IMMUNIZATION STATUS OF CHILDREN UNDER 1 YEAR OLD IN SAN JACINTO PANGASINAN

A Research Study Presented to The Faculty of the College of Nursing

Arellano St., Dagupan City

In Partial Fulfillment of the Requirements for the Degree Bachelors of Science in Nursing

OCTOBER 2012
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CHAPTER 1 INTRODUCTION

Background of the Study In 2005, the World Health Assembly approved, and the United Nations Childrens Fund (UNICEF) Executive Board endorsed, the Global Immunization Vision and Strategy (GIVS).The primary objective of GIVS is to reduce vaccine-preventable disease mortality and morbidity by two-thirds by 2015 compared to 2000, a contribution towards achieving the Millennium Development Goals, especially Goal 4, which calls for a twothirds reduction of under-5 mortality by 2015.GIVS identifies four strategic areas: immunizing more people against more diseases; introducing newly available vaccines and technologies; linking immunization to other critical health interventions; and managing vaccination programmed and activities within the context of global interdependence. GIVS articulates more than 25 new ideas and innovative approaches, and it is anticipated that countries will adopt the strategies most suited to their needs.GIVS was developed in the context of increasing resources for immunization; in 1999 a publicprivate partnership, The Global Alliance for Vaccines and Immunization (GAVI Alliance) was initiated to provide financial support for immunization in the worlds poorest countries. By the end of 2005, government and private sources had pledged a total of US$ 3.3 billion to the GAVI Alliance, enabling it to provide support to 73 of 75 eligible countries. Between 2000 and 2005, total GAVI Alliance disbursements were US$ 760.5 million.GAVI Alliances resource outlook over the next decade has
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improved with the launch of two innovative funding mechanisms: the International Finance Facility for Immunization (IFFIm),which could provide up to US$ 4 billion over the next 10 years, and the Pneumo Advance Market Commitment (AMC),which will provide US$ 1.5 billion to support low-income countries for the purchase of new vaccines against Streptococcus pneumoniae, a leading cause of childhood meningitis and pneumonia mortality (Lara J Wolfson et al.2008) In the Philippines most of the parent concern is all about health, particularly for those who cannot afford medical care and who often live in the communities that lack of even most basic of community health services. Childhood immunization is not only important in protecting the young ones from disease, death, and disability but also serve to protect the entire community as a whole (Samson, 2007) Most childhood ailments are highly infectious. Sicknesses like diphtheria, cholera, and measles can easily spread from one child to the others. Immunization helps to minimize the spread of contagious agents that may be detrimental to health. The immunization of children against a number of in infectious disease has become the most important health intervention over the years. It has prevented the small pox infection worldwide and made common infection such as measles and tetanus rarely occur (Scheider, 2011). Death in childhood from infectious disease has been vastly reduced because of widespread immunization program. Virtually all children are vaccinated against diphtheria, tetanus, pertussis, polio, measles, rubella, mumps, and hepatitis B before they
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enter school, because most of these immunizations are required by law. However, many preschool children are at risk because they do not receive immunization at the recommended ages. The mere mention of the names of certain infectious disease struck fear into the hearts of our ancestors. Today, Immunization is one of the great public health success stories of the 20th century, have made once common disease such as diphtheria, measles, mumps, and pertussis disease of the past. Vaccines are now available to protect children and adults against 15 life-threatening or debilitating diseases. In the face of all the obstacles and constraints affecting the health care system and the delivery Of equitable, appropriate, adequate, effective and efficient health services to the majority of the population, it seems that the wellness approach emphasizing a healthful lifestyle is the only viable strategy for individual who want to reach their own health goal and expectation, as well as for the community or country who wants to raise and maintain the wellbeing of its population. Public health workers, notably the community health nurse, should give priority to and spend more time in activities that promote health and prevent disease, rather than staying mainly in the clinic consulting with and treating the sick (Reyes-Bailon,2006). The Researchers conducting this research, because the researchers want do determine the immunization status of children under 1 year old in San Jacinto. And for able them to know the factors have affected the decrease in number of immunized children under 1 year old in Municipality of San Jacinto.
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Conceptual Framework The basis of the study is the Republic Act No. 10152, an act providing for mandatory basic immunization service for infants and children, repealing for the purpose of Presidential Decree No. 996 as amended (Official Gazette of the Republic of the Philippines, June 2011). Expanded Program on Immunization (EPI) was launched in 1974, less than five percent of the world's children were immunized during their first year of life against six killer diseases polio, diphtheria, tuberculosis, pertussis (whooping cough), measles and tetanus. By 2010, ensure routine immunization of children under one year of age reaches 90 per cent nationally and at least 80 per cent coverage in every district or equivalent administrative unit (UNICEF/WHO, November 2011). We are conducting this research because we just want to know about the immunization status among children in San Jacinto. And then we just want to give some advices to the mother of a child that who is not fully immunized and explain about the important of the said vaccines. Because vaccine is very important for the child to protect them against in many diseases.

