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LEVEL OF AWARENESS ON THE ADVERSE PHYSIOLOGIC EFFECTS OF THE FIVE EXPANDED PROGRAM ON IMMUNIZATION (EPI) VACCINES AMONG MOTHERS

AND HEALTH CARE TEAMS: BASIS FOR AN ENHANCED PRIMER

A Master’s Thesis Presented to the Faculty Of the Graduate School of Education University of Perpetual Help System DALTA Las Piñas City

In Partial Fulfillment Of the Requirements for the Degree Master of Arts in Nursing

By

JOENALYN C. CALAPATIA

November, 2011

APPROVAL SHEET This research entitled, “ LEVEL OF AWARENESS ON THE ADVERSE PHYSIOLOGIC EFFECTS OF THE FIVE EXPANDED PROGRAM ON IMMUNIZATION (EPI) VACCINES AMONG MOTHERS AND HEALTH CARE TEAMS: BASIS FOR AN ENHANCED PRIMER”, prepared and submitted by JOENALYN C. CALAPATIA in partial fulfillment of the requirements for the degree of Master of Arts in Nursing, has been examined and recommended for acceptance and approval for oral examination.

ALBERTO P. MENDOZA, Ed.D. Adviser

ORAL EXAMINATION COMMITTEE

Approved by the Committee on Oral Examination with a Grade of _____________

IMELDA O. JAVIER, RN.MAN. Ed.D. Member

ALFONSO H. LORETO, Member

HAZEL N. VILLAGRACIA , Ed.D. Chairman

Accepted and approved in partial fulfillment of the requirements for the degree of Master of Arts in Nursing.

IRINEO F. MARTINEZ JR.,LLB,MBA,PhD Dean, Graduate School of Education

ACKNOWLEDGMENT This thesis writing would not have been possible without the guidance and the help of several individuals who in one way or another contributed and extended their valuable assistance in the preparation and completion of this study. The researcher would like to thank God first and foremost for the Divine Guidance and Enlightment, for answering my prayers for giving me the strength to finish this thesis. Thank you so much dear Lord. As a gesture of gratitude and appreciation, the researcher also conveys her sincere thanks to the following people who extended their unparalleled assistance and unselfishly shared their ideas and time to successfully produce a true fruit of labor: Dr. Antonio and Daisy M. Tamayo, for the school benefits they granted to employees of the university which the researcher was able to avail; Dr. Alfonso H. Loreto, school director, for his usual support; Dr. Nieves M. Medina, former Dean of the Graduate School, for the insights she has shared; Dr. Alberto P. Mendoza, my adviser, for his unfailing support and unrelentless effort to bring out the best of the researcher in the pursuit of his goal;

Dr. Jesus B. Gollayan, for his clever assistance in the data analysis; Dr. Hazel N. Villagracia, the chairman of the thesis review panel whose suggestions, clever guidance and wisdom improved the researcher`s paper; Mrs. Imelda O. Javier, one of the members of the thesis review panel provided me brilliant directions and intelligent suggestions which added substance and meaning to this humble piece of work; Mrs. Rosario O. Broqueza, Principal of the School of Midwifery, for her consideration; Mrs. Louella N. Dancel and Mrs. Daisylou S. Bacay, for spending their time to review and edit this thesis and for the continuing support and guidance as well as sharing their knowledge in line of research to come up with this study; I am grateful too for the support from my faculty colleagues in Midwifery who always offered unflagging support; Mr. Nicolie Gydion B. Batuigas, for his supportive assistance in validating my tool. My thanks also to my students of Midwifery who assisted and supported my research especially during those times that we were having surveys;

Mr. Kayzee D. Crisostomo for his untiring support especially in helping me print and edit my papers For all those who have been part of this work, in one way or another, thank you and God bless you all. The Researcher

DEDICATION

This thesis is dedicated to my husband Noel who have supported me all the way since the beginning of my studies. Also, this thesis is dedicated to my kids Noelyn, Angelica,

Noel Angelo and Noel Christian who serves as my inspiration while doing this thesis. And also, to Dr. Hazel N. Villagracia who has been a great source of motivation. Finally, this thesis is dedicated to all those who believe in the richness of learning.

ABSTRACT Name of Institution : University of Perpetual Help System DALTA Address Address : : Pamplona 3, Las Pińas City Pamplona 3, Las Pińas City

Title

: LEVEL OF AWARENESS ON THE ADVERSE PHYSIOLOGIC EFFECTS OF THE FIVE EXPANDED PROGRAM

ON AMONG CARE Enhanced PRIMER Author Degree Major Date of Completion : : : :

IMMUNIZATION (EPI) VACCINES MOTHERS AND THE HEALTH For An

TEAMS:

Basis

Joenalyn C. Calapatia Master of Arts in Nursing Nursing Administration NOVEMBER 2011

STATEMENT OF THE PROBLEM: The study attempted to determine the level of awareness of the mothers and health care team on the adverse physiologic effects of the 5 EPI vaccines administered to infants before they reach 1 year of age. Specifically this study answered the following questions: 1. What is the profile of the mother according to: 1.1 Age; 1.2 Civil status; and 1.3 Number of children? 1.4 Educational Attainment?

2 What is the profile of the health care teams according to: 2.1 Age; 2.2 Gender; 2.3 Civil status; 2.4 Position; and 2.5 Length of stay in the Health Center? 3. What are the adverse physiologic effects of the 5 EPI vaccines based on the awareness of mothers and of the health care teams when taken as separate groups? 4. Are there significant differences between the level of awareness on the adverse physiologic effects of the 5 EPI vaccines of mothers and health care teams based on the various demographic variables?

5. Based on the results of the study, what primer can be developed to increase the level of awareness on the adverse physiologic effects of the 5 EPI vaccines?

METHODOLOGY: The study made use of the Descriptive-Correlational design. According to Jacobson (2003), correlation is classified as non-

experimental, descriptive method. The reason for that is because variables are not directly manipulated as they are in the experimental method. Although correlation is often described as a method of research per se, it is a statistical tool. A correlational study is one designed to determine the degree and direction of relationship between two or more variables or measures behavior. If two variables are known to be strongly related, we can distinguished one from another. This study covered the selected two communities and health centers in Las Piñas City for calendar year 2011. Respondents included in the study were 150 mothers and total enumeration of 8 health care team members employed in the health centers. A purposive sampling was used in selecting the Medical Health Officers (MHO) since there is only one in every barangay health center; and convenience sampling was used in selecting the nurses, midwives and mothers. Data gathered were organized in tables, and assessed and interpreted with the use of frequency, percentage, mean, rank, independent t-test, and one way analysis of variance test together with appropriate rating scales. FINDINGS:

The results of the statistical treatment of the data for a population of 150 mothers and 8 health care team residents of Las Pinas yielded the following findings; 1. Majority of the mothers involved in the study were 26 – 35 years

old, and nearly everyone was married having three to five children; and most of them finished high school. 2. Of the 2 health centers, majority involved in the study were in their

thirties and forties, and nearly all were females and around three-quarters were married. Twenty years and above were in the service and most of the respondents were nurses and midwives. 3. Mothers were aware on the adverse physiologic effects of BCG,

DPT, Hep B, and Measles Vaccines, and minimally aware on those related to OPV vaccine. The health care teams were aware on the adverse physiologic effects of BCG, OPV and Hep B and more than adequately aware as regard DPT and Measles vaccine. 4. There were no significant differences on the level of awareness on

the adverse physiologic effects of the DPT and OPV vaccines among mothers grouped according to age; however, there were significant differences noted in relation to the BCG, Hep B and Measles vaccines. 5. There were no significant differences on the level of awareness of

the adverse physiologic effects of the 5 EPI vaccines among mothers

when grouped according to civil status, number of children and educational attainment. 6. There were no significant differences on the level of awareness of

the adverse physiologic effects of the 5 EPI vaccines among the health care teams with regard to age, civil status and length of stay in the health centers; however, there were significant differences noted in terms of gender and position in relation to the Hep B and Measles vaccines. Conclusions After analyzing the data gathered, the researcher came up with the following conclusions: 1. Majority of the mothers involved in the study are relatively young ,

married with three to five children and are high school graduates. 2. Majority of the health care team members (mostly nurses and

midwives)involved in the study are approaching middle age, female, married and have stayed in the service for twenty years and above. 3. The level of awareness of mothers with regard to the EPI vaccines

varies from being aware to minimally aware while that of the members of the health care teams . ranges from being aware adequately aware depending of the vaccine. 5. There are no significant differences on the level of awareness of to more than

the adverse physiologic effects of the 5 EPI vaccines among mothers

when

civil status, number of children and educational attainment are

considered 6. No significant differences exist on the level of awareness of the

adverse physiologic effects of the 5 EPI vaccines among the health care teams when age, civil status and length of stay in the health centers are considered; however, there are, in terms of gender and position in

relation to the Hep B and Measles vaccines. Recommendations Based from the results of the study, the researcher would like to recommend the following; 1. Grandmothers, mothers and other concerned relatives should be

provided with adequate and updated information about the adverse physiologic effects of the 5 EPI vaccines by means of regularly attending health education class and seminars conducted in the health centers so as to increase their level of awareness. 2. There should be compulsory attendance in seminars about the

latest trends and issues on EPI among the health care team members as an additional related information or new / advanced theories that might increase their level of awareness. 3. The mass media should help in information dissemination about

the adverse physiologic effects of the 5 EPI vaccines. If there are new

development on vaccines, pamphlets should be distributed to the different cities in the Philippines for dissemination by the Units. 4. Additional research on vaccines should be conducted in other Local Government

communities in Las Piñas City to enrich available literature about the adverse physiologic effects of the 5 EPI vaccines . 5. The enhanced primer prepared as a result of this study should

serve as a guide to mothers and health care team members to increase further their level of awareness on the Expanded Program on Immunization.

TABLE OF CONTENTS PAGE i

TITLE PAGE APPROVAL SHEET ii ACKNOWLEDGEMENT DEDICATION vi ABSTRACT

iii

vii

TABLE OF CONTENTS LIST OF TABLES AND FIGURE CHAPTER 1. THE PROBLEM AND ITS BACKGROUND Introduction 1 Theoretical Framework Conceptual Paradigm Statement of the Problem 18 Hypotheses 19 Scope and Limitations of the Study 19 Significance of the Study 20 Definition of Terms 22 2. REVIEW OF RELATED LITERATURE Related Literature 25 Related Studies Synthesis

xiv xxxvv

11 17

30 43

3.

4.

RESEARCH METHODOLOGY Research Design Population and Sampling 47 Respondents of the Study 47 Research Instrument Validation of the Instrument 50 Data-Gathering Procedure 51 Statistical Treatment of Data PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA Problem Number 1

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Problem Number 2 Problem Number 3 Problem Number 4 Problem Number 5 DOH Health Advisory: Garantisadong Pambata Pamphlet
PRIMER : 7 Childhood Immunizable Diseases and the 5 EPI Vaccines ( English Version ) PRIMER : Ang Pitong Nakakahawang Sakit at ang Limang Bakuna Laban Dito ( Filipino Version )

55 57 77 89 90

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5. SUMMARY REFERENCES APPENDICES A The Standard Routine Immunization Schedule for Infants Given by the Barangay Health Center B C Distribution of Respondents WHO Standard Case Definition of EP Target Diseases

93 98

103

104 105

D E

Frequency Distribution of Mothers Profile Frequency Distributions of Health Care Teams Profile

107 108

F

Frequencies and Distributions of Responses of MotherRespondents

109

G

Frequencies and Distributions of Responses of Health Care 111 Team-Respondents

H

Letter to the City Health Officer of Las Pinas City

113

I

Letter to the Medical Health Officer of CAA-A Health Center

114

J

Letter to the Medical Health Center

Health Officer of Basa

115

K

Questionnaires

116

CURRICULUM VITAE

130

LIST OF TABLES AND FIGURE FIGURE 1 Conceptual Paradigm of the Study 17 TABLES 1 Frequency and Percentage Distribution of Mother-Respondents According to Demographic Variables Frequency and Percentage Distribution of PAGE

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Health Care Team-Respondents According to Demographic Variables 3 Level of Awareness of Mothers of the Adverse 58 Physiologic Effects of the BCG Vaccine on Babies 0 to 9 Months Old Level of Awareness of Mothers of the Adverse Physiologic Effects of OPV Vaccines Level of Awareness of Mothers of the Adverse Physiologic Effects of DPT Vaccines Level of Awareness of Mothers of the Adverse Physiologic Effects of Hep B Vaccines Level of Awareness of Mothers of the Adverse Physiologic Effects of Measles Vaccines Level of Awareness of the Health Care Teams of the Adverse Physiologic Effects of BCG Vaccine Level of Awareness of the Health Care Teams of Adverse Physiologic Effects of OPV Vaccine Level of Awareness of the Health Care Teams of Adverse Physiologic Effects of DPT Vaccine Level of Awareness of the Health Care Teams of Adverse Physiologic Effects of Hep B Vaccine Level of Awareness of the Health Care Teams of Adverse Physiologic Effects of Measles Vaccine F-Value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Mother-Respondents Grouped According to Age t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Mother-Respondents Grouped According to Civil 60

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Status 15 t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Mother-Respondents Grouped According to Number of Children F-Value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Mother-Respondents Grouped According to Educational Attainment t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care Team-Respondents Group According to Age t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care Team-Respondents Group According to Gender t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care Team-Respondents Group According to Civil Status 80

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t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care Team-Respondents Group According to Position t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care Team-Respondents Group According to Length of Stay in the Health Center

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Chapter 1 THE PROBLEM AND ITS BACKGROUND Introduction Worldwide, every year millions of children are born and will require vaccination. Despite the fact that there is continuous information dissemination on vaccination, most children under the age of five years die each year because majority of them do not get full routine immunization. This prompted the worldwide implementation of the fourth Millennium Development Goal (MDG4) which aimed to lessen the underfive mortality rate through a wider coverage of the five (5) Expanded Program on Immunization (EPI) vaccination, a locally introduced program (National Demographic Survey, 2003). Throughout this time, children under five years of age might have been infected with the seven (7) childhood immunizable diseases such

as tuberculosis, diphtheria, pertussis, tetanus, hepatitis B, polio, and measles. These diseases are of deadly strain like all viruses and bacteria which may affect anyone especially children who have low resistance and have no immunity to these common diseases. Tuberculosis, according to Richard N. (2007), is a common and in some cases, deadly infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans that attacks

the lungs but can also affect other parts of the body. It is spread through the air when people who have active Micro bacterium tuberculosis (MTB) infection cough, sneeze, or spit. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims. The typical symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss (the last giving rise to the formerly prevalent colloquial term "consumption"). Infection of other organs causes a wide range of symptoms. Diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as microscopic examination and microbiological culture of bodily fluids.

The second disease which is diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheria, a facultative anaerobic Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane (a pseudo membrane) on the tonsils, pharynx, and/or nasal cavity. A milder form of diphtheria can be restricted to the skin. Uncommon consequences include myocarditis (about 20% of cases) and peripheral neuropathy (about 10% of cases). Diphtheria is a contagious disease spread by direct physical contact or breathing the aerosolized secretions of infected individuals.

The Medical News Web of October 07, 2010 states that diphtheria cases have been reported to the World Health Organization (WHO) between 1997 and 2006. Diphtheria is a serious disease, with fatality

rates between 5% and 10%. In children under 5 years and adults over 40 years, the fatality rate may be as much as 20%. Outbreaks, though very rare, still occur worldwide, even in developed nations such as Germany and Canada. In 1991 there were 2,000 cases of diphtheria in the USSR. By 1998, according to Red Cross estimates, there were as many as 200,000 cases in the Commonwealth of Independent States, with 5,000 deaths. This was so great an increase that diphtheria was cited in the Guinness Book of World Records as "most resurgent disease".

Pertussis, on the other hand, is a highly contagious bacterial disease that causes uncontrollable, severe coughing. The coughing can cause a person to suffer from difficulty in breathing. There is a deep "whooping" sound which is often heard when the patient tries to take a breath.

Pertussis, or whooping cough, is an upper respiratory infection caused by the Bordetella pertussis or Bordetella parapertussis bacteria. It is a serious disease that can cause permanent disability in infants, and even death. When an infected person sneezes or coughs, tiny droplets

containing the bacteria move through the air, and the disease is easily spread from person to person. The infection usually lasts 6 weeks. Whooping cough can affect people of any age; it was most common in infants and young children (Cohn AC, et al, 2005).

Mandell (2009) states that tetanus is an infection of the nervous system caused by the potentially deadly bacteria Clostridium tetani. Spores of the bacteria C. tetani live in the soil and are found around the world. In the spore form, the virus may remain inactive in the soil, but it can remain infectious for more than 40 years. Infection begins when the spores enter the body through an injury or wound. The spores release bacteria that spread and make a poison called tetanospasmin. This poison blocks nerve signals from the spinal cord to the muscles, causing severe muscle spasms. The spasms can be so powerful that they tear the muscles or cause fractures of the spine. The time between infection and the first sign of symptoms is typically 7 to 21 days. Most cases of tetanus in the United States occur among those who have not been properly vaccinated against the disease.

Poliomyelitis, as one of the 7 immunizable diseases, is a viral disease that can affect nerves and can lead to partial or full paralysis. The disease is caused by infection with the poliovirus. The virus spreads by

direct person-to-person contact, by contact with infected mucus or phlegm from the nose or mouth, or by contact with infected feces. The virus enters through the mouth and nose, multiplies in the throat and intestinal tract, and then is absorbed and spread through the blood and lymph system. The time from being infected with the virus to developing symptoms of disease (incubation) ranges from 5 - 35 days (average 7 14 days).

In areas where there is an outbreak, those most likely to get the disease are children, pregnant women, and the elderly. The disease is more common in the summer and fall. Between 1840 and the 1950s, polio epidemic was worldwide. Outbreaks still occurred in the developed world, usually in groups of people who have not been vaccinated. Polio often occurred after someone traveled to a region where the disease was common (Berger, 2007).

