Enhancing Knowledge and Attitudes towards Measles Prevention among mothers of Under-Five Children

Thongam Kapeelta Devi¹, Mukta Gautam², Laxmi³, Mery Thomas⁴, Nidhi Dixon⁵

¹Vice-Principal, Nightingale Institute of Nursing, Noida.

^2,3,4,5Nursing Students, Nightingale Institute of Nursing, Noida.

*Corresponding Author E-mail: kapeel.thongam@gmail.com

ABSTRACT:

One illness that spreads quickly is measles. It is caused by a virus that is a member of the Paramyxovirus genus. Through direct touch and flight, it can spread. Children under five years old are most commonly affected. The purpose of this study was to evaluate the knowledge and attitude of mothers' young children under the age of five. Pre-experimental one group pre-test-post-test research was the method used for this investigation.100 mothers of under five children was chosen using purposive sampling from the local population in the community. Mothers of under five children received health education to help them become better informed and more proactive about preventing the measles. The post-test level of knowledge was 18.16 with standard deviation 1.390 which was higher than the calculated pretest level of knowledge i.e. 9.07 mean with the standard deviation 3.522 with mean difference of 9.13 and calculated Z test value is 25.25 which was higher than the table value i.e. 1.96 at df (99) at significance level of 0.05. The post-test level of attitude was 47.18 with standard deviation 2.719 which was higher than the calculated pre test level of attitude i.e. 22.37 mean with the standard deviation 2.460 with mean difference of 24.81 and calculated paired Z test value is 68.9 which was higher than the table value i.e. 1.96 at df (99) at 0.05 level of significance. The study finds that mothers of children under five years old had better knowledge and attitudes about measles management and prevention

KEYWORDS: Measles, Vaccination, Mothers of Under Five Children’s, Knowledge, Attitude

INTRODUCTION:

Measles is still a serious public health risk, especially for young children (under five). The virus that causes the measles is extremely contagious. The virus spreads swiftly via airborne transmission. It could lead to severe illness, others’ problems, or even death. While measles can infect anyone, children are the most susceptible to contracting it. An estimated 128 000 persons, mostly little children, perished from the measles in 2021 despite the availability of an effective and reasonably priced immunization.

Measles-related child mortality is still gradually increasing. Compared to 22 in 2021, there were 37 nations where there was a significant or disruptive measles outbreak in 2022. Where the outbreaks were occurring, there were six countries in the Eastern Mediterranean, two in South-East Asia, one in the European Region, and twenty-eight in the WHO Region for Africa.¹

According to a global report, India was one of the 37 nations where outbreaks occurred in 2022, with 40,967 cases reported. In 2022, an estimated 11 lakh youngsters in India were not vaccinated against measles, ranking the nation among the ten countries with the highest measles vaccination gap, even after the pandemic.²

NEED OF THE STUDY:

Between January and December 2013, 98 suspected outbreaks in 20 districts were investigated by Maharashtra State Health Agencies. Using a commercial enzyme immunoassay, samples were tested for rubella IgM antibodies (EIA) and measles. Out of the 98 suspected cases of measles, 61 instances of the disease, 12 cases of rubella, and 21 cases of mixed outbreaks were confirmed. Four epidemics remained unnamed.

Three cases were verified to be rubella and 91 to be measles out of the 126 cases from the nearby hospitals. Overall, the age range of 0–15 years old accounted for 93.6 percent (383/409) of confirmed cases of measles. In 18 out of 38 specimens taken from the probable patients, the measles virus was found. Four measles viruses were identified: one D8, three D4, and one D5. In all, the State of Maharashtra had 94 confirmed cases of measles and rubella in 2013, proving the need for the State to boost measles vaccination rates.³

According to the research, India was one of the 37 nations where outbreaks occurred, with 40,967 cases reported in 2022. There were still gaps in India's measles vaccine coverage even after the government launched specific immunization campaigns in response to the epidemic. Measles vaccination rates fell to their lowest points globally since 2008 during the pandemic, which led to a 43% increase in fatalities and an 18% increase in cases in 2022.² As a result of a national initiative, India immunised almost 348 million children against the measles and rubella between March 2017 and March 2023. Between 2017 and 2021, the number of measles cases decreased by 62%, or from 10.4 to 4 cases per million people, while the number of rubella cases decreased by 48%, or from 2.3 to 1.2 cases per million people. Enrollment in more research studies is possible.

