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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 17-22

Parents' knowledge, attitude, and practice toward seasonal influenza vaccination of primary school children in Buraidah City, Qassim in 2018–2019


1 Medical Intern, College of Medicine, Qassim University, Buraydah, Saudi Arabia
2 Associate professor of Anatomy and Histology, College of Medicine, College of Medicine, Qassim University, Buraydah, Saudi Arabia
3 Assistant Professor of Physiology, College of Medicine, Qassim University, Buraydah, Saudi Arabia

Date of Submission26-Dec-2020
Date of Decision06-Apr-2021
Date of Acceptance27-Apr-2021
Date of Web Publication07-Feb-2022

Correspondence Address:
Rahaf Khalid Alqarzai
Medical intern, College of Medicine, Qassim University, Buraydah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_172_20

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  Abstract 


Introduction: Influenza viruses cause seasonal influenza which is an acute respiratory infection. The WHO reported that annually, there are about 290,000–650,000 deaths worldwide due to seasonal influenza. Vaccination is one of the most effective ways to prevent seasonal influenza and despite the high recommendation and the proven effectiveness of seasonal influenza vaccines in children, still, there is hesitancy and refuse among children's parents. Objective: This study assesses the parents' knowledge, attitude, and practice toward children's seasonal influenza vaccines (knowledge, attitude and practices). In addition, it aims to figures out solutions to increase awareness toward seasonal influenza vaccines. Methods: This study targets the parents of primary school children aged from 7 to 12 years who live in Buraidah. On 800 sample size, we used cluster random sampling. Self-administer hard copy questionnaire has been distributed. Results: The result shows that there is a significant association between the gender and receiving of flu vaccine P = 0.006, and the most common barrier prevents patents to vaccinate their children was because of their thoughts about its potential side effects 20.2%. Furthermore, there is no relationship between the educational level and the knowledge about seasonal influenza vaccination benefits P = 0.483614. In addition, a great proportion of our participants trust the information given to them by the Saudi Ministry of health and by their doctors 95.5% and 94.2%, respectively. Conclusions: We suggest increasing the effort in awareness campaigns and find a solution to correct the misconception and limits the rumors to increase the number of influenza vaccine uptake.

Keywords: Children, influenza, vaccine


How to cite this article:
Alqarzai RK, Almaghyuli LM, Alolyan SA, Alharbi FM, Aljehani EK, Mohamed DA, Kamal MM. Parents' knowledge, attitude, and practice toward seasonal influenza vaccination of primary school children in Buraidah City, Qassim in 2018–2019. J Nat Sci Med 2022;5:17-22

How to cite this URL:
Alqarzai RK, Almaghyuli LM, Alolyan SA, Alharbi FM, Aljehani EK, Mohamed DA, Kamal MM. Parents' knowledge, attitude, and practice toward seasonal influenza vaccination of primary school children in Buraidah City, Qassim in 2018–2019. J Nat Sci Med [serial online] 2022 [cited 2023 Feb 9];5:17-22. Available from: https://www.jnsmonline.org/text.asp?2022/5/1/17/337375




  Introduction Top


Influenza viruses cause seasonal influenza which is an acute respiratory infection. It is spread all over the world as defined by the World Health Organization (WHO). It is well known that flu season differs from year to year, and also the virus can influence people in a different way.[1] WHO reported earlier influenza starts and peaks than each previous season. Its morbidity ranges from mild to severe and even death could occur. Annually, about 290,000–650,000 deaths worldwide due to seasonal influenza.[1]

Based on worldwide surveillance systems and the assumption of the strains that most likely would circulate, the WHO recommends the composition of influenza vaccines at 1973, they also provide another recommendation for the northern and southern hemispheres in 1999. A second influenza B strain was inserted in 2013 in the WHO recommendations, this allowed countries to decide either a trivalent or a quadrivalent influenza vaccine would be recommended.[2]

Vaccination is one of the most effective ways to prevent seasonal influenza. Children from 6 months and older should get a flu vaccine every year as the Center for Disease Control and Prevention recommended.[3] Despite the high recommendation and the proven effectiveness of seasonal influenza vaccines in children,[4],[5] still there is hesitancy and refuse among children's parents.[6],[7] Therefore, it is necessary for health educators to understand the factors affecting parents' thoughts about vaccines since parents' attitudes about vaccines have a high association with rates of childhood vaccination.[8]

Unfortunately, few studies have been done to estimate the parents' knowledge, attitude, and practice knowledge, attitude, and practices (KAP) toward children seasonal influenza vaccines. So, this study aimed to assess the parents' KAP toward children seasonal influenza vaccines.