Hepatitis B is the irritation and swelling (inflammation) of the liver due to infection with the hepatitis B virus (HBV). Hepatitis B infection can be spread through having contact with the blood, semen, vaginal fluids, and other body fluids of someone who already has a hepatitis B infection. The hepatitis B virus can be passed to an infant during childbirth if the mother is infected. Risk factors for Hepatitis B infection includes being

born, or having parents who were born in regions with high infection rates (including Asia, Africa, and the Caribbean); being infected with HIV; being on hemodialysis; having multiple sex partners and men having sex with men.

Most of the damage from the hepatitis B virus occurs because of the way the body responds to the infection. When the body's immune system detects the infection, it sends out special cells to fight it off. However, these disease-fighting cells can lead to liver inflammation (Perrillo R 2010).

Measles, being the last of the communicable diseases, is a very contagious illness caused by a virus. Maximum number of cases occurs in children less than 2 years of age. The disease occurs in all seasons but is more common in winter and springs. It is a highly contagious disease. It is characterized by fever, conjunctivitis, coryza, cough and rash and a self-limiting disease unless complication occurs. Serious and fatal complication may occur with this disease. The virus known as

paramyxovirus is spread when an infected person coughs or sneezes. Droplets of infected mucus or saliva in the air are breathed in by other people. The measles virus then grows in cells in the back of the throat and lungs (Chin, 2000).

Since the mortality of the aforementioned diseases is high, every infant needs to be vaccinated against these viruses upon birth and up to 9 months of age to 1 year old as part of the routine infant vaccination schedule. It is safe to vaccinate a sick child who is suffering from a minor illnesses such as cough, cold, diarrhea, fever or malnutrition; or who has already been vaccinated. If the vaccination schedule is interrupted, it is not necessary to restart. Instead, the schedule should be resumed using minimal intervals between doses to catch up as quickly as possible. People who choose not to have babies vaccinated put both children and communities at risk. There are several reasons why parents choose not to have babies vaccinated. Some mothers may not know how many immunizations their children need and the frequency of vaccination. Several are afraid of the adverse physiologic effects of vaccines that might occur following immunization and what them. they should do about

Others feel that when a child get sick, the current health-care

system can take care of any unfortunate events; and some just don't realize the implications of not being vaccinated. According to Albert Barskey, author of Expanded Program on Immunization manual, “vaccination is a subject that evokes very strong opinions and usually stirs up heated debate as to its efficacy, safety, and reliability”.

The main question parents have to answer is whether to immunize or not, and if so, when and with which ones. It is vital that health care team members educate parents as to the complications and benefits of vaccinations in order that they can then make an informed choice for their children. By providing a balanced view of the evidence on immunization, physicians and other health care providers can help people make bright decisions regarding their health care, and the health care of their dependents. In the Philippines, the response made to the universal child immunization goal in 1986 resulted in the preparation and implementation of the Expanded Program on Immunization (EPI). As part of the Child Survival Program, the Expanded Program on Immunization was created in 1974 by World Health Organization (WHO) with United Nation International Children’s Emergency Fund (UNICEF). This has increased the number of immunized children from 5 to 80% in 30 years. It

contained four major strategies that included sustaining high routine Full Immunized Child (FIC) coverage of at least 90% in all provinces and cities, sustaining the polio- free country for global certification, eliminating measles by 2008 and eliminating neonatal tetanus by 2008. Immunization is done every Wednesday and is adopted as the standard routine schedule in all parts of the country. It is done monthly in

barangay health stations and quarterly in remote areas of the country. The standard routine immunization schedule for infants in the Philippines has been adopted to provide maximum immunity against the seven childhood immunizable diseases in the country. The fully immunized child must have completed Bacillus Calmette Guerin (BCG) 1, Diphtheria Tetanus Pertussis (DPT) 1, DPT 2, DPT 3, Oral Polio Vaccine (OPV) 1, OPV 2, OPV 3, Hepatitis B vaccine, and measles vaccine before the child reached 1 year of age. At birth, infants have protection against certain diseases because antibodies have passed through the placenta from the mother to the unborn child. Breastfed babies up until they are 6 months, get the continued benefits of additional antibodies in breast milk. But the antibody protection from placenta and breast milk is only temporary. The report based on the State of the World`s Mothers (2008) that there is a great need to scale up immunization of children. Vaccination is a way of creating immunity to certain diseases by using small amounts of a killed or weakened microorganism that causes the particular disease. Microorganisms can be viruses, such as the viruses of the 7 childhood immunizable diseases, or they can be bacteria, such as Pneumococcus. Vaccines that can stimulate the immune system to react as if there were a

real infection; it fends off the "infection" and remembers the organism so that it can fight it quickly should it enter the body later. Some parents may hesitate to have their kids vaccinated because they are worried that their children will have serious reactions or may get the illness the vaccine is supposed to prevent. Because the components of vaccines are weakened or killed — and in some cases, only parts of the microorganism are used — they're unlikely to cause any serious illness. Some vaccines may cause mild reactions, such as soreness where the shot was given or fever, but serious reactions are rare (http://www.cdc.gov/nip/publications/VIS/vis-mmr.pdf). At this juncture, the researcher, who had been handling babies in different health care institution for several years while acting in her capacity as Clinical Instructor of Midwifery - Level 2 students on Wednesdays , realized the value of sustaining this program. Extra efforts is taken to impress on the students she handled the importance of

vaccination in improving the community health and will decide to conduct this research to make mothers cooperate with health care teams in the implementation of the program concerning the five EPI vaccines such as Bacillus Calmette Guerin ( BCG), Diphtheria Pertussis Tetanus, Oral Polio Vaccine, Anti-Hepa B vaccine, and Anti-Measles Vaccine. Consequently, mothers involved in this study would become more

knowledgeable on the adverse effects of each of the five vaccines thereby making them more prepared for the interventions that could be applied once these effects would be observed on their babies. The health care teams would enrich their knowledge and background about the vaccines and their adverse effects, thereby become more able to give support to the mothers of babies vaccinated. The researcher chose two communities in Las Piñas City which included Community 1 with a total population of 15,337 wherein the researcher got 75 mothers as respondents, and Community 2 with a total population of 25,345 with 75 mothers as respondents. For the healthcare teams, the total enumeration of 8 respondents employed in two selected communities were included in the study since they were only few. The study determined the level of awareness of mothers and health care teams on the adverse physiologic effects of the 5 Expanded Programs on Immunization (EPI) vaccines after administration on infants who have not turned 1 year old. In as much as the 7 diseases still registered a high mortality among children upon birth up to 1 year of age, the researcher deemed the study to be essential. Theoretical / Conceptual Framework In developing countries like Philippines, children face an elevated risk of illness and death due to incomplete immunization, with severe

implications for their growth potential and the risk of morbidity and mortality in later years. Despite extensive immunization programs of the government, more than a million children die from measles every year, 430,000 from neonatal tetanus, and close to 400,000 from whooping cough (UNICEF, 1990). The seven (7) childhood immunizable diseases mentioned in this study are some of the most highly contagious infectious diseases amongst children which can cause complications if not managed well. They are acquired thru contact with an infected person. The virus can remain active and contagious for up to 2 hours in the air or on surfaces (CDC Health Information for International Travel 2010). The diseases are dangerous because some people, who have acquired the disease, show signs of complications like ear infection, diarrhea, or a serious lung infection, such as pneumonia and are sometimes hospitalized. The virus can also cause severe disease in infants, to malnourished people or to people who are immunocompromised. Children who are not fully immunized are more susceptible to the seven childhood immunizable diseases. To prevent the occurrence of the diseases the Department of Health implemented eight (8) programs under the Primary Health Care and one of them is the Expanded Program on

Immunization (EPI) against seven childhood immunizable diseases. Its objective is to reduce infant’s mortality and morbidity through decreasing the prevalence of the diseases such as TB, diphtheria, pertussis, tetanus, polio, hepatitis B and measles. The Standard Routine Immunization Schedule for infants (See Table 1, Chapter 4), has been adopted in Barangay Health Centers to provide maximum immunity against the seven childhood immunizable diseases before the child’s first birthday. A child is said to be a `Fully Immunized Child` when he/she receives 1 dose of BCG, given at birth or anytime after birth to protect from acquiring tuberculosis; 3 doses of DPT and OPV giving the first dose at 6 weeks and with a minimum interval of 4 weeks between doses to reduces the chance of severe pertussis,

diphtheria and tetanus and to protect the person from acquiring poliomyelitis; 3 doses of hepatitis B vaccine given at birth in 3 doses with 6- week interval from 1st dose to 2nd dose; 8 weeks from 2nd dose to 3rd dose to reduce the chance of being infected by Hepatitis B; and 1 dose of measles vaccine at 9 months of age for 1 dose which gives 85% protection against measles ( Policy on Nationwide Implementation of EPI, 2003 ).

Children should not die young if they receive complete and welltimed immunization. Children who are not fully immunized are more predisposed to common childhood diseases. The Expanded Program on Immunization is one of the Department of Health (DOH) programs that has already been institutionalized and adopted by all Local Government Units (LGUs) in the region. Its objective is to reduce infant mortality and morbidity through decreasing the prevalence of seven immunizable diseases such as TB, diphtheria, pertussis, tetanus, polio, hepatitis B and measles. Particular campaign have been undertaken to improve further program implementation, notably the National Immunization Days (NID), Knock Out Polio (KOP) and Garantisadong Pambata (GP) since 1993 to 2000. This is being supported by increasing/sustaining the routine immunization and improved close watch system. Vaccines certainly have potential side effects and risks, but the benefits of getting vaccinated would prevail over the risks. Vaccines are continually monitored for safety. Thus, unless someone has specific health conditions that prohibit vaccination which are called

contraindications they are much safer being vaccinated than not being vaccinated. Any vaccines can cause side effects like a sore arm or lowgrade fever that will go away within a few days.

More so, infants or babies with a low -grade fever (below 38.5º Celsius) due to minor infections like colds; diseases such as diarrhea, malnutrition, kidney or liver disease, heart or lung disease; well controlled epilepsy or advanced age; and with non-progressive encephalopathy, are not contraindications in receiving the 5 EPI vaccines. Health care teams play a vital role in the aspect of administration of vaccines to infants. They should ensure that the Routine Immunization Schedule must be followed by mothers to minimize the occurrence of the 7 childhood immunizable diseases mentioned in this study. As a health care provider, it is important to give health education amongst all mothers on the importance of the 5 EPI vaccines to their babies in as much as it will improved and increased their child’s immunity on the 7 childhood immunizable diseases. Community health survey are conducted by the health care teams to detect whether there are mothers who have unvaccinated babies thereby minimizing the chance of spreading the socalled 7 childhood communicable diseases. Proper dissemination of information about the 5 EPI vaccines should be zealously implemented. The present study was anchored on Bandura’s Health Action Model (2009), which posits that “health promotion and disease prevention by social cognitive theory specifies a core set of determinants, the mechanism through which they work, and the optimal ways of translating

this knowledge into effective health practices. The core determinants include knowledge of health risks and benefits of different health practices, perceived self-efficacy that one can exercise control over one’s health habits, outcome expectations about the expected costs and benefits for different health habits, the health goals people set for themselves and the concrete plans and strategies for realizing them, and the perceived facilitators and social and structural impediments to the changes they seek.” It was utilized to determine the level of awareness

of mothers and health care teams by focusing on the knowledge and beliefs of the respondents. The researcher applied this model to the study and explained individual participation in programs for the Expanded Program on Immunization implemented by the Department of Health. With the advent of the so-called 7 childhood immunizable diseases, the model has been used to gain a better understanding of the 5 EPI vaccines given to infants from birth up to 9 months to 1 year of age. Participants in this study included mothers, particularly the informal settlers, residing in Las Piñas City and also health care teams working in the health center the communities involved. The related theory and concepts featured in Bandura’s Health Action Model as adapted, served as the backdrop for the work paradigm of the study shown in Figure 1.

Background

Perceptions

Action
> Health care teams conduct health teachings among mothers about the risks of the 7 childhood immunizable diseases > Mothers develop increased awareness of the benefits of immunization and the adverse effects the 5 EPI vaccines from the health care teams, media, articles,and from friends and relatives

PERCEIVED THREATS

A.Risk of acquiring the 7 childhood immunizable diseases among unimmunized

infants
B. Possible occurrence of adverse physiologic effects of the 5 EPI vaccines

A. Profile of the Respondents B. Level of Awareness on the Adverse Physiologic Effects of the 5 EPI vaccines

EXPECTATIONS

A. Perceived Benefit: > Immunization B. Perceived Barriers >Uncooperativene ss among mothers
> Insufficient supply of vaccines > Defaulters

An Enhanced Primer on the Adverse Physiologic Effects of the 5 EPI Vaccines

Figure.1 Conceptual Paradigm of the Study

The BACKGROUND consisted of the personal profile of the mothers and health care teams, and the level of awareness of the adverse physiologic effects of the 5 Expanded Program on Immunization (EPI) vaccines; the PERCEPTIONS focused on the perceived threats and expectations; and the ACTIONS which was the development of an Enhanced Primer on the Adverse Physiologic Effects of the 5 Expanded Program on Immunization Vaccines based on the perceptions of both the mothers and the health care teams. Statement of the Problem The study attempted to determine the level of awareness of the mothers and health care teams on the adverse physiologic effects of the Five EPI vaccines administered to infants before they reach 1 year of age. Specifically this study answered the following questions: 1. What is the profile of the mothers according to: 1.1 Age; 1.2 Civil status; and 1.3 Number of children; 1.4. Educational attainment? 2. What is the profile of the health care teams according to: 2.1 Age;

2.2 Gender; 2.3 Civil status; 2.4 Position; and 2.5 Length of stay in the Health Center? 3. What are the adverse physiologic effects of the Five EPI vaccines based on the awareness of mothers and of the health care teams when taken as separate groups? 4. Are there significant differences between the level of awareness on the adverse physiologic effects of the Five EPI vaccines of mothers and health care teams when they are grouped according to various demographic variables? 5. Based on the results of the study, what enhanced primer can be developed to increase the level of awareness on the adverse physiologic effects of the Five EPI vaccines? Null Hypothesis There are no significant differences between the overall level of awareness on the adverse physiologic effects of the Five EPI vaccines among mothers and of the health care teams. Scope and Limitations of the Study The study focused on the personal profile of the motherrespondents with respect to age, civil status, educational attainment and

number of children in the family for the mother-respondents; and, position and length of stay in the health center, in addition to the variables considered for the mothers, for the two selected health care teams composed of Municipal Health Officer, nurses, and midwives. The respondents were either residing in Las Piñas City or working in Health Centers in the same location. The study analyzed the level of awareness on the adverse physiological effects of the 5 EPI vaccines of mothers and the health care teams in 2 selected barangay health centers within the City. The study considered in the selection of 150 mother-respondents those whose babies were in the last stage of administration of vaccines to infants taking into account that the complete dosage had been given. For the health care team members, total enumeration was employed.

Significance of the Study This study was expected to have more impact primarily on mothers whose infants were due to be vaccinated, by increasing their level of awareness on the adverse physiologic effects of the 5 EPI vaccines to be administered. In addition, the results of the study were deemed to benefit the following sectors:

Department of Health. The result of this study could help the Department of Health improve or develop programs about the value of vaccination in order to minimize if not to have a total eradication of the diseases like tuberculosis, diphtheria, pertussis, tetanus, polio, hepatitis B, and measles. Barangay Health Centers. This study could provide information to the Barangay Health Centers about the adverse physiologic effects of vaccines administered to infants and inform people in the community especially mothers about the right age for the vaccination of infants during their house- to- house surveillance. Health Care Teams. This study could give pertinent information to other health care professionals about the adverse physiologic effects of the vaccines administered to infants upon birth up to 1 year of age through health education classes to parents. Mothers. The results of this study could make mothers more aware on the age they should submit their babies for vaccination through pertinent information about the 5 EPI vaccines and their adverse physiologic effects. Nursing Instructors/ Educators. This study could give the clinical instructors updated relevant knowledge and information the EPI vaccines and their adverse effects which they could share with their students.

Nursing Students. This study would help students bolster their stock of knowledge about health diseases and their adverse effects and could better prepare them to share such with interested parties. Local Government Units (LGUs). The result of this study could help the LGUs to continuously monitor the country for outbreaks of the diseases, so they can actively plan and implement immunization campaigns to ensure that Filipino children receive maximum protection against the 7 childhood immunizable diseases. Other Researchers. The results of this study could provide ideas amongst future researchers about possible focus of their projected investigations which are relevant to the community and to their field of specialization.

Definition of Terms: To have an in-depth knowledge of the study, the following terms were defined operationally: Age. This refers to the preferred age of infants receiving vaccines which in this study was from birth to 9 months of age. Adverse effects of vaccines. This refers to the physiologic

effects of the vaccines like fever, rashes, redness, swelling on the

injection site, etc. on the babies/infants after the administration of the 5 EPI vaccines. Enhanced Primer. This is the end -product or output of this study intended for the mothers and the health care teams wherein the 7 childhood immunizable diseases, their symptoms and physiologic effects of the the adverse

5 EPI vaccines as well as the nursing

interventions will be presented and discussed. Expanded Program on Immunization Vaccines. This refers to the 5 EPI vaccines that are made from microorganisms that cause the seven childhood immunizable diseases, which are part of the immunization schedule of babies from birth up to 9 months of age . Health Care Team-respondents. This refers to the Municipal Health officers, Nurses, and Midwives who are working in the health centers. Immunization. This refers to a method of giving vaccination to infants in order to give them protection from or against certain diseases. In this study, it refers to the vaccination of babies against the 5 immunizable diseases like TB, Hepatitis B, Pertusis, etc. Infants. This refers to babies’ ages 0 to 9 months of age who will be receiving the 5 EPI vaccines.

Mother-respondents. This refers to mothers whose babies or children are within the coverage period of the vaccine and who are involved this study. Perceptions. This refers to the observations of mothers and

health care teams as regard to the adverse physiologic effects of the 5 EPI vaccines. Potency of the vaccine. This refers to the sustained effectiveness of the vaccine as a result of proper handling and transporting . Prevalence. This refers to the common and widespread occurrence of the 7 childhood immunizable diseases across the nation. Profile. This refers to the demographic variables of the respondents such as age, civil status, number of children, educational attainment, gender, position, and length of stay in the health center

Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES This chapter presents and discusses the relevant literature and pertinent studies, both local and foreign, which were found to have strong bearing on the present investigation.

