A research proposal submitted to Debre Brehan university research coordinating office on assessment of mother’s practice towards child vaccination

and its associated factors with child vaccination in Debre Brehan town Principal Investigator
Endale Melesse (M.Sc.)

Debre Brehan, Ethiopia. October, 2010.
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A research proposal submitted to Debre Brehan university research coordinating office on assessment of mother’s practice to wards child vaccination and its associated factors with child vaccination in Debre Brehan town
Team Members 1. Tesfa Dejenie (B.Sc.) 2. Yohannes Gebireegzeabher (B.Sc.) 3. Sisay Mulugeta (B.Sc.)

Debre Brehan, Ethiopia. October, 2010.

Table of content

Page
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Table of content------------------------------------------------------------------------------------I List of abbreviation-------------------------------------------------------------------------------III Abstract---------------------------------------------------------------------------------------------1 1. Introduction-------------------------------------------------------------------------------------2 1.1. Back ground---------------------------------------------------------------------------2 2. Statement of the problem---------------------------------------------------------------------3 3. Literature review-------------------------------------------------------------------------------4 4. Significance of the study-----------------------------------------------------------------------5 5. Objective of the study--------------------------------------------------------------------------6 5.1. General objectives--------------------------------------------------------------------6 5.2. Specific objectives--------------------------------------------------------------------6 6. Methodology--------------------------------------------------------------------------------------6 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 study area----------------------------------------------------------------------------6 study design------------------------------------------------------------------------6 study period-------------------------------------------------------------------------6 study population--------------------------------------------------------------------6 source population------------------------------------------------------------------6 sampling unit------------------------------------------------------------------------6 study unit-----------------------------------------------------------------------------7 study variable------------------------------------------------------------------------7 6.8.1. Independent variables-------------------------------------------------------7 6.8.2. Dependent variables---------------------------------------------------------7 6.9. Inclusion and exclusion criteria--------------------------------------------------------7 6.9.1. Inclusion criteria--------------------------------------------------------------7 6.9.2. Exclusion criteria-------------------------------------------------------------7 6.10. Sampling technique and sampling size determination----------------------------7 6.11. Data collection tools and procedures------------------------------------------------8 6.12. Data quality assurance-----------------------------------------------------------------8 6.13. Data processing and analysis---------------------------------------------------------8 6.14. Operational definition of terms-------------------------------------------------------9 7. Dissemination of result----------------------------------------------------------------------------9 I
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8. Ethical consideration-------------------------------------------------------------------------------9 9. Action plan------------------------------------------------------------------------------------------10 10. Budget proposal-----------------------------------------------------------------------------------11 11. Reference-------------------------------------------------------------------------------------------14 12. Annex------------------------------------------------------------------------------------------------16 12.1. Questionnaire----------------------------------------------------------------------------17

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II

List of abbreviation
AEFI: Adverse effect following immunization BCG; Bacillus calmette Guerin BSC: Bachlore of science DTP: diphtheria–tetanus–pertussis EFY: Ethiopian fiscal year EPI: Expanded program of immunization FMOH: Federal Ministry of Health GAVI: Global alliance Vaccine and Immunization Heb: Hepatitis type b Hib: Homophiles influenza type b HSDP: Health sector development program IMR: Infant mortality rate MCH: Maternal and Child Health MDG: millennium development goal MPH: Master of Public Health NGO: Non-governmental organization NPW: Non pregnant women OPV: Oral Polio Vaccine PEI: Polio Eradication Initiative PI: Principal Investigator PW: Pregnant women RED: Reaching every district RHB: Regional health Bureau SOS: Sustainable outreach service TT: Tetanus toxoid Vaccine UN: United Nations UNICEF: United Nations children fund URTI: upper respiratory tract infection V.P.D: vaccine preventable diseases WCBA: Women child bearing Age WHO: world health organization

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III

ABSTRACT
Introduction: Infant and under five mortality rates in Ethiopia is among the highest in
the world. About 472,000 children die each year before their fifth birth days. The highest proportion for childhood deaths is due to Vaccine preventable diseases. EPI program encompass multiple activities to be conducted by different bodies at different level of organization and health sectors. EPI was started in Ethiopia in 1980 with the aim of reducing morbidity and mortality of children and mothers from vaccine preventable diseases. During the inception of EPI the objective was to increase immunization coverage by 10 % annually but this target has not been realized even after two decades because of factors such as poor health infrastructure, low number of trained manpower, high turnover of staff and lack of donor funding.

