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Original Research (Original Article) 


Mohammed Ewad Alkarim Altreyfy et al, 2019;3(11):913–919.

International Journal of Medicine in Developing Countries

Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia

Mohammed Ewad Alkarim Altreyfy1, Mohammed Saad Almalki1*, Ahmed Ibrahim Obaid1, Meshari Mushabbab Al-Ahmari2, Abdulah Mohammed Alshahrani2

Correspondence to: Mohammed Saad Almalki

*Prince Sultan Military Hospital, Taif, Saudi Arabia.

Email: mohmmed.121 [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 25 July 2019 | Accepted: 19 September 2019


ABSTRACT

Background:

Vaccination has an important preventive role for many types of infections, especially in the early years of life. However, some misconceptions about vaccination lead to the abstinence of some parents from vaccinating their children. This misconception is primarily due to the lack of knowledge and awareness toward childhood vaccination. The goal of the present study is to evaluate the level of knowledge and the behavior of parents toward the vaccination of their children in Taif city, Saudi Arabia.


Methodology:

A self-administered structured questionnaire was sent to the public through online Google forms, including questions on the knowledge about vaccination of children and the attitude of parents toward their children regarding their vaccination. All data were recorded in a pre-designed and validated excel sheet. Data were represented in terms of frequencies and valid percentages for categorical variables.


Results:

A total of 377 participants took part in this survey. Almost one-half of the participants (50.4%) were males while 49.6% were females. There was a statistically significant difference (p < 0.001) between males and females in all aspects of knowledge and attitude toward vaccination. The increased level of knowledge among females was linked to a significantly better (p < 0.001) attitude toward vaccinating their children.


Conclusion:

Awareness campaigns are very important for the public to improve their behavior toward children vaccination. Further studies are needed to explore the figures in other areas in Saudi Arabia.


Keywords:

Vaccination, MMR vaccine, parents, children, Taif city.


Introduction

The increasing utilization of vaccines had a great influence during the past two decades on morbidity and mortality [1]. In addition to reducing costs globally that could be spent in case of spreading of infections [2]. Most of the industrialized countries and few of the developed countries have powerful vaccination strategies [3]. This is mainly due to governmental efforts and good management of healthcare resources in addition to implementing a good framework that could organize the storage of vaccines as well as their distribution and utilization [4]. In spite of this, developing countries are still facing a major problem regarding this concern. This is related to the failure of these countries to apply vaccination programs for vaccine-avoidable diseases [5]. The World Health Organization has started an initiative to target these countries to solve the problem. This initiative aims at preventing diseases that could be avoided by the use of vaccines for all the communities [6]. Many trials on this investigated factors that could influence the target comprising misconceptions toward the effectiveness and safety of the available vaccines, poor knowledge of the public regarding their health, in addition to some cultural and religious barriers [7]. Moreover, some parental fears regarding the safety of vaccines, vaccination schedules, as well as multiple vaccinations remain to be the major challenges to overcome [8]. Vaccination rates have been decreasing during the past decade in the developing countries, including few countries in the Middle East [9]. This could be attributed to the wide-spreading myths about vaccination and the possibilities of causing harm [10]. These false myths, which are usually linked to cultural or religious thoughts, are becoming a major challenge for vaccination programs [11,12]. Additionally, side effects occurring from routine immunization due to poor practices may also have contributed to the emergence of decreased vaccination among people [13]. There have been a very limited number of studies that had looked into parental behavior toward childhood vaccination in Saudi Arabia [14]. Therefore, the present study aims at investigating the knowledge and attitudes of Saudi parents in Taif city, toward routine vaccination of their children.