Related Literature Prevention of the seven childhood immunizable diseases is the need of the day. The morbidity and mortality caused by these diseases and the rising costs of treating them requires everybody to focus more on their prevention. Some of these communicable diseases are tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, measles, and hepatitis B, which were discussed in Table 2 entitled WHO Standard Case Definition of Expanded Program on Immunization Target Diseases. According to Salma Ayub ( 2007), immunization is among the

most successful components of preventive medicine. Vaccinations are usually administered to healthy persons and often are mandated, therefore they are held to a higher standard of safety. However, as with all the medical products, no vaccine is perfectly safe or effective. Vaccines can cause minor adverse effects such as fever or local

reactions at the injection site. Rarely, they can cause serious adverse effects such as febrile seizures or allergic reactions. Forceful vaccine safety monitoring may lead to the discovery of adverse events associated with vaccination, and therefore the development and use of safer vaccines and recommendations to minimize the risk of it. In addition to the vaccines, the process of immunization is a potential source of the adverse physiologic effects that are believed to be caused by the immunization. These effects and/or vaccine reactions may be classified into common, minor reactions or rare, more serious reactions and in general do not result in long-term problems.

Integumentary adverse effects of the vaccines BCG causes a specific local reaction that starts as a papule or lump two or more weeks after immunization that then becomes ulcerated and heals after several months leaving a scar. Keloid or abscess on the injection site after immunization from the BCG lesion is more common among Asian and African populations. Systemic reactions such as allergic reaction like mild rashes may occur after immunization of OPV may sometimes occur. Babies may experience pain, swelling, and redness at the injection site can be expected in about 50% of vaccines for those injected with DPT. Babies may rarely experience urticaria after the shot of Hep B vaccine. For Measles vaccines, the systemic reactions arise from vaccine virus infection. Measles vaccines causes rash and affects 5% case of vaccines ( Immunization Safety Surveillance, 2011). Neurologic Adverse Effects of Vaccines Vaccines prepared from whole, killed organism in pertussis and possibly influenza, may cause neurological allergic reactions producing encephalopathy. These reactions are characterized by acute,

monophasic demyelinative processes and occur with no greater frequency than 1 per 100,000 vaccine recipients; onset is within 4 days of immunization, and recovery is usually complete. No evidence suggested that these vaccines produce an insidious, progressive encephalopathy. Vaccines prepared from live-attenuated viruses like measles, mumps, rubella, and trivalent oral poliovirus can cause symptomatic viral infection

of the nervous system, including measles encephalitis, which occurs in 1 of 1,000,000 vaccine recipients; rubella neuritis, in less than 1 of 10,000 recipients; and paralytic poliomyelitis, in 1 of 3,000,000 vaccine recipients or their close contacts (Fenichel,2011). Systemic reaction like fever usually occurs after a shot of DPT vaccines. Measles vaccines can cause fever also which affects 5-15% vaccines. Babies rarely suffer from febrile seizure as a systemic reaction due to high grade fever, that there is only 1 in 3,000 cases. Other adverse effects that occur rarely after injection are irritability with less than 1% cases, and drowsiness (Surveillance for Adverse Events Following Immunization Using Adverse Event Reposting System, 2011). Cardiac complications of vaccines Eckart et al.( 2005 ) in his study "Incidence and Follow-Up of Inflammatory Cardiac Complications After Smallpox Vaccination", stated that although smallpox is the most common vaccine that is associated with myocarditis, other vaccines have also been linked with myocarditis, such as diphtheria-tetanus-polio vaccine, tetanus vaccine alone, cholera, typhoid-cholera, and variola vaccines. In order to assess any relationship between smallpox vaccination and myocarditis more accurately, it would be essential to know what other vaccines were administered to the military personnel in his study.

Moreover, the occurrence of tachycardia that might follow after the shot, hypotension which is sometimes an incident after giving the vaccine, and palpitations that infrequently occurs are some of the adverse

effects that could be experienced rarely amongst babies. Gastro-intestinal side effects of vaccines According to the Adverse Events Following Immunization ( AEFI), (Surveillance for Adverse Events Following Immunization Using Adverse Event Reposting System, 2011), loss of appetite is one of the adverse effect due to DPT vaccine, and vomiting is at times happens among babies who cannot tolerate the OPV vaccine administered, followed by diarrhea which sometimes occur among babies as an effect of the Measles vaccine. Other common adverse physiologic effects of vaccines Common adverse physiologic effects of vaccines for BCG vaccine are pain, redness and swelling at the injection site which is a common adverse reaction after immunization which gives 90-95% cases, and dizziness among babies may sometimes occur following an injection. Again fever (above 38˚C) which is occasionally manifested by infants with less than 1% of case may be observed after giving OPV vaccine. Paralysis is a rare adverse effect of the vaccine with 1 case in 2.4 million doses. Body malaise may every so often occur with less than 1% cases

only. Fever is also a common reaction up to 50% cases after giving DPT injection, while irritability with 55% cases often experienced by babies after receiving the vaccine. For Hep B vaccine, fever (above 38˚C) with 1-6% cases may sometimes be experienced by infants, and also pain, swelling and redness at the injection site with approximately 5% cases commonly happen to infants. Measles vaccines common adverse effects on infants are fever (above 38˚C) up to 5 to 15% cases, pain, swelling and redness at the injection site with an approximately 10% of the cases. Babies rarely experienced pallor after receiving immunization (Adverse Events Following Immunization, 2011).

RELATED STUDIES

Communicable infections have been a major cause of morbidity and mortality in children, even though effective vaccines were first developed more than 40 years ago. Global efforts to prevent communicable diseases deaths have aligned around the United Nations' Millennium Development Goals (MDG), which identified childhood

mortality reduction as a key priority, specifically calling for a two-thirds reduction in mortality among children under age 5, between 1990 and 2015 (MDG 4) (Murray, 2007). Foreign

The study “Improving Vaccination Status of Children under Five Through Health Education” concluded that awareness and knowledge of mothers residing in Gulshan-e-Sikanderabad, regarding vaccine

preventable diseases as well as the immunization status of children under five , could be improved through health education messages by medical students of the Medical University in Karachi. The results of the study showed that there was an increase of 22% in block 1 (p=0.003) and 19% increase in block V through the utilization of the Primary Health Care Center for vaccination (p=0.001), which was explained through the mothers’ knowledge about vaccines and the importance of immunization ( www.epid.gov.l/.../Immunization%20). Ricardo Perez-Cuevas et al ( 2004), in their study “ Immunization Promotion Activities: Are They Effective in Encouraging Mothers to Immunize Their Children?”, evaluated the effectiveness of the Mexican National Vaccination Council communication activities for the Second National Week in Mexico City. Of 935 total number of respondents, 64.3% were classified as `aware`, 24% as `partly aware`, and 11.75% as `unaware`. The study revealed that there were some differences in awareness linked to the age of the mothers, with older mothers generally being more aware ( knowledgeable mothers: aged <25=85.9%, aged

>34=88.3%) and some differences resulting from the age and number of children. The study “ Mothers and Vaccination: Knowledge, Attitudes, and Behavior in Italy” by I.F. Angelillo et al (2005) evaluated knowledge, attitudes, and behavior of mothers regarding the immunization of 841 infants who attended public kindergarten in Cassino and Crotone, Italy. Overall, 57.8% of mothers were aware about all four mandatory vaccinations for infants (poliomyelitis, tetanus, diphtheria, hepatitis B). On the other hand, the World Health Organization (WHO) currently recommends that infants in developing countries should receive measles vaccine at 9 months of age. However, they recommend that infants at high risk of developing measles before 9 months of age, including those living in areas with measles outbreaks and those with HIV infection, should receive 2 doses of measles vaccine at 6 and 9 months of age. Because the HIV status of mothers was usually unknown, most children were vaccinated once at 9 months of age, regardless of HIV status. The decision to give measles vaccine at 9 months of age was based on

balancing the risk of developing measles at a young age with the increased rate of primary vaccine failure at younger ages because of interference by maternal antibodies and the child's immature immune system. Several studies have suggested that infants born to HIV-infected

mothers have lower levels of maternal antibodies and might

be

susceptible to measles infection at a younger age. Most studies of antibody responses after standard-titer measles vaccination have shown a lower response in HIV-infected children than in HIV-uninfected children, although a recent study in Zambia demonstrated an equivalent initial response to vaccination. In the study, “Immunization Against Diseases of Public Health Importance” in China (2006), findings indicated that all vaccines used for routine immunization were very effective in preventing disease, although no vaccine attains 100% effectiveness. They stated that more than one dose of a vaccine was generally given to increase the chance of developing immunity. In addition to this, vaccines were very safe, and side effects were minor especially when compared to the diseases they were designed to prevent. Serious complications occurred rarely. An

example of which was an immediate severe allergic reaction to measles vaccine (anaphylaxis) occurs in less than one case per million doses given. In 2006, Ahmet Topuzoglu, and colleagues published a study that determined the barriers against childhood immunizations: a qualitative research among socio-economically disadvantaged mothers. Based on the study, the socio-economically disadvantaged populations were among

the most susceptible groups that were under-vaccinated. The aimed of this study was to understand the behaviors of mothers concerning immunization of their children, the decision-making process, the perceived barriers, and the enabling factors to access the services in a suburban population in Istanbul. Eight focus group discussions and two in-depth interviews were carried out with the mothers who have children younger than five years. Results of the study showed that the age of the participants were ranged from 21 to 43 with a mean and a standard deviation of 30.3± 5.5. It was also revealed in the study that all the

participants were housewives and had an education of primary school or less. The mean number of children that mothers had was 2.4±1.3 with a maximum of eight. All the mothers had at least one child younger than 5 years old. Mothers were aware that childhood diseases could cause disability and death and they mostly perceived childhood immunizations as a beneficiary and a necessary practice. Another study which was conducted in Karachi, Pakistan by Waris Qidwai (2006) discussed about the knowledge, attitude and practice regarding immunization among family practice patients. The objective of the study was to determine the knowledge, attitude and practices about immunization among family practice patients. A questionnaire based survey was used and developed in line with the study objectives. Results

of the study revealed that there were 97 patients surveyed. The majority were men with 59.8% with a mean age of 29.69 years. Majority were unmarried (51.5%), with graduate and post-graduate education (73%), and in government and private service (48%). Vaccination was believed to prevent disease by 94% and majorities were informed about immunization by doctors and parents (94%). Media provided information about immunization to 62% of the patients. A 58% would recommend vaccination to others while sources about harmful effects of immunization were provided by friends and parents (80%). There were 43 ( 45%) and 29 ( 30%) respondents which belongs to those who lacks in education and funds which hurdle against immunization. The study result have identified a strong need for education program for the masses about immunization since major deficiencies have been identified. The study, “Uptake of Childhood Immunization Among Mothers of Under-Five in Southwestern Nigeria” by Daniel Adeyinka (2007), aimed at determining the awareness, attitude of mothers of under-five towards immunization and proportion of children fully immunized in the 12 -28 month age. The study used a descriptive cross sectional household

survey of perceptions of mothers with children under 5 years of age to immunization in Igbo-Ora, Oyo state, and a cluster sampling of the mothers were carried out. Results discovered that among the 503

mothers interviewed, there were 27.3 years as the mean age and standard deviation of 5.7 years. The mean age of the children was 19.7 months with a standard deviation of 14.4 months. Almost all the women interviewed (99%) were aware of the immunization with 65.7% obtaining information at antenatal clinics. A good proportion of children aged 12 to 33 months were fully immunized (76.9%), 30% were partially immunized and 0.7% were not fully immunized. Majority had good attitudes to immunization with 84.3% having attitude scores of 75% and above. Immunization of the children was not significantly associated with the socio-demographic characteristics at 5% level of significance. The reasons reported for not completing immunization include long waiting on queues (46.1%), payment at private clinics (20.2%) and distance (17.7%). The role of antenatal clinic as a source of awareness should further be strengthened by training more health workers to work since majority of the respondents got informed about immunization in the antenatal clinics, as concluded in the study. Jagrati V Jani, et al (2008) conducted a study on the “Risk Factors for Incomplete Vaccination and Missed Opportunity for Immunization in Rural Mozambique.” This study aimed at finding out the reasons for nonvaccination and the magnitude of missed opportunities for vaccination in children less than two years of age in a rural area in Southern

Mozambique. There was a total population of 668 mothers with children under two years of age who were interviewed in a cross-sectional study. The Road-Health card was utilized to check for completeness and correctness of vaccination schedule as well as for identifying the appropriate use of all available opportunities for vaccination. The chi-square test and the logistic regression were used for statistical analysis. Results of the study found out that there were 28.2% of the children had not completed the vaccination program by two years of age, 25.7% had experienced a missed opportunity for vaccination and 14.9% were incorrectly vaccinated. Reasons for incomplete vaccination were associated with accessibility to the vaccination sites, no schooling of mothers and children born at home or outside Mozambique. According to the study there should be efforts to increase vaccination coverage that should take into account factors that contribute to the incomplete vaccination status of children. Missed opportunities for vaccination and incorrect vaccination need to be avoided in order to increase the vaccine coverage for those clients that reach the health facility, especially in those countries where health services do not have 100% of coverage. The study “Awareness and Knowledge of Mothers of Under Five Children Regarding Immunization in Ahmedabad” conducted by

D.Adeyinka et al ( 2009 ), discussed about the level of knowledge of

mothers of Under Five Children, attending the Immunization Centre of Postpartum Unit , VS General Hospital, Ahmedabad regarding

immunization. The objective of the study was to assess the awareness & knowledge of mothers of Under Five Children regarding Immunization. The study area was done in the Immunization Centre of Post Partum Unit, VS General Hospital, Ahmedabad. Sample size use is 100

mothers of Under Five Children that were studied from March 2009 to May 2009. Results revealed that the mean age of the respondents was 28.4 years. 72% of the respondents were housewives & 65% of them were Hindus. 83% of the literate mothers had some knowledge about

VPDs. 85% of the respondents knew about poliomyelitis & only 15% knew about Hepatitis B. 80% of respondents had no knowledge about Vitamin A. The main source of information of mothers about VPD’s was Anganwadi Worker 47% & Television 35%. The study, “Knowledge, Attitudes and Practices of Mothers Regarding Immunization of One Year Old Child at Mawatch Goth, Kemari Town Karachi”, by Dr. Nighat Nisar ( 2010) stated its objective of assessing the knowledge, attitude and practices of mothers regarding immunization of one year old child in Karachi Pakistan. All mothers having less than one year old child were interviewed through a semi structured questionnaire regarding immunization knowledge, attitude and

practices. The data were collected through a questionnaire entered and analyzed by using SPSS program version 15. Results revealed that majority of the mothers were illiterate, belonging to low-income group and not aware about the name of diseases in EPI program. Based on the study, 70% of women started routine immunization of the child. The reasons for missing vaccination schedule were lack of understanding of next appointment, non-availability of health staff, mild flu and other reasons like household work. That there were about 31% of mothers who quitted immunization after missing one dose, health care staff were the main source of information. A positive attitude was reflected also from both the parents towards immunization. A significant number stated that vaccination is contraindicated in the mild illness of child. According to the study, the knowledge of mothers about vaccination was found inadequate with strong positive attitude and limited practices. The WHO, UNICEF, the American Red Cross, the United States Centers for Disease Control and Prevention, and the United Nations Foundation (2001) had showed a key role in advancing the global measles strategy. This strategy included: “Strong routine immunization for children by their first birthday”; A “second opportunity” for measles immunization through mass vaccination campaigns to ensure that all children received at least one dose; Effective

surveillance in all countries to quickly recognize and respond to measles outbreaks; Better treatment of measles cases, to include vitamin A supplements, antibiotics if needed, and supportive care that prevented complications.

Local Studies In the Philippines, the study about the “Level of Awareness of the Major Communicable Diseases in Slum and Non‐ slum Parts of Manila” (2003) aimed to investigate if awareness of major communicable diseases, incidence and treatment of childhood illnesses, access to immunization and maternal health care, child mortality, and child nutrition vary across slum and non‐ slum settlements of Manila. The results of this study in terms of variation in health outcomes across slum and non ‐ slum distinction were mixed. Descriptive analysis was used in the study. The application of the UN‐ habitat definition of slum dweller on data for Manila resulted in 28% of the household population classified as slum dwellers. Of the under‐ five children, for example, 37 percent were considered as slum residents, and of the ever married women respondents only 26 percent were identified as slum residents. The distribution of respondents into slum and non ‐ slum was therefore relatively sufficient for analysis. The study concluded that women in slum areas are equally aware of TB, the way it spreads, and that it can be

cured as their counterparts in non‐ slum areas. But women in slum areas were less aware of malaria and dengue fever and how these diseases spread. There was also little awareness of the prevention mechanisms. The use of medical treatment in general and oral rehydration in particular is lower in slum residences. Essential vaccines were less accessible to children in slums as well. Consequently, children in slums were more likely to die sooner than non‐ slum children. Maternal care in terms of antenatal/prenatal care and assistance were less available to mothers in slums. Another study, “A Descriptive Study on the Extent of Compliance to Immunization Regimen of Infants Delivered at Home and in Hospitals Among Selected Mothers of Selected Barangays in Cagayan de Oro City ” was conducted by Kinaadman Research Center Xavier University Ateneo de Cagayan in January to May 2008. The study focused on identifying the factors that influenced compliance of mothers to the immunization programs, and whether or not there was a significant difference in the extent of compliance to immunization among mothers who delivered their children in their own homes or in a hospital. Data were gathered from approximately 89 mothers from four different barangays in Cagayan de Oro City. Data analysis in this study showed that rate of compliance to the different immunizations was highly affected

by some of the demographic factors previously identified, and that the rate of compliance varied according to the type of vaccine given.

Based on the study under ProMED-mail, there was a series of measles outbreaks that were reported from the Philippines in the first four months of 2010, chiefly affecting the National Capital Region (NCR), Calabarzon, Ilocos, Central Luzon and Bicol. Almost 2000 cases were reported nationwide, five times as many as during the same period the previous year. In January 2011, there was a measles outbreak reported from the towns of Talaingod and Kapalong in Mindanao's Davao del Norte province after flooding and landslides. This study showed that all travelers born after 1956 should make sure they have had either two documented measles immunizations or blood test showing measles immunity. This did not apply to people born before 1957, who were presumed to be immune to measles. Although measles immunization was usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of MMR or measles vaccine before traveling to the Philippines. Dennis C. Teo M.D., in his study “Setting the Health Research Priorities 2006 TO 2010 :National Capital Region”, stated the goal of providing relevant research, research management, capacity-building, sharing of resources as well as health financing to mediate the gaps and

sustain growth and viability of the health research. The aim of his study was to illustrate the health profile, identify problems and researchable areas of the National Capitol Region (NCR) that would be used as part of the Zonal Health Research Prioritization Agenda.