BASIS

INPUT

PROCESS What is the

OUTPUT

immunization What is the demographic status of the children under 1 year old in the Municipality of San Jacinto status (percentage immunized children) of the children under 1 year old in the Municipality of of

Republic Act.No.10152

Is there a relationship between the immunization status of the population against the demographic data of the subjects?

San Jacinto per barangay?

Figure 1: Research Paradigm

Statement of the Problem This study aims to determine the Immunization Status of children under 1 year old in the Municipality of San Jacinto. 1. What is the demographic status of the children under 1 year old in the Municipality of San Jacinto in terms of: a. Age (in months) b. Gender c. Socioeconomic status (of parents) d. Highest Educational Attainment (of parents) 2. What is the immunization status (percentage of immunized children) of the children under 1 year old in the Municipality of San Jacinto per barangay? 3. Is there a relationship between the immunization status of the population against the demographic data of the subjects? Significance of the Study The results of this study are believed to be significant to the following aspects: Nursing Practice. This study will provide wider understanding to the Immunization Status of children under 1 year old in the Municipality of San Jacinto. Nursing practitioners can have a source of information regarding the possible factors that may cause in obtaining the unimmunized children, such factors can be identified and learn how to avoid or resolve them in order to have a better health. Nursing Education. The results of this study will contribute to educators and lead them to have knowledge in experiencing level of unimmunized children that may

cause certain factors. This result may at least help the nursing educators to know of what is the best approach or teaching strategy to encourage the mother in recognizing the difficult possible cause of being not immunized. Nursing Research. The result of this study would be another significant finding that may be used in other nursing researches concerning Immunization Status of children under 1 year old in the Municipality of San Jacinto. The researches would be able to make recommendations for those who are unaware of immunization. Further studies can be conducted to gain more knowledge and safety measures for the subject.

Scope and Limitations This study focused on the Immunization Status of children under 1 year old in the Municipality of San Jacinto.It involved all barangay namely: Awai, Bolo, Casibong, Capaoay, Guibel, Imelda, Labney, Labong, Macayug, Magsaysay, Pag-asa, San Guillermo, San Jose, San Juan, San Roque, San Vicente, Sta. Cruz, Sta. Maria and Sto. Tomas with 15 respondents each barangay with mothers with children under 1 year old. Definition of Terms The researches defined the following terms for the purpose of clarity and better understanding of readers: EPI. Expanded Program on Immunization; a program conceptualized by the Department of Health in which initiative was the early introduction of first line defense for such diseases. Immunization. The process of inducing immunity artificially by either vaccination or administration of antibody.
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Immunizations Status. A relative positions or standing of immunization in a society RHU. Rural Health Unit. The primary government health-care facility at the municipal level wherein health services are delivered. Vaccine. A preparations of proteins, polysaccharides or nucleic acids of pathogens that are delivered to the immune system as single entities, as part of complex particles, or by live-attenuated agents or vectors, to induce specific response that inactivate, destroy, or suppress the pathogen.

