Knowledge, attitudes, and practices (KAP) of vaccinators in government health clinics in Khayelitsha

Kwaw, William Bangoto (1999-12)

Assignment (MPA) -- University of Stellenbosch, 1999.

Thesis

ENGLISH SUMMARY: Immunization against the major killer diseases of childhood: measles, polio, diphtheria, whooping cough, tetanus, hepatitis B and tuberculosis remains the most cost effective, health intervention presently known. Immunization is the most precious gift that a health 'worker can give to a child. However there are times when a child who needs vaccination visits a health facility but is not immunized by the health staff a missed opportunity. Though reasons such as non-availability of vaccines and lack of integration of services can be blamed, more important reasons are misconceptions about contra-indications and provider failure to administer vaccines simultaneously. important in peri-urban squatter This is particularly settlements where immunization coverage tends to be low. the time has come to fill in the gap It is felt that that is to research an important forgotten link in the immunization chain - the vaccinator who is in an manage the immunization process marginalised areas. ideal position to in previously All vaccinators in government health Khayelitsha (a total of 40) were surveyed. obtain information on knowledge, attitudes clinics in This was to and practice concerning vaccination in order to plan an appropriate health intervention programme such as focused retraining with view to improving immunization services in the area. The response rate was 82.5%. Important findings included the following: 84.8% were registered professional nurses; 54.5% had 5 or more years experience in vaccinating children; the majority (90.9%) knew the routine immunization Department of Health: children while only schedule recommended by the 93.9% knew the measles policy for 15.2% knew the tetanus policy for mothers: important misconceptions and myths about. contraindications to vaccinations were· found in typical clinical situations; 97% received supervision from senior professional nurses of which 63.5% worked in the same clinic: performance feedback (45.5%) was the most popular method used by supervisors to upgrade skills of vaccinators; important job problems included staff shortages (75.8%), mothers not bringing children to clinic (63.3%), lack of supplies (27.3%) and training (18.2%), lack of integrated one stop service (27.3%): 48.5% had plans in place to learn about newborns or new immigrant children: 21.2% kept a register of all children in catchment areas: 30.3% routinely calculated drop-out rates however none could quote last figure calculated; all. (100%) participated in suggesting reasons to explain why some children may not receive vaccinations at the correct age and 93.9% contributed ideas towards improving immunization coverage in the area. It was found that the vaccinator wants to be an active participant in the immunization policy process. Recommendations for improved vaccination services in the area are the following: - Provision of immunisation at every health care contact. - Colour coding of vaccination schedule to make it more useful to illiterate mothers. Provision of information preferably in the mother tongue of the target population - for a more meaningful participation in the immunisation policy process. - Implementation of a one-stop-shop clinic concept where all promotive and preventive immunisation curative and rehabilitative services are provided. - Implementation of the child-to-child concept to help in identifying new immigrant children and in tracing immunization drop outs. This will ensure that children become active partners in their own health promotion and care. - Greater use of conventional media (radio, television and opinion leaders (including traditional healers to convey immunisation messages and to motivate parents. - Organization of workshops and seminars (as short term measure) aimed at addressing misconceptions and myths concerning contra-indications to immunisation. Inclusion of courses (as long term measure) in curricula of nursing training institutions to equip nurses to be effective vaccinators before graduation. - Greater advocacy role by vaccinators, to ensure that the immunisation policy agenda is firmly placed within the general framework of the human development process. This will ensure that more resources are committed for immunisation of children.