The objectives of his research were stating the present health situation of the region and identify pressing health problems and issues; the present health care industry as well as identify providers of health products and services, raw material availability, and production capability; to identify researchable areas based on the identified priority areas; and develop a regional agenda for health research.

Under the Health Programs, the Expanded Immunization ProgramNCR has immunized 282,733 children with a fully immunized child of 90.8%. Part of this was the follow-up Measles Elimination Campaign in NCR in which a total 2,218,995 children were immunized with Measles vaccine at a 98.3% coverage. Synthesis The literature both local and foreign and the studies and researches undertaken had similarity with the present investigation. The present research was similar to the study conducted in

Karachi, Pakistan about knowledge, attitude and practices of mothers

regarding immunization of one year old child by Nighat Nisar et al (2010) because the study evaluated knowledge, attitudes, and practices of the 209 mothers regarding the immunization of their one year old child in Karachi, Pakistan. World Health Organization (WHO) representative office in China in 2006 observed that though all vaccines used for routine immunization were very effective in preventing disease, no vaccine though, attained 100% efficacy. Serious complications occurred rarely. This variable was also investigated in this study. Kapoor Rachna in 2010 in his study “Awareness and Knowledge of Mothers of Under Five Children Regarding Immunization in Ahmedabad” assessed the awareness and knowledge of mothers of Under Five children regarding Immunization. The study was conducted amongst 100 mothers of Under Five Children attending the Immunization

Centre of Post Partum Unit, V.S General Hospital, Ahmedabad. The average attendance of the centre was 20 children per day. The respondents were tested by exit interviews with a pretested predesigned performed from March 2009 to May 2009 by the Under Graduate students of Smt. NHL Municipal Medical College, Ahmedabad. This was explored in the present study.

The aforementioned studies dealt on the level of awareness and knowledge of mothers regarding immunization of their children at birth up to 9 months of age. These variables were likewise investigated in the present study. Research differed with the reviewed studies because of its time frame, the variables used in the study, the respondents and number of respondents involved, and the area in which the study was conducted. The present research study was unique in its own way because there has been no study conducted about the level of awareness on the adverse physiologic effects of the 5 EPI vaccines based on the perceptions of mothers and health care teams when it came to the timing of vaccination. Though pamphlets or brochures on immunization were given by the health centers to mothers, an enhanced primer of the present study would be different because it would include not only the 7 childhood immunizable diseases but also the adverse physiologic effects of the 5 EPI vaccines with the clinical management of each of the effects so that mothers as well as the health care teams would know and increase their awareness on vaccination.

Chapter 3

METHODOLOGY This chapter contains the following sections: Research Design, Population and Sampling, Respondents of the Study, Research Instruments, Validation of Instruments, Data -Gathering Procedure, and Statistical Treatment of Data

Research Design The study made use of the Descriptive-Correlational design. According to Jacobson (2003), correlation is classified as nonexperimental, descriptive method. The reason for that is because variables are not directly manipulated as they are in the experimental method. Although correlation is often described as a method of research

per se, it is a statistical tool. A correlational study is one designed to determine the degree and direction of relationship between two or more variables or measures behavior. If two variables are known to be strongly related, we can distinguish one from another. To examine the distribution and relationship among variables, a normative survey method was applied. This method is purported to know the level of awareness on the adverse physiologic effects of the 5 EPI vaccines based on the perceptions of mothers and health care teams; this descriptivecorrelational research design is deemed best appropriate to be used. Population and Sampling Technique Purposive sampling was used in selecting the Municipal Health Officers (MHO) since there was only one in every barangay health center; and convenience sampling was used in selecting the nurses, midwives and mothers. The researcher chose the desired number of 150 mothers living in 2 selected communities in Las Piñas City as sample in order to

be able to determine their estimated level of awareness about the adverse physiologic effects of the 5 EPI vaccines. There were 75 mothers interviewed in Community 1, and 75 mothers in Community 2. For the healthcare teams, total enumeration was employed. There was one (1) Municipal Health Officer in every Health Center, 2 nurses, and 2 midwives

involved Center .

in Health Center 1; one (1) nurse and 1 midwife in Health

Respondents / Participants of the Study There were two groups of respondents: mothers and members of the Health Care Team composed of Municipal Health Officers (MHO), Nurses, and Midwives. One hundred fifty (150) mothers who had

babies that fell within the immunization period (0 to 9 months) were selected from each of the 2 communities in Las Pinas City. Community 1 (A), and community 2 (B),. This sample was used for several reasons. It had the possibility to reveal the adverse physiologic effects of the 5 EPI vaccines and the level of awareness of mothers and health care team on the adverse physiologic effects of the 5 EPI vaccines administered to infants from birth and up to 9 months before reaching 1 year old. The number of mothers involved (150) accounted for o 94.94% of the total number of respondents while the total enumeration of the healthcare team members (8 )broken down into 2 or 1.26% Municipal

Health Officers, 3 or 1.90% nurses, and 3 or 1.90% midwives. All the 150 mothers and 8 health care team members registered one hundred per cent of the total sample.

Research Instrument There was one set of questionnaires prepared by the researcher with two forms: one form in Filipino for the mothers and another in English for the Health Care Team members. The questionnaire consisted of two parts: Part 1: Demographic Profile of Respondents Form 1 was about the variables on the demographic profile of the mothers such as age, civil status, number of children in the family, and educational attainment. Form 2 was about the variables on the demographic profile of the MHO, nurses, and midwives such as age, gender, civil status, position, and length of stay in the health center. Part 2: Level of Awareness on the Adverse Physiologic Effects of the 5 EPI Vaccines. The equivalent rating scales that determined the level of awareness of the mothers and the health care teams are shown below, in which 5 was the highest response and 1 was the lowest:

Statistical Limit 4.05 – 5.00 3.05 – 4.00

Numerical Equivalent 5 4

Interpretation Fully Aware More Than Adequately

Aware 2.05 – 3.00 1.05 – 2.00 0.95 – 1.00 3 2 1 Aware Minimally Aware Unaware

Statistical Limit

Numerical Equivalent

Interpretation

4.05 – 5.00

5

May Ganap na Kamalayan

3.05 – 4.00

4

May Kamalayang Higit sa Karaniwan

2.05 – 3.00

3

May Pangkaraniwang Kamalayan

1.05 – 2.00

2

May Kaunting Kamalayan

0.95 – 1.00

1

Walang Kamalayan

Interviews were also conducted with the Municipal Health Officers, nurses, and midwives to validate findings and to gather additional data on the adverse physiologic effects of the 5 EPI vaccines.

Validation of Instruments This questionnaires (Form 1 and Form 2) underwent a pre-test and post-test analysis and was also tested for reliability, posting a result of 0.99851 for the pre-test and 0.9827 for the post - test. The tool was content validated by Dr. Esther H. Oliveros, City Health Officer of Las Piñas City, and Mr. Gydion Nicolie Batuigas, a nursing instructor of Concordia College and St. Dominic College of Asia, in consultation with the Dean of the Graduate School of Education. Data- Gathering Procedure To successfully accomplish the objective/s of the study, a letter of permission duly signed by the researcher endorsed by her adviser and recommended by Dr. Irineo F. Martinez Jr., was forwarded to the barangay health centers involved. Upon getting the permission, the validated questionnaires were distributed personally by the researcher and actual interviews with the MHO, nurses, midwives, and mothers were held in the two community health centers. The objective of the study was explained to the respondents before the distribution of the questionnaires. The respondents were supervised to make sure that the questions were well- understood so that reliable results could be generated.

Statistical Treatment of Data The following statistical treatment and tools were used to analyze and interpret the data obtained: Mean was utilized to describe the responses and determine the ranks of indicators. Frequency and Percentage distribution were utilized to describe the profile of the respondents. Independent t-test was used to compare the level of awareness of mothers and health care teams on the immunization given to infants , 0 – 9 months old. One-way analysis of variance (ANOVA) was used to compare the mean awareness on the Adverse Physiologic Effects of 5 EPI vaccines among different categories of the demographic variables.

Chapter 4 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA This chapter presents the answers to the specific problems raised earlier in the study. Problem 1. The profile of the mother according to age; civil status; number of children; and educational attainment. Table 1 presents the profile of mothers involved in the study according to age, civil status, number of children, and educational attainment. Table 1 Frequency and Percentage Distribution of Mother-Respondents According to Demographic Variables
Variable Age (years) 18 years and below 19 - 25 26 - 35 36 and above Total Civil status Single Married Widow Separated Total Frequency (n = 150) 15 47 56 32 150 10 130 0 10 150 Percent 10% 31.33% 37.33% 21.33% 100% 6.67% 86.67% 0% 6.67% 100%

Number of Children 1–2 3–5 6 – 10 11 and above Total Educational Attainment College graduate College undergraduate High school Elementary Total

75 66 9 0 150 18 25 92 15 150

50% 44% 6% 0% 100% 12% 16.67% 61.33% 10% 100%

Note: See Appendix D for detailed information about this summary table. Profile of the mothers according to age Table shows that majority of the mothers, 56 or 37.33%, were 26 to 35 years old, while 47 or 31.33% were between 19 – 25 years old, with 32 belonging to the 36 years old and above category or 21.33% ; the

remaining 15 or 10% were 18 years old and below. Profile of the mothers according to civil status The findings as shown in table revealed that 130 of the mothers or 86.67% were married while 10 or 6.67% were single and separated. It was assumed that following the Catholic teachings on the sacredness of marriage, the chosen respondents obtained matrimonial blessings before they got pregnant. Profile of the mothers according to number of children Data revealed that 75 or 50% of the mothers had 1 to 2 children ; 66 or 44% had 3 to 5 kids, and 9 or 6% had 6 to 10 children. This was to be expected because mothers believed that they

could take care of more than 1 child properly and give more attention to

the needs of each of their children; and probably because these mothers attended health education classes conducted in their respective health centers regarding Family Planning Method which many of them took to heart.

Profile of the mothers according to educational attainment Ninety-two or 61.33% reached high school while 25 or 16.67% were college undergraduates ; 18 or 12% were college graduates. Fifteen (15) or 10% among the respondents reached only elementary level. Problem 2. The profile of the health care teams according to age, gender, civil status, position, and length of stay in the Health Center. Table 2 presents the profile of the health care teams involved in this study according to age, gender, civil status, position, and length of stay in the health center. Table 2 Frequency and Percentage Distribution of Health Care TeamRespondents According to Demographic Variables
Variable Age (years) 19 - 25 26 - 35 36 - 45 46 and above Total Gender Male Female Total Civil status Single Married Widow Separated Frequency (n = 8) 1 1 3 3 8 3 5 8 2 5 0 1 Percent 12.5% 12.5% 37.5% 37.5% 100% 37.5% 62.5% 100% 25% 62.5% 0% 12.5%

Total Position MHO Pedia Ob-Gyne Nurse-Midwife Nurse Midwife Total Length of Stay n the HC Less than 1 year 1 – 5 years 5 – 10 years 10 – 20 years 20 years above Total

8 2 0 0 0 3 3 8 0 2 2 1 3 8

100% 25% 0% 0% 0% 37.5% 37.5% 100% 0% 25% 25% 12.5% 37.5% 100%

Note: See Appendix D for the basic data on which this summary table was derived.

Profile of the health care teams according to age Among the eight (8) health care team-respondents, the average age ranged from 19 – 46 years old and above. There were three or 37.5% among the respondents who fell under the 36 – 45 years category, and an equal number under the 46 years old and above bracket. One (1) each or 12.5% belonged to 19 - 25 years and 26 – 35 years old. It is possible that most of the health care team members went abroad after graduation and after passing the local board examination or were employed in other institutions like tertiary hospitals and private clinics at a younger age. Profile of the health care teams according to gender Most (5 or 62.5%) were female and 3 or 37.5% male. It is obvious that medical and allied health professions were most attractive among women. Males did prefer to choose professions that were suitable to them or made them appear more masculine. Profile of the health care teams according to civil status

As shown in Table, five (5 ) or 62.5% were married; 2 or 25 % were single, and 1 or 12.5% was separated. It was evident that most of the health care team-respondents had families to look after, a very justified reason that they chose to serve in the health centers. Profile of the health care teams according to position Of the twenty- eight (8) respondents, three ( or 37.5%) were

nurses and midwives, and 2 ( or 25%) were municipal health officers. The result in the percentage among health care teams was to be expected because there was a large number of nursing graduates as well as midwives who passed the local board examinations. They were absorbed in the different health care institutions including health centers in the country. Profile of the health care teams according to length of stay in the Health Center The length of service in the health centers of the respondents varied from less than 1 year to 20 years and above. Three (37.5%) had stayed for 20 years and above while 2 or 25% each had between 1 – 5 and 5 – 10 years of service respectively.. It is possible that most of the members of the health care teams preferred to stay or work in the primary health care setting because of the

convenient time schedule of their duty and also because of the proximity of their work station to their residences. Problem 3. The adverse physiologic effects of the 5 EPI vaccines based on the awareness of mothers and of the health care teams when taken as separate groups. Table 6 presents the data obtained from mother- respondents on the adverse physiologic effects of BCG vaccines. Table 3 Level of Awareness of Mothers on the Adverse Physiologic Effects of the BCG Vaccine on Babies 0 to 9 months Old
Adverse Physiologic Effects 1. Pagkakaroon ng abscess o keloid sa pinag-iniksyonan sa braso ng mga sanggol 2. Pagkakaroon ng ‘seizure’ Mean Interpretation Rank

3.52

May Kamalayang Higit sa Pangkaraniwan May Pangkaraniwang Kamalayan

1

2.57

5

3. Pagbilis ng tibok ng puso ng mga sanggol ilang minuto matapos mabigyan ng bakuna

2.59

May Pangkaraniwang Kamalayan

4

4. Pagkawala ng ganang dumede ng mga sanggol 5. Pamumula, pananakit at pamamaga sa bahaging iniksyonan

2.93

May Pangkaraniwang Kamalayan

3

3.18

May Pangkaraniwang Kamalayan

2

6. Pagkahilo ng mga sanggol pagkabakuna. OVER-ALL MEAN

2.00

May Kaunting Kamalayan

6

2.80

May Pangkaraniwang Kamalayan

Legend: 5 – May Ganap na Kamalayan 2 – May Kaunting Kamalayan 4 – May Kamalayang Higit sa Karaniwan 1 – Walang Kamalayan 3 – May Pangkaraniwang Kamalayan Note: See Appendix E for basic data on which the above summary table was derived.

Table 3 shows the mean scores of the ratings of the mothers’ on their level of awareness on the adverse physiologic effects of the BCG vaccine based on the 6 listed indicators. Based on the responses of the mothers, they were more than adequately aware /ganap ang kamalayan of indicator 1 ( babies may get abscess on the injection site after immunization) as indicated by a mean score of 3.52 and rank 1, followed by indicator 2 (pain, redness and swelling at the injection site) with a mean score of 3.18, rank 2 described as more than adequate awareness/higit sa pangkaraniwang kamalayan; and then by indicator 3 (loss of appetite) with a mean score of 2.93, rank 3, described as aware/pankaraniwang kamalayan. The last two indicators, ranked 5 and 6 with means of 2.57 and 2.0 respectively were : (seizure might be a possible adverse effect following immunization) , described as minimally aware/may kaunting kamalayan and( dizziness among babies) described as unaware /walang kaalaman. The over-all mean score of the level of awareness of mothers with respect to the adverse physiologic effects of the BCG vaccine based on the indicators, was 2.80 described as aware/ may karaniwang kamalayan. It is possible that mothers have the sufficient knowledge and awareness on the adverse physiologic effects of BCG vaccines because it was given post partum or right after delivery of their babies thus they

were able to observed the effects of the said vaccine at an earlier time. The study “Uptake of Childhood Immunization Among Mothers of Underfive in South Western Nigeria” states that almost all the mothers interviewed were aware of the immunization that obtained 65.7% of the information at antenatal clinic. Same study also on “Awareness and Knowledge of Mothers of Underfive Children Regarding Immunization” discussed the level of knowledge of mothers attending the Immunization center of Postpartum Unit. Table 4 Level of Awareness of Mothers of the Adverse Physiologic Effects of OPV Vaccines
Adverse Physiologic Effects Mean Interpretation Rank 1. tungkol sa puwedeng magkaroon ng allergy sa balat ang mga sanggol tulad ng rashes matapos mabigyan ng bakuna. 2. na puwedeng maging iritable ang sanggol kapag nabakunahan na. Ang kaso na nakaranas nito ay nasa 1% pababa. 3. na maaaring bumaba ang blood pressure ng sanggol matapos mabakunahan. 4.maaring magsuka ang mga sanggol sakaling hindi makayanan ang naibigay na bakuna 5. na maaaring lagnatin ( 38C pataas) ang mga sanggol na bihirang maobserbahan matapos mabigyan ng bakuna. Ang kaso ay nasa 1% pababa lamang. 6. na maaaring maging paralisado ang mga sanggol bilang isa sa mga bihirang epekto ng bakuna. May 1 kaso lamang sa 2.4 million doses. 7. tungkol sa bihirang panghihina ng mga sanggol na umabot lamang sa 1% ang nagkaroon nito. OVER- ALL MEAN

2.51

May Pangkaraniwang Kamalayan

3

2.99

May Pangkaraniwang Kamalayan

2

1.91

May Kaunting Kamalayan

7

2.06

May Kaunting Kamalayan

5

3.25

May Pangkaraniwang Kamalayan

1

May Kaunting Kamalayan 2.11 6

2.29

May Kaunting Kamalayan

4

2.45

May Kaunting Kamalayan

Legend: 5 – May Ganap na Kamalayan 2 – May Kaunting Kamalayan 4 – May Kamalayang Higit sa Karaniwan 1 – Walang Kamalayan 3 – May Pangkaraniwang Kamalayan Note: See Appendix E for the basic data on which this summary table was derived.