Subjects and methods

A cross-sectional prospective study that was carried out in the College of Medicine, Taif University, Saudi Arabia. Data were collected during the period from 05-May-2019 to 25-May-2019. A total of 377 participants responded to the questionnaire. An online self-developed questionnaire was distributed, via a link to Google forms to collect the data from parents of children in Taif city. The questionnaire consisted of three major section including section on participants’ characteristics which looked into age, gender, level of education, marital status, employment status, and number of children, participants’ knowledge section comprising 14 questions on parents’ information and knowledge about vaccination in Taif, Saudi Arabia and a section that assessed the participants’ attitudes through seven questions evaluating how parents deal with their children during vaccination schedules. All data were recorded in an excel sheet. Data were represented in terms of frequencies and valid percentages for categorical variables, while mean and standard deviation were used for the numerical variable. Correlations were done using the chi-square test for categorical variables. Data were analyzed using Statistical Package for the Social Science (SPSS) Armonk, NY, USA to perform all the statistical calculations, version 21 for Microsoft Windows. Data were collected and presented anonymously. A statement was written at the beginning of the questionnaire to indicate that the data will only be used for scientific research purpose and will be kept confidential.


Results

The present cross-sectional study involved 377 parents with children living in Taif, Saudi Arabia. The questionnaire aimed at assessing the responders’ knowledge, and attitude toward childhood vaccination. Descriptive figures and statistical analysis are shown below. The questionnaire included responders from both genders with 49.6% of females and 50.4% of males. Their age groups were varying between <20 years and >65 years. Parents aged between 20 to 40 years represented 58.62% of the whole cohort. Moreover, 85.9% of the responders were Saudi and 83.5% were married. Additionally, each participant was asked about his/her number of children, and then the number was categorized into less than 5, from 5 to 10, and more than 10. Among the total subjects, 74.27% of the participants had less than 5 children. All characters are described in terms of frequencies and percent in Table 1.

Furthermore, participants were asked about their education level and their employment status. The survey found that 38.74% had secondary education, these constituted the major portion of the investigated cohort as shown in Figure 1. Also, 55.96% of the participants mentioned that they had a job, while only 6.1% were still studying as shown in Figure 2.

The first part of the questionnaire included questions related to the knowledge of childhood vaccination. The questions were mainly examining knowledge related to the administration of vaccines, their benefits, risks, religious and cultural perceptions, and vaccinepreventable diseases. The responders had to choose between five different responses from strongly agree to strongly disagree. The highest frequencies of correct answers (295 responses) were recorded in questions related to immunization of healthy children, followed by the importance of immunization with 141 responses. The lowest number of correct answers (47 responses) was recorded for question discussing the risk of autism in children due to vaccination. Moreover, responses of males and females were compared with overall knowledge questions using the chi-square test (significance p-value < 0.005). It was revealed that responses of females were significantly higher compared to their male peers with p-value < 0.001. All knowledge questions are discussed in details in Table 2.

Table 1. Characteristics of study participants.

Frequency Percent
Gender
Male 190 50.4
Female 187 49.6
Age (years)
<20 8 2.12
20–40 221 58.62
41–65 127 33.69
>65 21 5.57
Nationality
Saudi 324 85.9
Non-Saudi 53 14.1
Marital status
Married 315 83.55
Divorced 33 8.8
Widowed 29 7.7
Number of Children
<5 280 74.27
5–10 67 17.77
>10 30 7.95

Figure 1. Educational level of responders.

Figure 2. Employment status of responders.

The final part of the questionnaire comprised seven questions to assess participants' attitude toward vaccination. The responders had to choose between three different responses with Yes, No, or I don't know. Question-related to immunizing children with all obligatory vaccination schedules got the highest correct responses with 303 responders are agreeing with this statement, while question-related to infection in spite of vaccination had the worst response with only 96 responders mentioning that their children were infected with a vaccine-preventable disease. A full description of the attitude questions is described in Table 3. Responses of males and females were compared using the chi-square test at a level of significance of p-value <0.005. All the responses of the females showed a better attitude toward children vaccination compared to males with p-value <0.001.


