CHAPTER I THE PROBLEM AND ITS BACKROUND INTRODUCTION Immunization is a basic health service and such it is integrated into

the health service being provided by the rural health unit. The standard routine Immunization schedule for infants in the Philippines is adopted to provide maximum against the seven vaccines preventable disease in the country before the childs first birthday. The fully immunized child must have completed Bacillus Calmette Guerin 1; Diphtheria Pertusis Tetanus 1; Diphtheria Pertusis Tetanus 2; Diphtheria Pertusis Tetanus 3; Oral Polio Vaccine 1;Oral Polio Vaccine 2; Oral Polio Vaccine 3;Hepatitis 1; Hepatitis 2; Hepatitis 3 and Measles before the child is 12 months of age. According to the Department of Health (www.doh.gov.ph), The Expanded Program on Immunization was launched in July 1976 by the Department of Health in cooperation with the World Health Organization and the UNICEF. The general objective was to reduce the morbidity and mortality rate among infants and children caused by the seven childhoods communicable disease such as Tuberculosis, Diptheria,

Pertusis, Tetanus, Poliomyelitis, Measles, and Hepatitis B. The government stands firm in their position that every child born must undergo vaccination to decrease the risk of disease and to promote wellness. Most parents in the rural areas are not aware about the importance of Immunization to their children. They take it for granted. Another factor is that they do not have enough money to avail of an immunization program for their children: while others 1

are simply ignoring the fact that they have to bring their children to a barangay health center to do their obligation. Here, immunizations are given for free. The researchers chose this topic to inform or give knowledge to parents the importance of immunization to their children. This study enables them to know the worth of being immunized. And the ideas of preventing diseases like measles, rubella, etc. STATEMENT OF THE PROBLEM This study aims to determine the Level of Knowledge and Compliance of Parents to Immunization Program of Selected Barangay Health Center in Antipolo City. Specifically this study will seek to answer the following questions: 1. How does the respondents profile be described in terms of: 1.1 Age 1.2 Gender 1.3 Marital Status 1.4 Parity 1.5 Educational Attainment 1.6 Family Income 2. What is the level of knowledge of respondents in immunization program in terms of: 2.1 Benefits 2.2 Schedule 2.3 Management

3. Is there any significant relationship between the level of knowledge and compliance in immunization program in the community. 2.4 Benefits 2.5 Schedule 2.6 Management

PURPOSE OF THE STUDY The purpose of the study is to determine the Level of Knowledge of respondents in immunization program in terms of benefits, schedule, and management. This is aims to identify the significant relationship between the level of knowledge and compliance of parents to immunization program in the community in terms of benefits, schedule and management. To informed the guardians about the importance of the immunization. SIGNIFICANCE OF THE STUDY This study focuses on the level of knowledge and compliance of parents to immunization program of selected baranggay health center in Antipolo, City. Local Officials. This study could help them to minimize the incidence of mortality and morbidity rate in children. Health Care Workers. This study could help them to promote wellness and awareness.

Parents. This study will benefit their children to prevent childhood diseases Community. The study will benefit the community to lessen the childhood diseases like Tuberculosis, Hepa, Polio, Diptheria, Pertusis and Tetanus. The community will be more productive and healthy. Future Researchers. This will also help them to obtain additional knowledge and general ideas regarding the level of knowledge and compliance on immunization program. SCOPE AND DELIMITATIONS OF THE STUDY The study focuses on identifying on the level of knowledge and compliance of parents to immunization program of selected barangay health center in Antipolo, City. The respondents are approximately 100 randomly selected parents or guardians with current children ages below 1 year old are being selected in two Baranggay Health Center in Antipolo, City. The barangay health centers are San Isidro and Dela Paz. The study conducted in the year 2012-2013. All data shall be treated with full confidentiality and presented in the right manner.

CONCEPTUAL FRAMEWORK INPUT Respondents Profile PROCESS Data Bank OUTPUT Updated

Level of Knowledge of parents in immunization program. - Benefit - Schedule - Management

Assess Level of Knowledge of parents in immunization program. - Benefit - Schedule - Management -

Assessed Level of Knowledge of parents in immunization program.

Is there any significant relationship between the level of knowledge and compliance of parents to immunization program of the community? - Benefit -Schedule - Management

Determine if there any significant relationship between the level of knowledge and compliance in immunization program in the community? - Benefit -Schedule - Management

Determined the significant relationship between the level of knowledge and compliance in immunization program in the community?

Figure 1

HYPOTHESIS The research hypothesis pursued in this study states that there is no significant relationship between the level of knowledge and compliance in immunization program in the community. DEFINITION OF TERMS BCG Refers to the first vaccine given at birth which provides protection against tuberculosis. BENEFITS Refers to the protection against disease and to prevent possible complication such as TB ( Tuberculosis), Diptheria, Pertusis, Tetanus, Poliomyelitis, Measles and Hepatitis B. COMPLIANCE Refers to how mother or guardian responds to immunization program. DIPTHERIA Refers to which vaccines provides protection against Diptheria. HEPA B - Refers to vaccine which provides protection against Hepatitis B. IMMUNIZATION Refers to the process of providing protection against a particular disease through the introduction of vaccines. IMMUNIZATION PROGRAM Refers to EPI which includes BCG, DPT, OPV, HEPA B and MEASLES. KNOWLEDGE Refers to the knowledge of mothers or guardian regarding immunization program.

MEASLES - Refers to vaccine which provides protection against measles. MANAGEMENT Refers to how mothers facilitate care after the administration of vaccines. OPV - Refers to which vaccine provides protection against polio. PARENTS refers to the mother and father of the child. PERTUSSIS - Refers to vaccine which provides protection against whooping cough. SCHEDULE Refers to the interval and routine of the vaccination. TETANUS Refers to one of the trivalent vaccine in DPT which provides protection against tetanus.

CHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES This chapter deals with related literature and studies, and relationship/differences of cited studies by local and foreign authors that were gathered from books, journals, researches, and other printed materials. FOREIGN LITERATURE HISTORY The expanded program on Immunization (EPI) was initiated in 1974 by the World Health Organization (WHO) with the goal to make vaccines available to all children throughout the world. Ten years later, in 1984, the WHO established a standardized vaccination schedule for original EPU vaccines; BCG (Bacillus Calmette-Guerin), DPT (Diphtheria-tetanus-pertussis), oral polio and measles. Increased knowledge of the immunologic factors of disease led to the new vaccines being developed and added to the EPIs list recommended vaccines. Hepatitis B (HepB), yellow fever in countries for the disease, and Haemophilus influenzae meningitis (Hib) conjugate vaccine in counties with high burden of disease. In 1999 the Global Alliance for Vaccines and Immunization (GAVI) was created with a sole purpose of improving children health in the poorest countries by extending the reach of the EPI. The GAVI brought together a grand coalition, including the UN agencies and institutions ( WHO, UNICEF, the World Bank), public health institutes, donor and implementing countries, the Bill and Melinda Gates Foundation and The

Rockefeller Foundation, the vaccine industry, non-governmental organizations (NGOs) and many more. The creation of the GAVI has helped to renew interest and to maintain the importance of immunizations in battling the worlds large burden of infectious diseases. The current goals of the EPI are: to ensure full immunization of children under one year of age in every district, to globally eradicate poliomyelitis, to reduce maternal and neonatal tetanus to an incidence rate of less than one case per 1000 births by 2005, to cut in half the number of measles- related deaths that occurred in 1999, and to extend all new vaccine and preventive health interventions to children in all district in the world. In addition, the GAVI has set up specified milestones to achieve the EPI goals: that by 2010 all countries have routine immunization coverage of 90% in their child population, that HepB be introduced in 80% in all counties by 2007 and that 50% of the poorest countries have Hib vaccine by 2005 EXPANDED PROGRAMME ON IMMUNIZATION

Since its inception in the 1970's, EPI in the Western Pacific has greatly evolved in many areas.

While EPI initially focused on building sustainable routine immunization systems to protect children against common childhood diseases through administration of vaccines during infancy, achieving by 1988 less than 80% coverage of children receiving the basic set of vaccines, in 1988, when the WHO World Health Assembly (WHA) and the Western Pacific RCM endorsed resolutions to eradicate poliomyelitis (WHA 41.28

and WPR/RC39.R15), WPR - EPI embraced a new era of eradication, elimination and accelerated control of specific diseases and as a result of those efforts, the last indigenous case of poliomyelitis occurred in 1997 and poliomyelitis eradication was certified on 29 October 2000. The poliomyelitis-free status has been maintained since although several episodes of imported wild poliovirus occurred and vaccine derived polioviruses (VDPV) emerged in areas of low coverage. None of these events though resulted in sustained poliovirus transmission. Measles had declined substantially in the Region over the past 25 years and most countries had attained the 90% disease reduction goal set by the 1989 WHO World Health Assembly due to high routine coverage with measles vaccine. The introduction of hepatitis B vaccine into the routine immunization programmes of all countries was almost achieved, with Cambodia and Lao PDR scheduled for September 2001. Neonatal tetanus (NT) had been eliminated in all but five countries of the Region. In this context regional measles elimination and hepatitis B control goals were established in 2003 by the Regional Committee Meeting (RCM), WHO's governing body in the Western Pacific, and a target year of 2012 was endorsed by the RCM in 2005. Focusing on providing hepatitis B vaccine birth dose and a second dose measles vaccine was perceived as offering new opportunities to complete the whole schedule. In the broader context of generally strengthening routine immunization services and health systems additional vaccine preventable diseases could be averted, and by fostering collaboration with mother and child health services further contributions can be made to reducing childhood mortality as well as maternal mortality, the latter mainly through

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prevention of tetanus. Both will support achieving the important respective Millennium Development Goals (MDG). Since the regional twin goals were established, efforts are also being made at regional and national levels to prepare countries to take informed decisions on introduction and expansion of new and underutilized vaccines against Haemophilus influenza type b (Hib), Streptococcus pneumoniae, Rotavirus, rubella, and Japanese encephalitis (JE). Introduction of new and expansion of underutilized vaccines will offer additional opportunities to reduce childhood deaths and progressively protected more people from vaccine preventable diseases. These new initiatives, build on the established routine immunization systems and the specific regional goals of measles elimination and hepatitis B control by 2012. http://www.wpro.who.int/sites/epi/ METHODS OF PROGRAM IMPLEMENTATION In each of the United Nations member states, the individual national governments create and implement their own policies for vaccination programs following the guidelines set by the EPI. Setting up an immunization program is multifaceted and contains many complex components including a reliable cold chain system, transport for the delivery of the vaccines, maintenance of vaccine stocks, training and monitoring of the health workers, outreach education program to inform the public, and a means of documenting and recording which child gets receives which vaccines.

