MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH MANYVANH VONGSY KNOWLEDGE AND PRACTICE REGARDING THE ADNINISTRATION OF THE PENTAVALENT VACCINE AMONG HEALTH CARE WORKER IN VIENTIAN CAPITAL, LAO PDR, 2019 MASTER OF PUBLIC HEALTH CODE: 8720701 HANOI, 2020 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH MANYVANH VONGSY KNOWLEDGE AND PRACTICE REGARDING THE ADNINISTRATION OF THE PENTAVALENT VACCINE AMONG HEALTH CARE WORKER IN VIENTIAN CAPITAL, LAO PDR, 2019 MASTER OF PUBLIC HEALTH CODE: 8720701 SUPERVISOR: VANPHANOM SYCHAREUN, MD, PhD DEAN OF THE FACULTY OF PUBLIC HEALTH UNIVERSITY OF HEALTH SCIENCE MINISTRY OF HEALTH VIEANTIANE, LAO PDR HANOI, 2020 i ACKNOWLEDGEMENTs This independent study would not have been possible without the help and support of many people. I am very thankful to the Ministry of Health of the Lao PDR, the LEARN project, the University of Health Science (UHS), and the Hanoi University of Public Health (HUPH) for funding and providing support during my period of study at the UHS in Laos and the HUPH in Vietnam. The help of the Xaythany District Hospital is also gratefully acknowledged for allowing me to study at the UHS and the HUPH. My sincere and deep gratitude goes to my advisors Dr.
Vanphanom Sychareun, PhD (Dean, Faculty of Public Health of Laos), and Dr. Do Thi Hanh Trang, PhD (Department of Disaster Management, Faculty of Environmental and Occupational Health Hanoi University of Public Health) for their valuable advice, as well as their constant supervision and encouragement throughout the challenging time of completing my dissertation. I would like to express my sincere gratitude to Dr. Kongmany Chaleunvong for his kind suggestions and valuable comments with respect to data analysis.
I would like to acknowledge the valuable comments and encouragement from Prof. Bui Thi Thu Ha who was the examination chair of my Independent Study Committee. I wish to thank Dr. Nguyen Ngoc Bich, and Dr.
Alongkone Phengsavanh, who were members of the study committee I am most grateful to the headmaster, teachers and students of Vientiane High School who kindly accepted to help and participate in this research. This study could not have been completed without their generous assistance. I am grateful to all the lecturers, teachers, coordinators and all staff of the UHS and the HUPH for their continuous assistance and helpful advice. ii I would like to thank my classmates for their kindness during the period of my studies at the UHS and the HUPH.
Finally, I would like to thank my family for their love, understanding, support, and encouragement during the time I studied at the UHS and the HUPH. Manyvanh VONGSY iii Contents ACKNOWLEDGEMENTS. i LIST OF TABLES. 3 CHAPTER 1: LITERATURE REVIEW.2 Situation of pentavalent immunization in Laos and the world .3 Knowledge and practice among health care workers and their importance .4 Determinants of knowledge and practice regarding child immunization.
22 Quantitative data collection. 22 Qualitative data collection .8 Measures for outcomes. Background information of participants.2 Description of knowledge .1 Knowledge of possible precautions and contraindications to vaccinations .2 Knowledge of health care workers on doses and routes of administration .3 Knowledge of health care workers on time of vaccine administration .4 Knowledge of health care workers on side effects of the pentavalent vaccine 35 3.5 Overall knowledge of health care workers regarding children’s immunization .3 Description of practice .1 Practice relating to preparatory steps.2 Practice relating to general vaccine measure .3 Practice relating to specific measures for the pentavalent vaccine .4 Overall vaccination practice of health care workers .4 Association of knowledge and practice of HCWs regarding the pentavalent vaccine .5 Determinant of knowledge regarding the pentavalent vaccine .1 Association between individual factors and knowledge .2 Association between organization factors and knowledge .6 Determinant of practice regarding the pentavalent vaccine .2 Association between organization factors and practice.7 Multivariate logistic regression analysis of factors associated with a knowledge of the pentavalent vaccine .8 Multivariate logistic regression analysis of factors associated with the practice. of the pentavalent vaccine………………………………………………………….
69 v Abbreviations and Acronyms AEFI Adverse Events Following Immunization CDC Centers for Disease Control and Prevention DTP3 Diphtheria-Tetanus-Pertussis three-in-one vaccine EPI Expanded Program on Immunization Hib B Haemophilus influenzae Type B Hep B Hepatitis B HCWs Health Care Workers HCPs Health Care Providers PHCPs Primary Health Care Providers PCU Primary Care Unit SDG Sustainable Development Goal VRE Vaccine safety Related Event vi List of Tables Table 3.1 Socio-demographic characteristics of participants………………………29 Table 3.2 Work related experiences of participants ….3 Knowledge of possible precautions and contraindications to vaccinations …………………………………………………………………………………….1 Knowledge of health care workers on doses and routes of administration .2 Knowledge of health care workers about the time for vaccine administration………………………………………………………………………34 Table 3.3 Knowledge of health care workers about side effects……….5 General vaccine measures……………………….6 Specific measures for the pentavalent vaccine……………………….7 Association of knowledge and practice of HCWs regarding the pentavalent vaccine ………….8 Socio-demographic characteristics associated with a knowledge regarding the pentavalent vaccine.9 Association between organizational factors and knowledge.10 Socio-demographic characteristics associated with the practice of the pentavalent vaccine.11 Association between organizational factors of practice.12 Multivariate logistic regression analysis of factors associated with knowledge and the pentavalent vaccine ………………………………………….13 Multivariate logistic regression analysis of factors associated with the practice of the pentavalent vaccine …………….1 Overall knowledge of health care workers regarding children’s immunization…………….2 Overall vaccination practice of HCWs……………………….………41 viii Abstract The pentavalent vaccination is an essential, cost-effective public health measure to reduce preventable, premature, child mortality and childhood morbidity. The pentavalent vaccination contributes to lowering the spread of vaccine-preventable diseases. Health care workers’ knowledge and practices with the use of the pentavalent vaccination are influential factors in preventing pentavalent vaccine failures. One of the main reasons parents accept immunization for their children is that it is recommended by health care providers.