Discussion

Vaccination is considered the best cost-effective strategy to decrease hospitalization, treatment costs, in addition to morbidity and mortality of vaccine-preventable diseases [7]. However, there are many obstacles that vaccination faces including the misconceptions on vaccines, side effects of vaccines, and vaccine-avoidable diseases [9]. Yet in the past two decades, developed countries have recorded good vaccination rates, while the developing countries recorded poor compliance of parents toward vaccinating their children [15]. The perception of parents regarding vaccination is crucial to improve the vaccination rate as well as parental compliance [5]. The most important factor influencing the behavior of parents toward their children vaccination is their knowledge about vaccination itself [8]. Previous studies have revealed that educational and training programs to improve parents’ knowledge could increase the success rates of vaccination programs in a country [1,3,7,16]. The present study is a survey cross-sectional study that aimed at investigation of parental knowledge and practices toward their children vaccination in Taif city, Saudi Arabia through an electronic self-administered survey. This could help explore the level of knowledge of parents in the city thus developing educational programs and awareness campaigns that could have an indirect positive impact on the success rates of the vaccination program in Taif, Saudi Arabia. The present found that the level of knowledge of parents in Taif is poor, especially for questions related to the myths and misconnection about vaccination such as the myth of causing Autism. Additionally, the behavior of parents was influenced by their level of knowledge. However, parents showed positive behavior when vaccination campaigns were postponed. Most the parents seek medical help immediately from their pediatrician. It is worth to mention that mothers had a better level of knowledge and behavior toward vaccination compared to fathers. Other studies have also looked into parental response toward childhood vaccination in other parts of Saudi Arabia. Alshammari et al. [9] for instance, evaluated the perception of parents on vaccination of children in Saudi Arabia at the beginning of 2017 using an 18-item questionnaire. Alshammari et al. [9] reported that parents at Saudi Arabia were quite knowledgeable about childhood vaccination with correct answers ranging between 60% and 90%. Additionally, the study showed that 18.4% of responders faced adverse effects due to vaccination. In contrast, the present study showed poor knowledge and practice on vaccination of children in Taif city. However, 69.23% of parents seek medical assistance immediately when they miss any vaccination campaigns. Also, 37% of parents had children who suffered from vaccination adverse effect, while 25% of parents had children who were diseased by a vaccine-preventable disease in spite of vaccination. The worsened attitude in the present study compared to Alshammari et al. [9] could be explained by the increased rates of vaccination side effects and diseased children compared to Alshammari et al. [9], this could have increased the fears of parents toward vaccination. A recent study by Alruwaili et al. [14] examined the knowledge, practice, and attitude of parents in North Saudi Arabia regarding children vaccination. The study included 367 participants which are almost comparable to the number of participants in the present study. The questionnaire included four sections including demographic data, questions for knowledge evaluation, attitude questions and finally practice question. The study revealed that the level of knowledge toward vaccination was considerably good which was reflected in the attitude and practice of parents toward the vaccination of their children. Although the findings of Alruwaili et al. [14] are contradicting with the present study, it is important to know that the average level of education of the responders is university degree while the average level of education in the present study was secondary degree. This difference in educational level may have contributed to the increase in the level of knowledge in North Saudi Arabia compared to Taif city. On the other hand, figures in Hail seems to be similar to that in Taif. Alshammari et al. [13] examined the knowledge, attitude, and practices of parents in Hail toward children vaccination. Alshammari et al. [13] distributed an electronic survey to the public in 2018 in Hail city. The questionnaire was answered by 420 participants and included 4 sections about demographics, knowledge, attitude, and practice. Alshammari et al. [13] found that level of knowledge and behaviors toward childhood vaccination was poor especially among illiterate and less educated people and in rural areas. These findings are in agreement with the outcomes of the present study. However, the present study has got limitations too. The small sample size, evaluating knowledge, and attitude without evaluating awareness and being single centered study are the most important limitations that should be considered while evaluating the outcome of this study. Additionally, most of the responders of the questionnaire had a considerably low educational level (secondary education) compared to other cities in the medical literature with a high educational level (university degree). This low educational level could have affected the level of knowledge of patients and their behavior toward childhood vaccinations. Future studies should consider the correlation between the parental level of education and level of knowledge and practice toward childhood vaccination. Finally, to our knowledge, this is the first study to evaluate the knowledge and practices of parents toward childhood vaccination in Taif city, Saudi Arabia.