Objective:

To assess knowledge, attitude and practice of mothers towards immunization in Debre Brehan district/ town, North Shoa administrative zone, Amhara region, Ethiopia.

Methodology: A descriptive community based cross sectional survey will be
undertaken to assess Knowledge, Attitude, and Practice among mothers of Debre Brehan town towards immunization from November to January 2003. A multi stage sampling technique will be used to select samples from the general population. By
considering 5% non-response rat, the total sample size will be 845. From the total 9 kebeles in the town 4 of them will be selected by lottery method. A structured questionnaire composed

of closed-ended questions will be administered to the respondents to collect the quantitative data. Qualitative data will be collected by observation by using check list. Data collectors will approach by introducing him/her self and interview the selected respondents after informed consent obtained. The data collectors will be recruited depending on the criteria, the one who has Bachelor of Science in nursing and above, and both female and male applicants will be accepted. The data gathered through the structured questionnaire will be entered to EPI- INFO version 6 and SPSS version 16 a statistically packed soft ware for analysis. Qualitative data will be analyzed and presented by descriptive statement.

Expected result:

80% of the sample mothers have good knowledge, 80% of the sample mother have good attitude, and 75% of the sample mother have good practice of immunization.

Budget summary: This proposal will require a total of 20,642.50 Ethiopian birr with
personnel cost of 12,600.00, equipment and supplies cost of 3,460.00, transportation and communication cost of 480.00, training /Refreshments cost of 1,410.00, and contingency (10%) of 2,692.50.

