PROGRAMME CERTIFICATE IN PAEDIATRIC

NURSING

COHORT COHORT 16

BLOCK BLOCK 2

FULL NAME WAN KHADIJAH BINTI WAN YUSOFF

NOOR AFIKA BINTI ‘AZRI

I.C NUMBER 850109036260

920810-09-5198

MATRIX NUMBER 3062161021

3062161006

TITLE A Study on Parental Knowledge and

Practice Toward Child Immunization

PROGRAMME COORDINATOR MADAM AMUDHA

MARK OBTAINED

2

TABLE OF CONTENTS

CHAPTER 1: Introduction 4

1.1 Background of the study 4

1.2 Problem Statement 6

1.3 Significance of the Study 7

1.4 Operational definition 7

CHAPTER 2: Literature review 8

2.1 Introduction 8

2.2 Immunization 8

2.3 Vaccine preventable diseases 11

2.4 Vaccine Refusal 11

2.5 Knowledge and vaccination practice 13

CHAPTER 3: Methodology 14

3.1 Design of the study 14

3.2 Study variable 14

3.3 Samples 15

3.3.1 Study Location 15

3.3.2 Target Population and sample selection 15

3.4 Instrumentation 15

3.5 Inclusion and exclusion criteria 16

3.6 Data analysis 16

3.7 Study limitation 17

3.8 Ethical Consideration 17

CHAPTER 4: results 18

4.1 Demographic assessment 18

4.2 Knowledge on child vaccination 21

4.3 Practice towards immunization 22

4.4 Association between parental knowledge and practice toward child vaccinations 23

3

CHAPTER 5: DISCUSSION 26

5.1 Parental demographic background versus child vaccination 26

5.2 Recormendation for better practice of child vaccination 28

5.3 Conclusion 29

REFERENCES 30

APPENDICES 33

4

CHAPTER 1: INTRODUCTION

1.1 Background of the study

Communicable disease is the main cause of deformities / defects and death among

children. It could leads to high morbidity and mortality rate. Immunization is one of very

effective health interventions in reducing the mortality rate of infants and toddlers due to

vaccine preventable diseases. It is one way to provide immunity to the infants and children

against various infectious diseases such as diphtheria, pertussis, measles, tetanus, and polio. In

earlier generations many children contracted communicable diseases like polio and whooping

cough, frequently with devastating consequences. Some children died; others were left with

permanent impairments. But the development of vaccines has made many of these childhood

illnesses relatively rare and has thus improved the lifetime health and well-being of millions of

people.

Children have quite clearly benefited more from vaccines than from any other preventive

public health program in history. In fact, Malaysia has been declared and certified polio free,

together with other countries in the World Health Organisation (WHO) Western Pacific Region

since 2000. Unfortunately, some parents have become comfort because most vaccine

preventable disease are no longer a major threat to their child so they simply delaying

vaccinated their child and some Parents hesitant to vaccinate their children, in worse case

senarion the emerganc of anti vaccine have posoning the parent through media social by posting

of side effects associated with certain vaccines, for example autism and double shoot cause

severe side efeeft to the child. However, the risks of not receiving immunisations are actually

immense compare to the side effect. Recent outbreaks of vaccine-preventable diseases in

malaysia have drawn attention to this phenomenon. For example, as can be seen in figure below,

5

the number of confirmed cases of diphtheria in Malaysia rise to 28 cases, including 5 deaths;

Kedah nine (9) cases with one (1) death, Negeri Sembilan seven (7) cases and with no deaths,

Sabah five (5) cases with three (3) death, Melaka three (3) cases with one (1) death, Penang two

(2) cases and with no deaths, Selangor and Perak each one (1) cases and no deaths.

Figure 1.1: The prevalence of vaccine preventable diphteria infection in Malaysia

According to MOH press statement on july 2016 out of 5 death cases 2 of them have been

comform not being given any vaccine for diptheria. And another 3 not comform taking vaccine

or not. This showed that wujudnye child who was not given vaccine and end up with mortality,

very sad to hear that parent putting the child life high risk due to unknown problems, why they

are unvaccinate or undervaccinate their child. So this study is clearly want to assess parent level

of awereness and practice toward their child vaccination because improved understanding of

the association between vaccine refusal and the epidemiology of these diseases is important to

make sure that good approach can be use to prevent unvaccinated or undervaccinated as well

as eredacating again the disease that have been completely eradecating before.