Table 4 shows the mean scores of the ratings on how mothers identify their level of awareness on the adverse physiologic effects which had been categorized into six indicators of the OPV vaccine. Mothers were aware/may pangkaraniwang kamalayan based on their responses on indicator 1 (allergic reaction like mild rashes may occur after immunization) as indicated with a mean score of 2.51 and rank 1; followed by indicator 2 (after the immunization, irritability with less than 1% cases might be experience by babies) with a mean score (above 38˚C) which is 1% of case) with a

of 2.99 rank 2; and then indicator 5 (fever occasionally manifested by infants with less than

mean score of 3.25 and rank 1. On the remaining OPV vaccine indicators, ranked as 4, 6 and 7 with means 2.29, 2.11 and 2.06 respectively were: (body malaise may every so often occur with less than 1% cases only ), vaccine with 1 case

followed by (paralysis is a rare adverse effect of the

in 2.4 million doses.), and (hypotension is sometimes an incident after giving the vaccine), described as minimally aware/may kakulangan sa kamalayan. The over-all mean score of the level of awareness of mothers with respect to the adverse physiologic effects of the OPV vaccine based on the indicators was 2.45 and kakulangan sa kamalayan. described as minimally aware/ may

This might mean that mothers were not totally aware of the adverse physiologic effects of OPV vaccines maybe because most of them were dependent on their husband who usually attended vaccination schedule of their baby. It is similar with the study which was conducted in Karachi, Pakistan which discussed about the knowledge, attitude and practices regarding immunization among family patients wherein majority of the respondents were men. Table 5 Level of Awareness of Mothers of the Adverse Physiologic Effects of DPT Vaccine
Adverse Physiologic Effects 1. na ang pamumula, pananakit at pamamaga ng iniksyonan ay mga epektong malimit maobserbahan pagkatapos mabigyan ng bakuna ang mga sanggol. Halos nasa 50 % ang bilang ng kaso na nagkaroon nito. 2. tungkol sa bihirang pagkahilo ng mga sanggol dulot ng bakuna. 3. ang pagbilis ng tibok ng puso ng mga sanggol ay bihirang mangyari matapos mainiksiyonan. 4. tungkol sa bihirang mawalan ng ganang dumede ang mga sanggol pagkaraang mabakunahan. 5. tungkol sa pagkakaroon ng lagnat ng mga sanggol . 50% ang bilang ng mga sanggol na nagkaroon nito matapos ang bakuna 6. na puwedeng maging iritable ang mga sanggol kapag nabigyan na ng bakuna. May 55% ng mga sanggol ang nakaranas nito. OVER-ALL MEAN Mean Interpretation Rank

3.63

May Kamalayang Higit sa Karaniwan

1

2.24

May Kaunting Kamalayan

6

2.65

May Pangkaraniwang Kamalayan

5

2.81

May Pangkaraniwang Kamalayan

4

3.61

May Kamalayang Higit sa Karaniwan

2

3.43 3.06

May Kamalayang Higit sa Karaniwan May Pangkaraniwang Kamalayan

3

Legend: 5 – May Ganap na Kamalayan 2 – May Kaunting Kamalayan 4 – May Kamalayang Higit sa Karaniwan 1 – Walang Kamalayan 3 – May Pangkaraniwang Kamalayan Note: See Appendix E for the basic data on which this summary table was derived.

The mean scores of the ratings on how mothers identify their level of awareness on the adverse physiologic effects which had been categorized into six indicators of the DPT vaccine were shown in table 8. According to the responses of mothers, they were more than adequately aware/may kamalayang higit sa karaniwan of the indicator 1 (babies may experience pain, swelling, and redness at the injection site which gives up to 50% of the cases)with a mean score of 3.63, rank 1, followed by indicator 5 (fever is a common reaction after giving injection that it gives 50 % cases ) with a mean score of 3.61 and rank 2, and experienced by babies

indicator 6 (irritability with 55% cases often

after receiving the vaccine ) with a mean score of 3.43 rank 3. The next two indicators, ranked 4 and 5 with means of 2.81 and 2.65 respectively were: (loss of appetite may sometimes occur ), and (tachycardia is a seldom adverse effect following immunization ) described as aware/may pangkaraniwang kamalayan. On the last indicator with mean score of 2.24 and rank 6 was (drowsiness rarely occurs after injection) described as minimally aware/may kaunting kamalayan. The over-all mean score of the level of awareness of mothers with respect to the adverse physiologic effects of the DPT vaccine based on the indicators was 3.06 described as aware/ may karaniwang kamalayan.

This could be possible that most mothers attended health teachings regarding immunization every time they bring their babies for vaccination. This would be supported by the study in the Related literature entitled “Mothers and Vaccination: Knowledge, Attitudes, and Behavior in Italy”, wherein mothers were aware about all the four mandatory vaccinations for infants and one of this is DPT vaccine and its effects.

Table 6 Level of Awareness of Mothers of the Adverse Physiological Effects of Hep B Vaccines
Adverse Physiologic Effects 1. tungkol sa bihirang pangangati ng mga sanggol matapos mabigyan ng bakuna 2.na puwedeng magkaroon ng seizure ang mga sanggol sanhi ng mataas na lagnat matapos ang iniksiyon ng bakuna 3. tungkol sa bihirang pagkakaroon ng mabilisbumagal na tibok ng pulso ng mga sanggol matapos mabakunahan. 4.sa pagkawalang ganang dumede ng mga sanggol matapos mabigyan ng bakuna 5. na maaaring lalagnatin ang mga sanggol (38˚C pataas) na may bilang 1-6% kaso ang nakaranas nito 6. na ang pamumula, pananakit at pamamaga sa iniksyonan ay mga epekto ng nasabing bakuna na malimit maobserbahan pagkatapos mabigyan ng Mean Interpretation Rank

2.45

May Kaunting Kamalayan

5

2.47

May Kaunting Kamalayan

4

2.25

May Kaunting Kamalayan

6

2.58

May Pangkaraniwang Kamalayan

3

3.10

May Pangkaraniwang Kamalayan

2

3.17

May Pangkaraniwang Kamalayan

1

bakuna ang mga sanggol. Halos 5 % lamang ang bilang ng kaso na nagkaroon nito. OVER-ALL MEAN 2.67 May Pangkaraniwang Kamalayan

Legend: 5 – May Ganap na Kamalayan 2 – May Kaunting Kamalayan 4 – May Kamalayang Higit sa Karaniwan 1 – Walang Kamalayan 3 – May Pangkaraniwang Kamalayan Note: See Appendix E for the basic data on which this summary table was derived.

Mothers identified their level of awareness on the adverse physiologic effects that has been categorized into six indicators of the Hep B vaccine showed the mean scores of ratings as revealed in the table. The table indicated that the following vaccine indicators dealt with Hep B vaccines made mothers aware/may pangkaraniwang kamalayan on indicator 4 (.babies may experience loss of appetite following

immunization ) with a mean score of 2.58, rank 3, followed by indicator 5 (fever (above 38˚C) with 1-6% cases, may.sometimes be experienced by infants )with a mean score of 3.10 rank as 2; and indicator 6 (pain, swelling and redness at the injection site with approximately 5% cases commonly happen to infants ) with a mean score of 3.17 rank 1. The

last three indicators ranked as 4, 5, and 6 with means of 2.47, 2.45, and 2.25 respectively were: (seizure due to high fever sometimes follow after the babies receive the vaccine), (babies may rarely experience urticaria after the shot ), and (palpitations infrequently occurs ), described as minimally aware/may kaunting kamalayan. The over-all mean score of the

level of awareness of mothers with respect to the adverse physiologic effects of the Hep B vaccine based on the indicators, was 2.80 described as aware/ may karaniwang kamalayan. awareness of mothers was 2.67 which made them aware/may pangkaraniwang kamalayan. This might be possible that most mothers attended health teachings regarding immunization every time they bring their babies for vaccination. This would be supported by the study in the Related literature entitled “Mothers and Vaccination: Knowledge, Attitudes, and Behavior in Italy”, wherein mothers were aware about all the four mandatory vaccinations for infants and one of this is Hep B vaccine and its adverse effects.. Table 7 Level of Awareness of Mothers of the Adverse Physiologic Effects of Measles Vaccine
Adverse Physiologic Effects 1.na matapos mabigyan ng bakuna ang mga sanggol ay magkakaroon ito ng rashes. May 5% lamang ang mga bilang ng kasong naobserbahan. 2. tungkol sa bihirang pagkakaroon ng seizure sanhi ng mataas na lagnat ang sanggol pagkainiksiyon ng bakuna. Naganap ito sa 1 kaso lamang sa 3,000. 3. tungkol sa pagblis ng tibok ng pulso ng sanggol matapos makatanggap ng bakuna. 4.na puwedeng magtae ang sanggol bilang epekto ng bakuna 5. na maaaring lagnatin ang mga sanggol (38˚C pataas)matapos ang pagbibigay ng bakuna. Ang bilang ng kaso nito ay nasa 5 to 15% . 6. na ang pamumula, pananakit at pamamaga sa iniksyonan ay mga epekto ng nasabing bakuna na puwedeng maobserbahan pagkatapos mabigyan ng bakuna ang mga sanggol. Halos nasa 10 % lamang ang nagkaroon ng ganitong kaso. 7. na bihira lamang maranasan ng mga sanggol ang pamumutla matapos mabigyan ng bakuna. Mean Interpretation Rank

2.51

May Pangkaraniwang Kamalayan

3.5

2.49

May Kaunting Kamalayan

5

2.35 2.26

May Kaunting Kamalayan May Kaunting Kamalayan

6 7

3.07

May Pangkaraniwang Kamalayan

1.5

3.07

May Pangkaraniwang Kamalayan

1.5

2.51

May Pangkaraniwang Kamalayan

3.5

OVER-ALL MEAN

2.61

May Pangkaraniwang Kamalayan

Legend: 5 – May Ganap na Kamalayan 2 – May Kaunting Kamalayan 4 – May Kamalayang Higit sa Karaniwan 1 – Walang Kamalayan 3 – May Pangkaraniwang Kamalayan Note: See Appendix E for the basic data on which this summary table was derived.

Table 7 shows the mean scores of the ratings on how mothers identify their level of awareness on the adverse physiologic effects which had been categorized into seven indicators of the Measles vaccine. Based on the responses of the mothers, they were aware/may pangkaraniwang kamalayan of indicator 1 (after giving the vaccine to babies, rashes may sometimes be observed which could only have 5%

case) and indicator 7 (babies rarely experienced pallor after receiving immunization ) with a mean score of 2.5,1 rank 3.5; followed by indicator 5 (fever (above 38˚C) as a common side effect of the vaccine may possibly experience by infants and that it has 5 to 15% cases ) and indicator 6 (pain, swelling and redness at the injection site with an approximately 10% of the case might observed among babies after

the shot ) with a mean score of 3.07, rank 1.5, described as aware/may pangkaraniwang kamlayan . The last 3 indicators, with means of 2.49, 2.35, and 2.26, ranks 5, 6, and 7 respectively were ( babies rarely suffer from febrile seizure, that there is only 1 in 3,000 cases), (tachycardia is a rare adverse effect that could occur following immunization), and

(diarrhea sometimes occur among babies as an effect of the vaccine ), described as minimally aware/may kaunting kamalayan. The over-all

mean score of the level of awareness of mothers with respect to the adverse physiologic effects of the Measles vaccine based on the indicators, was 2.61 described as aware/ may pangkaraniwang kamalayan. It could be possible because mothers who were exposed to the information about the adverse effects of Measles vaccines, particularly imparted by the health care workers, usually observed those effects on their babies that made them aware of it. Table 8 Level of Awareness of the Health Care Teams of the Adverse Physiologic Effects of BCG Vaccine
Adverse Physiologic Effects 1. babies may get abscess on the injection site after immunization 2. seizure might be a possible adverse effect following immunization 3. occurrence of tachycardia might follow after the shot 4. loss of appetite is one of the adverse effects due to the vaccine 5. pain, redness and swelling at the injection site is a common adverse reaction after immunization which gives 90-95% cases 6. dizziness among babies may sometimes occur OVER-ALL MEAN Mean Interpretation Rank

5

Fully Aware

1

3.38

Aware More Than Adequately Aware

4

3.88

3

1.88

Minimally Aware

5

4.5 1.5 3.36

Fully Aware Minimally Aware Aware

2 6

Legend: 5 – Fully Aware 2 – Minimally Aware 4 – More Than Adequately Aware 1 – Unaware 3 – Aware Note: See Appendix F for the basic data on which this summary table was derived.

Table 8 displays the mean scores of the ratings on how the health care team members identify their level of awareness on the adverse

physiologic effects which had been categorized into six indicators of the BCG vaccine. Based on the responses of the members of the health care team, they were fully aware/may ganap na kamalayan of indicator 1 (babies may get abscess on the injection site after immunization) with a mean score of 4.5 rank 2, followed by indicator 5 (pain, redness and swelling at the injection site is a common adverse reaction after immunization which gives 90-95% cases) with a mean score of 3.88, rank 3. Next indicator ranked 3 with a mean score of 3.88 was (occurrence of tachycardia might follow after the shot) described as more than adequately aware/may kamalayang higit sa karaniwan; and indicator 2 (seizure might be a possible adverse effect following immunization) with a mean score of

3.38 rank 4 described as aware/may pangkaraniwang kamalayan. The last two indicators ranked 5 and 6, with means of 1.88 and 1.5, respectively were: loss of appetite is one of the adverse effect due

to the vaccine), and (dizziness among babies may sometimes occur) described as minimally aware/may kaunting kamalayan. The over-all mean score of the level of awareness of health care teams with respect to the adverse physiologic effects of the BCG vaccine based on the indicators, was 2.80 described as aware/ may pangkaraniwang kamalayan.

It is expected because the members of the health care team were more knowledgeable about immunization and were seen to be a service for disseminating information related to the immunization program in the community.

Table 9 Level of Awareness of the Health Care Teams of the Adverse Physiologic Effects of OPV Vaccine
Adverse Physiologic Effects 1. allergic reaction like mild rashes may occur after immunization 2. after the immunization, irritability with less than 1% cases might be experience by babies. 3.hypotension is sometimes an incident after giving the vaccine 4. vomiting is at times happens among babies who cannot tolerate the vaccine 5. fever (above 38˚C) which is occasionally manifested by infants with less than 1% of case. 6. paralysis is a rare adverse effect of the vaccine with 1 case in 2.4 million doses. 7. body malaise may every so often occur with less than 1% case only. OVER- ALL MEAN Mean Interpretation Rank

3.13

Aware

3

3.63

More Than Adequately Aware

1

2.00

Minimally Aware

7

3.25

Aware

2

2.50

Aware

4

2.38

Minimally Aware

5

2.13 2.72

Minimally Aware Aware

6

Legend: 5 – Fully Aware 2 – Minimally Aware 4 – More Than Adequately Aware 1 – Unaware 3 – Aware Note: See Appendix F for the basic data on which this summary table was derived.

Table 9 displays the mean scores of the ratings on how the health care team members identify their level of awareness on the adverse

physiologic effects which had been categorized into seven indicators of the OPV vaccine. The health care team members were more than adequately aware/may kamalayang higit sa karaniwan of indicator 2 (after the immunization, irritability with less experience by than 1% cases might be

babies ) with a mean score of 3.63, rank 1, followed

by indicator 1 (allergic reaction like mild rashes may occur after immunization)with a mean score of 3.13 rank 3; and then by indicator 4 (vomiting is at times happens among babies who cannot tolerate the vaccine) with a mean score of 3.25 rank 2 ; and indicator 5 (fever (above 38˚C) which is occasionally manifested by infants with less than 1% of case.) with a mean score of 2.50 rank 4; described as aware/may pangkaraniwang kamalayan. The last three indicators, ranked as 5, 6, and 7, with means of 2.38, 2.13, and 2.00 respectively were: (paralysis is a rare adverse effect of the vaccine with 1 case in 2.4 million doses.), (body malaise may every so often occur with less than 1% cases only) and (hypotension is sometimes an incident after giving the vaccine)

describes as minimally aware/may kaunting kamalayan. The over-all mean score of the level of awareness of health care teams with respect to the adverse physiologic effects of the OPV vaccine based on the

indicators, was 2.72 described as aware/ may pangkaraniwang kamalayan. It is expected because members of health care team were more knowledgeable on the adverse physiological effects of OPV vaccines because these are common effects that could happen after the administration of OPV vaccine on infants.

Table 10 Level of Awareness of the Health Care Teams of the Adverse Physiologic Effects of DPT Vaccine
Adverse Physiologic Effects 1. babies may experience pain, swelling, and redness at the injection site which gives up to 50% of the cases. 2. drowsiness rarely occurs after injection 3. tachycardia is a seldom adverse effect following immunization 4. loss of appetite may sometimes occur 5. fever is a common reaction after giving injection that it gives 50 % cases 6. irritability with 55% cases often experienced by babies after receiving the vaccine. OVER-ALL MEAN Mean Interpretation Rank

4.63 2.63

Fully Aware Aware

2 6

3.25 2.75

Aware Aware

4 5

4.63

Fully Aware

2

4.63 3.75

Fully Aware More Than Adequately Aware

2

Legend: 5 – Fully Aware 2 – Minimally Aware 4 – More Than Adequately Aware 1 – Unaware 3 – Aware Note: See Appendix F for the basic data on which this summary table was derived.

Table 10 revealed the mean scores of the ratings on how the health care team members identify their level of awareness on the

adverse physiologic effects which had been categorized into six indicators of the DPT vaccine. As to the results of the responses on the level of awareness of health care team members on the DPT vaccine indicators, they were fully aware/may ganap na kamalayan of indicator 1 ( babies may experience pain, swelling, and redness at the injection site which gives up to 50% of the cases), followed by indicator 5 (fever is a common reaction after 50 % cases) and 6 (. irritability with 55%

giving injection that it gives

cases often experienced by babies after), with a mean score of 4.63 rank 2. The last three indicators ranked 4, 5, and 6, with means of 3.25, 2.75, and 2.63 respectively were: (tachycardia is a seldom adverse effect following immunization), (loss of appetite may sometimes occur), and (drowsiness rarely occurs after injection) described as aware/may

pangkaraniwang kamalayan. The over-all mean score of the level of awareness of health care team with respect to the adverse physiologic effects of the DPT vaccine based on the indicators, was 3.75 described as more than adequately aware/ may kamalayang higit sa karaniwan. The disparity in the mean response is to be expected because the members of the health care teams were more knowledgeable about the matter and are the ones charged with the responsibility of informing the mothers on the said effects.