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Each distinct region has slightly varying of setting up and implementing their own immunization program based on their existing level of health infrastructure. Some areas will have fixed site for vaccination: healthcare facilities such as hospitals or health posts that include vaccination along with many health care activities. But the areas where the number of structured health facilities is small, vaccination teams consisting of staff members from a health facility can deliver vaccines straight to individual towns and villages. These outreach services are often scheduled throughout the year. However, in especially underdeveloped countries where proper communication and infrastructure is absent, cancellation of the planned immunization visits leads to deterioration of the program. A better strategy in such counties is the pulse immunization technique, where pulses of vaccines are given to children in annual vaccination campaigns. Additional strategies are needed if the area of the immunization program consists of poor urban communities because such areas tend to have low uptake of vaccination programs. Door-to-door canvassing, also referred to as channelling, is used to increase uptake in such hard to reach groups. Finally, periodic national level mass vaccination campaigns are being increasingly included in the immunization programs. FOREIGN STUDIES IMMUNIZATION AS A HEALTH PROMOTION PROGRAM Immunization or vaccines are solutions administered to children to invoke an antibody response against a certain disease. Immunization provides artificial active immunity, wherein attenuated or weakened organisms are introduced into the childs body, which will trigger the body to produce antibodies against it. If at a later time that

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specific antigen will enter the childs body, it already has a memory of that pathologic organism and the antibodies will be able to fight it (Pillitteri, 2003). The Centers for Disease Control and Prevention (CDC) and the local public health departments in the USA share the goal of prevention and control of infection in the community. One of the methods employed to achieve this goal is implementing immunization programs, which is a wide-scale approach to prevent specific infectious diseases from occurring in a population. The immunization programs have markedly decreased the incidence of infectious diseases. Vaccines for the prevention of smallpox, measles, mumps, rubella, chickenpox, polio, diphtheria, pertussis, and tetanus are among the most successful vaccine programs. The USA has more than 25 licensed vaccines. The standard recommended vaccination schedule for infants and children was approved by CDC, American Academy of Pediatrics (AAP), and American Academy of Family Physicians (AAFP) (Smeltzer & Bare, 2004). Hepatitis B vaccine (HBV) is recommended for all infants in the USA. Three doses are required. For infants born from hepatitis B surface antigen (HbsAg) negative mothers, they should receive their dose in the newborn period or by age two months, the second dose one month after the first dose, and the third dose two months later but not before six months of age. For those born of HBsAg-positive mothers, they should receive hepatitis B globulin within twelve hours of birth plus the HBV. A second dose of HBV is recommended at one to two months and the third dose at six months. If the mothers HbsAg status is not known, the infants vaccines should be given the same as those born from HbsAg-positive mothers (Smeltzer & Bare, 2004).

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Hepatitis means inflammation of the liver, and the most common is hepatitis B. Hepatitis B virus can cause chronic infection in which the patient never gets rid of the virus and many years later develops cirrhosis of the liver cancer. It is also the most serious type of viral hepatitis and the only type causing chronic hepatitis (Reyala, Nisce, Martinez, Hizon, Ruzol, & Alcantara et al., 2000). More than two billion people alive today have at some time in their lives been infected with hepatitis B virus. Of these, about 350 million remain chronically infected carriers who can transmit the disease for many years before going on to develop cirrhosis of the liver or liver cancer. Every year there are about four million acute clinical cases of hepatitis B and about a million deaths. Primary liver cancer caused by hepatitis B is now one of the principal causes of cancer death in many parts of Africa, Asia, and the Pacific Basin (WHO, 2002, 6).

Globally, child-to-child and mother-to-child transmission accounts for the majority of infections and carriers. The disease can also be transmitted through sexual contact, through the use of unsterile needles or other medical equipment, infected blood products, and cultural practices involving skin piercing. Two thirds of the worlds population lives in areas with high levels of infection (WHO, 2000, 6). Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine is recommended for children to receive first a primary series of four immunizations with the vaccine, at two, four, six, and fifteen to eighteen months. A booster is then given between ages four and six years, or before entry into school (Smeltzer & Bare, 2004).

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Diphtheria is an infectious disease spreading from person to person by respiratory droplets from the throat through coughing and sneezing. The disease can be fatal. Between 5% and 10% of diphtheria patients die if the disease remains untreated (Pilliteri, 2003). Tetanus is a serious disease that causes the muscles of the body to become rigid and go into spasms. The disease has been referred to as lockjaw, because patients have difficulty in opening their mouth because of spasm of the jaw muscles. Three out of every 10 people who contact tetanus will die of it. Pertussis or whooping cough is a disease that causes severe coughing spells with a characteristic whooping sound. These coughing spells can interfere with breathing which may lead to convulsions or brain disorders (Pilliteri, 2003). Haemophilus influenza type B (Hib) is a vaccine against H. influenzae, a major cause of meningitis in children. It is administered in a two-dose or three-dose regimen. The two-dose regimen is given at age two and four months while the three-dose regimen is given at two, four, and sixteen months (Smeltzer & Bare, 2004). Meningitis is an infection of the cerebral meninges. The pathologic organism is spread to the meninges usually from an upper respiratory tract infection (URTI) or by direct introduction, like a skull fracture. Invasion of the infection into nerves can result in blindness, deafness, or facial paralysis. Children with this disease become increasingly irritable. They may have seizures (Pillitteri, 2003). Inactivated polio vaccine (IPV) or Salk vaccine is administered in a primary series of three doses and given along with DTaP at two, four, and six to eighteen months of age.

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A fourth booster dose is given between the ages of four and six years, before school entry (Smeltzer & Bare, 2004). Polio is a communicable disease, caused by polioviruses. Transmission of the virus occurs by direct person to person contact, by contact with infected secretion from nose or mouth and nose, multiplies in the blood and results to paralysis. The lower part of the body is most affected, but sometimes the upper part of the body may be paralyzed and can even result to death (Pilliteri, 2003). Polio is a communicable disease, caused by polioviruses. Transmission of the virus occurs by direct person to person contact, by contact with infected secretion from nose or mouth and nose, multiplies in the blood and results to paralysis. The lower part of the body is most affected, but sometimes the upper part of the body may be paralyzed and can even result to death (Pilliteri, 2003). Measles, mumps, and rubella (MMR) vaccine is first given around the time of the fifteen-month checkup. The second dose is generally given between the ages of four to six years or, if the child did not receive the four- to six-year dose, at eleven to twelve years (Smeltzer & Bare, 2004). Measles is an acute highly communicable infection characterized by fever and rashes at which stage grayish pecks (Kopliks spots) may be found on the inner surface of the cheeks. This is common among children under 2 years old that may lead to death if not promptly treated. Measles thrives in cities especially in deprived urban areas where overcrowding and poor sanitation (Pilliteri, 2003). Among vaccine-preventable diseases, measles remains the leading cause of child deaths, accounting for almost a million deaths every year, mainly in developing

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countries. Although global immunization coverage for measles vaccine was over 80% in 1997, in some countries, mainly in Africa, less than 50% of children are immunized (WHO, 2000, 4). Data of measles cases last 2002 was 162 and at 2003, 93 cases were admitted at hospitals, showing a 42.5% decrease. Twelve of the 93 cases had received measles vaccine previously, 25 had no vaccination, and 56 had unknown immunization status (DOH, 2003, 6). Mumps or parotitis is caused by the mumps virus. It begins with fever, headache, and malaise. A person complains of earache after 24 hours. This earache is actually to the jaw line just below the earlobe. This is because the parotid gland is swollen and tender. Chewing aggravates the pain. Rubella or German measles is caused by the rubella virus and spread through direct and indirect contact and droplet transmission. A discrete pink-red maculopapular rash appears first on the face. It spreads downward to the trunk and extremities and disappears on the third day. It is accompanied by low-grade fever (Pillitteri, 2003). Varicella or chickenpox vaccine may be given to infants at twelve to eighteen months. Children thirteen years of age or older should receive two doses, at least one month apart (Smeltzer & Bare, 2004). Varicella is caused by the varicella-zoster virus and is highly contagious. It is spread by direct or indirect contact of saliva or vesicles. This disease is characterized by low-grade fever, malaise, and the appearance of a rash in twenty-four hours. The lesions from a crust and are usually found on the trunk.