0

2

4

6

8

10

3 2 1

5

97

1

10

0

3

1

0

0

The reported cases of diphteria in Malaysia in August 2016

CASES MORTALITY

6

1.2 Problem Statement

Awareness on the importance of vaccination varies among parents in this country. Some think

vaccinations are just a government's regulation that must be met by parents. Some also believed

vaccination would affect their child's physical and mental development. In addition, there are

various practical level among parents in the scope of child vaccination. Some of working

parents feel the vaccination appointments with a doctor is difficult and as such, they are often

delay and skip certain doses of the vaccine for their children, while some parents who have

financial difficulties do not feel the need for vaccines to their children as a main priority. As a

result of poor knowledge and practice among parents, the children become victims as they are

not getting the benefits of vaccination and thus prone to vaccine preventable diseases.

1.3 Objective of the Study

A) General objective:

To evaluate parental knowledge and practice toward child immunization

B) Specific objectives:

There are three specific objectives to be achieved in this proposed study:

i) To determine the level of parental knowledge regarding child immunization

ii) To assess the depth of practice of child immunization among the parents

iii) To compare between parent’s knowledge and the practice of child immunization

7

1.4 Significance of the Study

This study will improve the awereness on the importance of children vaccination or

immunization among parents and the community. This study helps to detect common reasons

of parents for not vaccinate their child. The result could be used to plan for designing effective

public education programs or measures that can help parents to make the right decisions about

their children’s health and wellbeing. Those with inadequate knowledge and practices regarding

immunization need to be targeted to maintain and improve immunization coverage. In addition

the present study could be useful source of review for others (individual, group, organization

both governmental and non-governmental) who wants to intervene based on the results obtained

or who wants to do further researches to answer questions that are not answered in this study.

1.5 Operational definition

Assessment:

It is the organized systematic and continuous process of collecting data from parent

regarding vaccination/ immunization.

Knowledge:

It denotes the awareness or information that the Parent posses regarding

vaccination/immunization.

Parent:

A person who are holding responsibility to look after the child and make a decision for

vaccination

Practice:

Refer to the action taken by parent to vaccinate the child following the recommended

schedule

8

CHAPTER 2: LITERATURE REVIEW

2.1 Introduction

Vaccine is a very important compenant of preventing communicable disease. It is a well known

medical intervention from many country to reduce mortalty and morbility rate mong children.

It’s proven on eradication, elimination and reduce the number of cases of childhood

communicable disease significantly (Awadh et al., 2014). Vaccination had saved three million

child’s life but still another three millon live loss from vaccine preventable disease (Ehreth,

2003). This could be due to parental complience to vaccinate the child which cause them unable

to fight the infectious disease. Parental decisions regarding immunization are very important

for increasing the immunization rate and compliance and for decreasing any possible

immunization errors. Parents’ knowledge and practices regarding immunization are the major

factors that contribute to their vaccination decisions. A lot of investment done by government

to acchive 100% vaccine’s coverage of immunization including malaysia. Since 1950s

government has given the vaccine for free of charge to the public people as well as was

introduced immunization program(Awadh et al., 2014)

2.2 Immunization

Immunization is the process whereby a person is made immune or resistant to an infectious

disease, typically by the administration of a vaccine. Vaccines stimulate the body's own immune

system to protect the person against subsequent infection or disease. (CDC, 2016)

Meanwhile Vaccine is a special preparation of antigenic material that can be used to stimulate

the development of antibodies and thus confer active immunity against a specific disease or

9

number of diseases. It is usually given by injection but may be introduced into the skin through

light scratches; for some diseases (e.g. polio), oral vaccine is available. Many vaccines are

produced by culturing bacteria or viruses under conditions that lead to a loss of their virulence

but not of their antigenic nature. Other vaccines consist of specially treated toxins (toxoids) or

of dead bacteria that are still antigenic.