CHAPTER 2 REVIEW OF LITERATURE Local Expanded Program on Immunization (EPI) in the Philippines The basis of the study is the Republic Act No. 10152, an act providing for mandatory basic immunization service for infants and children, repealing for the purpose of Presidential Decree No. 996 as amended (Official Gazette of the Republic of the Philippines, June 2011). The Expanded Program on Immunization (EPI) in the Philippines began in July 1979 and in 1986 made a response to the Universal Child Immunization goal. The four major strategies include: sustaining high route Full Immunized Child (FID) coverage of atleast 90% in all provinces and cities, sustaining the polio-free country for global certification, eliminating measles by 2008 and eliminating neonatal tetanus by 2008. The standard routine immunization schedule for infants in the Philippines is adopted to provide maximum immunity against the seven vaccines preventable disease in the country before the childs first birthday. The fully immunized child must have completed BCG 1, DPT 1, DPT 2, DPT 3, OPV 1, OPV 2, OPV 3, HB 1, HB 2, HB 3 and measles vaccines before the child is 12 months of age (DOH, 2009). Here are those vaccines that they were being given during immunization at minimum age at 1st Dose. Bacillus Calmette-Guerin this vaccine given at earliest possible age protects the possibility of TB meningitis and other TB Infection in which infants are prone and this vaccine given to children at birth or anytime after birth. Diphtheria-

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Pertussis-Tetanus Vaccine the reason of this vaccine is to reduce the chance of severe pertussis and it is given within 6 weeks. Oral Polio Vaccine the reason of this vaccine is to extent of protection against polio is increased the earlier the OPV is given and it is given within 6 weeks. Hepatitis B Vaccine the reason of this vaccine is when an early start of Hepatitis B vaccine reduced the chance of being infected and becoming a carrier. Prevent a liver cirrhosis and liver cancer which are more likely to develop if infected with Hepatitis B early in life and this will be given at birth. Measles Vaccine the reason of this vaccine is to prevent the measles at least 85%. The EPI target diseases among infants and newborns (0-12 months) include tuberculosis, diphtheria, pertussis, neonatal tetanus, poliomyelitis, measles and hepatitis B. Cuevas (2007) traced how Expanded Program on Immunization (EPI) started in the Philippines from its conceptualization until to its introduction in the country in early 1990 that contributed to the declined of numerous cases of immunizable diseases. Cuevas defined immunization as the process by which vaccines are introduced into the body before infection sets in. Vaccinations promote health and protect children from diseasecausing agents. Infants and newborn need to be vaccinated at an early age since they belong to the vulnerable age group. According to Cuevas (2007), the standard routine immunization schedule for infants is every Wednesday and this immunization day is adopted in all parts of the country to provide maximum immunity against the seven vaccine preventable diseases before a childs first birthday. A child is said to be Fully Immunized when a child

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receives 1 dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of Hepatitis B and 1 dose of Measles vaccine. Tetanus toxoid vaccination for mother is also important to prevent neonatal tetanus. Furthermore, administration and procedures in giving the vaccine as well as the role of a nurse in improving the delivery of immunization service in the community are cited. National Wagman (2006) defined tuberculosis, diphtheria and pertussis. Tuberculosis is a common and often deadly infectious disease caused by Mycobacterium tuberculosis. Its classic symptoms are chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Diphtheria, on the other hand, is an upper respiratory tract illness caused by Corynebacterium diphtheria. The disease is characterized by sore throat, low fever and a pseudo membrane on the tonsils, pharynx and nasal cavity. Lastly, pertussis or whooping cough is a highly contagious disease caused by bacterium Bordetella pertussis. It is initially characterized by symptoms during catarrhal and paroxysmal stages. According to Porth (2002), poliomyelitis or infantile paralysis or Heine-Medin disease is an acute viral infectious disease. Affected individuals can exhibit a range of symptoms if the virus enters the stream. The virus infects and destroys motor neurons leading to muscle weakness and flaccid paralysis. On the other hand, measles or rubeola is an infection of the respiratory system caused by paramyxovirus of the genus Morbillivirus. Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three Cs (cough, coryza and conjunctivitis). An observation of Kopliks spots is also diagnosis of measles.