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1. Introduction
1.1. Back ground
Infant immunization is considered essential for improving infant and child survival. In 1974 when the world health organization (WHO) launched the Expanded program of immunization (EPI), the program was based on the belief that most countries already had some elements of nation immunization activities which could be successfully expanded if the program become a national priority with the commitment from the government to provide managerial manpower and fund to provide service to at least 85% of the target population .i.e. children under four years. Because of differences in epidemiological factors the common childhood diseases targeted for vaccination in Expanded Program on Immunization (EPI) are vary in different countries around the world. WHO recommended targeted diseases, and also adopted in Ethiopia are measles, pertussis (whooping cough), tuberculosis, tetanus, poliomyelitis and diphtheria. (1) Recently Hepatitis B virus and Homophiles Influenza type b are included in EPI program in Ethiopia. (2) EPI was started in Ethiopia in 1980 with the aim of reducing morbidity and mortality of children and mothers from vaccine preventable diseases. During the inception of EPI the objective was to increase immunization coverage by 10 % annually but this target has not been realized even after two decades because of factors such as poor health infrastructure, low number of trained manpower, high turnover of staff and lack of donor funding. The same factors still affect the program today. The target group when the program started were children under two years of age until it changed to one year in 1986 to be in line with the global immunization target. (3, 4) Ethiopia has developed a health policy in 1993 and revised EPI policy in 1997. The national EPI policy recommends that health workers should use every opportunity to immunize eligible children according to the recommended schedule. The policy says children who are hospitalized should be immunized as soon as their general condition improve and at least before discharge from hospital. An individual with known or asymptomatic HIV infection should receive all EPI vaccine at as early age as possible. Patients with overt AIDS should receive all vaccine except BCG and yellow fever. EPI service should be routinely available preferably on daily bases in all facilities (Governmental, NGO and private).The policy also state about the need to screen and assess status of children and women at every contact prior to giving antigens. The program strategies of EPI are directed for increasing immunization coverage, to reduce missed opportunities/ defaulters, increasing the quality of immunization service, improve public awareness and community participation, to sustain high immunization coverage
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and disease Eradication/control/Elimination strategies. One of the strategy to combat vaccine preventable disease is immunization , 2001 EFY national report showed that the immunization coverage of DPT3,measle and fully vaccinated has reached to 72.6%,64.9%,and 52.5% respectively and in Oromia region the coverage was 74.4% 81.8% and 51.0 % respectively. (5) The Polio Eradication Initiative (PEI) is a global program with the target of a polio free world by the year 2005. Ethiopia has achieved tremendous progress in its Polio Eradication Initiative activities since it commended in 1996. To achieve the Millennium Development Goal (MDG) of reducing child deaths by twothirds in 2015, Ethiopia has adopt strategies such as Sustainable outreach service (SOS) and Reaching every district (RED) that focus on identifying bottlenecks and developing community ownership of the services in order to improve routine immunization services and increase coverage. (6) The immunization program is funded primarily by partners and government; vaccine cost by UNICEF, salary by government, cold chain equipment, transport equipment, social mobilization and some operational cost by WHO, UNICEF and other development partner. In terms of health financing and budget provisions, the government has taken steps to reallocate resource from curative to preventive care targeting the rural population. So the involvement of stakeholders/partners is important for strengthening immunization service and the achievement of high coverage. Ethiopia is using different strategies and innovations to increase the national EPI coverage throughout the country to benefit from it in reducing child and infant mortality that is one of the millennium development goals of 2015 but still national EPI coverage is low. During the years 2001-2002 there was an increasing trend in EPI coverage where the national coverage based on DPT3 reached 70% and after wards the coverage began to decline to 65 % in 2003/4. (7) Currently, EPI policy guideline has revised in 2007,the country’s immunization effort move from developmental phase focusing on coverage to a phase that concentrates on disease control and eradication and this showed that the country commitment for strengthening immunization service and sustaining high immunization coverage. (13) Reaching every district (RED) is a multi-faceted approach with the goal of reaching >80% DTP3 coverage in every district in >80% of developing countries by 2005. This goal is referred to as the "80/80 goal". It is the accepted approach to achieve a sustained and equitable access to good quality immunization services and accelerate progress towards achieving the 80/80 goal. This approach means reaching every child in every district with quality immunization services. The main components of reaching every district (RED) include re-establishing outreach vaccination, supportive supervision, linking communities and services, monitoring for action, and planning and management of resources. The comprehensive approach for immunization are increase and monitor vaccination coverage, improve health system service delivery and management, decrease drop-out rate, improve logistics system, promote positive behaviors in support of immunization, improve epidemiological surveillance System, increase supervision process review and follow-up , maximize cost-effectiveness, improve inter-agency coordination. (7, 15)
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2. Statement of the problem
About 472,000 Ethiopian children die each year before their fifth birthdays. This make under five mortality rate bout 140/1000 with variations among the regions from 114 to 233/1000 .This tragic fact places Ethiopia sixth among the countries of the world in terms of the absolute number of child deaths. Among the cause of mortality, vaccine preventable diseases are the major ones (2). Every year more than 10 million children in low- middle-income countries die before they reach their fifth birthdays. Most die because they do not access effective interventions that would combat common and preventable childhood illnesses (3). A 2001 vaccine-preventable diseases estimate of WHO showed that the greatest burden of disease in Sub-Saharan Africa were deaths of pertussis, tetanus, and measles which account 58 percent, 41 percent, 59 percent, and 80 percent respectively. East Asia and the Pacific have the greatest burden from hepatitis B with 62 percent of deaths worldwide. South Asia also experienced a high disease burden particularly for tetanus and measles (11).In 2007, A total of 24.3 million infants not immunized DPT3, from which Africa account 7.3%, South East Asian account 11.5% ,Europe account 0.4%, Western pacific and Eastern Mediterranean account 1.95 each and America account 1.1% (12). Ethiopia has an estimated population of approximately 76 million. Although infant mortality rate (IMR) has declined from 97/1000 in 2000 to 77/1000 in 2005, it is still among the highest in the world. From a total under five deaths in Ethiopia 28% is due to pneumonia, 25% due to neonatal condition 20% each due to malaria and diarrhea, 4% due to measles and the rest by other. Yet there is effective low cost intervention to prevent two/third of these deaths of every 100 children in Ethiopia (14). EPI is essential for improving infant and child survival although the coverage can be improved by increasing KAP of the population. In Debre Brehan town there are health facilities that give service to the community including child vaccination. There are 1 hospital, 1 health center, 4 health post, 1 pharmacy, 1 higher clinic, 7 medium clinic, 8 low level clinic, 2 special clinic and 4 drug store which are both governmental and non-governmental. According the 2002 annual woreda health bereau report, the coverage of child vaccination is 56.3% BCG, 51% Penta3, 57.7% Penta2, 51% OPV3, 41.5% measles. 43.9% of children’s are fully immunized.