There are three types of vaccine use immunization which are live attenuated vaccine ,

Inactivated vaccine and Toxoid vaccine. Live attenuated vaccine is uses pathogen that are active

but have reduced virulence so they don’t cause disease. It Is the process of reducing the

virulence of the virus. It contains replicating microbes that can stimulate a strong immune

response due to the large number of antigen molecules. Meanwhile Inactivated vaccine can be

either whole agent vaccine produced with deactivated but whole microbes, or subunit vaccines

safer than live vaccines. Several doses usually required because there is no multiplication in the

body. The reaction do not resemble those of the natural disease and usually follow soon after

inoculation.Toxoid vaccine ia a chemically or thermally modified toxins used to stimulate

active immunity. It is useful for some bacterial disease e.g. Tetanus, Diphtheria. It require

multiple doses because they possess few antigenic determinants. When a child is given a

vaccine, they actually receives that part of the “weakened” or infectious organism that has been

killed and inactived that is able to stimulate child’s body to produce antibodies against it. These

antibodies then protect child against the disease and the protection is virtually life long. For

maximum protection and effectiveness of the vaccine given, immunisations should be

administered at specific ages. The vaccines most commonly recommended by doctors for

children are: DTaP, MMR, Varicella, Hepatitis B, Hepatitis A, IPV (Polio), Hib, Influenza,

Meningitis, and Pneumonia. The Hib or Haemophilus influenzae vaccine is used to prevent

bacterial meningitis. The HPV vaccination is new, added to the list of vaccines recommended

by the CDC in 2006 and is recommended for girls ages 11-12 and catch-up vaccination between

10

ages 13-26. These vaccinations, excluding HPV, are commonly administered at a period

starting at birth through the first two years of a child’s life with additional vaccination given at

older ages for groups of children with health needs that require additional vaccination or catch-

up vaccination for those who didn’t receive vaccines at early ages.

Vaccination choice and behaviors among parents varies. Parents may decide to fully vaccinate

all of their children, choose to vaccinate their children with certain vaccines and to exclude

others, vaccinate just some of their children, or decide that they will not vaccinate at all. Some

parents may also choose to modify the vaccination schedule, deciding to delay vaccination until

their children are older. Modification of the vaccination schedule is often due to concerns about

the safety of vaccination or concerns about the health of a child. Below is a chart that lists the

latest mandatory vaccinations recormended in Malaysia, including HPV, and the regular

schedule for the vaccinations.

Table 2.1:Immunazation schedule 2016

11

2.3 Vaccine preventable diseases

The outbreaks of vaccine-preventable diseases often occur as a result of non-immunization or

underimmunization among children and adults, as well as from exposure to infections brought

into the country by unvaccinated travelers who visit and return from high-risk or endemic

regions (McNair McKenzie, 2014). In this country, the recent cases of children death due to

diphtheria, a vaccine preventable disease found out two of the cases involved unvaccinated

childs. The child should receive most of the childhood immunisations before their second year

of life. These will protect the child against 10 major diseases which is tuberculosis, polio,

measles, mumps, rubella (German measles), pertussis (whooping cough), diphtheria, tetanus,

diseases caused by Haemophilus influenza (Hib) and hepatitis B. Immunisations also are

available against a host of other communicable diseases including chicken pox, diarrhoea,

influenza, rabies, meningococcal meningitis, pneumococcal infection and hepatitis A.

2.4 Vaccine Refusal

Many childhood vaccine-preventable diseases have been effectively controlled nowadays

(Whitney, Zhou, Singleton, Schuchat, & Centers for Disease Control and Prevention (CDC),

2014). However, recent outbreaks of vaccine-preventable diseases in some countries including

Malaysia have prompted clinicians, public health officials, politicians, the media, and the public

to pay greater attention to the growing phenomenon of vaccine refusal (Yang & Silverman,

2015). In some previous studies, vaccine refusal has been associated with outbreaks of invasive

Haemophilus influenzae type b (Hib) disease, varicella, pneumococcal disease, measles, and

pertussis (Phadke, Bednarczyk, Salmon, & Omer, 2016).