Table 11 Level of Awareness of the Health Care Teams of the Adverse Physiologic Effects of Hep B Vaccine
Adverse Physiologic Effects 1. babies may rarely experience urticaria after the shot 2. seizure due to high fever sometimes follow after the babies receive the vaccine 3. palpitations infrequently occurs 4.babies may experience loss of appetite following immunization 5. fever (above 38˚C) with 1-6% case, may .sometimes be experienced by infants 6. pain, swelling and redness at the injection site with approximately 5% cases commonly happen to infants OVER-ALL MEAN Mean 3.25 Interpretation Aware Rank 3

3.50 3.00

More Than Adequately Aware Aware

2 5

2.00

Minimally Aware

6

3.13

Aware

4

4.25 3.19

More Than Adequately Aware Aware

1

Legend: 5 – Fully Aware 2 – Minimally Aware 4 – More Than Adequately Aware 1 – Unaware 3 – Aware Note: See Appendix F for the basic data on which this summary table was derived.

Table 11 showed the mean scores of the ratings on how the health care team members identify their level of awareness on the adverse physiologic effects which had been categorized into six indicators of the Hep B vaccine. Results in the table shows that members of the health care teams were more than adequately aware/may kamalayang higit sa karaniwan of indicator 2 (seizure due to high fever sometimes follow after the babies receive the vaccine) with a mean score of 3.50 rank 2, and on indicator 6 (pain, swelling and redness at the injection site with approximately 5% cases commonly happen to infants) with a mean score of 4.25 rank 1; The awareness on indicator 1 (babies may rarely experience urticaria after the shot) with a mean score of 3.25 rank3; followed by indicator 3

(palpitations infrequently occurs) with a mean score of 3.00 rank 5, and then by indicator 5 (fever (above 38˚C) with 1-6% cases, may

.sometimes be experienced by infants) with a mean score of 3.13 rank 4. The last indicator ranked 6 with mean of 2.00 was (babies may experience loss of appetite following immunization) described as minimally aware/may kaunting kamalayan. The over-all mean score of the level of awareness of health care teams with respect to the adverse physiologic effects of the Hep B vaccine based on the indicators, was 3.19 described as aware/ may pangkaraniwang kamalayan. This was expected again since the health care teams were more exposed to the information about adverse physiologic effects of Hep B vaccine and thus have greater knowledge because they studied on it. Table 12 Level of Awareness of the Health Care Teams of the Adverse Physiologic Effects of Measles Vaccine
Adverse Physiologic Effects 1. after giving the vaccine to babies, rashes may sometimes be observed which could only have 5% case 2. babies rarely suffer from febrile seizure, that there is only 1 in 3,000 cases 3. tachycardia is a rare adverse effect that could occur following immunization 4.diarrhea sometimes occur among babies as an effect of the vaccine 5. fever (above 38˚C) as a common side effect of the vaccine may possibly be experienced by infants and that it has 5 to 15% Mean Interpretation Rank

4.25

More Than Adequately Aware More Than Adequately Aware

1.5

3.50

4

3.13

Aware

5

2.88

Aware

7

3.63

More Than Adequately Aware

3

cases 6. pain, swelling and redness at the injection site with an approximately 10% of the case might be observed among babies after the shot 7. babies rarely experienced pallor after receiving immunization OVER-ALL MEAN

4.25

More Than Adequately Aware

1.5

3.00 3.52

Aware More Than Adequately Aware

6

Legend: 5 – Fully Aware 2 – Minimally Aware 4 – More Than Adequately Aware 1 – Unaware 3 – Aware Note: See Appendix F for the basic data on which this summary table was derived.

Table 12 showed the mean scores of the ratings on how the health care team members identify their level of awareness on the adverse physiologic effects which had been categorized into seven indicators of the Measles vaccine. Based on the responses of the health care team members, they were more than adequately aware/may kamalayang higit sa karaniwan of indicator 1 (after giving the vaccine to babies, rashes may sometimes be observed which could only have 5% case) and indicator 6 (pain,

swelling and redness at the injection site with an approximately 10% of the case might observed among babies after the shot ) with a mean

score of 4.25 rank 1.5; followed by indicator 5 (. fever (above 38˚C) as a common side effect of the vaccine may possibly experience by infants and that it has 5 to 15% cases) with a mean score of 3.63 rank 3, and

indicator 2 (babies rarely suffer from febrile seizure, that there is only 1 in 3,000 cases) with a mean score of 3.50 rank 4. The last three indicators

with means of 3.13, 3.00, and 2.88 ranked as 5,6, and 7 respectively were: (tachycardia is a rare adverse effect that could occur following immunization), (babies rarely experienced pallor after receiving

immunization) and then (diarrhea sometimes occur among babies as an effect of the vaccine) described as aware/ may pangkaraniwang kamalayan. The over-all mean score of the level of awareness of health care teams with respect to the adverse physiologic effects of the Measles vaccine based on the indicators was 3.52 described as more than adequately aware/ may kamalayang higit sa karaniwan. It is expected because the members of the health care team were more knowledgeable about immunization and were seen to be a service for disseminating information related to the immunization program in the community. Problem 4. Significant differences between the level of

awareness on the adverse physiologic effects of the 5 EPI vaccines of mothers and health care teams when they are grouped according to various demographic variables? Table 13 presents the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among motherrespondents grouped according to age.

Table 13 F- Value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Mother-Respondents Grouped According to Age
Adverse Physiologic Effects 18 below 19-25 Age F-value Significance Decision

26-35

36 above 2.95 3.28 2.58 3.00 2.92

Computed

Critical

BCG DPT OPV Hep B Measles Vaccine

2.4 2.72 2.24 2.27 2.22

3.02 3.18 2.56 2.90 2.76

2.60 2.93 2.33 2.39 2.42

3.063 1.733 1.127 4.879 2.947

2.667 2.667 2.667 2.667 2.667

Significant Not significant Not significant Significant Significant

Reject Ho Accept Ho Accept Ho Reject Ho Reject Ho

Legend: α set at 0.05 level of significance

Table 16 presents the results of the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among mother-respondents group according to their age, using the analysis of variance. The analysis of data yielded the summary of the categories of the four age group such as 18 and below, 19 – 25, 26 – 35, and 36 and above age of the mothers; their computed F –value; and the

critical F-value as indicated in the table. The comparison among the age groups with respect to each of the vaccines indicators; BCG, Hep B, and Measles vaccines were found out to be significant since the computed Fvalues exceeds the critical F-value at 5 percent level, 3 and 146 degrees of freedom. Hence, the null hypothesis that there are significant differences between the level of awareness on the adverse physiologic effects of BCG, Hep B and Measles vaccines of mothers is taken as a test factor was rejected. On the other hand, the comparison among the age groups with respect to each of the vaccines indicators; DPT and OPV vaccines were found not significant since the computed f-values failed to exceed the critical f-value at 5 percent level, 3 and 146 degrees of freedom. As a result, the null hypothesis was accepted. Table 14 presents the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among motherrespondents group according to civil status. Table 14 t- value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Mother-Respondents Grouped According to Civil Status
Adverse Physiologic Effects

Civil Status

t-value

Significance

Decision

Single/ Separat ed

Married

Difference

Computed

Critical

BCG DPT OPV Hep B Measles Vaccine

2.77 2.78 2.37 2.37 2.49

2.80 3.11 2.46 2.71 2.63

-0.03 -0.33 -0.09 -0.34 -0.14

-0.165 -1.420 -0.436 -1.454 -0.613

1.976 1.976 1.976 1.976 1.976

Not significant Not significant Not significant Not significant Not significant

Accept Ho Accept Ho Accept Ho Accept Ho Accept Ho

Legend: α set at 0.05 level of significance

As shown in Table 14, results revealed that the two factors (single/ separated and married ) were not significantly differed among the vaccine indicators, in view of the fact that the computed t-values did not go over the critical t-value at 5 percent level, 3 and 148 degrees of freedom. For this reason, the null hypothesis that there are no significant differences between the overall level of awareness on the adverse physiologic effects of the 5 EPI vaccines of mothers is taken as a test factor was accepted. Table 15 presents the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among motherrespondents group according to their number of children. Table 15 t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Mother-Respondents Grouped According to Number of Children
Adverse Physiologi c Effects 1 or 2 BCG DPT 2.76 3.02 Number of Children t-value Significance Decision

3 or more 2.83 3.10

Difference -0.07 -0.08

Computed -0.447 -0.462

Critical 1.976 1.976 Not significant Not significant Accept Ho Accept

Ho OPV Hep B Measles Vaccine 2.37 2.59 2.58 2.52 2.75 2.64 -0.15 -0.16 -0.06 -1.002 -1.032 -0.379 1.976 1.976 1.976 Not significant Accept Ho Not significant Not significant Accept Ho Accept Ho

Legend: α set at 0.05 level of significance

With the outcome as revealed in table 15, the analysis of the data shows that they were not significantly differ according to the number of children as categories with the 2 groups (1 02 children and 3 or more children among mothers); likewise, the difference between their

computed t –value; and the critical t-value was based on the 5 percent level, 3 and 146 degrees of freedom. And so, the null hypothesis was accepted. From these findings, it may be concluded that there were no significant differences in the number of children among the motherrespondents in their analysis of the level of awareness. Table 16 presents the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among motherrespondents group according to their educational attainment. Table 16 F-Value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Mother-Respondents Grouped According to Educational Attainment
Adverse Physiologic Effects College Educational Attainment F-value Significance Decision

College

H.S.

Elem.

Computed

Critical

Grad. BCG DPT OPV Hep B Measles Vaccine 2.86 2.99 2.45 2.73 2.60

Undergrad 2.66 3.39 2.45 2.89 2.73

Grad. 2.84 3.02 2.47 2.68 2.65

Grad. 2.68 2.81 2.28 2.14 2.16 0.383 1.385 0.186 1.955 1.219 2.667 2.667 2.667 2.667 2.667 Not Significant Not Significant Not Significant Not Significant Not Significant Accept Ho Accept Ho Accept Ho Accept Ho Accept Ho

Legend: α set at 0.05 level of significance

Table 16 presents the results of the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among mother-respondents group according to their educational attainment, using the analysis of variance. The study of data capitulate the summary of the categories of the four age group such as college graduate, college undergraduate, high school graduate, and elementary, of the mothers; their computed F –value; and the critical F-value as indicated in the table. The comparison among the age groups with

respect to each of the vaccines indicators were all found not significant since the computed F-values exceeds over the critical F-value at 5 percent level, 3 and 146 degrees of freedom. Hence, the null hypothesis that there are no significant differences between the overall level of awareness on the adverse physiologic effects of the 5 EPI vaccines of mothers is taken as a test factor was accepted.

Table 17 presents the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among health care team-respondents group according to their age.

Table 17 t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care TeamRespondents Grouped According to Age
Adverse Physiologic Effects 1, 2, 3 BCG DPT OPV Hep B Measles Vaccine 3.77 3.67 3.17 3.43 3.69 4 2.67 3.89 1.95 2.78 3.24 Age t-value Significance Decision

Difference 1.10 -0.22 1.22 0.65 0.45

Computed 2.429 -0.390 1.714 0.892 0.877 2.447 2.447 2.447 2.447 2.447

Critical Not significant Not significant Not significant Not significant Not significant Accept Ho Accept Ho Accept Ho Accept Ho Accept Ho

Legend: α set at 0.05 level of significance

As indicated in the results of the independent t-test in Table 17, a cursory look at the values showed that among the health care teamrespondents group according to their age, they were not significantly differed on their vaccine indicators using the two factors (19-25, 26-35 and 36 – 45 years old, and 46 years old and above), since the computed t-values failed to surpass the critical t-value at 5 percent level, with 6 degrees of freedom (df). Hence, the null hypothesis that there are no

significant differences between the overall level of awareness on the adverse physiologic effects of the 5 EPI vaccines of mothers is taken as a test factor was accepted.

Table 18 presents the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among health care team-respondents group according to gender. Table 18 t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care TeamRespondents Grouped According to Gender
Adverse Physiologic Effects Male BCG DPT OPV Hep B Measles Vaccine 3.78 3.78 3.48 4.22 4.24 Gender t-value Significance Decision

Female 3.1 3.73 2.26 2.57 3.09

Difference 0.68 0.05 1.22 1.65 1.15

Computed 1.183 0.079 1.712 4.173 4.184

Critical 2.447 2.447 2.447 2.447 2.447 Not significant Not significant Not significant Significant Significant Accept Ho Accept Ho Accept Ho Reject Ho Reject Ho

Legend: α set at 0.05 level of significance

In terms of the gender, the comparison with respect to each of the vaccines indicators were not significantly differ on BCG, DPT, and OPV since the computed t-values not successfully exceed the critical t-value at 5 percent level, 6 degrees of freedom, using the independent t-test. The analysis of data revealed the outline of the categories of the 2 groups such as male and female; the difference between 2 categories; their

computed t –value; and the critical t-value as shown in the table. Consequently, the null hypothesis was accepted. In contrast, the comparison among the age groups with respect to Hep B and Measles vaccines were found to be significant since the computed t-values exceeds over the critical t-value at 5 percent level, 6 degrees of freedom. Therefore , the null hypothesis that there are significant differences between Hep B and Measles vaccine taken as a test factor was rejected. Table 19 presents the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among health care team-respondents group according to civil status Table 19 t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care TeamRespondents Grouped According to Civil Status
Adverse Physiologic Effects Single/ Separated BCG DPT OPV Hep B Measles Vaccine 3.11 3.89 1.85 3.06 3.47 Civil Status t-value Significance Decision

Married

Difference

Computed

Critical

3.50 3.67 3.23 3.27 3.54

0.39 0.22 -1.38 -0.21 -0.07

-0.634 0.390 -2.073 -0.268 -0.13

2.447 2.447 2.447 2.447 2.447

Not significant Not significant Not significant Not Significant Not Significant

Accept Ho Accept Ho Accept Ho Accept Ho Accept Ho

Legend: α set at 0.05 level of significance

Table 19 presents the results of the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines

among the health care team-respondents group according to their civil status, using the independent t-test. The analysis of data revealed the outline of the categories of the 2 groups such as single/separated, and married ; the difference between 2 categories; their computed t –value; and the critical t-value as shown in the table. The comparison among the civil status with respect to each of the vaccines indicators; were all found not significant on since the computed t-values not successfully exceed the critical t-value at 5 percent level, 6 degrees of freedom. Hence, the null hypothesis that there are no significant differences between the overall level of awareness on the adverse physiologic effects of the 5 EPI vaccines of mothers is taken as a test factor was accepted. Table 20 presents the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among health care team-respondents group according to their position. Table 20 t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care TeamRespondents Grouped According to Position
Adverse Physiologic Effects MHO Position t-value Significance Decision

Nurse/ Midwife 3.52 3. 72 2.43 2.75

Difference

Computed

Critical

BCG DPT OPV Hep B

3.84 3.84 3.57 4.5

0.32 0.12 1.14 1.75

0.529 0.174 1.337 3.439

2.447 2.447 2.447 2.447

Not significant Not significant Not significant Significant

Accept Ho Accept Ho Accept Ho Reject Ho

Measles Vaccine

4.43

3.22

1.21

3.404

2.447

Significant

Reject Ho

Legend: α set at 0.05 level of significance

The data in table 20 present the results of the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among the health care team-respondents group according to their position wherein it revealed the outline of the categories of the 2 groups such as municipal health officer, and nurse/midwife ; the difference between 2 categories; their computed t –value; and the critical t-value as shown in the table. Results displays that all were not

significant on BCG, DPT, and OPV since the computed t-values failed to reached the critical t-value at 5 percent level, 6 degrees of freedom. Hence, the null hypothesis that there are no significant differences between the level of awareness on the adverse physiologic effects of BCG, DPT, and OPV vaccines of mothers is taken as a test factor was accepted. On the contrary, the Hep B and Measles vaccines, it was found out that both were significant since the computed t-values have reached the critical t-value at 5 percent level, 6 degrees of freedom. Hence, the null hypothesis that there are significant differences between the level of awareness on the adverse physiologic effects of HepB and Measles vaccines of mothers is taken as a test factor was rejected.

Table 21 presents the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among health care team-respondents group according to their length of stay in the health center.

Table 21 t-value on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Among Health Care TeamRespondents Grouped According to Length of Stay in the Health Center
Adverse Physiologic Effects 1-5 Years BCG DPT OPV Hep B Measles Vaccine 3.84 3.78 2.5 3.42 3.72 Length of Stay in HC t-value Significance Decision

5 years above 3.20 2.79 2.79 3.11 3.45

Difference

Computed

Critical

0.64 0.99 -0.29 0.31 0.27

0. 964 1.651 -0.295 0.357 0.440

2.447 2.228 2.447 2.447 2.447

Not significant Not significant Not significant Not significant Not significant

Accept Ho Accept Ho Accept Ho Accept Ho Accept Ho

Legend: α set at 0.05 level of significance

Table 21 presents the results of the comparison between the level of awareness of the adverse physiologic effects of the 5 EPI vaccines among the health care team-respondents group according to their length of stay in the health center, using the independent t-test. The analysis of data revealed the outline of the categories of the 2 groups such as 1 – 5 years and 5 years above ; the difference between 2 categories; their computed t –value; and the critical t-value as shown in the table. The

comparison among the length of stay in the health center with respect to each of the vaccines indicators; were all found not significant since the computed t-values not successfully exceed the critical t-value at 5 percent level, 6 degrees of freedom. Hence, the null hypothesis that there are no significant differences between the overall level of awareness on the adverse physiologic effects of the 5 EPI vaccines of mothers is taken as a test factor was accepted. Problem 5. An enhanced Primer development on the

increase level of awareness on the adverse physiologic effects of the 5 EPI vaccine. A Primer about Immunization; Seven childhood immunizable diseases ;What Expanded Program on Immunization ( EPI ) Vaccine is; Five (5 Expanded Program on Immunization (EPI) vaccines given by the health centers to infants ages 0 to 9 months; Adverse physiologic effects of the 5 EPI vaccines; and an Immediate nursing intervention towards the adverse physiologic effects of the 5 EPI vaccines

Chapter 5 SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS This chapter includes the summary of findings, conclusions, and recommendations of the study. The study was conducted for the purpose of determining the level of awareness on the adverse physiologic effects of the 5 EPI vaccines as analyzed by the mothers in terms of age, civil status, number of children, and educational attainment; and health care teams in terms of age, gender, civil status, position, and length of service in the health center. The data were obtained from the interviews among the residents of Las Piñas City with mean, rank, frequency and percentage used as

statistical tools to answer this part of the problem. The level of awareness of mothers on the adverse physiologic effects of the 5 Expanded

Program for Immunization (EPI) vaccines were determined by computing the Adverse Physiologic Effects of each of the 5 EPI vaccine.