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Pneumococcal vaccine, which is against pneumococcal pneumonia, is recommended for all children at two to twenty-three months. It provides protection for six to ten years. Pneumococcal pneumonia is usually preceded by an URTI. The alveoli become filled with red blood cells and serum. A blood-tinged sputum may be coughed out. After twenty-four to fourty-eight hours, it will be replaced by fibrin, leukocytes, and pneumococci and the child raises thick purulent sputum (Pillitteri, 2003). Hepatitis A and influenza vaccines are recommended for at-risk populations. Susceptible individuals for influenza include those older than fifty years of age, residents of extended care facilities, those with chronic pulmonary or cardiovascular diseases, and those with diabetes, immunosuppression, or renal dysfunction (Smeltzer & Bare, 2004). Hepatitis A is caused by hepatitis A virus through the fecal-oral route. It also results to inflammation of the liver. Influenza can be caused by influenza virus A, B, or C through the droplets from infected persons (Smeltzer & Bare, 2004). This disease is accompanied by high fever, pains in the back and extremities, and a sore throat (Pillitteri, 2003). To reduce the infant mortality and morbidity, the DOH launched the EPI last July 1976. This is because infant mortality and morbidity in the Philippines include the seven immunizable diseases. The EPI is based on the epidemiological situation where schedules are based on the occurrence and characteristics of the studies. This program has a mass approach, protecting the whole community rather than just the individual. Health centers included immunization as one of the basic health services provided by the Rural Health Unit. Community immunization is the main focus of the EPI. Maintenance of the right

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temperature for storage of vaccines and during distribution of vaccines to different health institutions is also stressed in the EPI. Dissemination of information and communicating with the community to educate them about immunization is necessary before conducting assessment and evaluation of EPI. Maintenance of the proper health practices and monitoring of health institutions can be helpful for the continuous positive effect of vaccination. The EPI offers five free vaccines (Reyala, Nisce, Martinez, Ruzol, & Alcantara, 200). BCG is a live freeze-dried vaccine which must be reconstituted and administered intradermally with a special needle and syringe. If given correctly, the injection site raises a small "bleb" which looks like the peel of an orange that is usually observed from 2-12 weeks after inoculation. This expected effect of the BCG vaccine can be managed if mothers will be taught of not to apply alcohol in the injection site and avoid exposure to light. BCG is still the most widely used of all the EPI vaccines. In 1997, almost 90% of the worlds children were immunized against tuberculosis. The vaccine's main advantages are protection against the most serious forms of childhood tuberculosis: miliary tuberculosis, which mainly affects the lungs but also spreads via the blood throughout the body, and tuberculosis meningitis, which affects the brain and spine. However, the vaccine is only 50 to 80% effective against these forms of childhood TB. BCG offers some protection against leprosy but its protection against adult forms of tuberculosis is uncertain (Reyala, Nisce, Martinez, Hizon, Ruzol, & Alcantara et al., 2000).

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Tuberculosis is a highly infectious chronic diseased caused by the Mycobacterium tuberculosis. It is a respiratory disease, common among malnourished individuals living in crowded area, especially in children of underdeveloped countries and has been declared a global emergency in 1998 by the World Health Organization (WHO) (Reyala, Nisce, Martinez, Hizon, Ruzol, & Alcantara et al., 2000). BCG vaccination had the lowest accomplishment at 59.30%. A large number of children suffered from tuberculosis meningitis, a complication of tuberculosis, and other forms of tuberculosis. The DPT combination vaccine is a liquid vaccine, which must not be frozen. It contains vaccine components against diphtheria, tetanus, and pertussis (whooping cough). The vaccine is given intramuscularly. Three doses are needed for full protection, at least four weeks apart. In 1997, over 80% of children under one year old were immunized with three doses of DTP vaccine. The success rate of the DPT vaccine significantly reduced the diseases covered by this vaccine by 60% (Reyala, Nisce, Martinez, Hizon, Ruzol, & Alcantara et al., 2000). Nursing consideration about this vaccine is to ask about reactions to previous dose and teach every mother that expected reactions are fever within 24 hours and local soreness which disappears within 3-4 days. OPV is a live attenuated oral polio vaccine developed by Dr. Albert Sabin in 1961. It is a liquid vaccine comprising three serotypes of live attenuated poliovirus. The vaccine is administered orally. Once opened, vials of OPV can be stored and re-used, provided they are kept within the cold chain and not used beyond the expiry date.

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Important nursing consideration is to teach mother not to feed the child for 30 minutes after administration to avoid vomiting (DOH, 2000, 4). OPV is the vaccine of choice for eradication of poliomyelitis. But the overriding reason is its ability to induce immunity in the stomach, the key site where poliovirus multiplies. All endemic countries in the world have now begun to implement the strategies recommended by WHO to eradicate polio, including supplementary immunization with OPV. Polio has been eradicated from the Western Hemisphere since 1991, and is on the verge of eradication in the European and Western Pacific Region, including China (WHO, 1999, 5). Hepatitis B vaccine is a liquid vaccine, which requires three doses intramuscularly, at least four weeks apart. It must not be frozen. The vaccine is given at the same time as each dose of DTP. Hepatitis B vaccine is the first vaccine to be developed against a form of liver cancer. Important nursing consideration is to teach mothers that fever for 1-2 days after administration of this vaccine is an expected side effect (Pilliteri, 2003). Measles vaccine is a live attenuated freeze-dried vaccine. Once the vaccine has been reconstituted, it must be protected from the light and kept as cool as possible. It is given subcutaneously. Any doses remaining in an opened vial at the end of a vaccination session must be discarded. Important nursing consideration focuses on the parents education that expected effects of this vaccine include fever and rash 5-7 days after vaccination lasting for 3 days (Reyala, Nisce, Martinez, Hizon, Ruzol, & Alcantara et al., 2000).

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BARRIERS TO IMMUNIZATION The receipt of vaccines is hampered by some issues and concerns, such as pockets of resistance or refusal to accept immunization services due to misconceptions or lack of knowledge about the benefits of immunization (DOH, 2003, 2). The sustainability of health intervention depends not only on public compliance but also on public demand. Public acceptance of vaccination is said to be based on incomplete knowledge that makes it vulnerable to questioning of its motives, benefits, and safety. Understanding and monitoring the acceptance and non-acceptance of vaccinations by parents in diverse social and cultural aspects is crucial to sustain high immunization coverage (WHO, 2002, 2). In a study conducted by Luman, McCauley, Shefer, and Chu (2001) among African-American mothers, it was found that their beliefs inhibit them from seeking immunizations. The result shows that one third of mothers did not believe that the vaccines for measles or pertussis were effective. They were not consistently connected to the health care system. For example, families frequently lacked referrals to a health care provider for immunization. Also, undervaccination were strongly associated with mothers who had less than a high school education, were divorced, separated, or widowed, had multiple children, and had incomes below the 50% of the poverty level. Another finding found in the study done by National Vaccine Advisory Committee (NVAC) in the United States of America, demographic factors have strong correlation with underimmunization than with overall belief of the parents in the importance of immunizations and the seriousness of the diseases they prevent. Their belief that the timing of immunizations is not important was the only attitude that was

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consistently associated with late receipt of immunizations. However, there are children whose parents are against vaccination, thereby posing an obvious barrier (NVAC, 1999, 4). In that same study, NVAC concluded that children often fall behind in their immunizations because their parents do not know when immunizations are due. Parents may not seek immunizations because they believe their child's immunizations to be upto-date. It also stated that the maintenance of current immunization rates remains essential through dissemination of information to parents regarding new vaccines and changes to the schedule (NVAC, 1999, 5). A survey done by DOH on the knowledge, attitude and practice of mothers revealed that the most common reasons for the non-vaccination of a child were mothers do not have time (23%), do not know about the immunization (17%) and do not know or forgot the childs vaccination schedule (17% to 22%). About 5% of mothers also said that vaccines were not available at clinics (DOH, 2002, 8). According to a research about barriers to immunization, The lack of family support, perceived barriers to receipt of well-child care and vaccinations, lack of adequate prenatal care, and living in poverty were associated with undervaccination at ages 3 and 7 months in socioeconomically disadvantaged infants and mothers. This stresses that socioeconomically disadvantaged urban children continue to be at high risk for undervaccination (Bates & Wolinsky, 2000). Bates and Wolinskys (2000) study also found the following: Mothers who felt less control over their life and were less responsible

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for life events, were more likely to have their children's vaccinations not up to date. Surprisingly, perceived benefit of medical care to prevent diseases (measles, whooping cough, and polio) as measured at follow-up also was related directly to underimmunization at age 2 years.

Although the decline in the overall incidence of preventable childhood diseases is encouraging, as many as 50% of children under 4 years of age in some communities are still not fully immunized. Childhood infectious disease will increase again if immunization is not maintained as a high national priority (Pilliteri, 2003).

It has been estimated that as many as 59% of infants are not fully vaccinated at 7 months of age. The National Health Interview Survey found that only 14% of children ages 19 to 35 months had received recommended immunization coverage. A 1991 to 1995 study of urban areas found that from 42% to 89% of children were behind their immunizations (Givens & Moore, 1995).

DOES IMPROVING MATERNAL KNOWLEDGE OF VACCINES IMPACT INFANT IMMUNIZATION RATES? A COMMUNITY-BASED RANDOMIZEDCONTROLLED TRIAL IN KARACHI, PAKISTAN. (In the study of Wilson, Feleta L.et al.) In Pakistan, only 59-73% of children 12-23 months of age are fully immunized. This randomized, controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates. Methods: Three

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hundred and sixty-six mother-infant pairs, with infants aged = 6 weeks, were enrolled and randomized into either the intervention or control arm between August - November 2008. The intervention, administered by trained community health workers, consisted of three targeted pictorial messages regarding vaccines. The control group received general health promotion messages based on Pakistan's Lady Health Worker program curriculum. Assessment of DPT/Hepatitis B vaccine completion (3 doses) was conducted 4-months after enrollment. A Poisson regression model was used to estimate effect of the intervention. The multivariable Poisson regression model included maternal education, paternal occupation, ownership of home, cooking fuel used at home, place of residence, the child's immunization status at enrollment, and mother's perception about the impact of immunization on child's health. Results: Baseline characteristics among the two groups were similar. At 4 month assessment, among 179 mother infant pairs in the intervention group, 129 (72.1%) had received all 3 doses of DPT/Hepatitis B vaccine, whereas in the control group 92/178 (51.7%) had received all 3 doses. Multivariable analysis revealed a significant improvement of 39% (adjusted RR = 1.39; 95% CI: 1.06-1.81) in DPT3/Hepatitis B completion rates in the intervention group. Conclusion: A simple educational intervention designed for low-literate populations, improved DPT-3/Hepatitis B vaccine completion rates by 39%. These findings have important implications for improving routine immunization rates in Pakistan.