AIM OF THE STUDY:

The study's objective was to evaluate mothers of children under five in a chosen community's knowledge, attitude, and efficacy of a planned training program about measles prevention.

METHODOLOGY:

Research Design:

Prior to experimentation A single group pre- and post-test research design was used to examine the effects of a planned education program on measles prevention among mothers of children under five in a particular community area.

Participants:

The study included mothers who lived in the community area and had less than five children. The study's inclusion criteria included mothers with children under five who were able to comprehend and complete the structured knowledge questionnaire and structured likert scale.

Sampling Procedure:

The study utilized purposive sampling as a means of participant recruitment, considering the pragmatic limitations related to reaching and involving mothers of children under five. The available participants who met the predetermined inclusion criteria for the research period were chosen to determine the sample size.

Data Collection:

The study utilized three instruments: a structured knowledge questionnaire, a Likert scale constructed and demographic data (age, family type, number of children, child's age, and history of measles vaccination).

Ethical Considerations:

The current study complied with the Declaration of Helsinki's ethical guidelines. Every participant gave their informed consent before to participation. Participants were assured of confidentiality, and data were anonymized during analysis.

Data Analysis:

Descriptive statistics such as frequency, percentage mean and SD were used while Z test in inferential statistics was used to test the impact of planned teaching program on knowledge and attitude in pretest and post test group. For statistical significance, a p-value of less than 0.05 was used.

RESULTS:

Regarding demographic distribution demographic distribution of the study participants revealed a diverse sample of mothers of under five children residing in community area. The majority were in the 23-26 years, living in joint family, held a primary school and housewife. The monthly income distribution was primarily ranged from Rs.6000 - 10,000. Few mothers of under five children has previous knowledge.

DISCUSSION:

In the current study the mothers of under five children who took the pre-test, 68(68%) had average knowledge and 32(32%) had poor knowledge. 13(13%) had average knowledge in the post-test, while 87(87%) had good knowledge. This study finding converge with (S Singh, U Chawla 2008) which demonstrated that there was a negative attitude and lack of awareness about the measles vaccine. Just 56.6% of mothers were able to inform that our child is unlikely to contract the measles if they receive the vaccine. Merely 13.9% of children were found to have had the measles vaccine. This demonstrates their ignorance of the measles vaccine and their attitude toward it. Additionally, 84.4% of mothers restricted their child from eating milk and cookies while they were sick with the measles, indicating a negative attitude regarding food. As a result, children will be more likely to experience problems, which will raise mortality and morbidity.⁸

The mean post-test level of knowledge was 18.16 with a standard deviation of 1.390, greater than the calculated mean pretest level of knowledge, which was 9.07 with a standard deviation of 3.522 and a mean difference of 9.13. The calculated Z score is 25.25 which was higher than the critical Z value i.e., 1.96 at df (99) at 0.05 level of significance. This finding correlate with (Elbert B, Zainumi CM 2023) Mothers had only moderate awareness, and only 62.8% of participants had children with complete immunization records.

The present study shows that mothers of children under five, 31(31%) had a neutral attitude, 69(69%) had an unfavourable attitude, and none had a good attitude based on their pre-test results. According to the post-test attitude scores of mothers of children under five, 56 (56%) had a neutral attitude, 44(44%) had an unfavourable attitude, and none had a good attitude. he results of this study are consistent with those of (S Singh, U Chawla 2008), which showed that ignorance about the age and location of vaccines (56.5%) as well as fear of infection and a far vaccination site were the primary factors of the low immunization rate. Of the responses, 16.1% and 4.8% of mothers, respectively, disagreed that getting the measles vaccination was necessary.⁸

The mean post-test level of attitude was 47.18 with a standard deviation of 2.719, greater than the calculated mean pretest level of attitude, which was 22.37 with a standard deviation of 2.460 with mean difference of 24.81. The calculated Z score is 68.9 which was higher than the critical Z value i.e., 1.96 at df (99) at 0.05 level of significance. Hence, research hypothesis was accepted and null hypothesis was rejected. This study finding with (Khan, M., Akber, 2024) as Parents' fears over their children's vaccinations ranged from 35.3% to 64.7%. 52.9% of mothers in this research said there was no advantage to vaccination, while 47.1% said there would be harm to their children if they had the shots.