3. Literature review
A survey conducted in China about KAP towards Vaccine preventable disease the result shows that the level of immunization knowledge among parents was positively associated with attitude and practice of immunization. Immunization coverage was 89.3% in the high stratum in 63.8% in the low stratum service area (28). In Africa, a serious 30 cluster immunization coverage survey was undertaken as a survey of KAP among parents result of the survey showed 90% of population begins immunization but 30% drop out. The survey conducted in Ethiopia and the weighted national immunization coverage assessed by card plus history for children aged 12-23
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months vaccinated before the age of one year was BCG 83.4%, DPT1 84.3%, DPT3 66.0% ,measles 54.3%, and fully immunized children 49.9% . A community based cross sectional survey in Ziway town eastern showa shows 53% of children was fully immunized, 19 % was defaulters and the rest were totally non-immunized. The reasons for defaulters were inconvenience of vaccination time, child sickness and lack of information about the need for repeated vaccination (30). April 1995 in Gonder and surrounding villages in West Ethiopia cluster sampling was conducted to assess immunization coverage in area and problem associated with vaccination delivery. Among the sample children 47.4% fully immunized while 30% were not immunized at all. The reason given for not immunizing children were lack of knowledge 39.7% social problem 38.7% various obstacles 22% such as child sickness and health institution related problems (31). A cross sectional community based study was carried out in Jimma town South west Ethiopia to determine reason for defaulting from expanded program of immunization (EPI) using structured questionnaire in March 1997. A total of 376 children aged 12 to 23 months and their mothers were covered in study. Out of total 376 children 46.5% were fully immunized, 53.5% were defaulters. The reason given by mothers for not completing vaccination were missed appointments time (48.8%) mothers and no enough time (25.9%) and child was sick (23.4%) maternal age, neonatal care , parity, education knowledge about vaccine preventable disease and immunization. Another study in Jimma town shows higher acceptance of immunization by mothers who have been educated to above 6 grade and the higher of educational status the higher rate of completing the vaccination schedule and the relation between occupation and child immunization were government employee was the first to fully immunize their child that is i.e. 94% and the least was house made that is 50% the reason for this might be government employee could have access to know the benefit of immunization from their passed education and daily activities but house maids might have lack of education & economy. Also the study had been identified factors associated with non immunization and defaulters was illiteracy, lack of knowledge about EPI target diseases attitude of mothers were 45.6% said very useful, 54.1% said useful and the rest 0.3% said not useful (32). Currently a great consideration have given for immunization, the result have been under expected. The aim of this study will be to assess the obstacles in relation to the mother KAP to child immunization.

4. Significance of the study
The highest proportion for child hood death is due to vaccine preventable disease (2). The service with the provision of health message to the population about the vaccine is the first to increase the EPI coverage. Non- immunization was associated with low socioeconomic status, maternal illiteracy and lack of mother’s knowledge on vaccination as recommended by the expanded program on immunization (23). The problem of management of intersectional co-ordination and lack of public awareness of the purpose and importance of immunization persisted (25). Lack of information about the child’s immunization status, complexities of immunization schedules, misconception regarding multiple vaccine contradiction and inadequate
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emphasis to parent about the importance of the timely completion of immunization are factors that affect immunization (25). Lack of community participation was also found to be crucial constraining factors (26). However, the two principle problems in the way of achieving effective immunization for all children are lack of awareness and lack of knowledge. Miss information about immunization is amongst the most serious traits to the success of immunization program. Some examples of rumors are: “Vaccines are contraceptives to population or to limit the size of certain ethnic group”, “Vaccines are contaminated by HIV “, and “Children are ding after receiving vaccines“. The consequence of rumors can be serious and if not unchecked those can drawback the EPI program (21). This study helps to detect mothers KAP towards the eight types of vaccination, common defects of mothers for not vaccinate their child. The result could be help to plan for child immunization based health education to the community, and better practice among mothers who have poor practice to immunize their children. In addition the study will used as literature for others (individual, group, organization both governmental and nongovernmental) who wants to intervene based on the result obtained or who wants to do further study to answer question that are not answered by this study.

5. Objective of the study
5.1. General Objectives
To assess practice of mothers towards child vaccination and its associated factors with child vaccination in Debre Brehan district/ town, North Shoa administrative zone, Amhara region, Ethiopia.

5.2. Specific objectives
 

To assess the practice of mother to vaccinate their children in Debre Brehan town. To determine the associated factors towards child vaccination in Debre Brehan town.

6. Methodology and material
6.1. Study Area
The study will be conducted in Debre Brehan district/ town, North Shoa administrative zone, Amhara region, Ethiopia. The district has 9 administrative kebeles. The district / Debre Brehan town is located at 130 km North of Addis Ababa, capital city of Ethiopia. Based on the 2007 population and housing census, the total population size of the district estimated to be 72,097. The number of married couples/ households in the district is estimated to be 16,767. According to the information obtained from District Health Office; in the district there are 1 hospital, 1 health center, 18 clinics and 4 health posts which render health services for the community. In most of the health facilities including health posts immunization in service and outreach service is available for who need the service.
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6.2. Study design
A descriptive community based cross sectional survey will be undertaken to assess practice of mothers towards child vaccination and its associated factors with child vaccination in Debre Brehan district/ town.