Independent t-test was used to compute for the comparison between the level of awareness of the Adverse Physiologic Effects of the 5 EPI vaccines among the respondents group according to demographic variables. One-way analysis of variance was also used to compare the level of awareness on the adverse physiologic effects among different categories of demographic variables.. All analyses were performed using Stata Software and all inferential analyses were carried out at 5% level of significance (α = 0.05)

Summary of Findings The results of the statistical treatment of the data for a population of 150 mothers and 8 health care team residents of Las Pinas yielded the following findings; 1. Majority of the mothers involved in the study were 26 – 35 years

old, and nearly everyone was married having three to five children; and most of them finished high school. 2. Of the 2 health centers, majority of personnel involved in the study

were in their thirties and forties, and nearly all were female and around three-quarters were married. Twenty years and above were in the

service and most of the respondents were nurses and midwives.

3.

Mothers were aware of the adverse physiologic effects of BCG,

DPT, Hep B, and Measles Vaccines, and minimally aware of those related to OPV vaccine. The health care teams were aware of the

adverse physiologic effects of BCG, OPV and Hep B and more than adequately aware as regard DPT and Measles vaccine. 4. There were no significant differences on the level of awareness of

the adverse physiologic effects of the DPT and OPV vaccines among mothers grouped according to age; however, there were significant differences noted in relation to the BCG, Hep B and Measles vaccines. 5. There were no significant differences on the level of awareness of

the adverse physiologic effects of the 5 EPI vaccines among mothers when grouped according to civil status, number of children and educational attainment. 6. There were no significant differences on the level of awareness of

the adverse physiologic effects of the 5 EPI vaccines among the health care teams with regard to age, civil status and length of stay in the health centers; however, there were significant differences noted in terms of gender and position in relation to the Hep B and Measles vaccines. Conclusions After analyzing the data gathered, the researcher came up with the following conclusions:

1.

Majority of the mothers involved in the study are relatively young ,

married with three to five children and are high school graduates.. 2. Majority of the health care team members (mostly nurses and

midwives)involved in the study are approaching middle age, female, married and have stayed in the service for twenty years and above. 3. The level of awareness of mothers with regard to the EPI vaccines

varies from being aware to minimally aware while that of the members of the health care teams . ranges from being aware adequately aware depending of the vaccine. 5. There are no significant differences on the level of awareness of to more than

the adverse physiologic effects of the 5 EPI vaccines among mothers when civil status, number of children and educational attainment are

considered 6. No significant differences exist on the level of awareness of the

adverse physiologic effects of the 5 EPI vaccines among the health care teams when age, civil status and length of stay in the health centers are considered; however, there are, in terms of gender and position in

relation to the Hep B and Measles vaccines. Recommendations Based from the results of the study, the researcher would like to recommend the following;

1.

Mothers, grandmothers, and other concerned relatives should be

provided with adequate and updated information about the adverse physiologic effects of the 5 EPI vaccines by means of regularly attending health education class and seminars conducted in the health centers so as to increase their level of awareness. 2. There should be compulsory attendance in seminars about the

latest trends and issues on EPI among the health care team members as an additional related information / theories that might increase their level of awareness. 3. The mass media should help in information dissemination about

the adverse physiologic effects of the 5 EPI vaccines. If there are new development on vaccines, pamphlets should be distributed to the different cities in the Philippines for dissemination by the Local Government Units. 4. Additional research on vaccines should be conducted in other

communities in Las Piñas City to enrich available literature about the adverse physiologic effects of the 5 EPI vaccines . 5. The enhanced primer prepared as a result of this study should

serve as a guide to mothers and health care team members to increase further their level of awareness on the Expanded Program on

Immunization..

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http://www.wpro.who.int/NR/exeres/CEF3E8A4-D201-4E04-A3BDE4BEB81D7D74.htm

Appendix A The Standard Routine Immunization Schedule for Infants Given by the Barangay Health Centers Minimum Minimum Number Vaccine Age at 1st interval between Rationale of doses dose doses To protect the person Anytime 1 from acquiring BCG after birth Tuberculosis(TB) Reduces the chance of 6 weeks 3 4 weeks severe pertussis, DPT diptheria and tetanus To protect the person 6 weeks 3 4 weeks from acquiring OPV Poliomyelitis 6 weeks from 1st Reduces the chance of dose to 2nd dose; Hepatitis 6 weeks 3 being infected by 8 weeks from 2nd B Hepatitis B dose to 3rd dose Gives 85% protection 1 Measles 9 months against measles

Appendix B Distribution of Respondents

Community 1

Community 2

Total N

F

MHO- Health Center Nurses- Health Center Midwives Health Center Mothers Total

1 2 2 75 80

1 1 1 75 78

2 3 3 150 158

1.26% 1.90% 1.90% 94.94% 100%

Appendix C

WHO Standard Case Definition of EPI Target Diseases ( 2003 )

Disease Tuberculo sis

Standard Case Definition > A child with history of contact with a suspect or confirmed case of pulmonary tuberculosis > Any child who does not return to normal health after measles or whooping cough > Loss of weight, cough and wheeze which does not respond to antibiotic therapy for acute respiratory disease > Abdominal swelling with a hard painless mass and free fluid > Painful firm and soft swelling in a group of superficial lymphnodes > Any bone or joint lesion or slow onset > Signs suggesting meningitis or disease in the central nervous system

Agent Mycobact erium tuberculos is

Reservoir > Man >Diseased cattle

Sources of Infection Droplet infection, that is through inhalation of bacilli from patients

Occurrence > Worldwide > Mortality and morbidity higher in developing countries

Transmissible Period > A person who excretes tubercle bacilli is communicable > The degree of communicability depends upon: - the number of bacilli in the air - virulence of bacilli environmental conditions like overcrowding

Duration of Natural Immunity Not known Reactivation of old infection commonly causes diseases

Risk Factor for Infection Low access to care Immunodeficie ncy Malnutrition Alcoholism Diabetes

Dipthteria

It is an acute pharyngitis, acute nasopharyngitis or acute laryngitis with pseudomembrane

Coryneba cterium Diphteria

Man

By respiratory droplets from discharge of a cause or carrier

> Worldwide > Endemic in developing countries with unimmunized populations

Pertussis

History of severe cough and history of any of the following: Cough persisting 2 or more weeks fits of coughing Cough followed by vomiting

Bordetella pertussis

Man

Neonatal tetanus

A newborn with history of all three of the following: - normal suck for the first two days of life - onset of illness between 3 to 26 days - inability to suck followed by stiffness of the body and /or convulsions

Clostridiu m tetanii

> Soil > intestinal canals of animals ( esp horses ) >man

> Primarily by direct contact with discharges from respiratory mucus membrane of infected persons > Airborne route probably by droplets > indirect contact with articles freshly soiled with the discharges of infected persons > Unhygienic cutting of umbilical cord > Improper handling of cord stump esp. when treated with contaminated substance

> Worldwide > Morbidity higher in developing countries

> may last for 2-3 weeks > may be shortened in patients with antibiotics treatment > dipthteria transmission is increased in schools, hospitals, households and in crowded areas > Highly communicable in early catarrhal stage, before paroxysmal cough > Antibiotics may shorten the period of communicability from 7 days after exposure to 3 weeks after onset of typical paroxysms to only 5 to 7 days after onset of therapy

Usually lifelong

Crowding Low socioeconomic status

Usually lifelong

Young crowding

age

> Worldwide > Morbidity higher in developing countries > More common in agriculture and underdevelop ed areas where contact with animal excreta is more likely

> Susceptibility is general > Immunity can be obtained after 2 primary doses of tetanus toxoid at 4 weeks interval in mothers one month before delivery. Three booster doses increases antibody levels in mother

No immunity induced by infection

Contamination of umbilical cord Agricultural work

Poliomyel itis

Hepatitis B

A suspect cases of polio is defined as any patient below 15 years of age with acute flaccid paralysis for which no other cause can be immediately identified It is the liver infection caused by the B type of hepatitis virus. It attacks the liver often resulting in inflammation

Polio virus type 1, 2 and 3

Man, mostly children

> Oral-fecal route > Oral route through pharyngeal secretion > contact with infected persons

> Cyclical > Worldwide > Morbidity and mortality higher in developing countries

> 7 t 16 days before onset of symptoms > first few days after onset of symptoms

Type specific immunity lifelong

Poor environmental hygiene

Hepatitis B virus

Man

Hepatitis B spreads through the ff: - from child to child or mother to child after birth

Measles

A highly communicable disease with a history of the following: > Generalized blotchy rash, lasting for 3 days. > Fever above 38˚C or hot to touch, and > runny nose,. Red eyes/ conjunctivitis

Virus

Humans

Close respiratory contact and aerosolized droplets

> In the Philippines approximatel y 12 % of the population are chronic carriers > Most Filipinos are infected before the age of 6 years > Some infected infants are not able to develop immunity and become chronic carriers > Hepatitis B is especially dangerous for children > Worldwide > Morbidity and mortality higher in developing countries

> Infants born to immune mothers may be protected up to 5 months > Recovery from clinical attack is not always followed by lasting immunity > Immunity is often acquired through inapparent infection or complete immunization series with dipthteria toxoid

If lifelong

develops.

HBeAg + mother Multiple sexual partners

4 days before until 2 days after rash

Lifelong attack

after

Crowding Low socioeconomic status

Appendix D Frequency Distribution Mothers` Profile
Variables Frequency 1. Age 18 yrs and below 19 – 25 yrs old 26 – 35 yrs old 36 yrs and above Total 2. Civil Status Single Married Widow Separated 3. Number of Children 1 -2 3–5 6 – 10 11 and above Total 4. Educational Attainment College graduate College Undergraduate High school Elementary Total 41 30 4 0 75 27.33% 20% 2.67% 0% 50% 34 36 5 0 75 22.67% 24% 3.33% 0% 50% 75 66 9 0 150 50% 44% 6% 0% 100% 0 68 0 7 0% 45.33% 0% 4.67% 10 62 0 3 6.67% 41.33% 0% 2% 10 130 0 10 6.67% 86.67% 0% 6.67% 7 26 26 16 75 4.67% 17.33% 17.33% 10.67% 50% 8 21 30 16 75 5.33% 14% 20% 10.67% 50% 15 47 56 32 150 10% 31.33% 37.33% 21.33% 100% Community 1 Percentage Frequency Community 2 Percentage Total Frequency Percen tage

9 11 51 4 75

6% 7.33% 34% 2.67% 50%

9 14 41 11 75

6% 9.33% 27.33% 7.3% 50%

18 25 92 15 150

12% 16.67% 61.33% 10% 100%

Appendix E Frequency Distribution Health Care Teams Profile
Variables 1. Age 19 -25 yrs old 26 - 35 yrs old 36 - 45 yrs old 46 yrs and above Total 2. Gender Male Female 3. Civil Status Single Married Widow Separated Total Community 1 Frequency Percentage 1 0 2 2 5 2 3 0 4 0 1 5 12.5% 0% 25% 25% 62.5% 25% 37.5% 0% 50% 0% 12.5% 62.5% Community 2 Frequency Percentage 0 1 1 1 3 1 2 2 1 0 0 3 0% 12.5% 12.5% 12.5% 37.5% 12.5% 25% 25% 12.5% 0% 0% 37.5% Frequency 1 1 3 3 8 3 5 2 5 0 1 8 Total Percentage 12.5% 12.5% 37.5% 37.5% 100% 37.5% 62.5% 25% 62.5% 0% 12.5% 100%

Variables 4. Position MHO Pedia Obgyne Nurse-midwife Nurse Midwife Total 5. Length of Stay in the Health Center Less than 1 year 1 – 5 years 5 – 10 years 10 – 20 years 20 years and above Total

Community 1 Frequency Percentage 1 0 0 0 2 2 5 12.5% 0% 0% 0% 25% 25% 62.5%

Community 2 Frequency Percentage 1 0 0 0 1 1 3 12.5% 0% 0% 0% 12.5% 12.5% 37.5%

Total Frequency Percentage 2 0 0 0 3 3 8 25% 0% 0% 0% 37.5% 37.5% 100%

0 1 2 1 1 5

0% 12.5% 25% 12.5% 12.5% 62.5%

0 1 0 0 2 3

0% 12.5% 0% 0% 25% 37.5%

0 2 2 1 3 8

0% 25% 25% 12.5% 37.5% 100%

Appendix F Frequencies and Distributions of Responses of MotherRespondents Mothers ( n=150)
Vaccine Indicators Level of Awareness Not Aware (1) 18 40 44 30 25 65 Minimally Aware (2) 13 44 32 25 19 38 Aware (3) 51 30 38 53 53 37 More Than Adequately Aware (4) 9 25 14 9 10 2 Fully Aware (5) 59 65 22 33 43 8 Total Weighted Mean Rank

BCG1 BCG2 BCG3 BCG4 BCG5 BCG6

150 150 150 150 150 150

3.52 2.57 2.59 2.93 3.18 2.00

1 5 4 3 2 6

Vaccine Indicators

Level of Awareness Not Aware (1) 45 28 73 58 22 66 55 Minimally Aware (2) 32 29 38 47 23 34 38 Aware (3) 47 49 27 32 48 30 34 More Than Adequately Aware (4) 4 5 3 4 10 8 4 Fully Aware (5) 22 39 9 9 47 12 19

Total

Weighted Mean

Rank

OPV1 OPV2 OPV3 OPV4 OPV5 OPV6 OPV7

150 150 150 150 150 150 150

2.51 2.99 1.91 2.06 3.25 2.11 2.29

3 2 7 5 1 5 4

Vaccine Indicators

Level of Awareness Not Aware (1) 11 57 42 39 13 15 Minimally Aware (2) 19 34 32 26 18 21 Aware (3) 48 39 38 42 45 51 More Than Adequately Aware (4) 8 6 12 11 13 11 Fully Aware (5) 64 14 26 32 61 52

Total

Weighted Mean

Rank

DPT1 DPT2 DPT3 DPT4 DPT5 DPT6

150 150 150 150 150 150

3.63 2.24 2.65 2.81 3.61 3.43

1 6 5 4 2 3

Vaccine Indicators

Level of Awareness Not Aware (1) 51 45 55 37 19 17 Minimally Aware (2) 35 45 40 42 36 33 Aware (3) 34 28 35 41 44 50 More Than Adequately Aware (4) 5 9 3 7 13 8 Fully Aware (5) 25 23 17 23 38 42

Total

Weighted Mean

Rank

HepB1 HepB2 HepB3 HepB4 HepB5 HepB6

150 150 150 150 150 150

2.45 2.47 2.25 2.58 3.10 3.17

5 4 6 3 2 1

Vaccine Indicators

Level of Awareness Not Aware (1) 45 45 56 57 26 23 45 Minimally Aware (2) 39 37 32 41 29 30 37 Aware (3) 36 40 36 27 43 49 39 More Than Adequately Aware (4) 4 5 5 6 12 9 4 Fully Aware (5) 26 23 21 19 40 39 25

Total

Weighted Mean

Rank

MV1 MV2 MV3 MV4 MV5 MC6 MV7

150 150 150 150 150 150 150

2.51 2.49 2.35 2.26 3.07 3.07 2.51

3.5 5 6 7 1.5 1.5 3.5

Appendix G Frequencies and Distributions of Responses of Health Care TeamRespondents Health Care Teams ( n=8)
Vaccine Indicators Level of Awareness Not Aware (1) 0 2 1 5 0 5 Minimally Aware (2) 0 1 1 1 0 2 Aware (3) 0 1 1 1 1 1 More Than Adequately Aware (4) 0 0 0 0 2 0 Fully Aware (5) 8 4 5 1 5 0 Total Weighted Mean Rank

BCG1 BCG2 BCG3 BCG4 BCG5 BCG6

8 8 8 8 8 8

5 3.38 3.88 1.88 4.5 1.5

1 4 3 5 2 6

Vaccine Indicators

Level of Awareness Not Aware (1) 2 1 4 1 3 4 4 Minimally Aware (2) 1 1 2 2 2 1 2 Aware (3) 2 2 1 2 1 1 0 More Than Adequately Aware (4) 0 0 0 0 0 0 1 Fully Aware (5) 3 4 1 3 2 2 1

Total

Weighted Mean

Rank

OPV1 OPV2 OPV3 OPV4 OPV5 OPV6 OPV7

8 8 8 8 8 8 8

3.13 3.63 2.00 3.25 2.50 2.38 2.13

3 1 7 2 4 5 6

Vaccine Indicators

Level of Awareness Not Aware (1) 0 3 1 2 0 0 Minimally Aware (2) 0 1 1 2 0 0 Aware (3) 1 2 3 2 1 1 More Than Adequately Aware (4) 1 0 1 0 1 1 Fully Aware (5) 6 2 2 2 6 6

Total

Weighted Mean

Rank

DPT1 DPT2 DPT3 DPT4 DPT5 DPT6

8 8 8 8 8 8

4.63 2.63 3.25 2.75 4.63 4.63

2 6 4 5 2 2

Vaccine Indicators

Level of Awareness Not Aware (1) 1 1 0 4 2 0 Minimally Aware (2) 2 1 4 2 0 0 Aware (3) 2 2 2 1 3 3 More Than Adequately Aware (4) 0 0 0 0 1 0 Fully Aware (5) 3 3 2 1 2 5

Total

Weighted Mean

Rank

HepB1 HepB2 HepB3 HepB4 HepB5 HepB6

8 8 8 8 8 8

3.25 3.50 3.00 2.00 3.13 4.25

3 2 5 6 4 1

Vaccine Indicators

Level of Awareness Not Aware (1) 0 1 2 2 1 0 2 Minimally Aware (2) 0 0 0 1 0 0 0 Aware (3) 3 4 3 2 3 3 4 More Than Adequately Aware (4) 0 0 1 2 1 0 0 Fully Aware (5) 5 3 2 1 3 5 2

Total

Weighted Mean

Rank

MV1 MV2 MV3 MV4 MV5 MC6 MV7

8 8 8 8 8 8 8

4.25 3.50 3.13 2.88 3.63 4.25 3.00

1.5 4 5 7 3 1.5 6

Appendix H

May, 2011 Dra Esther. Oliveros City Health Officer Las Pinas City Madam: Greetings ! I am currently enrolled in thesis writing as a partial requirement for the degree Master of Arts in Nursing at the University of Perpetual Help System Dalta, Las Pinas. My research is entitled “Level of Awareness on the Adverse Physiologic Effects of the 5 Expanded Program on Immunization (EPI) Vaccines Among Mothers and Health Care Teams: Basis for an Enhanced Primer”. The focus of the study is to know the adverse physiological effects of the 5 EPI vaccines administered to infants at age 0 to 9 months in selected health centers / communities of Las Piñas. In line with the objective of the study, I would like to seek your assistance so I can be allowed to conduct my study through the attached survey questionnaire. Your favorable response will be very much appreciated. Thank you, Very respectfully yours JOENALYN C. CALAPATIA MAN Candidate Noted: DR. IRINEO F. MARTINEZ JR. Dean Noted : DR. ALBERTO P. MENDOZA Thesis Adviser

Appendix I

May, 2011 Dr. Joseph Manapsal Medical Health Officer CAA-A Health Center Saging St. CAA Las Pinas City Madam: Greetings !

