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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 21-32

Dentist in mission indradhanush: A target-to-target India's unvaccinated children


Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India

Date of Web Publication20-Jan-2017

Correspondence Address:
Ravneet Malhi
Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-1471.198784

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  Abstract 

Introduction: Immunization is one of the most effective, safest, and efficient public health interventions and was first introduced in India in 1978. While the impact of immunization on childhood morbidity and mortality has been great, its full potential has yet to be reached. Objective: This study aimed to assess the level of knowledge, attitude, and practice (KAP) among local community and dental students studying in dental college toward child immunization. Methodology: In this cross-sectional, questionnaire-based study, data were collected from patients attending the outpatient section of pediatric department of four private hospitals and dental students who are studying in a dental college. Further, data were analyzed using Statistical Package for Social Sciences (SPSS) 18.0, as well as descriptive and analytical tests, including mean, standard deviation, and Chi-square test. Results: Impaired KAP regarding immunization were observed among the parents and significant higher knowledge was assessed among dental students. A significant relationship was observed between level of education and awareness of immunization and between age and attitude to immunization (P < 0.05). Conclusion: Immunization has delivered excellent results in reducing morbidity and mortality from childhood infections in the last 50 years, but still there is a room for improvement.

Keywords: Awareness, dental students, dentist, immunization, immunization programs, vaccination


How to cite this article:
Malhi R, Basavaraj P, Singla A, Gupta R, Pandita V, Vashishtha V. Dentist in mission indradhanush: A target-to-target India's unvaccinated children. Dent Med Res 2017;5:21-32

How to cite this URL:
Malhi R, Basavaraj P, Singla A, Gupta R, Pandita V, Vashishtha V. Dentist in mission indradhanush: A target-to-target India's unvaccinated children. Dent Med Res [serial online] 2017 [cited 2017 Oct 20];5:21-32. Available from: http://www.dmrjournal.org/text.asp?2017/5/1/21/198784


  Introduction Top


Delivering vaccines to hard-to-reach populations has always been a challenge. Thousands of children still die from vaccine-preventable diseases (VPDs) each year.[1],[2] VPDs are still responsible for over 5 lakh deaths annually in India. VPDs significantly contribute to under-five mortality, and according to 2015 censuses in India, under-five mortality is 47.7/1000.[3] According to the Global Routine Vaccination Coverage (Global Alliance for Vaccines and Immunization), 2010, about 19.3 million children were not fully vaccinated and remained at risk for diphtheria, tetanus, and pertussis and about 50% of these children are from India only. Even though the immunization services in India are being offered free of cost in public health facilities, still there has been deterioration in the performance of Universal Immunization Program (UIP). About 45% of Indian children are deprived of the recommended vaccinations.[3]

India, along with many developing countries, is lagging behind sufficient coverage of routine immunization (RI). Surveys carried out during National Family Health Survey I, II, and III and by independent agencies such as UNICEF have revealed that the coverage levels may be lower by as much as 15%–40% compared to reported levels of coverage in the UIP.[3]

Immunization is one of the most effective, safest, and efficient public health interventions and was first introduced in India in 1978.[1] While the impact of immunization on childhood morbidity and mortality has been great, its full potential has yet to be reached. Indeed, there are a few states in India that have efficiently running UIP and several that do not as in Uttar Pradesh and Bihar. The UNICEF 2009–2010 survey also recorded the complete vaccination in 58.5% rural infants compared to 67.4% urban infants. Main reasons identified for poor coverage include inadequacy of community participation in RI.[2],[3]

There are some issues on “supply side” that poses challenges to achieving high RI rates. They include inadequate delivery of health services (supply shortages, vacant staff positions, lack of training); lack of accountability, inadequate supervision, and monitoring; lack of micro-planning at district level; general lack of inter-sectoral coordination; and lack of coordination between state and central governments, resulting in missed opportunities to improve immunization coverage and quality.[3]

Only 65% of children in India received all of their primary vaccines by 12 months of age and to expand this to at least 90% of the children of the country; Mission Indradhanush was launched by the Union Health Minister on December 25, 2014. It aims to immunize all children against seven VPDs, namely, diphtheria, whooping cough (pertussis), tetanus, polio, tuberculosis, measles, and hepatitis B, by 2020.[4]

Ensuring equal access to health promotion and disease prevention services for all people is a fundamental tenet of public health. However, due to lack of follow-up by pediatricians and primary care providers, parents are not properly informed regarding the specific type and number of vaccine doses required by age. For this reason, the dental profession, particularly pediatric dentists, may provide an additional source of information and encouragement for parents to immunize their children.[5]

In an endorsement of the immunization schedule recommended by the American Academy of Pediatrics, the American Academy of Pediatric Dentistry states that “pediatric dentists should consider immunization status as a part of the periodic medical history for their patients and should encourage parents to seek appropriate immunization for their children.”[6] Due to lack of communication, inadequate knowledge, and many other factors, it is important to know attitudes and behaviors toward child immunizations in order to improve services and maintain high coverage rate. Dentists along with other health professionals can act as first responders and bring well-honed skills to an emergency. Members of the established public health systems and medical community must understand that in medical surge events, members of dental profession are an additional source of assistance in response activities.[7] Regular and sufficient vaccine supply is a must for universal immunization coverage and can be achieved with appropriate logistic management involving dentists.

