Bacha Khan Medical Complex Shah Mansoor, Swabi 4. Prof. of Surgery, JMC, Peshawar

ABSTRACT

Objectives: To determine vaccination coverage against measles and the factors predicting it.

Study Design: Cross sectional, Analytic

Place and Duration of Study: This study was conducted at Peshawar District Khyber Pakhtunkhwa, Pakistan and the duration was 1st June 2014 to 20th June 2014.

Materials and Methods: The study was carried on sample of 210 children in District Peshawar, Khyber Pakhtunkhwa, Pakistan. The district was first divided into clusters of 105. Out of these 21 clusters were randomly selected. Sample of 10 children aged 1-2 were randomly taken from each cluster. Cluster sampling technique was used and the data was collected by face to face interview using structured Questionnaire as tool.

Results: Overall vaccination coverage was 57.6% with a male to female ratio of 50.4% and 49.6% respectively. Mother’s Education with vaccination status of Children suggests a strong relationship. Mothers with no education (illiterate) vaccinated 36.3% and mother with education (Literate) vaccinated 82.5% of their children. The Chi-square test is significant (X2 =45.605; p-value .000).

Conclusions: Parents Education, Household Income and knowledge of mothers about measles vaccination age were found important predicting factors for vaccination status of children.

Key Words: Measles, Parents Education, Household Income


INTRODUCTION

Measles vaccine became available in 1963. It is a live attenuated vaccine, before this measles was considered a life event. Before 1963 each year 3-5 million case of measles occurred in United States, with deaths tools of approximately 500. Epidemic cycles of the disease occurred every 2-3 years and affected half of the population by six years of age and 90% by age of 15 years (3,4). After the measles vaccine became available in United States, the number of cases dropped dramatically by 90%.(1, 5) Measles is a well known infectious communicable viral disease of global nature affecting children particularly in the age group of 1-5 years. Symptoms include fever, cough, runny nose, red eyes and a generalized Maculopapular Erythematous rash. Measles is spread through respiration (contact with fluids from an infected person’s nose and mouth, either directly or through aerosol transmission) and is highly contagious – 90 % of people without immunity sharing living space with an infected person will catch it (2). The infection has an average incubation period of 14 days (range 6-19 days) and infectively lasts form 2 – 4 days prior, until 2 – 5 days following the onset of the rash. Complications of measles are relatively mild and less serious diarrhea, to pneumonia and encephalitis (sub-acute), corneal ulceration leading to scarring. Complications are usually more severe amongst adults who catch the virus. The vaccine for measles is a live attenuated type and the 1st dose is given at the age 12-15 months (8). It gives 95% immunity against measles but a boaster dose is now recommended between age of 5 and 19 years to ensure protection of the remaining 5% children. The primary objectives of the study are to estimate the vaccination coverage of children and determine the factors affecting vaccination status of children (7). The variable of study Parents education, Household income and mother knowledge about the age of measles vaccination were evaluated (8, 9). Analytic cross-sectional study design was used. Samples were collected through random cluster sampling. Data was selected using interview with structured Questionnaire. The data was analyzed by using SPSS version 17.

MATERIALS AND METHODS

The Study Design is Analytic, Cross-Sectional Study. The sampling method         used is Cluster Sampling while the sample size is n = 210. The data collection technique used is Interview schedule using structured Questionnaire and the data was analyzed using SPSS version 17. The study was carried out in district Peshawar Khyber Pakhtunkhwa Pakistan between 1st June to 20th June 2014. The district was first divided into clusters of 105. Out of these, 21 clusters were randomly selected. Sample of 10 children aged 1 – 2 years were randomly taken from each of 21 clusters. The data was collected by face to face interviews using a structured Questionnaire, consisting of questions about age and sex of child, father education, household income, mother’s education, mother knowledge about the age of measles vaccination and the vaccination status of child, the information on vaccination status of the child was collected from history by mother depending on her recall. For analysis the variables were categorized as, household income of up to Rs. 5000 / moth Cat1, Rs. 5001 to Rs. 10,000 / month Cat 2, Rs. 10,001 and above Cat 3. The education of father was given categories as, no education Cat0, 1 – 5 years of education Cat1, 5 – 10 years of education Cat 2, 11 years of education and above Cat 3. Education of the mother was given categories as, illiterate Cat 0, Literate Cat 1. Yes / No answer to the questions were given the categories of Yes Cat 1, No Cat 2.