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Porth (2002) also defined hepatitis B as an infectious illness caused by hepatitis B virus which infects the liver of humans, and causes an inflammation called hepatitis. Another condition is neonatal tetanus or lockjaw, a medical condition characterized by a prolonged contraction of skeletal muscle fibers. Hockenberry (2005), explained BCG or Bacillus Calmette-Gurin as a vaccine against tuberculosis that is prepared for a strain of the attenuated live Mycobacterium bovis that has lost its virulence in humans by being specially cultured in an artificial medium for years. According to Hatfield (2003), hepatitis B vaccine is a vaccine developed for the prevention of hepatitis B virus infection. The vaccine contains one of the viral envelope proteins and hepatitis B surface antigen. Oral Polio vaccine, on the other hand, is a live attenuated vaccine usually clear and red or pink produced by the passage of the virus through non-human cells at a sub-physiological temperature, which produces spontaneous mutations in the viral genome. Behrman (2004) characterized DPT or Diphtheria-Pertussis-Tetanus vaccine as turbid, whitish suspension that may have a faint odor. Lastly, measles vaccine is a live attenuated strain of the measles virus grown in chick embryo tissue culture. This vaccine is a shot given spontaneously.

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Factors Affecting Immunization Status Local Another crucial factor in eliminating Maternal and neonatal tetanus (MNT) is the distance of health facilities from the homes of mothers in these high-risk areas. As such, some resort to their local manghihilot or untrained midwives, because its the most convenient and inexpensive method of giving birth. However, this exposes them to health risks, such as the use of unsterile equipment and unhygienic child-delivery environments. Local health workers therefore play a big role in educating and encouraging possible and expectant mothers in high-risk areas to go through tetanus immunization and to know how far they have to travel to reach a health facility. (Borromeo/Garcia. 2007). In this study, immunization as the process by which vaccines are introduced into the body before infection sets in. Vaccinations promote health and protect children from disease-causing agents. Infants and newborn need to be vaccinated at an early age since they belong to the vulnerable age group. So that a child is said to be Fully Immunized when a child receives 1 dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of Hepatitis B and 1 dose of Measles vaccine. Tetanus toxoid vaccination for mother is also important to prevent neonatal tetanus. Furthermore, administration and procedures in giving the vaccine as well as the role of a nurse in improving the delivery of immunization service in the community are cited.