6.3. Study period
From November to January 2003.

6.4. Source population
All mothers between the age of 15-49 years old in Debre Brehan town.

6.5. Study population
All mothers between the age of 15-49 years old in the selected sample kebeles.

6.6. Sampling unit
Household in the selected cluster.

6.7. Study unit
Individual mother with the age between 15-49 years.

6.8. Study variable
6.8.1. Independent variables
• Age • Sex •Occupation •Educational status • Monthly income •BCG scar

6.8.2. Dependent variables
•Knowledge •Attitude •practice

6.9. Inclusion and Exclusion criteria
6.9.1. Inclusion criteria
 Mothers in selected kebeles.  Mothers with age 15-49 year.
 Mothers who can able to communicate without difficulty. 12

6.9.2. Exclusion criteria
 Mothers with age <15 and >49 years.  Mothers can’t able to communicate easily.  Mothers of other kebeles of the town.

6.10. Sampling technique and Sampling size determination
A multi stage sampling technique will be used to obtain the total sample size of respondent. The total sample size to be calculated based on the assumption below. Z (Confidence level) = 95%, which have 1.96 value. P (Proportion of Secuss) =50%, because it is unknown. d (Margin of error) = 5%, p (Proportion of failurity) =1-P Design effect = 2
n= Z 2 pq = d2 n= 1.96 2 * 0.5 * 0.5 = 384 0.05 2

n = 384*2, with design effect of 2. By considering 5% non-response rat, the total sample size will be 845. From the total 9 kebeles in the town 60%of them (5 kebeles) will be selected by lottery method. From those kebeles households are selected proportionally until we meet the total sample. The first house hold will be obtained by using sharp dot pencil with closed eye on the sample frame. Every Kth house hold will be included in the sample. K is calculated by dividing the total number of house hold by the sample house hold.

Schematic presentation of sampling

Debre Brehan Town

Kebele-1

Kebele-2

Kebele-3

Kebele-4

Kebele-5

Kebele-6

Kebele-7

Kebele-8

Kebele-9

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Kebele-2

Kebele-4

Kebele-6

Kebele-8

Kebele-9

Household

6.11. Data collection Tools and Procedures
A structured questionnaire composed of closed-ended questions will be administered to the respondents to collect the quantitative data. Qualitative data will be collected by observation by using check list. The questionnaire is prepared in English and it will be translated in to Amharic language for appropriate and easiness in interviewing the study subjects as they are Amharic language speakers. The Amharic version will again be translated back to English to check the consistency of meaning. Translation of questionnaire will be done by language experts in both cases. The questions included in the questionnaire are prepared depending on review of different related literatures and variables identified to be measured. Data collectors will approach by introducing him/her self and interview the selected respondents after informed consent obtained. A household will be revisited for two more times if the study the next subject not available on the first visit and if not be found during the revisit, household will be considered. Incase there is no eligible mother in the household the next household is taken as a sample.

6.12. Data quality assurance
The data collectors will be recruited depending on the criteria, the one who has Bachelor of Science in nursing and above, and both female and male applicants will be accepted. Training will be given on the basic technique of interviewing. The issue of confidentiality and privacy will be stressed during the training session and they will practice on pre-testing of the questionnaire after their training. The data collectors will be supervised daily by supervisors who are qualified in masters of public health. The filled questionnaires will be checked daily by the supervisors and principal investigator. If there is any problem the solution will be given daily by discussing with the supervisors and the data collector. Data quality will also be maintained by Cross checking the filled questionnaire by repeating the interview on a randomly selected households from which that data collected. Different methods of handling missed data will be used. Moreover, a pretest of questionnaire will be conducted on 30 mothers’ age 15-49 years to assess its completeness in providing the information needed for the study in the area that will be out of selected kebeles.
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6.13. Data processing and analysis
The data gathered through the structured questionnaire will be entered to EPI- INFO version 6 and SPSS version 16 a statistically packed soft ware for analysis. Also the data will be checked and cleaned for its completeness and errors in data entering. All the data obtained from the study population will be entered, cleaned and analyzed by the investigator. The result will be presented by using tables, charts, and graphs. Qualitative data will be analyzed and presented by descriptive statement.

