Predictors of childhood immunization completion in a rural population
Introduction
Immunization with vaccines provides protection from infectious diseases, including some that are potentially life threatening. Epidemiological investigations of recent outbreaks of vaccine preventable diseases have indicated incomplete immunization as a major reason for the incidence of these diseases. In the United States, the incidence of mumps, diphtheria, tetanus, pertussis, measles, and poliomyelitis has declined by more than 97% in the last few decades as a result of vaccines (Orenstein, 1992). The decline in these vaccine preventable diseases has correlated strongly with rising rates of immunizations in school-age children. Health statistics suggest immunization rates are 95% or more in school-age children which have been primarily attributed to school immunization laws in each state (Hinman, 1988). Because all states require up-to-date immunizations for day care or school entry, the vast majority of school-age (5–6 years of age) children are fully immunized. However, the same is not true for children who do not go to day care, or preschool children (less than 5 years of age), a large portion of whom are not adequately immunized on time. A survey conducted in March 1992 by the West Virginia Immunization program indicated that, at the second birthday, only 48.2% of the children had completed the recommended primary series of immunizations (4 DTP, 3 OPV, and 1 MMR). Furthermore, immunizations were significantly lower at eighteen months with only 26.5% of the children achieving the desired immunization status. Thus, low immunization coverage in children under two years of age has been a serious problem and public health concern in the state of West Virginia.
Section snippets
Significance of childhood immunization
Despite the extent of state, federal, and private efforts to increase childhood immunization rates, much needs to be done to achieve the Healthy People 2000 goal of 90% immunization coverage in children before age two. Childhood immunizations are recommended because, despite the decline in the incidence of infectious diseases, these diseases still exist and can be potentially life-threatening. In the measles epidemic from 1989–1991 there were 55,000 reported cases, 11,000 hospitalizations, and
Childhood immunization barriers
Low immunization coverage indicates the existence of important barriers in the immunization delivery process. To investigate and catalog the barriers to childhood immunization, the Institute of Medicine conducted a workshop in December, 1993 titled, ``Overcoming Barriers to Immunization'' (Institute of Medicine, 1994). This workshop reviewed past studies and made recommendations on the basis of the workshop presentations and discussions. Childhood immunization barriers that were identified at
Immunization as a preventive health behavior
Preventive health behavior has been defined as ``any activity undertaken by a person who believes himself to be healthy for the purpose of preventing disease in an asymptomatic stage'' (Kasl and Cobb, 1966). Childhood immunization is a preventive health behavior that is directed toward the child by the parent. In this sense, childhood immunization behavior can be defined as a preventive child health behavior in which the parent gets the child immunized for the purpose of preventing infectious
Hypothesized study model
Based on the previously mentioned information, a model was hypothesized to explain immunization completion on the basis of immunization barriers. In addition, the model was also used to test inter-relationships among the various immunization barriers and the direct and indirect effects of immunization barriers on immunization completion. It was hypothesized that mothers' perceived clinic support and attitude towards immunization would directly affect immunization completion. Furthermore, it was
Study objectives
The specific objectives of this study were as follows:
Methods
The study sample consisted of mothers of two-year old children from 18 rural counties in rural West Virginia. The study sample was identified from a birth record file (matched with death record files to screen and remove records of deceased children) obtained from the West Virginia Birth registry for 1992 which represented 99.99% of all births in West Virginia for the year 1992. The 18 rural counties were selected as they were designated rural according to the US Census data, and because they
Statistical methods
The trends in the extent of time taken to complete the various sets of immunizations in the 4DTP:4HIB:3Polio:1MMR series were graphically analyzed. Percent completion of each of the immunizations in the series were also calculated to determine the utilization pattern of the various vaccinations. Furthermore, immunization completion was calculated by counting the number of immunizations the child has had in the last 2 years with the maximum being 12 (4 doses of the DTP vaccine, 3 oral polio
Results
A total of 316 usable responses, 269 using the telephone survey and 47 using the mail survey were obtained and used for data analysis. Prior to data analysis, a survey response analysis was performed.
Discussion
This study investigated the problem of childhood immunizations from a socio-behavioral perspective. The results are significant in terms of obtaining an understanding of the behavioral processes underlying mothers' childhood immunization-seeking behavior. Childhood immunization is a preventive health behavior that is directed toward the child by the parent. Several frameworks have been posited by researchers to study preventive health behaviors in an attempt to influence it (Becker and Maiman,
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