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POSTPARTUM MOTHERS ATTITUDES, KNOWLEDGE, AND TRUST REGARDING VACCINATION (In the study of Chen Wu et.al) To examine attitudes and knowledge about vaccinations in postpartum mothers. Methods This cross-sectional study collected data via written survey to postpartum mothers in a large teaching hospital in Connecticut. We used multivariable analysis to identify mothers who were less trusting with regard to vaccines. Results of 228 mothers who participated in the study, 29% of mothers worried about vaccinating their infants: 23% were worried the vaccines would not work, 11% were worried the doctor would give the wrong vaccine, and 8%worried that they are experimenting when they give vaccines. Mothers reported that the most important reasons to vaccinate were to prevent disease in the baby (74%) and in society (11%). Knowledge about vaccination was poor; e.g., 33% correctly matched chicken pox with varicella vaccine. Mothers who were planning to breastfeed (P = .01), were primiparous (P = .01), or had an income \$40,000 but did not receive support from the women, infants, and children (WIC) program were less trusting with regard to vaccines (P = .03). Although 70% wanted information about vaccines during pregnancy, only 18% reported receiving such information during prenatal care. Conclusion: Although the majority of infants receive vaccines, their mothers have concerns and would like to receive immunization information earlier. Mothers who are primiparous, have low family incomes but do not qualify for the WIC program, or are 26

breastfeeding may need special attention to develop a trusting relationship around vaccination. Mothers would benet from additional knowledge regarding Study Design This was a cross-sectional survey of postpartum mothers. A self-administered survey of postpartum mothers was conducted on the postpartum ward of a large teaching hospital that serves a diverse population with 4,700 births per year. Subjects were consecutive postpartum mothers who were present in the hospital on a weekday between June 2003and August 2003. Eligible subjects included all mothers who had given birth 1 5 days previously, were English- or Spanish-speaking, and had delivered healthy newborns. The research assistant approached all mothers on the postpartum wards to determine eligibility. Mothers who had newborns who stayed in the neonatal intensive care unit for more than 24 h were excluded. The study wasapproved by the Yale University School of MedicinesInstitutional Review Board.the risks and benets of vaccines particularly during prenatal care. Results: 296 mothers approached, 228 (77%) completed questionnaires. Respondents and non respondents did not differ with respect to whether the newborn was in the NICU for less than 24 h or the date of birth of the baby. Of the non respondents, 6% reported that they could not read English or Spanish. The survey was completed in English by 93% of the mothers and in Spanish by the remaining 7%. For 39%, this newborn was their rstborn, for 38% this was their second-born child. Seventy percent of mothers and 92% of the fathers were employed. Fifty-ve percent of mothers and 53% of fathers had a college or higher education. Ninety-six percent of mothers planned to have their baby get

27

vaccines, while 1%planned for baby to not get vaccines, .5% were not sure, and 2% reported that their baby will receive some vaccines. Of 216 mothers responding to the question, 2% reported that the family sees a homeopath, 3% naturopath, 1%herbalist, and 6% chiropractor. Mothers were asked to rank reasons to vaccinate their babies. Seventyfour percent of mothers felt that preventing disease in their babies was the most important reason to vaccinate and 11% felt that preventing disease was the most important reason. Thirty-seven percent of mothers felt the second most important reason to vaccinate was to prevent disease in society and 20% felt their trust in the pediatrician or pediatric careprovider was the second most important reason to vaccinate. . Seventy-eight percent felt that a reason to vaccinate is the pediatricians recommendation and 75% agreed that a reason to vaccinate was that they had no problems in the past. Sixty-nine percent of mothers stated their opinions about vaccines were most inuenced by their pediatrician, while 5% were most inuenced by another doctor or obstetrician. The entire study populations of mothers were asked questions about specic concerns, 31% of all mothers worried about death from vaccination, 24% worried about immune problems, autism, or SIDS from vaccination, 23% worried about pain, and 22% worried about fever. Primiparous mothers did not differ in their responses signicantly compared to multiparous mothers. We believe that knowledge about parenting should include knowledge about vaccinations and should be transmitted to parents during obstetrical prenatal visits or prenatal visits with pediatric providers. Our study found that primiparous mothers may be less trusting of vaccination, thus the prenatal visit may be a particularly important time to focus on vaccination. Prenatal visits among urban, low-income mothers result in 28

increased rates of breastfeeding, decreased emergency department visits, and improved doctorpatient relationships, [41] and have the potential to improve trust in vaccinations. Our ndings should be considered in light of their generalizability and validity. The generalizability of the study may be limited as the respondents were mostly Caucasian, English-speaking, and well-educated, and the sample size was relatively small. Despite the racial, ethnic, educational, and economic background of our population, our ndings are consistent with results from a recent study showing that black and Hispanic parents, lower household income, and lower educational level were associated with high concerns about vaccination safety [42]. Thus, our study population actually provides an additional strength to our study because we examined a previously unstudied group. Validity of the results may be affected by response bias as 23% of questionnaires were not returned and some respondents purposefully or inadvertently skipped some of the questions. As with any survey of this type, the responses may be affected by social desirability bias which we attempted to preclude through our pilot testing. The ndings from this study imply that communication between pediatric providers and parents will benet from a focus on improving knowledge and developing trusting relationships. In particular, work on developing trusting relationships and conveying information about vaccines should begin as early as possible and involve collaboration with obstetrical groups. Pediatric providers should recognize the high proportion of parents with concerns about vaccinating and may need to spend more time discussing vaccination with groups who may be more distrustful about vaccines.

29

MATERNAL

HEALTH

LITERACY

AND

LATE

INITIATION

OF

IMMUNIZATIONS AMONG AN INNER-CITY BIRTH COHORT. (In the study of Pati, Susmita et. al) To determine if maternal health literacy influences early

infant immunization status. Longitudinal prospective cohort study of 506 Medicaideligible mother-infant dyads. Immunization status at age 3 and 7 months was assessed in relation to maternal health literacy measured at birth using the Test of Functional Health Literacy in Adults (short version). Multivariable logistic regression quantified the effect of maternal health literacy on immunization status adjusting for the relevant covariates. The cohort consists of primarily African-American (87%), single (87%) mothers (mean age 23.4 years). Health literacy was inadequate or marginal among 24% of mothers. Immunizations were up-to-date among 73% of infants at age 3 months and 43% at 7 months. Maternal health literacy was not significantly associated with immunization status at either 3 or 7 months. In multivariable analysis, compared to infants who had delayed immunizations at 3 months, infants with up-to-date immunizations at 3 months were 11.3 times (95%CI 6.0-21.3) more likely to be up-todate at 7 months. The only strong predictors of up-to-date immunization status at 3 months were maternal education (high school graduate or beyond) and attending a hospital-affiliated clinic. Though maternal health literacy is not associated

with immunization status in this cohort, later immunization status is most strongly predicted by immunization status at 3 months. These results further support the importance of intervening from an early age to ensure that infants are fully protected against vaccine preventable diseases. 30

LOCAL LITERATURE VACCINE, ADVOCACY: MISSION NOT IMPOSSIBLE Globally, 12 million children less than five years of age die annually from vaccines-preventable disease. Without immunization programs worldwide, the death toll could be higher: 2.7 million are expected to die from measles, 1.2 million from tetanus, 10,000 from diphtheria and 800,000 from polio. Data from National Statistics Office and UNICEF showed that 35 out of 1,000 Filipino infants die annually from vaccinepreventable diseases such as measles, tetanus, pertussis, hepatitis and meningitis. The launching of the Expanded Program of Immunization (EPI) by the World Health Organization (WHO) in the 60s caused a significant decrease in disability and death from these diseases. Thanks to the government support and implementation of the EPI, compulsory basic immunization is provided by the local health centers. As the number of fully immunized children increased to about 80 to 90 percent, the infant mortality rate subsequently declined. Despite these encouraging results, the Philippines has long way to go in terms of achieving a fully immunized population. Essentially, limited resources pose problems in implementing a successful immunization program. While the EPI dramatically improved the health situation, it only covers BCG (for tuberculosis), DPT (diphtheria, pertussis and tetanus), measles and hepatitis B. It does not include vaccines against other potentially deadly diseases such as HiB vaccine for Haemophilus influenza type b, MMR for measles, mumps, and rubella varicella vaccine for influenza, pneumococcal vaccine for

31

Strep. Pneumoniae, rotavirus vaccine for rotavirus diarrhea, meningococcal vaccine for N, meningitides, hepatitis A, and typhoid. Thus, the Philippines Foundation for vaccination, Inc. (PFV) --- a non-stock, nonprofit organization which aims to protect and advocate for the promotion of vaccination as essential to disease prevention, was established in 2000. To fulfil its goals, the foundation works closely with government health care agencies, non government organizations, and other relevant institutions in disseminating informations and updates on immunization conference participated in by medical and paramedical health care workers, health maintenance personnel, media and other socio-civic organizations. Aside from developing and updating a recommended schedule of immunization for Filipinos, it also conducts vaccine missions in school and universities. CHILDRENS RIGHTS

EARLY YEARS

Give children the best possible start in life.

VERY FEW CHILDREN GET A HEAD START IN LIFE

Close to 12 million children are below 5 years old.

23 out of 1,000 children die before reaching the age of 1.

28 out of 1,000 children die before reaching the age of 5.

Only 7 out of 10 infants are fully immunized. 32

Only 3 out of 10 children attend day care programs or pre-schools.

Infant deaths, undernutrition, poor immunization coverage, lack of micronutrient supplementation, inadequate attention to cognitive and psychosocial development, and low birth registration threaten childrens survival and development. All of these are critical issues in the childs ability to enjoy his right to education to the fullest extent possible.

Child mortality rates in the Philippines have steadily decreased since 1998. But disparities across regions remain. In 2003, 7 out of 17 regions were estimated to have infant and under-five mortality rates higher than the national average. Rural areas are worse off with an infant mortality rate of 36 deaths per 1,000 live births.

Immunization is one of the most important and cost-effective interventions that the governments health system can provide to the poor and most vulnerable populations. Routine immunization of children and women leads to the control and eventual eradication of preventable diseases.

In the Philippines, immunization rates had steadily gone uphill from 1990 until 1999. When the government changed its strategy of procuring vaccines in 2000, the coverage plummeted because the supplies were not delivered on time and inevitably resulted in stock shortage. In 2003, the government approved a new set of policies on the Expanded Program of Immunization (EPI) that included the procurement of vaccines through UNICEF. Complete immunization coverage for children below 2 years old reached almost 70 percent in 2003.

33

Early learning for children below 6 years old remains a major concern. Data from the education department show that only 3 of 10 children attend pre-school or day care services. Despite the passage of a national law on early childhood care and development, many parents still shun the practice of early learning stimulation whether through formal or non-formal structures.