6.14. Operational definition
 Satisfactory knowledge– those mothers who answers >80% of the knowledge questions.  Un Satisfactory knowledge– those mothers who answers < 60% of the knowledge questions.  Good attitude– those mothers who answers >75% of the attitude questions.  Poor attitude– those mothers who answers <55% of the attitude questions.  Good practice-those mothers who answers >70% of the practice questions.  Poor practice-those mothers who answers <50% of the practice questions.

7. Dissemination of result
The result of the study will be disseminated to;  District health office.  Debre Brehan University research coordinating office.  Debre Brehan University, School of Health science.  Debre Brehan Save the children coordinating office.  Private clinic in the town.

8. Ethical consideration
This study will be conducted after the approval of the proposal by Debre Brehan University research coordinating office. Primarily, ethical clearance will be obtained from director of research coordinating office of Debre Brehan University. Formal letter of cooperation will be written for District Health Office. Consent from District Health Office will be obtained. The District Health Office will write cooperation letter to the town/district administrator. The town/district administrator will write to the respective kebeles. The data collectors will clearly introduce him/her self and explain the aims of the study. Information will be collected after obtaining verbal consent from each participant. Respondents will also be informed that they can refuse or discontinue participation at any time they want and the chance to ask anything about the study. Information will be recorded anonymously and confidentiality will be assured throughout the study period. Data collectors will put their signature for they could obtain verbal consent for the interview from the respondents. A woman who did not practice will be advised about the benefits of immunization and for more information to communicate with health workers
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in the district.

9. Action Plan
Time frame (2010) No Major Activities . 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 . 11 . 12 .
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October

November

December

Topic Selection Proposal Development Selection of data collectors Training of data collectors House numbering Conducting pretest Data collection Data coding, entry and cleaning Data analysis and write up Submission of first draft of the result Submission of final research paper. Presentation of findings

N.B. For the above activities Debre Brehan University, Nursing Staffs are responsible.

10. Budget proposal
Personnel Cost Title Qualification Rate Duration of work (DAYS) 7 7 2 4 2 Number of persons 10 2 2 2 1 Total

Data collectors Supervisors Trainer of data collector Data analysis, write up and presentation Secretarial work SUB TOTAL1

BSCs above MPH, BSC MPH/statistician MPH Diploma

100 200 150 250 100

7,000.00 2,800.00 600.00 2,000.00 200.00 12,600.00

Equipment and supplies cost Category
Questionnaire Printing Questionnaire duplication Result paper printing Result paper duplication Stapler Staples Eraser Pen Pencils

Unit Page Page Page page Number Pack Number Number Number

Quantity 5 4225 80 480 1 2 5 7 7

Unit price 2.00 0.50 2.00 0.50 60.00 15.00 1.50 3.00 1.50

Total price 10.00 2,112.50 160.00 240.00 60.00 30.00 7.50 21.00 10.50

Remark

BIC DOT

17

Binder Flash disk Compact disc (CD) Bag

Number Number Number Number

7 1 3 5

20 300.00 6.00 70

140.00 300.00 18.00 350.00 3,460.00 GENX-4GB Nature-720MGB

SUB TOTAL2

Transportation and communication cost Category Transport Mobile-phone card SUB TOTAL3 Others for training /Refreshments Category Food /launch Soft drink Tea break Per diem for trainee SUB TOTAL 4 SUB TOTAL (1+2+3+4) Contingency GRAND TOTAL Unit Individual person Individual person Individual person Number of person 7 7 7 5 Number of days 2 2 2 2 Unit price/price per day 50.00 per individual 5.00 per individual 10.00 per individual 50 per individual Total price Remark 700.00 70.00 140.00 500.00 1,410 17,950.00 2,692.50 20,642.50 Unit Trip Card Quantity 140 4 Unit price 2.00 50.00 Total price 280.00 200.00 480.00 Remark Minibus

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Summary: Personnel Cost =12,600.00 Equipment and supplies cost =3,460.00 Transportation and communication cost =480.00 Others for training /Refreshments = 1,410.00 Contingency (10%) = 2,692.50

11.

