A Pilot Study Exploring Opinion and Belief of Parents towards Immunization Program of Oral Polio Vaccine ( OPV ) In Pediatric Ward in Gondar University Hospital , Northwest-Ethiopia

Rational: Little attention has been given to evaluation of parents’ knowledge and barriers towards poliomyelitis vaccination. Aim: Explore knowledge and delineate barriers of parents to polio vaccine.


Background
Poliomyelitis is a highly infectious disease leading to paralysis and deformity.Global immunization efforts and initiatives were made to eradicate poliomyelitis by the year 2000 [1].A report Study population: The population was composed of parents of pediatric patients.A representative sample of 21 parents was used in the pilot study.The sample was selected by non random consecutive sampling technique.Parents were invited and agreed participants were consented post reading of study information sheet.

Methodology
The demographics of parents and their children were collected via the administration of questionnaire administered by the clinical pharmacist.Information for occupation, education, marital status (married/divorced/widow), residency (town/ rural/remote area), number of children's and age of last child was also collected by the question naire.We have used an interview tool through in-depth interviews of parents attending pediatric wards.The tool was a concise questionnaire asking parents their knowledge about polio: Are you familiar of a disease called "POLIO", what is the source of parents information ,are you aware where to get vaccinated for polio vaccines, are you aware that polio vaccines are provided free of cost, have you ever vaccinate your child for polio, if yes then how recent, from where you vaccinated and who told you to vaccinate, does any vaccination people ever came to your home to vaccinate, how the polio vaccine is given like tablets, injections, drops.
We have also addressed barriers of polio vaccination by two questions: if you have not vaccinated your child recently "what was the reason" and what is the specific reason that may hinder you to vaccinate your child against polio.

Results
Our study was carried out with twenty one parents (mean age 29.57±3.2years).The mean children age was 3.62±3.47and the mean number of children was 2.33±1.52.The parents mean age was 30±8.1 for females and 29±4.8 for males.
More than half of parents were illiterate (54.14%), dwelling in town (81.34%) and with an average of 2.33 children.Less than one third (28.6%) of parents has an idea and knowledge about polio and were familiar with the disease called "POLIO".After in-depth interview with interviewees, about 80% of parents described their knowledge towards immunization with polio vaccine was through community nurses and healthcare workers in hospitals.33.3% were aware where to get vaccinated with "POLIO vaccine", while (38.1%) were aware that polio vaccines were provided free of cost, Furthermore 52.3% have vaccinated their child for POLIO and few parents 15.3% have declared that POLIO vaccination person came to their home.Very few parents (9.5%) know the source of information about POLIO and less than quarter (19.0%) knew the sources of information about POLIO.However, the same percent of parents 19% indicated that POLIO vaccine was given to their children.With the exception of 2 parents, (95.2%) knew the route of polio vaccination.

Parental barriers to POLIO immunization
The main barriers to OPV have been addressed by the parents were lack of awareness from healthcare workers, not aware of importance of OPV, lack of structured informative parental program and access to services.

Discussions
The main finding of this pilot study was the lack of structured education program tailored to parental of children at their age of receiving immunization with OPV.We have reported that an appreciated percent of interviewed parents admitted the fact that no specific education and no awareness was provided towards immunization with polio vaccineand no awareness was informed about polio immunization.This finding was concordant with earlier reports [5,6,8].In our study, it was observed that polio campaigns in Ethiopia lack conducting face-to-face communication between parents and healthcare immunization workers for better understanding of the importance of polio vaccination, increasing the knowledge and minimizing the barriers regarding polio immunization among parents.
Our findings towards knowledge were similar to Bonuand and coworkers [7]; where they highlighted the diversities of polio eradication initiatives between sub-Saharan Africa and South Asia.In Rwanda and Rubavu [8], researchers trained the polio campaigning staff prior to each campaign and provided other services to public to lay out clear plans to transfer additional knowledge and polio-related information to the public.In some cases contributing workers' fatigue through repetition can weaken the focus in providing polio-related information to the public.The social workers and community leaders play a significant role in imparting knowledge to the child bearing families by reaching out to the masses and motivating them.

Parental barriers to immunization by polio vaccine
Some studies highlighted that in Ethiopia, the polio eradication program has delivered its most unambiguously positive impacts and all efforts continue to focus on providing polio vaccination to children across the country, but the barriers and misconceptions remain questionable.

Parental beliefs
We have observed that there was non-belief about effectiveness of OPV and some of the parents mentioned difficulty in communicating, and fear of side effects.Similar results were reported in one study [9].

Economic barriers
Evidences suggest that the high-income families are adequately immunized and those most children in this group receive oral and injectable polio vaccines through pediatricians in the private sector [10].

A Pilot Study Exploring Opinion and Belief of Parents towards Immunization Program of Oral Polio Vaccine (OPV) In Pediatric Ward in Gondar University Hospital, Northwest-Ethiopia
Copyright: © 2016 Bhagavathula et al.
elusive; many factors may lead to clustering of unimmunized children, who are at high risk of getting polio.It was evident from the Ethiopian Demographic and Health survey-EDHS reports in 2011, that only 24% of the children aged12-23 months were fully vaccinated [11].
Recently, there is a global growing concerns and fear about POLIO disease and unvaccinated children in areas such as Afghanistan and Syria.Furthermore the cross boarder of refugees and those fleeing from war called for WHO to recall their global concerns about POLIO outbreaks.In this respect, more strategic WHO POLIO program should incorporate these conflicts and collaborate with United Nations and concerned authorities to limit the spread of POLIO in such areas.
Despite global achievements, vaccine refusal and scant information on the importance and availability of OPV at the community level continue to impede poliomyelitis eradication efforts in some African countries.One of the strategic solutions is to engage the community to raise the acceptance of OPV [12][13][14].This can be achieved by active involvement of traditional leaders in the communities and villages to encourage the parents for OPV.The idea is to enhance the bottom of societies in rural areas and scanty communities where no health services or health setup facilities are available.

Conclusions
Lack of knowledge and misperceptions about polio vaccination lead to continued polio transmission in the Ethiopian population unless targeted activities are undertaken to promote immunization.
There is a need to raise the parental educational awareness and knowledge about the benefits and importance of immunization by polio vaccination.The concern of the deleterious consequences that results from non-complete immunization deserves special attention.
We recommend that the relevant government authorities take proactive measures to improve the access to the polio vaccination program.The benefits of polio vaccination need to be well understood by the parents to immunize their children.
• Highlights:Evaluation of the parents' knowledge about POLIO is imperative in low socio-economic population.
• Studying the barriers towards poliomyelitis vaccination deserve attention.
Parental assessment regarding immunization with Oral Polio Vaccine (OPV) is very important to improve immunization rate.

Table 1 :
The demographics of parents.

Table 2 :
Parental questionnaire (21 parents) Questions 6 to 8 were reported as know the answer (Yes) or does not know the answer (No).Part B: Questions 1 and 2 were reported as parent gave the answer (Yes) or did not give the answer (No).