The prevalence of underweight children (0-5 years old) has decreased since 1998 from 32% to 28% in 2003. But the rate of progress is still not sufficient to reach the national target of 17% in 2015.

EXPANDED PROGRAM ON IMMUNIZATION

Estimates reveal that tuberculosis, poliomyelitis, diptheria, pertusis, tetanus, and measles are responsible for the deaths of about 5 million children every year in developing countries. These diseases are preventable thru immunization with a handful of vaccines that can be given within the first year of childs life.Immunization has been

recognized and accepted as one of the most important components in the prevention and control of communicable diseases, a basic health service integrated into the health care delivery system of the Health Department.

Estimated eligible population for this program is 3% of the total population, 012 months old. Out of the target we were able to immunize 451 children of BCG anti TB for the newborn 0-12 months old. Where in the total births is 598. DPT vaccine means anti-diptheria, pertusis, and tetanus vaccine given to 1320 children 34

in 3 divided doses, most often than not the DPT vaccine is given with oral polio vaccine, 1,278 children were administered the OPV, also in 3 divided doses.

Hepatitis B vaccine is administered to 765 children below 1 year of age, also in 3 divided doses.DPT, OPV, Hepatitis B vaccine is administered to a child who is 45 days old to 12 months old. Anti measles vaccine is given 559 children whose age range from 9 months12monthsold. LOCAL STUDIES A study entitled local beliefs and attitudes of mothers on immunization did a survey on maternal knowledge, belief and concept on immunization in a fast growing city in the south. Out of 530 mothers, the survey revealed that the majority of mothers know that immunization is important, safe and affective means of prevention of disease (Antilion and Guerero, 2006). A high percentage of children were immunized though some have no immunization or incompletely immunized. The reasons for no

immunization or incompletely immunization are summarized as follows: (1) Mothers are to busy to bring the child for immunization: (2) The child is sick on the schedule or frequent cough and colds: (3) Afraid of fever after immunization; (4) Mother of afraid of side effects: (5) Mother or child afraid of shots: (6) Mothers forgot the schedule: (7) Mother believed it is not necessary: they are also lack of knowledge on the contraindications of immunization and on the expected reactions or side effects of the specific vaccines given giving rise to some undue fears and misperception on the part of the mother.

35

A research found that: (1) the majority of the respondents belong to the 21-30 age bracket who were college graduates mostly unskilled workers earning a monthly income which is lower than the poverty through hold: with small size family most of them are Roman Catholic who lives in the rural areas. (2) They are not so much aware of the need of immunization and vaccines are not often available as to accessibility, they always sought the services of the midwife at the rural health unit and never from a private clinic or hospital. (3) As to immunization status most of the children have a complete immunization (partially immunization). (4) There is no significant relationship between the immunization status and age, educational attainment, monthly family income, religion, occupation and place of residence. (5) There is a significant relationship between these factors and immunization on the other hand, availability of vaccines and availability of health worker an attitude toward immunization status (Quico 2004). HIGH AWARENESS, NO ACTION Press Release/27 June 2002 The Department of Health today disclosed that most (94%) mothers are aware that measles is a contagious disease but cases at the San Lazaro Hospital revealed that majority (71%) were unvaccinated. A survey on the knowledge, attitude and practice of mothers revealed that the most common reasons for the non-vaccination of a child were mothers do not have time (23%), do not know about immunization (17%) and do not know or forgot the childs vaccination schedule (17%-22%). About 5% of mothers also said that vaccines were not available at clinics. 36

In 1998, the Philippines Measles Elimination Campaign (PMEC) was launched to achieve zero measles cases in 2008. Despite the Expanded Program of Immunization and the PMEC, there are still many cases. A review of surveillance records showed that from 1999 to 201, unimmunized cases reached up to 73%. A review of three measles outbreak investigation done in 2001 revealed that almost 75% of cases were not immunized. To avert an increase in cases, Health Secretary Manuel Dayrit recently launched the Iwas-Tigdas campaign in key cites of Metro Manila with full support from the local government, Philippines Pediatric Society and other partners. The campaign, dubbed as Iwas-Tigdas Ginhawa sa Measles vaccine at vitamin A, is a preview of next years nationwide measles campaign. Meanwhile, Dayrit disclosed that there were 1,711 measles cases admitted at the San Lazaro Hospital from January to June 15 this year. There were 82 deaths. Most affected group belong to the 1-4 years age group. Most of the cases came from Manila (581), Quezon City (209) and Caloocan (170). Clustering of cases was also noted in Baseco compound, Port area, Parola compound in Manila; Road 10, North Bay Boulevard in Navotas; Guadalupe Viejo in Makati; and Olivares compound in Sucat, Paraaque. The health chief is urging regional health offices to monitor areas with low immunization coverage and ensure adequate supply of vaccines in far-flung villages. He also stressed that mothers should find time to bring all nine-month old children to health centers for free measles vaccination to avoid complications and deaths. 37

Measles is a contagious, viral disease characterized by fever, rashes, runny nose, and sore eyes. Based on the 1997 Health Statistics, it is the 7th leading cause of deaths among infants. This article explore the hypothesis that formal education of women results in increased survival because of the protective function of the major childhood immunizations. Education is also associated with .greater awareness of proper immunization schedules. Irrespective of mothers formal education level, specific immunization knowledge with an increased likehood of using immunization. The Indonesian analysi is important as a model for preventive health campaigns among other populations with low education levels among women. Across sectional study on immunization coverage in the town of Palani was conducted and a total of 166 mothers were interviewed using a pre-tested interview schedule/questionnaire on knowledge, Attitudes, Perception and Expectation (KAPE). The result showed among the 12-24 month old children 50% fully, 31.3% partially and 18.7% not all immunized. High levels of initial vaccination rates and low levels of OPV/DPT3 (62.7%) and measles (51.8%) vaccines indicate that completing vaccination schedule needs attention. Almost all children in the study, 165 out of 166 received two doses of polio vaccine from the Pulse polio Immunization programme. Majority of the mothers expressed favourable attitudes and satisfaction regarding on the programme. Though many were aware on the importance of vaccination in general, specific information about importance of completing the schedule and knowledge about vaccine preventable disease other than poliomyelitis was very limited. Obstacles, misconceptions/ beliefs among the mothers of partially immunized children and lack of information 38

among not all immunized group were the main reasons of non- immunization. The implications of the study are: to enhance the maternal knowledge about the vaccine preventable disease and importance of completing the immunization schedule through interpersonal mode to overcome obstacles to immunization such as accessibility and lack of family support. MEASLES IMMUNIZATION ACCEPTANCE IN SOUTHEAST ASIA: PATTERNS AND FUTURE CHALLENGES (In study of Laurie Serquina-Ramiro et. al) In 1991, another contributor to this paper ( L S - R ) , conducted a study to assess the effects of various psychosocial and socio-demographic factors on measles vaccination uptake among mothers in Agno, a rural municipality in the Philippine province of Pangasinin (Serguino- Ramiro, 1994). The municipality of Agno is divided into two districts: Agno I is composed of nine barangays, or villages, located at the centre of the town, while seven of Agno II's eight villages are on the periphery. During the first two weeks of May 1991, a household c e n s u s was conducted in 16 barangays [one barangay (Macaboboni) was not included in the study since residents at- tended the health services of the adjacent town of Bani] to determine which mothers, with children aged 13 to 24 months, had immunized their children against measles; and to obtain an unstructured observation of the study area. Of the 1,653 mothers contacted, 6 7 ( 4 % ) were excluded either because the interviewers were unable to confirm the measles immunization status of the child, the mother had not resided in the study area for at least two years, or consent was not PAST

39

obtained. Fifty-two percent ( 8 2 4 ) of the 1,586 mothers included in the sampling frame were found to have had their children aged 13-24 months immunized against measles (acceptors) while 48% ( 7 6 2 ) did not have their children of the same age group vaccinated against the disease (non-acceptors). These findings call into question the accuracy of full immunization rates of 4 5 -1 13% of the target population [The rate of higher than 100% indicates that the actual number of fully immunized children exceeded the target population] for various barangays in Agno from government reports. Using a case-control design, 220 randomly selected acceptors served as cases and another 220 randomly chosen non-acceptors served as controls. T h e cases and controls were administered a pre-tested questionnaire measuring the following independent variables: maternal attributes, personal health beliefs, perceived social influences and perceived situational constraints. In-depth interviews and focus group discussions were carried out with acceptors and non-acceptors to better understand their responses to the questionnaire. In addition, key formant interviews and focus group discussions were conducted with a selected group of mothers not included in the random sample, fathers, health workers, local government officials, and teachers to obtain a more comprehensive picture of measles immunization acceptance in the community. Participant and nonparticipant observations were performed at the rural health centres and barangay health stations. The qualitative results showed that com- munity beliefs about measles were well embedded within the traditional modes of thinking characteristic of Northern Luzon. Agpayso nga tikada or true measles was said to becaused by bad winds o r 40

by

an

airborne

virus. The disease was normally managed at home through the

application of conventional folk practices. It was considered unwise if measles was "opposed" by taking measures to prevent the rash surfacing. Sinking or suppression of the rash from measles was thought to lea to serious complications and possibly death. A number of the mothers who had their eligible children vaccinated against measles (acceptors) thought of vaccination a s a form of resistance against any type of

disease such that: a) the vaccinations would make it more difficult for the child to succumb to the measles virus, or b) would make the measles easily curable once contracted. Others were of the opinion that vaccination is: a ) good for health, or b) can make a child grow stronger. Many mentioned having 'a peace of mind' as a reason for obtaining immunization. Non acceptors' On t h e other h a n d ' were more inclined to believe that measles was not a serious disease and that immunization is unnecessary and can make the children more serious disease and that immunization is unnecessary and can make the children more sickly. Many non- acceptors claimed that although their children were not immunized nothing had happened to them. This experience of nothing negative happening to unvaccinated children reinforced their attitudes regarding the necessity of immunization. Analysis of the quantitative results confirmed that mothers who perceived measles a s a more serious disease are more likely to have their child immunized against measles compared with mothers who perceived measles as less serious.