Vaccine refusal is reflects concern about the decision to vaccinate oneself or one children .There

are a number of factors that contribute to the refusal among parents which include both medical

12

or non-medical exemptions. The latter include religious exemptions, i.e. if a parent feels that

immunizations conflict with their religious or spiritual beliefs (e.g. objection to the use of fetal

tissue in the production of some vaccines), or personal belief exemptions, if a parent objects to

immunizations for moral or philosophical reasons (e.g. objection to the use of non-natural

products or the total number of vaccines to be administered). Sometimes it is difficult to

distinguish between purely religious or philosophical objections to immunization and safety

concerns about vaccines that manifest as nonmedical exemptions. In the United States, an

outbreak of measles in late 2014 highlighted vaccine refusal and related disease outbreaks

(Phadke et al., 2016). Approximately half the cases were among unvaccinated persons, most of

whom were eligible for vaccination yet intentionally remained unvaccinated (CDC, 2015). In

Malaysia, a number of vaccine preventable diseases had re-appeared recently and caused death

in some cases (Ministry of Health, Malaysia, 2016) which have alarmed how serious it can be

when the community, especially parents neglect their child vaccination or simply refuse

because of their belief or misconcepts they learned from rumours or social media.

13

2.5 Knowledge and vaccination practice

A descriptive study was conducted to evaluate knowledge attitude, and behavior of 841 Italian

mothers regarding the immunization. Over all 28.5% of mothers were aware about Hib

vaccination. Respondent’s attitude towards the utility of vaccination was favourable only for

22.5%. The results of a multiple logistic regression analysis showed that the knowledge was

significantly greater among mother with a higher education level and among those who were

older at the time of childbirth. Study emphasized the need for health education programmes

for promoting immunization of under five children. (Angelillo et al., 1999)

14

CHAPTER 3: METHODOLOGY

3.1 Design of the study

Study design is quantitative and cross-sectional study. Cross-sectional study used to determine

or uncover association between conditions or factors at one point in time. In this case, cross-

sectional study involving 30 parents from Aman Perdana Residents. The factors involved in

the data collection were Knowledge level and factor influence parental vaccination.

The samples were chosen through stratified random sampling. A total about 458 parent

reside in the Taman Aman Perdana, klang, only 30 parent were randomly selected from these

resident and screened for their eligibility to participate in this study. The inclusion criteria of

the participants are (i) aged between 20 and 55 years old and (ii) have a child at least 1 child.

Exclusions criteria were parent who are (i) age more than 55 years old and (ii) Parent who are

not having a child.

3.2 Study variable

The dependent variable adopted in this study was the knowledge and practice of the mother

toward child immunization .Therefore,demographic data of parent include age, religion,

education level, occupation and family income were use as indipendent variables.

15

3.3 Samples

3.3.1 Study Location

The present study was conducted in Taman Aman Perdana with permission sought from the

Kpj HealthCare University College. Taman Aman Perdana is a housing estate in the town of

Kapar in Klang.

3.3.2 Target Population and sample selection

Data collection was carried out by distributing questionnaire to the parents. The population of

this study was selected in 3 catogeries of residential; bungalow house, single story terrace and

flat house residents, In order to presume their range of income and level of education as well.

3.4 Instrumentation

The Questionnaire data concerns on parent knowledge and practice of child vaccination, there

will be there part for respondent to fill in which is:

Part I: regarding parent demographic data.

Part II: Consist of questions to assess the knowledge of parent regarding child immunization

Part III: Consists of question to find out parent practice on child immunization.

Thirty questionnaires were printed and distributed to the respondant as follow:

1. Ten questionnaires for banglow house residents

2. Ten questionnaires for single story terrace residents

3. Ten questionnaires for flat house residents

16

3.5 Inclusion and exclusion criteria

The inclusion criteria of the participants are (i) aged between 18 and 55 years old and (ii)

have a child more than one child. Exclusions criteria were parent who are (i) age less than 18

and more than 55 years old and (ii) Parent who are not having a child.

3.6 Data analysis

All data obtained from the questionnaires will be analysed by using Statistical Packages for

Social Sciences (SPSS) version 23.0 for Windows with the statistical significance value of

<0.05. Demographic data will be analyses using descriptive statistics. Meanwhile Microsoft

excel 2007 will be used for inserting and organizing the collected data in which worksheet will

be prepare using this software. Data will be analyzed according to the objectives of the study

using descriptive and inferential statistics and will be presented in the form of graphs, tables

and diagrams.

Descriptive statistics

Frequency and Percentage will be used to describe the distribution of parent according to

demographic characteristics.

Similarly, Parent level of knowledge were also assess by using frequency and percentage.