AFRIKAANSE OPSOMMING: Immunisasie teen die hoof kindersiektes: masels, polio, difterie, kinkhoes, tetanus, hepatitis B en tuberkulose bly steeds die mees koste-effektiewe gesondheidsintervensie tans bekend. Immunisasie is die kosba'arste geskenk wat 'n gesondheidswerker aan 'n kind kan gee. Tog is daar dikwels geleenthede waar kinders wat immunisasie benodig gesondheidsinstellings besoek maar nie die nodige vaksienasies ontvang nie -'n verspeelde geleentheid. Alhoewel redes soos niebeskikbaarheid van vaksienes en 'n tekort aan integrasie van dienste dikwels die 'blaam kry, is meer belangrike redes die wanopvattings oor kontra-indikasies en vaksienes wat nie op dieselfde tyd toegedien word nie. Hierdie aspek is veral belangrikin peri-stedelike plakkerskampe waar immunisasiedekking geneig is om laag te wees. Die tyd om hierdie leemte te vul het aangebreek en dit sluit in om navorsing oor die belangrike vergete skakel in die immunisasie ketting - die toediener van die vaksienes te doen. Hierdie persoon is in die ideale posisie om die immunisasieproses in gemarginaliseerdse areas te bestuur. Alle immuniseerders in staatsgesondheidsklinieke in Khayeli tsha (totaal van 40) is by die studie ingesluit. Die doel was om inligting te bekom oor die kennis, benadering en praktyk van immunisasies, met die oog daarop om voldoende gesondheidsintervensie programme daar te stel deur heropleiding, ten einde immunisasiedienste in die area te verbeter. 82.5% response is bekom. Belangrike bevindinge sluit die volgende in: 84.4% was geregistreerde professionele verpleegsters, 54.5% het meer as 5 j aar ondervinding in die immunisasie van kindersi die meerderheid (90.9%) was bekend met die roetine immunisasie skedule soos voorgestel deur die Departement van Gesondheidi 93.9% was bekend met die maselsbeleid vir kinders terwyl slegs 15.2% bekend was met die tetanusbeleid vir moedersi belangrike wanopvattings en mites oor kontra-indikasies ten opsigte van immunisasies is gevind in tipiese kliniese situasiesi 97% was onder toesig van senior professionele verpleegsters, waarvan 63.5% in dieselfde kliniek werki terugvoer is die mees gewilde metode gebruik deur toesighouers om die vaardigheidsvlakke van die immuniseerders op te gradeer (45.5%) i belangrike werksprobleme sluit in: personeel tekort (75.8%), kinders wat nie na die kliniek gebring word nie (63.3%) , voorraadtekorte (27.3%), onvoldoende opleiding (18.2%) en tekort aan geintegreerde eenstop-dienste (27.3%) i 48.5% het planne in plek gehad om meer te wete te kom oor pasgebore babas. en immigrasie kinders i 21.2% hou rekord van aIle kinders in hul dreineringsgebied, 30.3% bepaal uitvalkoerse as roetine aktiwiteit, alhoewel niemand die laaste berekening hieroor kon weergee nie; almal (100%) het redes voorgestel waarom kinders nie die immunisasies op die regte ouderdom kry nie en 93.9% het idees bygedra oor hoe om immunisasiedekking in die area te verbeter. Die studie het bevind dat die immuniseerder 'n aktiewe deelnemer wil wees in die proses van beleidvorming rondom immunisasie. Voorstelle ter verbetering van immunisasiedienste in die omgewing is die volgende: Voorsiening vir immunisasie by elke gesondheidsorg geleenthied. - Kleurkodes vir vaksienasie skedules om dit meer gebruikers vriendelik te maak vir moeders wat nie kan lees nie. - Inligting moet beskikbaar wees in die moeder taal, van die teikengroep, ten einde sinvolle deelname aan die immunisasie - beleidsproses te verseker. Die daarstelling van n een-stop kliniek konsep waar alle promosie en voorkomende immuniserings-, kuratiewe en rehabiliteringsdienste beskikbaar is. - Implementering van 'n kind-tot-kind konsep om nuwe immigrant kinders te help identifiseer en uitvallers op te spoor. Dit sal verseker dat kinders aktiewe vennote in hul eie gesondheidsbevording en -sorg word. - Beter gebruik van media (insluitende tradisionele boodskap oor te dra, en kinders te immuniseer. (Radio, televisie) en leiers helers om die immunisasie ouers te moti veer om hulle Organisering korttermyn· wanopvattings van werkswinkels en maatreel) wat daarop seminare gemik is en mites oor kontra-indikasies immunisering uit die weg te ruim. (as om tot - Insluiting van kursusse (as langtermyn maatreel) in die kurrikula van verpleegopleidingsinstellings ten einde verpleegters toe te rus om voor graduering reeds effektiewe immuniseerders te wees. - 'n Groter bewusmakingsrol vir immuniseerders, ten einde te verseker dat die immuniseringsbeleidsagenda geplaas word binne die raamwerk van die menslike ontwikkelingsproses. Di t sal verseker dat meer hulpbronne toegewys word vir immunisering van kinders.

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