Similarly, mothers who perceived measles vaccination a s effective and useful were more likely to have their children immunized against measles compared with 41

mothers who perceived measles vaccination a s less effective and useful. Beliefs in the efficacy of vaccination were found to have a stronger association with acceptance status in the more central district (Agno I) than in the more peripheral district (Agno 11). T h e questionnaire results also revealed that mothers with higher a

socioeconomic status(as determined by number of household facilities such a s

radio, television set, refrigerator), higher levels of education, and who lived closer to the center of the town were more likely to have their child immunized against measles compared to mothers with l oder socioeconomic and educational background and mothers who lived in the peripheral areas. Among the three factors, education and socio-economic status were the most significant predictors of measles immunization acceptance. More than 50% of the mother-respondents indicated that government

immunization campaigns and the opinions of husbands affected their decisions to immunize their children against measles. Aside from these two social influences , mo r e acceptors were convinced by midwives and doctors to obtain measles immunization. Non-acceptor immunization. displayed mo r e independence in their decisions, whereas acceptors were more likely to be pressured by external social factors. When stratified by socioeconomic status, mothers from the lower and upper socioeconomic classes were more likely to have considered social pressures in their decisions to immunize their children against measles compared to mothers in the middle class because of fewer number of perceived environmental and situational constraints From the indepth interviews and participant observation, a number of environmental and

situational factors were noted to affect immunization acceptance. These factors correlate 42

with pas studies on immunization and acceptance. T h e

perceived barrier to measles

vaccination among acceptors were related to information regarding the schedule of immunization, weather and season, and peace and order. Distance to health center from home, access to transportation, number of transpor- tation facilities, economic conditions and competing work of the mother we r e seen a s impediments among non-acceptors.. Our investigation in the rural Philippines suggests that many of the mothers investigated can be described as passive acceptors of immunization in general. Nichter ( 1 9 9 3 ) defines passive acceptance as "...yield (ing) to the recommendations and social pressure, if not prodding, of health workers and community leaders and other people significant to the mother (italics supplied)". Active acceptance, on the other hand, entails adherence to immunization programs by an informed public which

perceives the need for specific immunizations. In the latter case, the mother is assumed to understand the rationale behind her health behavior and seeks to have her child immunized mainly because she appreciates the importance of a specific type of vaccination. Passive acceptance was manifested among the by 1) their involuntary presentation at Filipino mother-

respondents

the health

centers during

immunization d a y s ; 2) their inability to identify the exact vaccine given; 3) their in- sufficient knowledge regarding etiology of vaccine-preventable diseases and the purpose of immunization; a n d , 4) their susceptibility to external pressures and

incentives to have their child immunized. T h e majority of the Javanese mothers might also be described a s passive acceptors according to these criteria. The main factors perpetuating this passive acceptance style, we suggest, are in effective health 43

education interventions. The work culture of health workers, economic incentives directed at the local health providers and the sociocultural predisposition of the lower social status women in the area. SYNTHESIS: This study is similar to the study conducted by Quico on 2004, Antilion and Guerero 2006, entitle Local Belief and concept on Immunization in a Fast Growing City in the South. Similar findings are: Research Design used was Descriptive type of Research, Respondents were mothers, and the survey revealed that the majority of the mothers knew that child immunization is of utmost importance, most respondents were belonged to the nuclear family. Data Gathering Instrument used was the QuestionnaireChecklist. And the Data Procedure was done by securing a permit, having it approve then distributed the questionnaire to the intended respondent This study is in-contrast to the study by the press, released on June 27, 2002, entitled High Awareness, No Action. Different findings are: Respondents did not know or forgot the child vaccination schedule. While in this study and the respondents knew the schedule of vaccination.

44

CHAPTER III METHODOLOGY OF RESEARCH This chapter presents a discussion on the methodology used in the study, the respondents of the study, data gathering instrument, procedure and statistical treatment of the data. RESEARCH DESIGN This study made use of the Descriptive correlational method of research to find out the level of knowledge and compliance in immunization program in selected barangay health center in Antipolo,City. Descriptive correlational (Polits on 2006) researchers were interested describing relationship among variable, without seeking to establish causal connections. RESPONDENTS OF THE STUDY The respondents of the study are the 100 parents or guardian (male or female) with atleast 1 current child in selected barangay in the eastern part of Rizal. SAMPLING PROCEDURE Purposive sampling (Polits on 2006) is based on the belief that researchers knowledge about the population can be used to hand pick cases (on type of cases) to be included in the sample. Researchers might decide purposely to select the widest possible variety of respondents or night choose subjects who are judged to be typical of the population in question or particularly knowledgeable about the issue under study.

45

We will conduct a study to identify the level of knowledge and compliance of parents to immunization program of selected barangay health center in Antipolo,City. A 1- round survey with a purposive sample of parents or guardians (male or female) who had atleast 1 current child in selected barangay in the Eastern part of Rizal.

RESEARCH INSTRUMENT The researchers have required the accurate data through generating a self constructed questionnaire checklist is determining the level of knowledge and compliance of parents to immunization program of selected brgy. health center in Antipolo,City. Part I is how does the respondents profile be describes in terms of Age, Gender, Marital Status, Parity, Educational Attainment and Family Income. Part II is the level of knowledge of respondents in immunization program in terms of Benefits, Schedule and Management. Part III is the significant relationship between the level of knowledge and compliance in immunization program in the community through Benefits, Schedule and Management. Also, Likert scale is utilized in this study. It is a psychometric scale commonly involved in research that employs questionnaires. . It is the most widely used approach to scaling responses in survey research. It has a scale of: 5-outstanding, 4-above average, 3average, 2- fair, 1- poor for knowledge.

46

To interpret or describe the assessment of data for knowledge, the following are used as basis: Scale Value 5 4 3 2 1 Range of Weighted Mean 4.50-5.00 3.50-4.49 2.50-3.49 1.50-2.49 0-1.49 Interpretation OUTSTANDING ABOVE AVERAGE AVERAGE FAIR POOR

VALIDATION OF RESEARCH INSTRUMENT The researchers formulated a self-constructed questionnaire in the form of checklist to determine the level of knowledge and compliance of parents to immunization program of selected barangay health center in Antipolo City. The researcher consulted the adviser for the study to evaluate the questionnaire made. After that, a revision was made and conducted a pilot study with nonparticipating 10 respondents. Before it was administered to the respondents, The result was consistent. STATISTICAL TREATMENT OF DATA Problem 1 Percentage will be use: FORMULA: P=f/n x 100 Where: P= percentage 47

f= frequency n= Total no. of respondents Problem 2 Weighted Mean will be use: FORMULA: W.M.= scale value x f N

Where: W.M. = weighted mean f= frequency s = scale N = total no. of respondents Problem 3 Pearson R will be use: FORMULA : r= NXY- (X)(Y)

(Nx2-(x)2)(NY2-(Y)2) Where: N= number of pairs XY= product of XY (multiply) XY = multiply each X with each Y, then sum the products

48

CHAPTER IV PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA This chapter represents the data and information obtained from the questionnaires answered by the respondents. The data will be summarized and presented with corresponding tables in order and sequence of the question based in the statement of the problem. TABLE 1.1 The Frequency and percentage distribution of respondents in terms of Age:
AGE 15-20 21-25 26-30 31-35 36-40 41-45 46-50 TOTAL: FREQUENCY 13 35 23 17 8 3 1 100 PERCENTAGE 13 35 23 17 8 3 1 100

Interpretation: There are thirteen (13) respondents who belong to the 15-20 Age groups who got thirteen (13 %). Thirty five (35) of the respondents belong to the 21-25 age groups with the percentage of 35. In 26-30 Age groups got the twenty three (23) with (23%). Out of 100 respondents there are seventeen (17) respondents who belong to the 31-35 age groups with seventeen (17%). In 36-40 age group got the eight (8) respondents with eight (8%). There are three (3) respondents who belong to the 41-45 age groups which got three (3 %). In 46-50 age group there is only one (1) respondent with the percentage of one (1).

49

This implies that the majority of the respondents were belong to the 21-25 age bracket. By this age this the right age to bear a child, it is also advice by the doctors the endometrium lining are matured. In the age of 46-50 got the lowest percentage. It is said to that by this age most of the mothers are being menopause and more high risk to bear a child. TABLE 1.2 The Frequency and percentage distribution of respondents in terms of Gender
GENDER MALE FEMALE TOTAL: FREQUENCY 0 100 100 PERCENTAGE 0 100 100

Interpretation: There are no male respondent which has zero (0) percentage. One hundred (100) respondents are female which got one hundred (100 %). This implies that most of the mothers are taking care of their child while the father are the one who is responsible for providing the needs of the family. According to Antilion and Guerero (2006), majority of mothers know that immunization is important, safe and affective means of prevention of disease. TABLE 1.3 The frequency and percentage distribution of respondents in terms of Marital Status:
MARITAL STATUS SINGLE MARRIED SEPARATED WIDOWED TOTAL: FREQUENCY 10 84 6 0 100 PERCENTAGE 10 84 6 0 100

50

Interpretation: As shown on Table above, ten (10 %) of (100) one hundred respondents are single. There are 84 respondents who are married which got eighty four (84%). There are six (6) who were separated which got the six (6%). And out of one hundred (100) respondents there is no or zero (0) percentage are widowed. This implies that most of married couple are the one who is planning to have a child. And being widowed he or she would not be capable in bearing a child TABLE 1.4 The frequency and percentage distribution of respondents in terms of parity:
NO. OF CHILDREN 1 2-3 4-5 5 and up TOTAL: FREQUENCY 39 48 11 2 100 PERCENTAGE 39 48 11 2 100

Interpretation: There are thirty nine (39) respondents who have one (1) child with the percentage of thirty nine (39). There are forty eight (48) respondents who have 2-3 children with the percentage of forty eight (48). And eleven (11) of the respondents has a 4-5 children which got the eleven (11%). Two (2) out of one hundred (100) respondents has a five (5) and up children with the percentage of two (2). As shown on table above, There are forty eight (48%) of the respondents is having 2-3 children which indicates that their following the family planning teaching by the DOH. And two (2 %) of the respondents are having 5 and up children are not aware about family planning. 51

Accoding to Quico (2004), that the majority of the repondents are belong to the small size family. TABLE 1.5 The frequency and percentage distribution of respondents in terms of Educational Attainment:
EDUCATIONAL ATTAINMENT DIDNT STUDY AT ALL ELEMENTARY UNDERGRADUATE ELEMENTARY GARDUATE HIGHSCHOOL UNDERGRADUATE HIGHSCHOOL GRADUATE VOCATIONAL COLLEGE UNDERGRADUATE COLLEGE GRADUATE TOTAL: FREQUENCY 0 1 5 9 37 12 19 17 100 PERCENTAGE 0 1 5 9 37 12 19 17 100

Interpretation: There is no or zero (0) of the respondents was not able to study. There is one (1) out of 100 respondents is elementary undergraduate got one (1 %). There are five (5) of the respondents are elementary graduate with the percentage of five (5). High school undergraduates are nine (9) respondents out of 100 respondents with the percentage of nine (9). There are thirty seven (37) high school graduates with the percentage of thirty seven (37). The twelve (12) of the respondents are finished vocational courses with the percentage of twelve (12). There are nineteen (19) respondents who are college undergraduate who got nineteen (19 %). And seventeen (17) of the respondents are college graduate with seventeen (17 %) of the respondents.