Inferential Statistics

Chi-Square test will be used to determine the association of knowledge and practice of

parent with demographic characteristics.

17

3.7 Study limitation

The number of sample for this study is limited to 30 and only questionnaire method was used

for data collection due to time constrain.

3.8 Ethical Consideration

The study has underwent approval by ethical committee of Kpj university College. All

respondents were informed clearly about the study procedures, informed of the purposes of the

study and the importance of information given by them. Selected participants will be informed

that their participation in this study was voluntary and they could withdraw at any time, their

confidential data were kept private, and that none of them will be identified in any publications

arising from the study (Appendix 1).

18

CHAPTER 4: RESULTS

4.1 Demographic assessment

Data from questionnaires were analyzed by using SPSS Version 23.0. The analysis focus

mainly on the educational background and income of parents versus their knowledge and

practices toward child immunization. The age groups of parents involved in this study fall into

one of three groups: (i) <25 years old; (ii) 25-35 years old; and (iii) 35-45 years old. Out of 30

participants, majority were in the second age group (25-35 years old) and followed by younger

and elder parents respectively (Figure 4.1).

Figure 4.1 Pie chart showing the partition of age groups among parents surveyed in this study.

In terms of educational bacground, most parents seems to underwent tertiary educational level

with majority were a diploma holder (43%) followed by upper (SPM) and lower (PMR)

secondary school qualifications with percentage of 27% and 13% respectively, degree holder

(10%) and Master holder (7%). No participants in this study were from doctoral qualificaation

level (Figure 4.2).

33%

40%

27%

Age group of parents

<25 years

25-35 years

35-45 years

19

Figure 4.2 Bar graph referring the educational background of parents participated in this study

Apart from age group and educational background, another factor that has been shown in a

number of previous studies to influence parents’ decision to vaccinate their children was belief

or religion. For example, some Muslims believed that vaccines are manufactured using

substance linked to porcine biological tissues and thus refuse it at the first place regardless the

consequences they could face from the refusal. In this study, most of the participants were

Muslims and followed by Buddhist and Hindhu as shown in Figure 4.3. Their practices toward

child vaccination will be discussed later.

Monthly family income of each respondents was also included in the questionnaire as economic

statuses played significant roles in determining one’s actions toward his or her child health and

well being. Data collected in this study respondents are almost equally divided into four income

categories since the questionnaires were distributed equally to high-end and low-end residential

area. Seven out of thirty (23%) total respondents came from a low economic class family with

monthly family income of less than RM1500 per month (Figure 4.4).

13.3%

26.6%

43.3%

10%

6.6%

0

0 2 4 6 8 10 12 14

PMR

SPM

DIPLOMA

DEGREE

MASTER

DOCTORAL

Frequency

20

Figure 4.3 Chart depicting the religion or belief of the participants shows that Muslims are the

majority followed by Buddhists and Hinduists

Figure 4.4 Monthly family income shows respondents were well categorized into four separate

income range.

73.3%

13.3%

13.3%

0, 0%

Religion of the participants

Islam

Buddha

Hindu

Others

23.3%

20%

30%

26.6%

Monthly income of the respondents

<RM1500

RM1500-3000

RM3000-5000

>RM5000

21

4.3 Knowledge on child vaccination

All respondents seemed to know what the vaccination or immunization is in general. However

not everyone was able to describe correctly what is the main benefits of child vaccination. As

shown in Figure 4.5, most of them (60%) understood that vaccines are given to prevent

infections but few (17%) thought it is a therapy used to cure infections while there were also

respondents (13%) who simply admitted they have no idea what it is for and even two

respondents (7%) believed vaccine is a drug to enhance children’s physical growth; and a

supplement for babies, respectively.

Figure 4.5 Assessment on the respondents’ knowledge regarding the benefits of child vaccination

Upon further explanation on the benefits, all respondents are able to name at least one disease

preventable by vaccine listed in the questionnaire and mostly picked measles as the answer.

When asked whether they ever heard a child having problems related with vaccination, mostly

(23/30) answered ‘no’ and only 8/30 of the respondents answered ‘yes’. Those who answered

‘yes’ further explained their answer by stating paralyzed (n=1), became deaf (n=3), fever (n=3)

and swelling (n=1) as the consequences, respectively.