Therefore, the present study was carried out to assess the level of knowledge, attitude, and practice (KAP) among local community and dental students studying in dental college toward child immunization as the findings obtained may serve as the basis for effective intervention.


  Methodology Top


Study setting

The study was conducted in Modinagar which is located in the western part of Uttar Pradesh, India.

Study design

This was a questionnaire-based, cross-sectional study.

Study population

A cross-sectional, questionnaire-based study was carried out among the patients attending the outpatient section of pediatric department of four private hospitals of Modinagar from June to September 2015 and dental students who are studying in a Dental College, Modinagar. A total of 1177 subjects from the patients attending pediatric department and 170 dental students were selected for the study along the basis of convenient judgment sampling. Mothers whose child/children are older than 5 years and those who did not give consent were excluded from the study.

Ethical clearance

Ethical approval was received from the Institutional Review Board, and informed consent was obtained from all the study participants. Participation in the study was voluntary and confidentiality of data was maintained.

Questionnaire

The questionnaire was constructed by three-step approach. The first part included the patients' demographic data and the second one included the knowledge and practice about immunization. The third questionnaire had five closed questions regarding the attitude toward immunization. The closed questions were rated using a 5-point Likert scale. When KAP toward immunization were identified, another questionnaire was designed to know the knowledge and attitude of dental students toward child immunization.

Questionnaire validation

The questionnaire was pretested by conducting a pilot study on 73 patients who comprised 20% of the study sample. Reliability of the questionnaire was assessed using test-retest, and the values of measured kappa (k) were 0.86 and weighted kappa (k) was 0.9. Internal consistency of the questionnaire was assessed by applying Cronbach's alpha (ᾳ), and the value of ᾳ = 0. 78 was obtained.

Statistical analysis

The collected data were analyzed using Statistical Package for Social Sciences (SPSS) 18.0, (SPSS Inc., Chicago, IL, USA) as well as descriptive and analytical tests, including mean, standard deviation, and Chi-square test.


  Results Top


The questionnaire-based study was carried out among 1177 participants from private hospitals and 170 dental students regarding the awareness of community toward the child immunization, out of which 948 participants responded to the questionnaire, generating the response rate of 80.5%, and 150 of dental students responded back, generating the response rate of 94%. [Table 1] shows the demographic data of studied participants.
Table 1: The demographic data of parents

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[Table 2] shows that the most of the parents had moderate knowledge regarding immunization and having positive attitude toward the immunization [Table 3]. However, it was clearly seen that there was lack of immunization practice among the parents [Table 4]. [Table 5] presents the significant factors associated with parents' knowledge of child immunization and [Table 6] shows that most of the parents who were educated had positive attitude toward the immunization attitude (P < 0.05). [Table 7] presents that parent's educational status had significant association with source of immunization provided at the time of delivery (P < 0.05) whereas mother's age at the time of delivery had not significant association with practice of child immunization.
Table 2: Knowledge about immunization of parents

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Table 3: Attitude about immunization of parents

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Table 4: Practice of immunization of parents

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Table 5: Association of knowledge of parents with sociodemographic variable

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Table 6: Association of attitude of parents with sociodemographic variable

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Table 7: Association of practice of parents with sociodemographic variable

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It can be seen clearly that among dental students for most of the items, there was considerable high level of knowledge regarding child immunization. Almost all of the dental students (100%) were aware regarding the source of vaccination and its beneficial effects and they had positive attitude toward child immunization as majority of them are strongly agreed that vaccination is effective and it should be recommended [Table 8].
Table 8: Knowledge and attitude about immunization of dental students

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  Discussion Top


Immunization is one of the most effective, safest, and efficient public health interventions, and it is widely accepted that childhood immunization programs have played a great part in the prevention of many diseases; hence, vaccination coverage is an indirect way to assess child health care from public health point of view.[5]

The results of this present study offer insight into the KAPs of the community toward immunization. In our present study, we found that most of the parents were illiterate and they had less knowledge toward immunization schedule, different type of vaccines, source/place of immunization, which is in agreement with the study done by Adil et al. in Islamabad (2008) as immunization status was good only in those children whose parents were well aware of the name and schedule of vaccine.[8]