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National The prevention of child mortality through immunization is one of the most costeffective public interventions in use in resource-poor settings. The Expanded Program on Immunization (EPI) aims at delivering the primary immunization series to at least 90% of infants. However, inadequate levels of immunization against childhood diseases remain a significant public health problem in resource-poor areas of the globe. Nonetheless, the reasons for incomplete vaccination and non-uptake of immunization services are poorly understood. In Mozambique, the EPI targets seven diseases, namely tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B and measles. The reported coverage of the basic EPI vaccines in Mozambique is 80%95%, but these figures include incomplete and incorrect vaccinations. This may be one of the reasons why measles epidemics continue to occur in Mozambique despite of the reported 80% measles vaccination coverage. Additionally, it has also been shown that immunization coverage in not uniform throughout the country, with rural areas presenting significantly lower coverage's and, thus, contributing to the circulation of wild-type measles. The effectiveness of immunization programs in resource-poor settings can be influenced by factors such as the coverage of the health network, the existence and quality of outreach service, the quality of the cold chain, the liaison of communities with health services, the existence of population movements, and several other factors that are related to the vaccines in use, to health services or to communities. The relative effect of each one of the above factors may significantly vary according to geographical areas. In this context, the understanding of local hurdles for effective immunization programs is crucial to develop and implement appropriate solutions. (Jani, et.al, 2008)
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Inadequate levels of immunization against childhood diseases remain a significant public health problem in resource-poor areas of the globe. Nonetheless, the reasons for incomplete vaccination and non-uptake of immunization services are poorly understood. Aside from the pain, health workers and officials told us that there are other reasons why women in rural areas are afraid to be immunized. These include the fear of needles and the misconception that the vaccines will either make them sterile or cause a miscarriage if they are already pregnant. We are conducting this research because we just want to know about the immunization status among children in San Jacinto. And then we just want to give some advices to the mother of a child that who is not fully immunized and explain about the important of the said vaccines. Because vaccine is very important for the child to protect them against in many diseases. And because of the Inadequate levels of immunization against childhood diseases remain a significant public health problem in resource-poor areas of the globe. Nonetheless, the reasons for incomplete vaccination and non-uptake of immunization services are poorly understood. Thats why many of them are prone to any desease within our community.

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Chapter 3 METHODOLOGY

Research Design The researcher employed descriptive-quantitative research method in this study. A Descriptive Quantitative Research Method is a study that describes the nature of phenomenon under investigation after a survey of condition that relate to the phenomenon. Descriptive studies involves analysis of extremely broad range of phenomena, its result is a comprehensive presentation and interpretation of the statistical tabulation of data yielded by the survey. This type of research answers the questions and satisfies curiosity about a certain phenomenon at the time of the study. Moreover, descriptive studies are concerned with existing conditions, its meaning and significance and then making adequate and accurate interpretations of these data with or without the aid of statistics (Tan, 2006). This research attempts to describe, interpret and analyze the Immunization Status of children under 1 year old in the Municipality of San Jacinto. Source of Data This research consisted of fifteen (15) respondent mothers who have children under 1 year old involved all barangay namely: Awai, Bolo, Casibong, Capaoay, Guibel, Imelda, Labney, Labong, Macayug, Magsaysay, Pag-asa, San Guillermo, San Jose, San Juan, San Roque, San Vicente, Sta. Cruz, Sta. Maria and Sto. Tomas with 15 respondents each mother with children under 1 year old. Using Lynch formula weve come up with 15
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respondents. The following sample size formula by Lynch and others (1972) is suggested over other available formulas found in statistic books because it yields a more adequate size when the population is small and the normal approximation of the population is poor. (Avdales, V., 2008) Instrumentation and Data Collection Instruments are specially prepared tools or devices used to collect needed data or information and facilitate observation and measurement of research variables, consistent with the purpose of the study. A Questionnaire is the most frequently used clerical research instruments to gather needed data from respondents pertinent to the purpose of the study. It is paper and pencil approach in which participants are asked to answer a set of printed question. Data and information is base on the demographic profile and perceptual assessment of the respondents regarding the variables of the study. In gathering data, the research implements the following procedures: The researchers will seek permission from the Mayor and all Barangay Chairmen in San Jacinto to allow them to conduct their survey. The researcher also took the same opportunity to make ocular visitation of the setting of the study. The researchers will prepare a questionnaire which is the instrument used in this study. It was drafted and submitted to their adviser for comments and suggestion. After the corrections, the questionnaire was improved.

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The researchers will reproduce the final copy of the questionnaire and prepared for distribution. Statistical Analysis The collected data are statistically treated by using frequency count, percentage distribution, and verbal interpretation. Percentage is computed to determine the proportion of a part to a whole such as a given number of respondents in relation to the entire population. To answer sub problem no. 1 data will be obtained from records of RHU in San Jacinto, hence frequency and percentage will be used.