17%

60%

13%

7%

0

2

4

6

8

10

12

14

16

18

20

To cure infections To prevent infections I don't know Others

Benefits of vaccination

22

4.4 Practice towards immunization

The main focus question in this category was whether they had their child vaccinated and

suprisingly four (13%) said ‘no’ (Figure 4.6). When asked the reason behind their decision

mostly chosen time inconvenience as the main excuse. It is unclear however whether they

omitted few or completely all vaccinations mandatory for all Malaysian citizens. Even some of

those answered (n=9) ‘yes’ admitted they skipped some vaccinations as scheduled due to time

constrains or simply forget to go for repeated dose (Figure 4.7).

Figure 4.6 The pie chart above shows the number of respondents who did not send their child for

vaccination (red) and those who did (blue).

86.6%

13.3%

Vaccination among respondents' children

Yes

No

23

Figure 4.7 Respondents’ excuses for not completing their child vaccination schedule

Finally regarding the awareness on vaccination respondents were asked whether their

healthcare provider explained on the importance of vaccination. More than half (53%) chosen

‘no’ as their answer. They were then asked how did they get information regarding vaccinations

and mostly picked at least one source as the answer. Overall, the majority of respondents chosen

parenting magazines and internet as their primary sources of information, followed by doctors,

other parents, books, public health nurses, and alternative medicine provider.

4.5 Association between parental knowledge and practice toward child vaccinations

Parental knowledge and judgement toward child vaccination was determined by assessing their

responds in few related questions such as ‘What is the purpose of vaccination?’ and ‘choose

disease(s) preventable by vaccination’ as well as ‘have you ever heard child having a problem

following vaccination..’. These knowledge based questions were analyzed for association with

their practice toward child vaccination. As seen in Table 4.1, all parents who understood that

3

1

5

0 1 2 3 4 5 6

FORGET TO GO FOR REPEATED DOSE

UNAWARE THE NEED TO RETURN

TIME INCONVENIENCE

Reasons for incomplete vaccinations

24

vaccination is used to prevent future infections (17/30) did send their child for vaccination and

even those who have slight misconception (6/30), i.e. thought vaccine is a medicine to cure an

infection also did have their child vaccinated. However, two out of three respondents who had

no idea what is the purpose of vaccination did not send their child for vaccination (2/30) and

another two respondents who totally have misconcept idea about vaccination did not vaccinated

their child as well (p<0.05).

Table 4.1 Cross-tabulation between parental knowledge on vaccination purpose and their practice

Practice

X2 p-value

Have you

vaccinated your

child?

Yes No

Kn

ow

led

ge

Purpose of child vaccination

To cure

infections 6 0

14.75 0.002

To

prevent

infections

17 0

I do not

know 3 2

Others 0 2

While it is significant that better knowledge affect parental practices toward child vaccination,

the negative side effects of vaccination seemed not too influencing their decision to vaccinate

their children. Five out of 30 respondents who claimed they ever heard of children suffering

paralyzed, deafness, fever or swelling following vaccination did send their child for vaccination

(Table 4.2).

25

Table 4.2 Parents perceived information on child vaccination

Practice

X2 p-value

Have you

vaccinated your

child?

Yes No

Kn

ow

led

ge

Did you ever heard child having

problems following vaccination?

Yes 5 0

0.923 0.337

No 21 4

26

CHAPTER 5: DISCUSSION

5.1 Parental demographic background versus child vaccination

Overall, the respondents of this study could be grouped into those with high, medium and

low family income. Second category is age group, i.e. <25 years old, 25-35 years old and 35-

45 years old. Third category is religion which encompassed Islam, Buddha and Hindu and lastly

educational level, i.e. secondary school, diploma, degree and postgraduate level. When data

have been collected and analysed, it is found that four out of 30 total respondents admitted they

did not vaccinated their child. The data reveals the background of them. All of them were

Muslims with highest educational level of diploma. Three of them are less than 25 years old

and one is within 25-35 years old. In terms of family income, one of them have monthly family

income of more than RM5000 per month, two are within RM3000-RM5000 income range and

another one fall into group of RM1500-RM3000 monthly. None of them came from a group of

family income less than RM1500 or low class group. This is strongly suggest that neither family

income nor educational level define the refusal for vaccination among the community. This

finding is almost similar to the study done by Salmon et al. (2005). The most strong reason for

parents not vaccinating their child in this study is religion or belief as well as age of the parents.