It was found through this study that the knowledge score was lower in women with a compromised educational standard. The results are in agreement with studies done by Al-Zahrani in Saudi Arabia (2013) and by Kapoor and Vyas in Ahmadabad (2010).[1],[9] Compromised level of knowledge was also seen in various studies among local communities as studies done by Al-Lela et al. in Iraq (2014) and Al-lela OQ et al. in Italy (1999) also showed the inadequate or limited immunization knowledge or bad immunization practice.[2],[10]

In this study, mostly, parents were illiterate and they had negative attitude with poor immunization practices and these findings are in agreement with studies done by Mapatano et al. in Kinshasa (2008) where parents were not aware whether their child was up to date or not regarding immunization status, whereas Sultana et al. in Pakistan (2001) and Kabir et al. in Nigeria (2005) also noted positive attitude among those mothers only who had good educational status.[11],[12],[13]

The overall present results are in agreement with the study done by Awodele et al. in Nigeria (2009), where significant relationship was observed in between ethnicity and awareness of immunization, between level of education and awareness of immunization, and between age and attitude to immunization.[14]

Hence, overall, we can say that there were impaired KAP regarding immunization as the problem is not with the vaccine-related KAP, but low vaccination coverage which marks the failure of the central government. This might be due to ineffective provider practices which lead to missed opportunities for vaccination and these missed opportunities may be attributable to deficiencies in the knowledge among parents regarding immunization practices.

Address the issue of poor utilization of immunization services, obstacles, and lack of awareness or motivation is need for professionally designed behavior change communication interventions. Hence, to improve the efficiency of immunization, knowledge and attitude of dental students were assessed in the present study as dentist can also impart the knowledge to the local people by implementing and managing the vaccination programs. It has been known that dental professionals already possess the basic knowledge and skills which are necessary to perform the vaccination, and we found in this study too that dental students have greater knowledge and positive attitude toward child immunization, which indicates that to achieve the 2020 annual goal of complete immunization, dentists can render the health care. In the present study, it was clearly seen that almost all of the dental students had through knowledge regarding source of immunization and their full schedule as well as their effective measures. Hence, they can articulate the levels at which they can undertake vaccine advocacy.

Although dentists comprise an important aspect of health team, their role or utility has not been emphasized. Oral health-care personnel can be successfully integrated into the medical response system in building needed partnerships, identifying and garnering resources, and facilitating training, policy development, surveillance, and evaluation. Performing these duties is a natural extension of their skills and serves as just one example of how oral health care professionals can be a valuable asset in the vaccination programs.

The study done by Colvard et al. in 2015 in Chicago showed that the mass vaccination drill (the influenza mass vaccination drill), even with a short training session, the majority of dental responders could successfully serve as vaccinators in public health situations. As used in this study, such training could be coordinated through the primary health-care workers, which are already available within many communities worldwide.[15]

Sometimes, physicians and nurses may be unable to implement immunization program in critical time frame. Hence, dentists can participate in mass immunization programs with the minimum of additional training. Dental offices can be used as immunization sites to minimize the concentration of potentially infected persons.[7]

Hence, we can say that dentists can form an important part of the health care community, but there is a need to harvest the services of wide distribution of dentists practicing in our country. Dentists are well versed in the daily practice of infection control, taking and using information from medical histories to guide their actions, taking and interpreting radiographs, administering injections, suturing wounds, managing infections, prescribing medications, and making diagnosis on the basis of clinical signs and symptoms. All of these skills can apply directly with proper training.[7]

Mostly, dentist possesses a knowledge regarding basic immunology relating to the vaccine and they can also describe the VPD as well as explain their societal impact, and as a public health dentist, we can also participate in complete immunization goal by 2020 by rendering the knowledge of immunization to local population through the awareness camps and motivating them for immunization, measuring and reporting vaccination coverage through surveys, and addressing local issues surrounding the implementation so that necessary actions could be taken in order to improve the immunization status.


  Conclusion Top


Immunization has delivered excellent results in reducing morbidity and mortality from childhood infections in the last 50 years, but still there is a room for improvement as the immunization program has failed in achieving its target as universal coverage in India is neither uniform nor cent percent. Hence, there is need to step up efforts to strengthen all components of UIP (vaccination schedule, delivery and monitoring, and VPD surveillance), overcome all barriers (geographical, politico-social, and technical) to achieve immunization's full potential and a healthier nation. Training and reorientation of health workers, supervision of the ongoing UIP, along with timely feedback should be considered as the key component to further improve and sustain RI coverage in order to reach the unreached. A dual approach has to be planned; viz., a short-term plan to reduce vaccination inadequacy and inequity and a long-term strategy to strengthen the overall health-care system, and it can be achieved with appropriate logistic management involving dentists. Here, it is recommended that dentist should also be appointed at the health-care centers as all of the healthcare providers, policymakers, and health education form an essential component that can go a long way in improving the prevailing scenario of immunization in the country. Like nature, a disease can affect anyone without enquiring status and affordability, so benefit of recommendation should be equal to all segments of society because every child is important for nation.