The present study shown that the relationship between the post-test knowledge and attitude level and the demographic variables was examined using the chi square test. There was significant association between the level of attitude with demographic variable that is child vaccinated with measles dose and utilization of vaccination, hence research hypothesis were partially accepted. This study finding parallel to (Pritu D Pawan K et al 2024) as 11.5% of children in India still not having received a measles vaccination, the percentage of children who received zero doses was noticeably higher. Birth order, age, quintile of wealth, social group, religion, place of residence, mother education, delivery location, media exposure, and style of delivery are among the factors that affect the prevalence of vaccination. The results of the geographical study indicate that the northeastern Indian states have a significant concentration of zero-dose children.⁹

A study conducted on the assessment of knowledge and practices of mothers regarding measles immunization for children analyzed that 29% of mothers out of 96 were having a knowledge about measles vaccination and only 11.5% mothers were having practices of measles vaccination. It's states that there is an insufficient knowledge of mothers about immunization on measles in the selected area because of illiteracy, lack of educational programs, health camps in the community especially for mothers regarding immunization and diseases control.

One of the goals of the study was to identify the variables that affect Jordanian parents' willingness to take the measles, rubella (MR) vaccination. A previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument was used for this cross-sectional questionnaire-based investigation. Data were collected in October 2023, and 391 parents made up the final study sample (n = 273), with mothers accounting for 69.8% of the participants. Of the parents who took part in the study, the majority (n =169, 43.2%) voiced resistance towards MR immunization, whereas only 54 participants (13.8%) expressed reluctance. MR vaccine acceptance was substantially correlated with behaviour having fewer children, and faith in the safety and efficacy of vaccines, according to multivariate analysis. The current study found that parents in Jordan exhibited a significant degree of MR vaccination reluctance or resistance, which may indicate a public health emergency in the nation. It is highly advised that this issue be addressed immediately and specifically, and that large-scale initiatives be launched to increase public confidence in the efficacy and safety of the MR vaccination.¹³

CONCLUSION:

In India, it has been found that a child's birth order and gender affect how soon they receive their measles vaccination.¹²The present study was aimed to assess the knowledge and attitude of mothers of under five children regarding prevention of measles. The level knowledge of mothers of under five children in pre-test revealed that 32% of them had poor knowledge, 68% had moderate knowledge, and none of them had adequate knowledge. The level of knowledge of mothers of under five children in post-test revealed that 87% of them had adequate knowledge and 13% had moderate knowledge The mean post-test level of knowledge was 18.16 with a standard deviation of 1.390, greater than the calculated mean pretest level of knowledge, which was 9.07 with a standard deviation of 3.522 and a mean difference of 9.13.

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Received on 02.08.2024 Revised on 19.11.2024

Accepted on 21.01.2025 Published on 22.02.2025

Available online from March 20, 2025

Int. J. Nursing Education and Research. 2025;13(1):10-14.

DOI: 10.52711/2454-2660.2025.00002

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Level of Knowledge	Grading	Pretest		Post test
Level of Knowledge	Grading	Frequency	Percentage	Frequency	Percentage
Good	17-23	0	0	87	87%
Average	8-16	68	68%	13	13%
Poor	0-7	32	32%	0	0

Attitude Level	Gradings	Pre- Test		Post- Test
Attitude Level	Gradings	Frequency	Percentage	Frequency	Percentage
Favourable	38-50	0	0%	0	0%
Neutral	24-37	31	31%	56	56%
Unfavourable	10-23	69	69%	44	44%

Table:4- Mean, Median, Mean difference, Standard deviation and Z score of Attitude score regarding prevention of measles among mother under five age children. N=100