As previously mentioned, some Muslim people believe that vaccines are not produced

complying to their Syariah law and uses non-halal component during the manufacturing

process.

In fact, although there are vaccines produced by using porcine tissue components there

are always options for vaccines that have been certified halal by the authorized body. However,

this information may not reach to some peoples regardless of their economic statuses or

educational level, causing them to believe the wrong information or rumours. To tackle this,

27

the government, especially the Ministry of Health should intensify their campaign to promote

child vaccination in every possible way including by using the social media. The Muslim

authorized bodies also should stand firm to promote the benefits of child vaccination in

preventing future infections which is parallel to the teachings of Islam. Younger parents also

tend to take thing for granted when it comes to vaccination (Awadh et al., 2014). This could

happen when nobody is providing good advise to them on every important things they need to

know upon becoming parent. Younger parents are also busier with work commitment since they

are just entering career phase and could be harder for them to apply for leaves, i.e. to bring their

child for vaccination.

Apart from that, data from this study also shown some respondents did vaccinate their

child but the process is not completed. The main reason of this were (i) unaware of the need to

return for the subsequent dose(s), followed by (ii) time inconvenience and (iii) forget to go for

repeated dose(s). There are a number of possible causes that make parents fail to complete child

vaccination schedule. For example, they could be left unaware if the clinicians or nurses they

attended never remind or explain to them thoroughly on the vaccination matter especially when

they are not from healthcare or medical field. Even though they are given vaccination book or

card to complete sometimes they just do not have time to go through it and over time they will

forget. In this context, clinicians, staff nurses or public health nurses should be more

informative when dealing with parents especially those young parents. Time inconvenience is

mainly due to the lack of commitment among the parents themselves. Even though they are

working parents but there are lots of clinics which provide vaccination services open until night.

However, the parents have to take leaves or time-off from duty should they choose to go to

government clinics over private clinics since the former does not operate after working hours.

Such situation may happen to a parent with low family income as they could not afford to pay

28

the vaccination charges in private clinics and eventually they might skip one or two

appointments set during working hours.

Although some parents surveyed in this study knew that there are some isolated cases

when vaccines cause negative side effects to the child such as paralyzed, deafness or high fever,

most of them realized that benefits of vaccination weighing out its risks although in reality there

is only very little or no risk when children being vaccinated nowadays. This awareness is

something good and shows the spread of messages on the importance and benefits of child

vaccination in the community.

5.2 Recormendation for better practice of child vaccination

As been disscussed earlier the religion and belief play an important role in parents’ decision to

vaccinate their child. As such, the burden on vaccination refusal should not be handed totally

on Ministry of Health. Religion public figures or authorized bodies should taking part in

reducing the number of unvaccinated child. In this case, the Ministry of Health could plan for

more effective strategies with Jabatan Kebajikan Islam Malaysia (JAKIM) to convince parents

to better comply with their child vaccination and thus avoiding mortality due to vaccine

preventable diseases. In terms of side effects to the child, there are always improved method

from time to time in every aspects of vaccination such as manufacturing, delivery, and storage

in order to fully eliminate the risks. To date, there is a method of combining vaccines in a single

injection which confers various benefits to the child and parents (Partridge & Yeh, 2003). Such

method is undoubtedly less painful because less injections will be given to the child and parents

also will be more convenient since they do not have to frequently visit the clinics. Besides, it

will also benificial to parents who are likely to forget next vaccination dates, thus ensuring

much better compliance. As well, the campaingns on vaccination should stress on the type of

29

vaccines currently used by the MOH which is acellular organism type. This type causes no side

effects like pain, fever and sweeling to the child and thus the parents do not have to worry on

the negative consequences. This will further enhance the success of the country’s vaccination

programme and the universal protection of all of our children.

5.3 Conclusion

Although the majority of parents understand the benefits of immunization and support its use,

many parents have important misconceptions that could erode their confidence in vaccines. A

systematic educational effort addressing common misconceptions is needed to ensure informed

immunization decision-making.

Physicians, nurses, and other providers of primary care have a unique opportunity to educate

parents because parents see us as the most important source of information about

immunizations.

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APPENDICES