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Bibliography Books Avdales, V. V. (2008). Methods of Research. Educational Publishing House. Ermita Manila. Behrman, R. E. (2004). Nelson Textbook of Pediatrics Seventeenth Edition. Cuevas, F.R L. et al. (2007). Public Health Nursing in the Philippines. Edition. Philadelphia: Lippincott Williams and Wilkins. Edition. Singapore: Elsevier Mosby Inc. Encyclopedia. China: Trident Press International. Engelkirk, P. G. (2008) Burtons Microbiology for Health Sciences (8th Edition). Reprint Authorized by; Lippincott Williams and Wilkins. Hatfield, N. (2003). Broadribbs Introductory Pediatric Nursing. Philadelphia: Hockenberry, M. J. (2005). Wongs Essentials of Pediatrics Nursing Seventh Lippincott Williams and Wilkins. Manila: National League of Philippine Government Nurses Inc. Philadelphia: Elsevier Mosby Inc. Porth , C. M. (2002). Pathophysiology Concepts of Altered Health States Sixth Quezon City: Gentess Printing Press. Reyes-Bailon, S. G. (2006). Community Health Nursing The Basic of Practice. Published by: National Bookstore. Samson, R.F. (2007). Vaccination & Its importance. Missouri: Prentice Hall Publishing. Schneider, M.J. J. (2011). Introduction to Public Health (3rd Edition). Published by Jones and Bartlett Learning. Tan, C. B. (2006). A Research Guide in Nursing Education Third Edition. Wagman, R. J. (2006). The New International Standard Medical and Health

Stand-alone Web document

Unicept and Who. (2011). from http://www.unicef.org/immunization/index_coverage.html

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Journal article, Internet-only journal Barromeo, M., & Garcia, L.G. (2007). Project Eliminate MNT. Retrieved October 10, 2012, from http://www.unicef.org/Philippines/realives_18717.html Jani, J., De Schacht, C., Jani, I., & Bijune, G. (2008). Risk Factors for incomplete vaccination and missed opportunity for immunization. Retrieved October 10, 2012, from http://www.ncbi.nlm.hih.jou/bme/articles/ PMC 2405792 Wolfson, Lara J. et al. (2008). Estimating the costs of achieving the WHOUNICEF Global Immunization Vision and Strategy. Retrieved October 25,2012, from
http://www.who.int/bulletin/volumes/86/1/07-045096.pdf.

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Dear Respondents, Greetings! We, the level IV nursing students of Escuela de Nuestras Seora De lasalette are conducting a study entitled IMMUNIZATION STATUS OF CHILDREN UNDER 1 YEAR OLD IN SAN JACINTO PANGASINAN The purpose of this study is to determine the Immunization status of children under 1 year old in San Jacinto. In line with this, we have chosen you as one of our respondents. Please answer the following questions as honestly as possible. We assure you that the data that will be collected will remain confidential. Your response will help us in pursuing our research study. Your response will be highly appreciated. Thank you! More power and God bless you!

Sincerely yours, The Researchers

Approved by: ______________________________________

Thesis Adviser

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Questionnaires Part I. Kindly specifies what those vaccines were given to immunized child under 1 year old by putting a check on each acquired vaccine. Immunization: BCG DPT1 OPV1 Hepa.B1 MEASLES Part II. Direction: Please answer the following questions by putting a check mark ( / ) on the appropriate column corresponding to your option using the scale below. Arbitrary Value 5 4 3 2 1 Descriptive Rating Strongly Agree (SA) Agree (A) Neutral (N) Disagree (DA) Strongly Disagree (SD) DPT2 OPV2 Hepa.B2 DPT3 OPV3 Hepa.B3

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FACTORS
1. Lack of time 2. Lack of knowledge 3. Lack of information dissemination 4. Home distance from RHU 5. Unavailability of health resources (e.g. health personnel, facilities) 6. Others please Specify________________.

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