  Literature Review Top


There are many causes to explain the parent's negative attitude toward seasonal influenza vaccines. For example, one previous study had been done among 456 children parent's in South India showed lack of doctors' recommendation is the most common reason.[7] Another study in Singapore mentioned that vaccination knowledge and willingness were high in some parents' population, but children influenza vaccine uptake was still low. They recommended that healthcare provider engorgement is one of the most effective ways to improve vaccines uptake.[9] However, a national study in Saudi Arabia showed that 90% of their participants are convinced that vaccines are not safe because of their adverse effect.[10]

Also, influenza vaccination hesitancy was assessed in King Abdulaziz Medical City in Riyadh. This study was reported that 17% of all their participants only refused the vaccination due to their believing in the vaccine's ineffectiveness and unreasonably.[11]

It was documented that there is an association between household income and the uptake of seasonal influenza vaccines.[12] A study has been done in Puerto Rico during 2013–2014 influenza season showed limited access to vaccination, no need for vaccination and vaccination safety matters play a major role among the unvaccinated participants.[8]

Moreover, there was an Indian study among corporate employees that reported that the knowledge and attitude could be improved by a qualified awareness program for the population particularly, parents.[13]

Nevertheless, despite these great number of studies about influenza vaccination, there is lacking in the assessment of influenza vaccination among the Kingdom of Saudi Arabia children. And to assess parents' perspective towards seasonal influenza vaccine as they are the primary caretaker of their children, we conducted a cluster-randomized controlled study with a larger sample size to closely approximate the population aiming to understand what demographic data turns parents aside vaccinated their children and what misconceptions about influenza vaccination are often cited by concerned parents in Buraydah region.


  Research Methodology Top


Study design

This study is a cross-sectional study (prevalence study).

Study area

Parents have been selected randomly from seventeen different primary schools in Buraidah which is the largest city in the Qassim region with an area of 1291 km2.

Study population and sampling

This study targets the parents of primary school children aged from 7 years to 12 years who lives in Buraidah. We used cluster random sampling to represent parents of 68,136 students in primary schools in Buraidah city.

Sample size and selection of sample

By using the equation n = Z2pq/d2 and with a margin of error set as 5%, a confidence level of 95%. The result was around 400. After that, we multiplied the result by the design effect. Eventually, the sample size was 800.

After obtaining ethical approval from the Local Committee for Research Ethics in the Qassim region, all primary schools were listed and randomized by computer statistical software. Overtly, eight schools were chosen two schools from each cluster. Unfortunately, only 420 questionnaires had been filled. For that reason, we had to randomize and reselect additional nine schools. Finally, we obtained 801 questionnaires.

Source of data

The self-administer hard copy questionnaire was filled by parents of primary school children in selected schools in Buraidah city.

Method for data collection

Self-administer hard copy questionnaire had been distributed and the questions in the survey were adapted from two different previous studies [Appendix 1].[11],[14] The questionnaire includes 4 sections: The first part involves the demographic data of the parents, the second section which includes the general health of the selected child and the last two sections which evaluate KAP of parents toward childhood immunization and the effect of awareness campaigns that have been done by the Ministry of Health on parents' attitude toward seasonal influenza vaccines. Informed consent was included in the questionnaire.



Data analysis

After obtaining and sorting all data, the data were subjected to statistical analysis by using the Statistics Package for the Social Sciences version 25 Corporate headquarters 1 New Orchard Road Armonk, New York 10504-1722, United States. For all categorical data, frequencies and percentages were used. Associations between variables and the parents' KAP toward seasonal influenza vaccination were done using the Chi-square test. Seven items Likert scale and summed scores were used for each participant to determine the knowledge level. Statistical differences between participants regarding their knowledge about seasonal influenza vaccination benefits were done with one-way of ANOVA test. Statistical significance was set at P ≤ 0.05.

Ethical consideration

Ethical approval was granted by Regional Committee of Bio-Ethics (REC) in Qassim region to conduct this study. Research intentions was explained, and participation was voluntary after obtaining a written informed consent.