Recommendations

The findings from the present study point the need of establishing appropriate approaches to achieve the target of full coverage by 2020.

  • Policymakers should involve the dentists while making and formulating the policies to overcome immunization challenges faced by the population
  • Dentist can work collaboratively with medical health professionals and nonprofit organizations to provide a valuable and rich opportunity to increase knowledge of infectious risks and improve immunization in the vulnerable group
  • Provision of immunization services in oral health clinics should be taken into consideration in order to provide universal coverage
  • A planned educational program is needed; the educational level of the parents needs to be taken into consideration when the program is planned, especially as regards those with a lower educational level. Dentist can impart knowledge about the benefits and importance of vaccination, as well as the harmful consequences of noncomplete immunization
  • Along with dental education at community outreach activities, dentists can impart a clear and appropriate health education messages regarding vaccination of children as well as adequate and quality outreach services of vaccination to counter the cause of laziness.


A good attempt to address these factors may go a long way to improve vaccine utilization and subsequent protection of the children against childhood infectious diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kapoor R, Vyas S. Awareness and knowledge of mothers of under five children regarding immunization in Ahmedabad. Health Line 2010;1:12-5.  Back to cited text no. 1
    
2.
Jose J, Lobo RM, Nisha K, Shilpa GS, Umarani J. Awareness on immunization among mothers of underfive children. Int J Innov Res Dev 2013;2:620-6.  Back to cited text no. 2
    
3.
Vashishtha VM, Kumar P. 50 years of immunization in India: Progress and future. Indian Pediatr 2013;50:111-8.  Back to cited text no. 3
    
4.
Mission Indradhanush. Available from: http://www.missionindradhanush.in/.[Last accessed on 2015 Dec 10].  Back to cited text no. 4
    
5.
Angadi MM, Jose AP, Udgiri R, Masali KA, Sorganvi V. A study of knowledge, attitude and practices on immunization of children in urban slums of Bijapur city, Karnataka, India. J Clin Diagn Res 2013;7:2803-6.  Back to cited text no. 5
    
6.
Hicks JM, Flatiz J. Role of the pediatric dentist in optimization of childhood immunization. Am Acad Pediatr Dent 1996;18:395-8.  Back to cited text no. 6
    
7.
Gambhir RS, Kapoor D, Singh G, Sawhney GS, Setia S. Disaster management: Role of dental professionals. Int J Med Sci Public Health 2013;2:424-9.  Back to cited text no. 7
    
8.
Adil MM, Zubair M, Alam YA, Khan MS, Ishtiaque ZB, Qureshi AA. Knowledge of Mother's about children immunization status in the urban areas of Islamabad. Rawal Med J 2009;34:33-5.  Back to cited text no. 8
    
9.
Al-Zahrani J. Knowledge, attitude and practice of parents towards childhood vaccination. Majmaah J Health Sci 2013;1:29-38.  Back to cited text no. 9
    
10.
Al-lela OQ, Bahari MB, Salih MR, Al-Abbassi MG, Elkalmi RM, Jamshed SQ. Factors underlying inadequate parents' awareness regarding pediatrics immunization: findings of cross-sectional study in Mosul-Iraq. BMC Pediatr 2014;14:29.  Back to cited text no. 10
    
11.
Sultana A, Jahan S, Ahmad I. Knowledge, attitude and practice of immunization in an urban population. Pak Armed Forces Med J 2001;51:177-81.  Back to cited text no. 11
    
12.
Kabir M, Iliyasu Z, Abubakar IS, Gajida AU. Knowledge, Perception and belief about childhood immunization and attitude toward uptake of poliomyelitis immunization in North. Ann Niger Med 2005;1:21-6.  Back to cited text no. 12
    
13.
Mapatano MA, Kayembe K, Piripiri L, Nyandwe K. Immunisation-related knowledge, attitudes and practices of mothers in Kinshasa, Democratic Republic of the Congo. S Afr Fam Pract 2008;50:61-4.  Back to cited text no. 13
    
14.
Awodele O, Oreagba1 IA, Akinyede1 A, Awodele DF, Dolapo DC. The knowledge and attitude towards childhood immunization among mothers attending antenatal clinic in Lagos University Teaching Hospital, Nigeria. Tanzanian J Health Res 2010;12:1-8.  Back to cited text no. 14
    
15.
Colvard MD, Hirst JL, Vesper BJ, DeTella GE, Tsagalis MP, Roberg MJ, et al. Just-in-time training of dental responders in a simulated pandemic immunization response exercise. Disaster Med Public Health Prep 2014;8:247-51.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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