Table 2. Responses to knowledge questions.

Questions Answers Male Female p-value
Do you think that childhood immunization is important? Strongly agree 141 136 <0.001*
Agree 39 39
Neutral 5 6
Disagree 3 0
Strongly Disagree 1 2
Do you think that the benefit of Immunization weight its risk? Strongly agree 121 127 <0.001*
Agree 51 42
Neutral 15 10
Disagree 1 3
Strongly Disagree 2 2
Do you think that immunization is safe? Strongly agree 110 117 <0.001*
Agree 54 49
Neutral 20 12
Disagree 4 3
Strongly Disagree 1 3
Do you think that immunization is forbidden from a religious perspective? Strongly agree 17 16 <0.001*
Agree 3 9
Neutral 16 12
Disagree 101 98
Strongly Disagree 50 50
Do you think that the timing of immunization is important? Strongly agree 98 114 <0.001*
Agree 69 53
Neutral 13 9
Disagree 5 5
Strongly Disagree 3 4
Do you believe that immunization will keep your children healthy? Strongly agree 97 108 <0.001*
Agree 67 57
Neutral 21 14
Disagree 1 4
Strongly Disagree 1 1
Do You think that immunization might cause autism? Strongly agree 12 23 <0.001*
Agree 10 10
Neutral 39 34
Disagree 106 92
Strongly Disagree 21 26
Do you think that Diphtheria and Tetanus could be prevented through immunization? Yes 77 82 <0.001*
No 18 29
I Don’t Know 91 70
Is hepatitis A from the infections that could be avoided by immunization? Yes 122 138 <0.001*
No 13 18
I Don’t Know 53 29
Is hepatitis B from the infections that could be avoided by immunization? Yes 121 133 <0.001*
No 11 17
I Don’t Know 55 34
Could immunization rarely lead to fever or seizures? Yes 84 97 <0.001*
No 27 44
I Don’t know 78 42
Do you think all healthy children should be immunized? Yes 145 150 <0.001*
No 12 12
I Don’t Know 32 21
Do you think that diabetes could be prevented by immunization? Yes 77 67 <0.001*
No 53 80
I Don’t Know 58 36
Do you think that the last immunization shot is at the age of one year? Yes 54 63 <0.001*
No 92 92
I Don’t Know 41 29

*Chi-square test at a level of significance p < 0.005.

Table 3. Responses to attitude questions.

Questions Answers Male Female p-value
Have any of your children been exposed to immunization side effects? Yes 46 95 <0.001*
No 96 65
I Don’t Know 45 25
Have any of your children been infected by a disease in spite of being immunized against it? Yes 41 55 <0.001*
No 101 99
I Don’t Know 45 28
Are you keener to immunize your male children compared to females? Yes 22 20 <0.001*
No 139 127
Not applicable 29 37
Do you immunize your children with all obligatory immunizations? Yes 150 153 <0.001*
No 27 16
I Don’t Know 12 13
Are you keen to immunize your children during immunization campaigns? Yes 138 149 <0.001*
No 31 25
I Don’t Know 21 10
Do you start immunization from the first day of birth? Yes 141 143 <0.001*
No 18 18
I Don’t Know 29 23
What do you do when immunization campaigns are postponed? Call the doctor immediately 132 129 <0.001*
Wait for other campaigns 31 40
Skip this immunization shot 1 0
Do not immunize 0 1
Not sure 24 13

*Chi-square test at a level of significance <0.05.