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This implies that thirty seven (37 %) are high school graduates which indicate that most of the respondents are not able to finish their studies regarding on financial problem. And there are no respondents who was not capable on studying which indicates that their parents wants what is best for their child. TABLE 1.6 The frequency and percentage distribution of respondents in terms of monthly income:
MONTHLY INCOME 5000- BELOW 5001-10000 10001-15000 15001-20000 20000 and up TOTAL: FREQUENCY 57 27 10 2 4 100 PERCENTAGE 57 27 10 2 4 100

Interpretation: There are fifty seven (57) respondents who answers that their income monthly was 5,000 and below with the percentage of fifty seven (57). Three are twenty seven (27) respondents said that their income monthly is 5,001-10,000 which has twenty seven (27%). There are ten (10) respondents and ten (10 %) has a monthly income of 10,00115,000. There are two (2) and twenty five (25%) of the respondents are having an income of 15,001-20,000 in a month. And four (4) and four (4%) of the respondents has an income of 20,000 and up in a month. As shown on table above, this implies that fifty seven (57%) or most of the respondents are below the minimum wage or has a salary or income of 5,000 and below which indicates that they were not able to provide their family the basic needs. While the

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respondents whose monthly income is 15,001-20,000 are much capable on giving the needs of their family. The table shows the level of knowledge in terms of BENEFITS TABLE 2.1 QUESTIONNAIRE(Mga katanungan) 1. Ang immunisasyon ay nakakatulong para maiwasan ang mga sakit kagaya ng T.B (Tuberculosis), Polio, Tigdas, Tetano, Diptheria, Pertusis. 2. Ang bakuna ay nagbibigay lakas at proteksyon sa inyong anak. 3. Ang bakuna ay nakakatulong upang mabawasan ang komplikasyong dulot ng isang sakit. TOTAL (Weighted Mean): Interpretation: As shown in Table above, in benefits, the question 1, the immunization help to prevent the diseases like tuberculosis, polio, measles, tetanus, diphtheria and pertusis got a result of 4.67, while in question 2, the vaccine gives strength and protection to your child got a result of 4.8 and lastly, the vaccine help to decrease the complication that causes by one disease got a result of 4.71. The vaccine gives strength and protection to your child got the highest result of 4.8 and the immunization help to prevent the diseases like tuberculosis, polio, measles, 54 W.M 4.67 VERBAL INTERPRETATION Completely Agree RANK 3

4.8

Completely Agree

4.71

Completely Agree

4.73

Completely Agree

tetanus, diphtheria and pertusis got the lowest result of 4.67. Therefore the guardians are aware that immunization gives strength and protection to their children. According to Pilliterie (2003), Immunization or vaccines are solutions administered to children to invoke an antibody response against a certain disease. Immunization provides artificial active immunity, wherein attenuated or weakened organisms are introduced into the childs body, which will trigger the body to produce antibodies against it. If at a later time that specific antigen will enter the childs body, it already has a memory of that pathologic organism and the antibodies will be able to fight it. The table shows the level of knowledge in terms of SCHEDULE TABLE 2.2 QUESTIONNAIRE(Mga katanungan) 1. Ang BCG (Bacillus Calmette Guirine) ay binibigay pagkasilang o lumipas ang ilang araw ng kapanganakan. 2. Ang DPT (Diptheria Pertusia Tetanus), OPV (Oral Polio Vaccine), Hepatitis B ay may tatlong doses at ibinibigay sa 1 month old ng inyong anak, ito ay may interbal na isang buwan. 3. Ang bakuna para sa tigdas ay binibigay tuwing ika-9 na buwan. TOTAL (Weighted Mean) W.M 4.49 VERBAL INTERPRETATION Moderately Agree RANK 3

4.53

Completely Agree

4.57

Completely Agree

4.53

Completely Agree

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Interpretation: As shown in Table above, in schedule, the question 1, the BCG (Bacillus Calmeete Guirine) is given at birth or after a day after birth got a result of 4.49, while the question 2, the DPT (Diptheria Pertusis Tetanus), OPV (Oral Polio Vaccine), Hepatitis B has three doses and given at 1 month old of your child, it has 1 month interval got a result of 4.53 and lastly question 3, the vaccine for measles is given for 9 months old got a result of 4.57. The vaccine for measles is given for 9 months old got the highest result of 4.57 and the BCG (Bacillus Calmeete Guirine) is given at birth or after a day after birth got the lowest result of 4.49. Therefore guardians are aware about the schedule of the immunization for measles and they know it is fatal disease than the schedule for BCG vaccine. According to WHO,Among vaccines- preventable disease measles remain the leading cause of child deaths,

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The table shows the level of knowledge in terms of MANAGEMENT TABLE 2.3 QUESTIONNAIRE(Mga katanungan) 1. Pagkatapos bakunahan ng DPT dapat maghanda ng paracetamol para sa posibleng pagkakaroon ng lagnat ng inyong anak. 2. Pagkatapos ibigay ang OPV di muna kailangang padedehin ang inyong anak sa loob ng 30 minuto. 3. Pagkatapos bakunahan ng BCG ang inyong anak kung nagkaroon ng pamamaga sa parte ng pinagbakunahan kelangan ng Warm Compress. TOTAL (Weighted Mean): Interpretation: As shown in table above, in management, the question, after vaccination the DPT (Diptheria Pertusis Tetanus) you should prepare paracetamol for possible having a fever got a result of 4.65, while the after giving the OPV should not feed the baby after 30 minutes and lastly after vaccination of BCG if your child having inflammation in the vaccination site it should perform warm compress got a result of 4.52. The question 1, after vaccination the DPT (Diptheria Pertusis Tetanus) you should prepare paracetamol for possible having a fever got the highest result of 4.65 and after vaccination of BCG if your child having inflammation in the vaccination site it should perform warm compress got the lowest result of 4.52. Therefore the guardians are aware W.M. 4.65
VERBAL INTERPRETATION RANK

Completely Agree

4.52

Completely Agree

4.47

Moderately Agree

4.47

Moderately Agree

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about the management for DPT which parents should prepare paracetamol possible having a fever than the management for BCG. According to Ruzol and Alcantara et al. (2000), The DPT combination vaccine is a liquid vaccine, which must not be frozen. It contains vaccine components against diphtheria, tetanus, and pertussis (whooping cough). The vaccine is given intramuscularly. Three doses are needed for full protection, at least four weeks apart. In 1997, over 80% of children under one year old were immunized with three doses of DTP vaccine. The success rate of the DPT vaccine significantly reduced the diseases covered by this vaccine by 60%. Nursing consideration about this vaccine is to ask about reactions to previous dose and teach every mother that expected reactions are fever within 24 hours and local soreness which disappears within 3-4 days. Significant relationship between level of knowledge and compliance in terms of benefits TABLE 3.1
R BENEFITS 0.22 T 2.23 Verbal Interpretation Significant Decision Reject

Interpretation: The table above shows, the relationship of the level of knowledge in terms of benefits and the level of compliance which is treated statistically using Pearson r and T test. The Pearson r has a result of 0.22 which is interpreted as weak correlation. The result of T test is 2.23 which are greater than the critical value of 1.980. Therefore, there 58

is a significant relationship between the level of knowledge in terms of benefits in immunization and the compliance. According to DOH (2003), The receipt of vaccines is hampered by some issues and concerns, such as pockets of resistance or refusal to accept immunization services due to misconceptions or lack of knowledge about the benefits of immunization.

Significant relationship between level of knowledge and compliance in terms of schedule TABLE 3.2
Pearson r SCHEDULE 0.42 T test 4.58 Verbal Interpretation Significant Decision Reject

Interpretation: The table above shows, the relationship of the level of knowledge in terms of schedule and the level of compliance which is treated statistically using Pearson r and T test. The Pearson has a result of 0.42 which is interpreted as marked correlation. The result of T test is 4.58 which is greater than the critical value of 1.980. Therefore, there is a significant relationship between the level of knowledge in terms of schedule and the level of compliance. According to Smeltzer and Bare (2004), The standard recommended vaccination schedule for infants and children was approved by CDC, American of Pediatrics (AAP), and American Academy of Family Physicians (AAFP).