I am presently pursuing a Degree of Master of Arts in Nursing at the University of Perpetual Help System Dalta, Las Piñas City. As partial fulfillment of the said degree, I am doing a study entitled “Level of Awareness on the Adverse Physiologic Effects of the 5 Expanded Program on Immunization (EPI) Vaccines Among Mothers and Health Care Teams: Basis for an Enhanced Primer”. In line with this, may I request your permission to gather needed information from your health personnels that will be helpful for my study. . Thank you, Very respectfully yours, JOENALYN C. CALAPATIA Noted:
DR. IRINEO F. MARTINEZ JR.

Dean

Appendix J May, 2011 Dr. Rex Bose Medical Health Officer Basa Health Center Basa Compd., Zapote Las Pinas City Madam: Greetings !

I am presently pursuing a Degree of Master of Arts in Nursing at the University of Perpetual Help System Dalta, Las Piñas City. As partial fulfillment of the said degree, I am doing a study entitled “Level of Awareness on the Adverse Physiologic Effects of the 5 Expanded Program on Immunization (EPI) Vaccines Among Mothers and Health Care Teams: Basis for an Enhanced Primer”. In line with this, may I request your permission to gather needed information from your health personnels that will be helpful for my study. Thank you, Very respectfully yours, JOENALYN C. CALAPATIA Noted:
DR. IRINEO F. MARTINEZ JR.

Dean

Mahal na Magulang, Ako po ay nagsasagawa sa kasalukuyan ng isang pag-aaral tungkol sa antas ng kamalayan sa mga pisiyolohikal na epekto ng 5 bakuna batay sa mga obserbasyon ng mga ina at ng pangkat ng pangangalaga ng kalusugan sa napiling barangay / health center sa Las Pinas City bilang bahagi ng mga iniaatas para sa degree Master of Arts in Nursing. Kaugnay nito, hinihiling ko po na pakisagutan ang talatanungan o survey na ito sa abot ng inyong kaalaman. Ang inyong sagot ay mananatiling kompidensiyal. Salamat po.

Lubos na Gumagalang, Joenalyn C. Calapatia

Survey ng Antas ng Kamalayan tungkol sa mga Epektong Pisiyolohikal Sanhi ng 5 EPI na Bakuna ( Para sa mga Ina ) Bahagi I. Propayl ng mga Ina Direction : Lagyan ng tsek (/) ang patlang na nagbibigay ng hinihinging impormasyon tungkol sa inyong sarili. 1. Edad / Gulang ( taon )
_________________18 taon gulang pababa _________________19 – 25 taong gulang _________________26 - 35 taong gulang _________________36 taong gulang pataas

2. Kalagayang Sibil _________________Walang asawa / dalaga _________________May asawa _________________ Balo _________________ Hiwalay 3. Bilang ng anak sa Pamilya _________________1 – 2 anak ________________3 – 5 anak ______________6 – 10 anak ______________11 anak pataas 4. Edukasyon: _________________College graduate _________________College Undergraduate _________________High School _________________Elementary

Bahagi II. Antas ng Kamalayan tungkol sa mga Epektong Pisiyolohikal Sanhi ng 5 EPI na Bakuna
Panuto :. Sagutan ang bawat aytem sa pamamagitan ng paglalagay ng tsek ( /) sa kolum na nagpapahiwatig ng antas ng kamalayan: Scale: 5 – May Ganap na Kamalayan 4 – May Kamalayang Higit sa Karaniwan 3 – May Pangkaraniwang Kamalayan 2 – May Kakulangan sa Kamalayan 1 – Walang Kamalayan 5 May Ganap na Kamalayan 4 May Kamalayang Higit sa Karaniwan 3 May Pangkaraniwang Kamalayan 2 May Kaunting Kamalayan 1 Walang Kamala yan

BCG

Ikaw ay may kaalaman .. 1. tungkol sa pagkakaroon ng abscess o keloid sa pinaginiksyonan sa braso ng mga sanggol matapos mabigyan ng bakuna 2. na posibleng magka-seizure ang mga sanggol pagkatapos mabigyan ng bakuna 3. Na puwedeng bumilis ang tibok ng puso ng mga sanggol ilang minuto matapos mabigyan ng bakuna 4. na isa sa mga epekto ng bakuna ay ang pagkawalang ganang dumede ng mga sanggol sanhi ng bakuna 5. na ang pamumula, pananakit at pamamaga sa ininiksyonan ay mga epekto ng nasabing bakuna na malimit maobserbahan pagkatapos mabigyan ng bakuna ang mga sanggol. Halos nasa 90 – 95 % ang bilang ng kaso na nagkaroon nito.

6. tungkol sa bihirang pagkahilo ng mga sanggol dulot ng bakuna.

OPV

5 May Ganap na Kamalayan

4 May Kamalayang Higit sa Karaniwan

3 May Pangkaraniwang Kamalayan

2 May Kaunting Kamalayan

1 Walang Kamala yan

Ikaw ay may kaalaman .. 1. tungkol sa pagkakaroon ng allergy sa balat tulad ng rashes matapos mabigyan ng bakuna 2. na puwedeng maging iritable ang mga sanggol kapag nabigyan na ng bakuna. Ang bilang ng kaso na nakaranas nito ay nasa 1% pababa 3.na maaaring bumaba ang blood pressure ng mga sanggol matapos mabakunahan. 4.tungkol sa pagsusuka ng mga sanggol kung sakaling hindi makayanan ang naibigay na bakuna. 5. na maaaring lagnatin ( 38C pataas) ang mga sanggol na bihira lang maobserbahan matapos mabigyan ng bakuna. Ang bilang ng kaso ay nasa 1% pababa lamang. 6. na ang pagiging paralisado ng mga sanggol ay maaaring mangyari bilang isa sa mga bihirang epekto ng bakuna.. Ang bilang ng kasong nangyari ay 1 lamang sa 2.4 million doses. 7. tungkol sa bihirang panghihina ng mga sanggol na umabot lamang sa 1% ang kaso.

DPT

5 May Ganap na Kamalayan

4 May Kamalayang Higit sa Karaniwan

3 May Pangkaraniwang Kamalayan

2 May Kaunting Kamalayan

1 Walang Kamalayan

Ikaw ay may kaalaman .. 1. na ang pamumula, pananakit at pamamaga sa iniksyonan ay mga epekto ng nasabing bakuna na malimit maobserbahan pagkatapos mabakunahan ang mga sanggol. Halos nasa 50 % ang bilang ng kaso nito. 2. tungkol sa bihirang pagkahilo ng mga sanggol dulot ng bakuna. 3. ang pagbilis ng tibok ng puso ng mga sanggol bilang epekto ng bakuna ay bihirang mangyari matapos mainiksiyonan. 4. tungkol sa bihirang mawalan ng ganang dumede ang mga sanggol kapag nabakunahan na. 5. tungkol sa pagkakaroon ng lagnat ng mga sanggol na 50% ang nagkaroon nito matapos ang pagbabakuna. 6. na puwedeng maging iritable ang mga sanggol kapag nabigyan na ng bakuna. Nasa 55% lamang ang nakaranas nito.

HEP B

5 May Ganap na Kamalayan

4 May Kamalayang Higit sa Karaniwan

3 May Pangkaraniwang Kamalayan

2 May Kaunting Kamalayan

1 Walang Kamala yan

Ikaw ay may kaalaman .. 1. tungkol sa bihirang pangangati ng mga sanggol matapos mabakunahan. 2.na puwedeng magkaroon ng seizure ang mga sanggol sanhi ng mataas na lagnat matapos mabakunahan. 3. tungkol sa bihirang pagkakaroon ng mabilisbumagal na tibok ng pulso 4.sa pagkawalang ganang dumede ng mga sanggol matapos mabigyan ng bakuna 5. na maaaring lagnatin ang mga sanggol (38˚C pataas) na may 1-6% lamang ang nakaranas nito, 6. na ang pamumula, pananakit at pamamaga sa iniksyonan ay mga epekto ng nasabing bakuna na malimit maobserbahan matapos mabakunahan ang mga sanggol. Halos 5% lamang ang nagkaroon nito.

MEASLES VACCINE

5 May Ganap na Kamalayan

4 May Kamalayang Higit sa Karaniwan

3 May Pangkaraniwang Kamalayan

2 May Kaunting Kamalayan

1 Walang Kamala yan

Ikaw ay may kaalaman .. 1.na matapos mabakunahan ang mga sanggol ay magkakaroon ito ng rashes. Nasa 5% lamang ang bilang ng kasong naobserbahan dito. 2. tungkol sa bihirang pagkakaroon ng seizure sanhi ng mataas na lagnat ng mga sanggol na nabakunahan. May 1 kaso lamang sa 3,000 doses ng gamut. 3. tungkol sa pagbilis ng tibok ng pulso ng mga sanggol matapos makatanggap ng bakuna. 4.na puwedeng magtae ang mga sanggol bilang epekto ng bakuna 5. na maaaring lagnatin ang mga sanggol (38˚C pataas)matapos mabakunahan. Nasa 5 hanggang 15% ang nagkaroon nito. 6. na ang pamumula, pananakit at pamamaga sa iniksyonan ay mga epektong puwedeng maobserbahan pagkatapos mabakunahan ang mga sanggol. Halos nasa 10 % lamang ang nagkaroon nito. 7.nabihira lamang maranasan ng mga sanggol ang pamumutla matapos mabakunahan.

Dear Respondents, I am presently conducting a study on the level of awareness of the adverse physiological effects of the 5 EPI vaccines based on the perceptions of mothers and the health care teams in selected barangay/community health centers in Las Pinas City, as part of the requirements for the degree Master of Arts in Nursing. In this connection, may I request you to accomplish this questionnaires as best as you can. Your responses will be held in strict confidentiality. Thank you

Ms. Joenalyn C. Calapatia

Questionnaire on the Level of Awareness of the Adverse Physiologic Effects of the 5 EPI Vaccines Administered to Infants ( for the members of the Medical Health Team ) Part 1 – Profile of the Health Care Team- Respondents Direction : Please put a checkmark (/) before the item that best describes yourself. 1. Age : _________________19 – 25 years old _________________26 – 35 years old above 2. Gender _________________Male _________________Female 3. Civil Status _________________Single Widower _________________Married 4 Position _________________Medical Health Officer _________________Pediatrician _________________Obstetrician _________________Nurse-Midwife 5. Length of Stay in the Health Center in years ________________less than 1 year ________________1 – 5 years ________________5 – 10 years ________________10 – 20 years ________________20 years and above _________________Nurse _________________Midwife _________________Nursing Aide _________________Separated _________________Widow/ _________________36 - 45 years old _________________46 years old and

Part III. Level of Awareness about Immunization Given to Infants Age 0 to 9 months Directions : Indicate your level of awareness on each of the items by placing a check (/) in the appropriate column based on the rating scale given. Scale: 5 – Fully Aware 4.- More Than Adequately Aware 3- Aware 2 – Minimally Aware 1 - Unaware
5 Fully Aware 4 More Than Adequately Aware 3 Aware 2 Minimally Aware 1 Unawar e

BCG

You are aware that.. 1. babies may get abscess on the injection site after immunization

2. seizure might be a possible adverse effect following immunization 3. occurrence of tachycardia might follow after the shot 4. loss of effects 5. pain, injection reaction 90appetite is one of the adverse due to the vaccine redness and swelling at the site is a common adverse after immunization which gives 95% cases

6. dizziness among babies may sometimes occur

OPV

5 Fully Aware

4 More Than Adequatel y Aware

3 Aware

2 Minimally Aware

1 Unaware

You are aware that.. 1. allergic reaction like mild rashes may occur after immunization 2. after the immunization, irritability with less than 1% cases might be experienced by babies. 3.hypotension is sometimes an incident after giving the vaccine 4. vomiting is at times happens among babies who cannot tolerate the vaccine 5. fever (above 38˚C) which is occasionally manifested by infants with less than 1% of case. 6. paralysis is a rare adverse effect of the vaccine with 1 case in 2.4 million doses. 7. body malaise may every so often occur with less than 1% cases only.

DPT

5 Fully Aware

4 More Than Adequately Aware

3 Aware

2 Minimally Aware

1 Unaware

You are aware that.. 1. babies may experience pain, swelling, and redness at the injection site which gives up to 50% of the cases. 2. drowsiness rarely occurs after injection 3. tachycardia is a seldom adverse effect following immunization 4. loss of appetite may sometimes occur 5. fever is a common reaction after giving injection that it gives 50 % cases 6. irritability with 55% cases often experienced by babies after receiving the vaccine.

HEP B

5 Fully Aware

4 More Than Adequately Aware

3 Aware

2 Minimally Aware

1 Unaware

You are aware that.. 1. babies may rarely experience urticaria after the shot 2. seizure due to high fever sometimes follow after the babies receive the vaccine 3. palpitations infrequently occurs 4.babies may experience loss of appetite following immunization 5. fever (above 38˚C) with 1-6% cases, may .sometimes be experienced by infants 6. pain, swelling and redness at the injection site with approximately 5% cases commonly happen to infants

MEASLES VACCINES

5 Fully Aware

4 More Than Adequately Aware

3 Aware

2 Minimally Aware

1 Unaware

You are aware that.. 1. after giving the vaccine to babies, rashes may sometimes be observed which could only have 5% case 2. babies rarely suffer from febrile seizure, that there is only 1 in 3,000 cases 3. tachycardia is a rare adverse effect that could occur following immunization 4.diarrhea sometimes occur among babies as an effect of the vaccine 5. fever (above 38˚C) as a common side effect of the vaccine may possibly experience by infants and that it has 5 to 15% cases 6. pain, swelling and redness at the injection site with an approximately 10% of the cases might observed among babies after the shot 7. babies rarely experienced pallor after receiving immunization

CURRICULUM VITAE

Name Address

: :

Joenalyn C. Calapatia 29 Camille Raymond St. BF Resort Village, Las Pinas City

Gender Date of Birth Place of Birth Civil Status Spouse Religion Present Position Office Address

: :

Female January 01, 1974 Manila

: : : : :

Married Noel B. Calapatia Roman Catholic Faculty / Clinical Instructor School of Midwifery and Health Related Services, Alabang – Zapote Rd. Pamplona, Las Piñas City

EDUCATIONAL BACKGROUND Graduate Studies : Candidate, Master of Arts in Nursing University of Perpetual Help System Dalta, Las Pinas City Tertiary : Bachelor of Science in Nursing San Juan De Dios College Roxas Blvd., Pasay City 1999 Secondary : St. Michael`s Institute Bacoor, Cavite 1991 Elementary : St. Augustine`s School Ilocos Sur 1987

 Certifications  Health Research and Development Information Network (HERDIN) Online Training  Investigator Workshop  The Anatomy of Nursing Malpractice Acts  Basic Techniques in Managing and Handling Diverse Learners  Winning the Job Interview: Learn How to Stand Out from the Rest  Dialysis Nursing  Nurse Enterpreneurship : Alternative Road to Success  Utilizing Research Data to Improve Instruction and Student Performance and Achievement  Research Capacity Seminar on `A Review of the Research Agenda, Policies and Guidelines of UPHSD`  Values Integration in Different Learning Areas Towards Human Capital Development Training Program and Good Clinical Practice

 Seminar –Workshop on Test Construction and Preparing the Table of Specifications  Unang Yakap: Yakap ng Ina, Yakap ng Buhay  Faculty Development Seminar: Continuously Enhancing Faculty Capacity Towards Quality Nursing Education  Towards the Development of a Healthy Nation through Ethical Scientific Researches and Health Care Practices  Five – Day Summer Training of Selected UPHS Faculty  Midwives Conference  Quality Care: Midwives Commitment to Women,Newborn, and Families  Trainor`s Methodology 1 / Assessors Methodology 1 ( TM-AM)  National Certificate ( NC I and NC II )  Institutional COP Conference  6th National Homebirthing Conference  Adolescent Pregnancy – An Emergency Concern  Integrated Management of Childhood Illness

 Intravenous Therapy (IVT)  Membership  Member, Philippine Nurses Association  Member, ANSAP  Employment  2004-Present: Faculty , Clinical Instructor ( UPHSD Las Pinas )  2002-2004  2001-2002  2000 : ICU Staff Nurse (Las Pinas Doctors Hospital) : Staff Nurse ( UPHRMC ) : ER Nurse ( Alabang Medical Hospital )