RESULTS

The frequency distribution, cross tabulation and Chi-square results of the factors I have analyzed and discussed are given below.

Table No.1.1: Sex of Child

 

 

Frequency

Percent

Valid

Male

113

53.8

Female

97

46.2

Total

210

100.0

Table No.1.2: Frequency distribution for vaccination status of children

 

 

Frequency

Percent

Valid

Yes

121

57.6

No

89

42.4

Total

210

100.0

Table No.1.3: Sex of Child *Vaccination Status of Child

 

Vaccination Status of Child

Total

Yes

No

Sex of Child

Male

 

Count

% within vaccination

61

50.4%

52

58.4%

113

Female

 

Count

% within vaccination

60

49.6%

37

41.6%

97

total

Total

 

Count

% within vaccination

121

100.0%

89

100.0%

210

100.0%

Chi-Square Test value for this association of household income with vaccination status of Children is 37.380 and a p-value of .000.

Table 3.1: Frequency Statistics Father’s Education

 

 

Frequency

Percent

Valid

No Education

46

21.9

1-5 years

40

19.0

6-10 year

54

25.7

11 year and above

70

33.3

Total

210

100.0

                                         

Table 3.2: Father’s Education *Vaccination Status of Child

 

Vaccination Status of Child

Total

Yes

No

Fathers Education

No Edu-cation

 

Count

% within Father Education

7

21.9%

25

78.1%

32

100.0%

1-5 Years

 

Count

% within Father Education

57

51.8%

53

48.2%

110

100.0%

6-10 Years

 

Count

% within Father Education

 

 

 

11 Years

 

Count

% within Father Education

57

51.8%

11

16.2%

68

100.0%

Total

 

Count

% within Father Education

121

57.6%

89

42.4%

210

100.0%

Chi-Square Test value for this association is 44.890 with a p-value of .000 for the relation of father’s education with vaccination status of children.  

Table No.4.1: Frequency Statistics Mother’s Education

 

 

Frequency

Percent

Valid

Illiterate

113

53.8

Literate

97

46.2

 

210

100.0

Table 4.2: Mother’s Education, Vaccination Status of Child

 

Vaccination Status of Child

Total

Yes

No

Mother’s Education

Illiterate

Count

% within Mother’s Education

41

36.3%

72

63.7%

113

100.0%

Literate

Count

% within Mother’s Education

80

82.5%

17

17.5%

97

100.0%

Total

 

Count

% within Mother’s Education

121

57.6%

89

42.4%

210

100.0%

Chi-Square Test value for this association of mother’s education with vaccination status of children is 45.605 with p-value of .000.

DISCUSSION

According to this study the overall Vaccination Coverage against measles was found to be 57.6% with a male to female ratio of 50.4% and 49.6% respectively (1). Tables 1.2 and 1.3. Sex of Children was not having important association with vaccination coverage of 50.4% for male and 49.6% for female respectively. Table 1.3 Chi-square value for the association is 1.325 with a p-value of .250 which is not significant.  Table 2.2 indicates that in the lower income group the vaccination coverage is 21.9%, in the middle income 51.8% and in the upper income group 83.8% which shows a strong association of income with vaccination status of children. This difference is statistically significant (X2 = 37.380; p .000). Father Education level is a strong contributing factor towards vaccination status of children as with no education the vaccination rate is 50.0%, with 1-5 year of education it us 30.0%, with 6-10 years of education it is 44.4% and with education of 11 years and above it goes up to 88.6% (2,3, 5). Table 3.2. The Chi-Square value for this association is 44.890 with a p-value of 0.000. Table 4.2 of cross tabulation for the mother’s education with vaccination status of children suggests a strong relationship. Mothers with no education (illiterate) vaccinated 36.3% and mothers with education (Literate) vaccinated 82.5% of their children (9). The Chi-Square test value for this relationship is 45.605 with a p-value of .000, which shows a significant association between mother’s education and vaccination of children.

CONCLUSION

This study indicates that Fathers Education, Household Income, Mothers Education and the Mothers knowledge about measles vaccination age are important factors affecting the vaccination status of children.

In this study sex of child did not influence vaccination status of children and was found insignificant by Chi-Square test of significance.

REFERENCES

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Address for Corresponding Author:

Prof. Dr. Muhammad Ishaq,
Chairman & Founder
Jinnah Medical College
Warsak Road Peshawar.

Cell: 0333-9152060