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Significant relationship between level of knowledge and compliance in terms of management TABLE 3.3
R MANAGEMENT 0.35 T 3.70 Verbal Interpretation Significant Decision Reject

Interpretation: The table above shows, the relationship of the level of knowledge in terms of management and the level of compliance which is treated statistically using Pearson r and T test. The Pearson r has a result 0.35 which is interpreted as weak correlation. The result of T test is 3.70 which are greater than the critical value of 1.980. Therefore, there is a significant relationship between the level of knowledge in terms of management and the level of compliance. Summary Table of significant relationship between the level of knowledge in terms of benefits, schedule and management and the level of compliance TABLE 3.4
r T VERBAL INTERPRETATION Significant Significant Significant DECISION RANK

BENEFITS SCHEDULE MANAGEMENT

0.22 0.42 0.35

2.23 4.58 3.70

Reject Reject Reject

3 1 2

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Interpretation: As shown on table above, the level of knowledge in terms of benefits has a result of 0.22 in Pearson r with the t test of 2.23 which is greater than the critical value of 1.980 that indicates there is a significant relationship and the hypothesis is accepted. In terms of schedule the result of the Pearson r is 0.42 with the t test of 4.58 which is greater than the critical value of 1.980 that indicates there is a significant relationship and the hypothesis is accepted. In terms of management the result of Pearson r was 0.35 with the t test of 3.70 which is greater than the critical value of 1.980 which indicates that there is a significant relationship and the hypothesis is accepted. This implies that the comparison of level of knowledge and compliance in terms of schedule got the highest rank and the level of knowledge and compliance in terms of benefits got the lowest rank. It shows that the guardians or parents based their compliance to immunization on the schedule given. According to NVAC (1999), That children often fall behind in their immunizations because their parents do not know when immunizations are due. Parents may not seek immunization because they believe their childs immunizations to be up-todate. It is also stated that the maintenance of current immunization rates remains essential through dissemination of information to parents regarding new vaccines and changes to the schedule.

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CHAPTER V This chapter presents the summary of findings of the study, conclusion and recommendation.

SUMMARY FINDINGS This study was undertaken to assess the level of knowledge and compliance of parents to immunization program of selected barangay health center in Antipolo City. The findings are as follows: 1.1 Majority of the respondents belonged to the ages 21-25, with a result of thirty five percent (35%). 1.2 Majority of the respondents are female, with a result of one hundred percent (100 %). 1.3 Majority of the respondents status are married, with a result of eighty four percent (84%). 1.4 Majority of the respondents belonged to 2-3 parity, with a result of forty eight percent (48%). 1.5 Majority of the respondents school attainment belonged to the high school graduate with a result of thirty seven percent (37%). 1.6 Majority of the respondents monthly income belonged to below 5,000 with a result of fifty percent (50%). 2.1 Benefits in immunization had an average weighted mean of 4.73 which interpreted as Completely Agree. 2.2 Schedule in immunization had an average weighted mean of 4.53 which interpreted as Completely Agree.

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2.3 Management in immunization had an average weighted mean of 4.47 which interpreted as Moderate Agree 3.1 Benefits relationship to compliance had a result of 0.22 which interpreted as weak correlation. 3.2 Schedule relationship to compliance had a result of 0.42 which interpreted as marked correlation. 3.3 Management relationship to compliance had a result of 0.35 which interpreted as weak correlation. CONCLUSION: Based on the findings of the study the following conclusion was formulated: The study shows that most of the respondents are in the age group of 21-25. Majority of the respondents are female, married and has a 2-3 children, high school graduate with the monthly income of 5000 and below.The people are aware that there is free Immunization Program in the barangay health center. The Benefits of the immunization Program is significant prior to the implementation of free vaccines in the barangay health center.The scheduling of immunization program used by the Barangay was good. The willingness of the respondents to go the barangay health center to have vaccine was significant.The management of the respondents in regard to the side effects of the vaccines are significant.

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RECOMMENDATION: Based on the summary of findings and conclusion were developed, the following recommendations are hereby given: For the Local Officials. To provide a designated and convenient place that will accommodate both the mother and child. To provide transportation for local staff so that health services will be provided to those clients who live in distant places. For the Barangay Health Care Workers. To provide information or advertisement about immunization program in the barangay health center. And a house to house visit to ensure that immunization program is being complied. To conduct a survey for those who were incomplete immunized. Parents To comply on the immunization program of the DOH. To be knowledgeable and aware about the immunization. For the Community. To comply on the said schedule of the immunization. To know the importance of the immunization before to comply. For Future Researchers. To include in the demographic data of the parents occupation, age of the current child. And also to have a Comparative studies about urban area, rural area and rurban area in terms immunization program.

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BIBLIOGRAPHY BOOKS: BMC Public Health, 2011 Pilliteri, 2003 Smeltzer & Bare, 2004 INTERNET: www.cinahl.com www.tm.mahidol.ac.th www.philstar.com/article www.unicef.org JOURNAL: Maternal and Child Health Journal, 2011 THESIS Chiao, Nerelyn Factors Affecting The Immunization Services in Pasolo Valenzuela City (Unpublished Thesis, Our Lady of Fatima University, N.D.) Montague, Jobelle, et.al. Effectiveness of Expanded Program on Immunization (Unpublished Thesis, World Citi College, 2008)

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Octavo, Toni-Mey, et.al. Advocacies on Immunization Utilized by Selected Barangay in Antipolo City (Unpublished Thesis, World Citi College, 2009)

TIME TABLE
st

1 Semester

ACTIVITY Formulating title of the thesis. Working for chapter 1, including the introduction and statement of the problem. Also the purpose of the study, significance of the study, scope and limitations, conceptual framework, hypothesis and definition.

Finding for foreign and local literature and studies and working for its synthesis. Working for chapter 3, including research design, sampling procedure, respondents of the study, research instrument and statement of the problem. 2nd Semester We worked for our questionnaire. We conduct pilot study. We calculate different formula. We conduct our true study for 100 respondents. We finalized our thesis by checking it cover to cover.

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LEVEL OF KNOWLEDGE AND COMPLIANCE OF PARENTS TO IMMUNIZATION PROGRAM OF SELECTED BARANGAY HEALTH CENTER IN ANTIPOLO, CITY SURVEY Direksyon: Ang inyo pong magiging kasagutan ay mananatiling confidential o sekreto. Paki lagyan lamang po ng tsek ( ) ang angkop na sagot para sa iyo. Maraming Salamat po! RESPONDENTS PROFILE: NAME (optional):_______________________________ AGE:__ ____ (pangalan) (edad) GENDER: (kasarian) [ ] MALE (lalaki) [ ] FEMALE(babae) MARITAL STATUS: (estado sa buhay) [ ] Dalaga [ ] May Asawa [ ] Hiwalay sa Asawa [ ] Balo NUMBER OF CHILREN: (bilang ng mga anak) [ ]1 [ ] 2-3 [ ] 4-5 [ ] 5 pataas EDUCATIONAL ATTAINMENT: (natapos na edukasyon) [ ] Di nakapagral [ ] Elementary Undergraduate [ ] Elementary Graduate [ ] Highschool Undergraduate [ ] Highschool Graduate [ ] Vocational [ ] College Undergraduate [ ] College Graduate INCOME MONTHLY [ ] 5,000 pababa [ ] 5,001-10,000 [ ] 10,001-15,000 [ ] 15,001 20,000 [ ] 20,000 pataas Anu ano po ang mga bakuna natanggap ng inyong anak: [ ] DI KUMPLETO Paki tsek ang mga hindi pa nakukuha na bakuna ng inyong anak [ ] BCG [ ] HB1 [ ] DPT1 [ ] HB2 [ ] DPT2 [ ] HB3 [ ] DPT 3 [ ] MEASLES [ ] OPV1 [ ] OPV2 [ ] OPV3 [ ] KUMPLETO 67

DIREKSYON: Lagyan ng tsek ang angkop na sagot para sa kahalagahan ng Benepisyo, Schedule, at Management na nakukuha ng inyong anak. Ang 5 po ang pinakang mataas at ang pinakang mababa ay 1. (CA)- COMPLETELY AGREE o Lubos na Sumasang-ayon- 5 (MA)- MODERATE AGREE o Sumasang-ayon- 4 (A)- AGREE o sang-ayon- 3 (MD)- MODERATE DISAGREE o Di- Sumasang-ayon- 2 (CD)- COMPLETELY DISAGREE o Lubos na Di- Sumasang-ayon- 1 BENEFITS: CA MA 5 4 A 3 MDA CDA 2 1

QUESTIONNAIRE(Mga katanungan) 4. Ang immunisasyon ay nakakatulong para maiwasan ang mga sakit kagaya ng T.B (Tuberculosis), Polio, Tigdas, Tetano, Diptheria, Pertusis. 5. Ang bakuna ay nagbibigay lakas at proteksyon sa inyong anak. 6. Ang bakuna ay nakakatulong upang mabawasan ang komplikasyong dulot ng isang sakit. SCHEDULE: QUESTIONNAIRE(Mga katanungan) 4. Ang BCG (Bacillus Calmette Guirine) ay binibigay pagkasilang o lumipas ang ilang araw ng kapanganakan. 5. Ang DPT (Diptheria Pertusis Tetanus), OPV (Oral Polio Vaccine), Hepatitis B ay may tatlong doses at ibinibigay sa 1 month old ng inyong anak, ito ay may interbal na isang buwan. 6. Ang bakuna para sa tigdas ay binibigay tuwing ika-9 na buwan.

CA MA 5 4

A 3

MDA CDA 2 1

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MANAGEMENT: QUESTIONNAIRE(Mga katanungan) 4. Pagkatapos bakunahan ng DPT dapat maghanda ng paracetamol para sa posibleng pagkakaroon ng lagnat ng inyong anak. 5. Pagkatapos ibigay ang OPV di muna kailangang padedehin ang inyong anak sa loob ng 30 minuto. 6. Pagkatapos bakunahan ng BCG ang inyong anak kung nagkaroon ng pamamaga sa parte ng pinagbakunahan kelangan ng Warm Compress. CA MA 5 4 A 3 MDA CDA 2 1

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CURICULUM VITAE:

Personal profile

Name: Age: Add:

Mae Angelique L. Caluma 24 years old 117 C Lawis St. Barangay San Isidro Antipolo, City

Place of Birth: Antipolo Rizal

Educational Attainment Elementary: Secondary: College: Antipolo Immaculate Conception School Antipolo Immaculate Conception School World Citi Colleges

Organization/ Achievements:

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CURICULUM VITAE

Personal profile Name: Age: Add: Cheeney T. Lorete 21 years old 30 M.L Quezon St. Barangay Poblacion Teresa, Rizal

Place of Birth: Morong, Rizal

Educational Attainment Elementary: Secondary: College: Quiterio San Jose Elementary School Teresa National High School World Citi Colleges

Organization/ Achievements: Director of Interact Club of Teresa

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