  Results Top


This study aimed to evaluate the parents' knowledge, attitude, and practice toward seasonal influenza vaccination for their children at primary school in Buraidah city.

This study was applied to 801 parents, most of them were male 465 (58.9%) and 325 (41.1%) were female. The age distribution showed that parents between 35–44 years old are 404 (50.4%), and 161 (20.1%) parents were between 25–34 years old, about 156 (19.5%) parents were between 45–55 years old. The rest were older than 55 or younger than 24 (6.2%) and (3.7%), respectively [Table 1].
Table 1: Demographic characteristics of the study participants

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When they were asked about their educational level, 197 (25.3%) individuals completed their primary and intermediate education. Furthermore, 197 (25.3%) had completed their high school education, whereas the majority 385 (49.4%) had finished their higher education. Most of the participants have more than three children 499 (62.3%), 164 of them have three children (20.5%), 95 have two children (11.9%), while 43 (5.4%) have only one child [Table 1].

Among all the participants 45 have a child with asthma, 7 participants have a child with diabetes mellitus and 17 individuals have a child with other diseases.

When testing multiple factors that associated with taking the influenza vaccine before it was found that there is a significant association between the gender and receiving of flu vaccine, where significantly more females (72.2%) reported that their children did not receive flu vaccine than males (62.9%) (P = 0.006). On the other hand, the age factor is about to be significant (P = 0.073). The other factors show no significant association [Table 2].
Table 2: Multiple factors associated with receiving a flu vaccine before

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When the participants were asked if they know what influenza is, 756 (94.7%) of them answered yes and 42 (5.3%) answered no.

735 of the participants have heard about influenza vaccines, the majority of them heard about it from awareness campaign 262 (35.6%) and media 259 (35.2%) [Figure 1].
Figure 1: Sources of information of the participants about influenza vaccines, data expressed as frequency, percentage is between parentheses

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It was found that the most common barriers that prevent patients to vaccinate their children were their thoughts about its potential side effects 80 (20.2%) and their belief that they do not need it because they are healthy 75 (18.9%), plus other barriers, as shown in [Figure 2].
Figure 2: Common barriers that prevent patents to vaccinate their children data expressed as frequency, percentage is between parentheses

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To evaluate parents' knowledge about influenza vaccine each participant was asked for how long does he or she think one shot of flu vaccine will be effective. The majority of participants 309 (42.6%) thought that it last for approximately 1 year, while 227 (31.3%) had chosen (approximately 6 months) and 60 (8.3%) of them answered (approximately five years), while 130 (17.9%) parents believed that one shot of flu vaccine would last for life.

Furthermore, the result of the one-way ANOVA test indicates that there are no significant differences between different educational levels regarding the knowledge level about seasonal influenza vaccination benefits (P = 0.483614) (F = 0.727193) [Figure 3].
Figure 3: Knowledge level about seasonal influenza vaccination benefits. Data are expressed as mean values (±1 standard deviation)

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657 (83.1%) participants were aware that the Saudi Ministry of Health gives flu vaccine for free when they were asked: Do you think that the influenza vaccine is available in Saudi Arabia for free? [Table 3].
Table 3: Questions to test participants' knowledge and confidence regarding the information and services provided by doctors and Saudi ministry of health

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And to evaluate the effect of awareness campaigns that have been done by the Saudi Ministry of Health on parents' attitude toward seasonal influenza vaccine, they were asked if they have ever heard about influenza vaccine awareness campaigns that are provided by the Saudi Ministry of Health, 579 (73.8%) answered yes while others did not hear about it [Table 3].

750 (95.5%) of the sample trust the information given to them by the Saudi Ministry of health and 734 (94.2%) trust the information given to them by their doctors [Table 3].


  Discussion Top


Understanding about influenza might be the cooperative way to adapt the preventive measures such as social distancing, seeking medical attention, and being vaccinated. Awareness toward this disease embarks the primary step in efforts to achieve its adequate control. Satisfactory knowledge about the causative agent, route of transmission, clinical symptoms, and serious complications associated aid the people to take proactive steps toward prevention and control. This study was designed to evaluate KAP towards seasonal influenza vaccination among children.[15]

Previous study raised in England recorded high rate in parents that referred major factor affecting uptake was having a serious side effects. It reported a sudden increase in uptake between the two influenza seasons, this difference probably reflects the gap between intentions and behaviors that is commonly observed across many health behaviors.[16] Another study in north-western China concluded that the occupation of the child's mother is positively correlated with his/her vaccination, possibility, but not by the occupation of father.[17] While the results of this study suggest that majority of the parents agreed that vaccinations are important to keep child's health, compliance with the vaccination schedule is very important and benefits of vaccinations exceed their harms.