Reference
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1, M.K.JINADU, Lecturer, perspective in primary care: A case study in the Administration of the expanded program of immunization in Nigeria, Journal of tropical pediatrics, 1983 29(217-219) 2. World Health Organization, United Nations Foundation, (2004). “Immunization in Practice” Modules for Health Staff 2004 update, United Printers, Ethiopia 3. FMOH, EPI policy guideline, Ethiopia 2007. 4. http://www.who.int/countries/eth/areas/immunization/en/ (1 of 2) accessed in 8/25/2009 10:19:32 AM 5. FMOH, health and health related indicator, 999E.C (2006/7 G. c) 6. Expanded program of immunization, Ethiopia, November 8, 2008, accessed from internet, in 26/8/2009 7. (FMOH, 2004). FMOH, Ethiopia Family Health Profile, 2003/4. 9, UNICEF, Immunization-expanding immunization coverage, accessed from internet in Aug.25, 2009 10. FMOH, National strategy for child survival in Ethiopia, July 2005, AA, Ethiopia 11. Disease control priorities project Estimates of the Current Burden of Vaccinepreventable Diseases and of the Burden Averted by Vaccination, [http/www .dcp2.org/disease/47,accessed on internet on Aug 30, 2009.) 12. WHO, progress towards global immunization goals-2007, summary presentation of key indicators, updated September 2008, slide Global immunization, PDF 13, JW Lee. Child survival: a global health challenge. Lancet 2003; 362: 262- (Cross reference:http://www.who.int/bulletin/volumes/85/6/06-031526/en/index.html#R1.) 14. WHO Vaccine preventable disease: monitoring system, 2006 global summary, WHO/IVB/2006 15. WHO and FMOH, Enhancing Routine Immunization Service in Ethiopia: field guide and essential tools for implementation, no date]-2 16. FMOH, National strategy for child survival in Ethiopia, July 2005, AA, Ethio8. FMOH, EPI: Comprehensive multi-year plan 2006-2010, August 2006 Ethiopia. 17. FMOH, National strategy for child survival in Ethiopia, Ethiopian National health policy, July 2005, AA, Ethiopia 18. Onta, Sabroe & Hansen, The quality of immunization data from routine primary Health care reports: a case from Nepal. Health Policy Plan 1998, 13:131-139. Pub Med Abstract] [Publisher Full Text 19. WHO Regional Office for Africa, “Mid- Level Management Introductory Course for EPI Managers) draft, March 2004 20. Expanded program on immunization, policy guideline, federal democratic republic of Ethiopia minister of health revised in 2007 21. [Ethiop .J .Health Dev. 2008; 22(2):148-157] 22, kersa woreda health office yearly report 2001ec
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23. Rahman MM; Esram MA; Mahalanab is D. Mother knowledge about vaccine preventable disease and immunization coverage of population with high rate of illiteracy journal of tropical pediatrics 1995 deci 41(6)376-8 24. Stratified K.SingarimbunM. Social factor affecting the use of child hood immunization in yogyakata ,java ,Yogyakarta Indonesia ,Gadiah moda university .population study center 1986 jun V.59 25. Gore prosannal ; Madhovan suresh, curry Duauld, MC clung gorden castiglia Marrye; arosenbluth Sidney smego 48(1999) 1011-1024 26.Okoro Ji ,Eghwn in Essential facter in the implementation of EPI in an urban periurban community in Nigera Asia Pac. J Public health 7(2);105-10;1994. 27. Shieferaw T.survey of immunization levels and facter affecting program participation in Kaffa south weast Ethiopia ,Ethiopia journal health devt 1990 4(1)51-59 28. Zhang X wang L;Zhux wang K. Knowledge attitude and practice Survey on immunization service delivery in Gu angxi and Gansu china ,social science and medicine 1999;49(8) 1125-7 29, Field R; Overcoming obstacles to immunization in Africa (unpublished)1993 presented at the 121st Annual meeting of the American public health Association . 30, Berhane Y;Masresha ,F;Zerfu M;Birhanu M;Kebede ,S;shashikant ,S; status of EPI in A rural to can south Ethiopia .Ethiopia medical journal ,Vol 33,no 2;PP.83-93,1995 31,Gedlu ,E, tesemma,T, immunization coverage and identification of problem associated with vaccination delivery in Gondar north west Ethiopia .east Africa medical journal ,Vol 74,no 4;1997 pp23 9-241 32, Jira ,Chali ;MPH Reason for defaulting from expanded program of immunization in Jimma town south western Ethiopia . Ethiopia journal of health science July 1999 vol 9 (2)93-99 33, Guide line of immunization in practice Ethiopia 2009 revised. 34. Joyce M.hawkins; the oxford mini dictionary clarendon press .New York 1991., 35. 35. Research on KAP about benefit of breast feeding by HO student’s 2009 at Metu Hospital. 35. Abdurahman M; A thesis proposal submitted to the school of public health, college of medicine and health sciences, university of gondar, in partial fulfillment of the requirements for the degree of masters of public health. 36. Ewunet A; Proposal to be submitted to jimma university, college of medical and public health, department of nursing as partial fulfillment for t he degree of bachelor of scienc jan, 2010 G.C. 37. Debre Brehan town administrator health bereau, 4th quarter and annual report June, 2002 E.C.