Conclusion

Vaccination is crucial to decrease the burden of epidemics and vaccine-preventable disease. Parents in Taif, Saudi Arabia showed a low level of knowledge regarding childhood vaccination and poor practices toward vaccinating their children, especially among males compared to females. Governmental efforts should be directed to these finding by targeting educational programs and awareness campaigns for parents and grandparents on the importance of vaccination not only for their children but for the whole community. Further studies are also required to show the figures of parental perception to childhood vaccination in Saudi Arabia on a national level. Also, further studies should consider investigating any relationship between the level of education of parents and their attitude and knowledge toward childhood vaccination.


List of Abbreviations

SPSS Statistical Package for Social Sciences

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The current study (Application number: 2019-397) was approved by the research ethics committee of armed forces hospitals on 05-May-2019.


Author details

Mohammed Ewad Alkarim Altreyfy1, Mohammed Saad Almalki1, Ahmed Ibrahim Obaid1, Meshari Mushabbab Al-Ahmari2, Abdulah Mohammed Alshahrani2

  1. Prince Sultan Military Hospital, Taif, Saudi Arabia
  2. Children’s hospital, Taif, Saudi Arabia

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How to Cite this Article
Pubmed Style

Altreyfy MEA, Almalki MS, Obaid AI, Al-Ahmari MM, Alshahrani AM. Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia. IJMDC. 2019; 3(11): 913-919. doi:10.24911/IJMDC.51-1564055564


Web Style

Altreyfy MEA, Almalki MS, Obaid AI, Al-Ahmari MM, Alshahrani AM. Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia. https://www.ijmdc.com/?mno=58499 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1564055564


AMA (American Medical Association) Style

Altreyfy MEA, Almalki MS, Obaid AI, Al-Ahmari MM, Alshahrani AM. Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia. IJMDC. 2019; 3(11): 913-919. doi:10.24911/IJMDC.51-1564055564



Vancouver/ICMJE Style

Altreyfy MEA, Almalki MS, Obaid AI, Al-Ahmari MM, Alshahrani AM. Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia. IJMDC. (2019), [cited October 15, 2021]; 3(11): 913-919. doi:10.24911/IJMDC.51-1564055564



Harvard Style

Altreyfy, M. E. A., Almalki, . M. S., Obaid, . A. I., Al-Ahmari, . M. M. & Alshahrani, . A. M. (2019) Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia. IJMDC, 3 (11), 913-919. doi:10.24911/IJMDC.51-1564055564



Turabian Style

Altreyfy, Mohammed Ewad Alkarim, Mohammed Saad Almalki, Ahmed Ibrahim Obaid, Meshari Mushabbab Al-Ahmari, and Abdulah Mohammed Alshahrani. 2019. Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (11), 913-919. doi:10.24911/IJMDC.51-1564055564



Chicago Style

Altreyfy, Mohammed Ewad Alkarim, Mohammed Saad Almalki, Ahmed Ibrahim Obaid, Meshari Mushabbab Al-Ahmari, and Abdulah Mohammed Alshahrani. "Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 913-919. doi:10.24911/IJMDC.51-1564055564



MLA (The Modern Language Association) Style

Altreyfy, Mohammed Ewad Alkarim, Mohammed Saad Almalki, Ahmed Ibrahim Obaid, Meshari Mushabbab Al-Ahmari, and Abdulah Mohammed Alshahrani. "Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia." International Journal of Medicine in Developing Countries 3.11 (2019), 913-919. Print. doi:10.24911/IJMDC.51-1564055564



APA (American Psychological Association) Style

Altreyfy, M. E. A., Almalki, . M. S., Obaid, . A. I., Al-Ahmari, . M. M. & Alshahrani, . A. M. (2019) Assessment of knowledge and attitude of the practice of parents toward vaccination of children in Taif city, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (11), 913-919. doi:10.24911/IJMDC.51-1564055564