At the same time, regarding suggested factors affecting the vaccination process, we found that there is no association with other factors such as, level of education, occupational state and even supposing that the child had any chronic diseases. This results in line with other studies[18] who mentioned that parental education was not significantly associated with child vaccination knowledge and attitude. However, some studies revealed an association between higher paternal educational level and higher knowledge and attitude toward child immunization.[19] In addition, one of limitations of this study is its cross-sectional design, making causal inferences difficult to draw for some of the associations could be observed.

The source about seasonal influenza vaccine of our participants showed a low percent (23.7%) from medical staff (doctors, nurses, and students), in comparison to media (TV, newspaper…etc.) which represents the most popular source of information among parents (35.2%). In the same way, the Internet could be considered as an important source of information (28.7%), this is why it is important to encourage the medical staff to spread the knowledge and awareness to parents by themselves or through the Internet. Furthermore, a relatively high percent (26.5%) have heard about vaccination from other individuals or groups. Concerning the personal-based information that could be mistaken and misleading with rises the misapprehension. Some studies revealed the main source about child vaccination was the medical staff. This finding suggests a great responsibility of medical staff (physicians and nurses) not only in giving vaccines but also in educating parents toward better health care practices.[20] Other study has shown that parents obtained vaccine information from other sources such as social media and books.[21]

In this work, there are some common causes that prevent parents from vaccinating their children were recorded. For example, some parents did not believe that their children are in need because their physical well-being and noncomplaining. While others did not receive vaccination because it was not recommended by medical staff/other. Previous study had been done among 456 children parents in South India, which showed lack of doctor's recommendation is the most common reason.[7] In contrast, the majority of our participants reported that their reason is serious side effects 80 (20.2%) happened in the previously vaccinated child. Similar national study has been done in Saudi Arabia showed that 90% of their participants are convinced that vaccines are not safe because of their adverse effect,[10] this high percentage 80 (20.2%) could be explained by the false information that propagated through the unreliable resources. The study also shows other important barriers, for instance, no positive effects or benefits gained from seasonal vaccination so there is no need to have it. In addition, some of participants said that their friends or their doctors asked them to reject it.

Knowing what actually seasonal influenza is and the benefits of taking its vaccine are obviously has a positive effect on parents' attitude and willingness to take the seasonal influenza vaccine. We assumed that the higher educational level would be the main determinant of the parents' knowledge, but surprisingly, the result shows no relation between the educational level and the knowledge of seasonal influenza and its vaccine among our study population (P = 0.483614). Furthermore, only 125 (32.6%) out of 259 participants who have higher education told that their child has received influenza vaccine before. Similar to a study carried out in Taiwan that showed only 36 (40%) of their participants with more than 13 years of education are vaccinated.[22] Previous study had been done among young workers in South China where the high educational level was one of the main determinants for the participants' willingness to continue vaccination.[23] On the contrary, it emphasized that there are other factors as gender and misconceptions have a more significant effect than the educational level in seasonal influenza its vaccine knowledge and uptake in Buraidah city.

The results showed that 95.5% of the parents trust their doctors and 94.2% trust the Saudi Ministry of Health. Hence, there is a need to increase the awareness of doctors and health providers toward influenza vaccination and its importance. In turn, they encourage the parents to vaccinate their children and correct their misconceptions and beliefs about influenza vaccines. In addition, we think that the doctors and the Saudi Ministry of Health employees should know the barriers that prevent parents from vaccinating their children so they can take action.


  Conclusions Top


In Conclusion, we look forward to increasing the number of influenza vaccine uptake by increasing the effort in awareness campaigns and find a solution to correct the misconception, and limits the rumors which are propagated through social media.

Ethical approval

The study approved by the Local Committee for Research Ethics in the Qassim region, Saudi Arabia (approval No. 20180806 on August 7,2018).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Introduction
Literature Review
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