This fact underlines the important role of health care providers in increasing parents’ confidence in immunization by dealing with their concerns, answering their questions and convincingly resolving their doubts. The aim of this study is to assess the knowledge and practice of providing pentavalent vaccines and their related factors among health care workers This was a cross-sectional analytical study, using the mixed-method approach that combines qualitative and quantitative methods. This study was conducted in nine district hospitals and 33 health centers in Vientiane Capital. In total, 184 health care workers were involved in the study and 12 HCWs were involved in the in-depth interviews.
The quantitative data was entered using the EpiData programme and analyzed using the Stata 14. Descriptive and inferential statistics were applied to determine the factors associated with the knowledge and practice of pentavalent vaccines. A thematic analysis was applied for the qualitative data. From among the 184 respondents, the results showed that under two thirds of them (63.3%) had a poor knowledge of the pentavalent vaccine and that slightly less than two thirds of health care workers (65.7%) had a good practice of the pentavalent vaccine.
The findings from the in-depth interviews which were also supported by the quantitative method showed that the HCWs in this study had a poor knowledge of the side effects of pentavalent vaccines as they had incorrect answers about the severe side effects of pentavalent vaccines such as analphylactic shock and the loss of appetite after receiving the pentavalent vaccine. ix Factors significantly related to a knowledge of pentavalent vaccines included HCWs who received (or did not receive? This seems unusual) training related to vaccines who were nearly three times more likely to have a risk of low knowledge (AOR=2. There were no factors significantly associated with the practice of the pentavalent vaccine among HCWs. The study also found that all participants on the supply side suggested that training would be the first option to improve the health staff’s competency, improved knowledge and the practice of immunization.
The data from this research indicated that more than half of the health care workers had a low level of knowledge about the pentavalent vaccine, while the vaccination practice level of the studied health care workers was good. The knowledge score was higher among midwives compared to other HCWs. The attainment of higher education was a better predictor of knowledge and practice among health care workers. The work experience of HCWs was also linked to improved knowledge and practice.
Training related to vaccines was an important factor associated with the knowledge and practice of HCWs. This study field requires more efficient training and continuous education for health care workers in the field of immunization. Therefore proper training and professional advice are important to increase the knowledge and confidence of vaccination use among HCWs. Keywords: Pentavalent vaccine, health care workers, knowledge and practice 1 Introduction The pentavalent vaccination is an essential, cost-effective public health measure to reduce preventable, premature, child mortality and childhood morbidity, and contributes to lowering the spread of vaccine-preventable diseases (Sychareun, Rowlands, Vilay, Durham & Morgan, 2019; Xeuatvongsa, Hachiya, Miyano, Mizoue & Kitamura, 2017).
During 2010-2016 immunization coverage rates in Laos in- creased steadily for the Diphtheria-Tetanus-Pertussis three-in-one vaccine (DTP3) from 74% to 82%. However, compared to other countries with similar income levels the coverage in Laos is much lower (Phoummalaysith et al. The prevalence of vaccine-preventable diseases is high in the Lao PDR. For example, diphtheria outbreaks have been reported in the last decade (Black et al.
Between October and mid-December 2012, the National Centre for Laboratory and Epidemiology (NCLE) reported 93 suspected cases of diphtheria, including six deaths, from the Xamtai and Huameuang districts, Houaphan province (Nanthavong et al. The pentavalent vaccine coverage in Laos for the first dose in 2017 was 72.5%, while the second dose was 67.2% and the third dose was 60.8%, However, the coverage of the pentavalent vaccine in Vientiane Capital for the first dose was 76.6% for the second, and 68.3% for the third (Lao Statistics Bureau, 2018). Health care workers’ knowledge and practices in immunization, especially the pentavalent vaccine are influential factors in preventing vaccine failures (El Shazly, Khalil, Ibrahem & Wahed, 2016). One of the main reasons for parents to accept pentavalent immunizations for their children is the recommendations given by health care providers.
This fact underlines the important role of health care providers in increasing parents’ confidence in immunization by dealing with their concerns, answering their questions and convincingly resolving their doubts (Schuler et al. The health care provider’s recommendation is the most consistently cited factor associated with vaccine acceptance and uptake, even among parents and patients with negative vaccine attitudes. Understanding the gaps in knowledge and factors associated with vaccine provider practices may contribute to the development 2 of interventions to improve vaccine recommendations and ultimately immunization coverage rates (Dempsey et al. The intensification of immunization programmes has contributed to a significant decline in the infant mortality rate in the last few years, but there is still a lack of knowledge regarding immunization among health workers.
Adequate knowledge and practices in vaccination are important to keeping the potency of vaccines and the effectiveness of immunization (Swarnkar, Baig, Soni, Shukla & Ali, 2016). Therefore, health workers are grassroot agencies for immunization in rural and urban populations. An inadequate knowledge of vaccinations and their incorrect administration may reduce the potency of vaccines and lead to adverse effects also. So, it becomes important to understand the knowledge level and practices of this huge workforce regarding the important mission of preventing diseases with vaccines (Swarnkar et al.
There is limited research evidence both published and unpublished about the knowledge and practice of the pentavalent vaccine by health care workers. Therefore, the aim of this study is to assess the knowledge and practice of pentavalent vaccine administration and its related factors among health care workers.