12. Annex
12.1. Questionnaire
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Consent form
My name is______________________ I am from Debre Brehan University, School of Health Science, Program of Nursing. I am here on the behalf of Debre Brehan University that conduct research in the community to collect data on assessment of mother’s practice to wards child vaccination and its associated factors with child vaccination. The university gets permission from the district/ town health office and kebeles administrator to conduct this research in your community. The objective of this study is to assess mother’s practice to wards child vaccination and its associated factors with child vaccination at Debre Brehan town to provide useful information for program managers and providers who enable them to improve the service provision. You were selected for the study because you are in the study group. We are kindly requesting you to answer the questions that we have prepared for you. Your information is very useful to this study and it needs your patience, full cooperation and sincerity. All information taken will be kept confidential. Only the data collector and principal investigator access the information. You have the right not to participate in the interview or to refuse at any stage of interviewing. There is no compensation that is given to you after end of interview or observation. Would you be willing to participate? I agree continue I disagree Respondent Stop

Data collector: Name______________________ Signature________ Signature___________________ Date____________ Date_______________________

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Questionnaire for child immunization status.
Part –I: Socio - demographic characteristics 1. Name of mother (Code) _____________________ 2. Age_____________ 3. Address /Keble/___________________ 4. Marital status 1. Single 5. Religion 1. Muslim 2. Orthodox specify_____________ 6. Ethnicity 1. Tigre 1. Illiterate 2.Oromo 2. Read and write 3.Amhara 3. Grade 1-6 4. Others (specify) 4. Grade 7-11 5. 12+ 5. 7, Educational status mother 8. Occupation of the mother 1. House wife 2. Government Employed 3. House maid 4. Self- employed Farmer 6. Other (specify) _____________ 9. Monthly income of the family 1. <150 2. 150-300 3. 300-600 4. 600-1000 4. Other 5. > 1000 10. Who in the family make the decision to take the child for vaccination? 1. Mother 2. Father (specify)___________ Part II-Practice towards immunization 1. Have you vaccinated your child? 1. Yes 2. No 2. Lack of information about vaccination 3. Child 5. Time inconvenience 6. Mother is busy 7. 2. If your answer is No for Q No1, why? 1. Too far from vaccination site was sick 4. Mother is sick Other /specify/______ 3. Both together 3. Protestant 4. Other 2.Married 3. Divorced 4.Widowed

3. If your answer is yes for Q NO 1, did the child complete vaccination according to the schedule? 1. Yes /Fully immunized/ 2. NO /Defaulter/ 4. If your answer is No (Defaulter) for Q No 3, why? 1. Too far from vaccination site 2. Child was sick 3. Mother is sick 4. Time inconvenience 5. Unaware the need to return for repeated vaccine dose 6. Forget to go for repeated dose
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7. Change in place of vaccination site /specify/___________________________

8. Other

5. How much times your child received vaccine? 1. Once 2. Twice 3.Three times 4. Four times Other/specify_____________ 1. Yes 2. No 3. Rash 5. > Five 6.

6. Have you ever seen side effect of a vaccine while children’s have vaccinated? 7. If Yes for Q. No 7 describe 1. Fever 2. Swelling, pain, readiness at the site of injection 4. Loss of apatite 5. Other /specify/_____________ 8. Does the provider told you about the importance of immunization? 1. Yes 1. Yes 2. No 2. Teared by children 3. Other 2. No 9. Do you have a card that you immunize your child? 10. If your answer is No for Q No 2, why? 1. Not given by health professional (Specify)_________

9. Do you have any idea how the service can be improved?

Check lists for direct observation
Schedul e Immunization given BCG OPV0 Polio OPV1 OPV 2 OPV3 DPT-HIBHBV1 Pentavalent DPT-HIBHBV2 DPT-HIBHBV3 Measles

BCG scare

Present

Not Present

THANK YOU!
Name of Interviewer_______________________ Date______________ Sign_________ Name of supervisor________________________Date______________Sign__________
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