A Study on Parental Knowledge and Practice Toward Child Immunization

1. PROGRAMME
CERTIFICATE IN PAEDIATRIC
NURSING
COHORT COHORT 16
BLOCK BLOCK 2
FULL NAME
WAN KHADIJAH BINTI WAN YUSOFF
NOOR AFIKA BINTI ‘AZRI
I.C NUMBER
850109036260
920810-09-5198
MATRIX NUMBER
3062161021
3062161006
TITLE
A Study on Parental Knowledge and
Practice Toward Child Immunization
PROGRAMME COORDINATOR MADAM AMUDHA
MARK OBTAINED

2. 2
TABLE OF CONTENTS
CHAPTER 1: Introduction 4
1.1 Background of the study 4
1.2 Problem Statement 6
1.3 Significance of the Study 7
1.4 Operational definition 7
CHAPTER 2: Literature review 8
2.1 Introduction 8
2.2 Immunization 8
2.3 Vaccine preventable diseases 11
2.4 Vaccine Refusal 11
2.5 Knowledge and vaccination practice 13
CHAPTER 3: Methodology 14
3.1 Design of the study 14
3.2 Study variable 14
3.3 Samples 15
3.3.1 Study Location 15
3.3.2 Target Population and sample selection 15
3.4 Instrumentation 15
3.5 Inclusion and exclusion criteria 16
3.6 Data analysis 16
3.7 Study limitation 17
3.8 Ethical Consideration 17
CHAPTER 4: results 18
4.1 Demographic assessment 18
4.2 Knowledge on child vaccination 21
4.3 Practice towards immunization 22
4.4 Association between parental knowledge and practice toward child vaccinations 23

3. 3
CHAPTER 5: DISCUSSION 26
5.1 Parental demographic background versus child vaccination 26
5.2 Recormendation for better practice of child vaccination 28
5.3 Conclusion 29
REFERENCES 30
APPENDICES 33

4. 4
CHAPTER 1: INTRODUCTION
1.1 Background of the study
Communicable disease is the main cause of deformities / defects and death among
children. It could leads to high morbidity and mortality rate. Immunization is one of very
effective health interventions in reducing the mortality rate of infants and toddlers due to
vaccine preventable diseases. It is one way to provide immunity to the infants and children
against various infectious diseases such as diphtheria, pertussis, measles, tetanus, and polio. In
earlier generations many children contracted communicable diseases like polio and whooping
cough, frequently with devastating consequences. Some children died; others were left with
permanent impairments. But the development of vaccines has made many of these childhood
illnesses relatively rare and has thus improved the lifetime health and well-being of millions of
people.
Children have quite clearly benefited more from vaccines than from any other preventive
public health program in history. In fact, Malaysia has been declared and certified polio free,
together with other countries in the World Health Organisation (WHO) Western Pacific Region
since 2000. Unfortunately, some parents have become comfort because most vaccine
preventable disease are no longer a major threat to their child so they simply delaying
vaccinated their child and some Parents hesitant to vaccinate their children, in worse case
senarion the emerganc of anti vaccine have posoning the parent through media social by posting
of side effects associated with certain vaccines, for example autism and double shoot cause
severe side efeeft to the child. However, the risks of not receiving immunisations are actually
immense compare to the side effect. Recent outbreaks of vaccine-preventable diseases in
malaysia have drawn attention to this phenomenon. For example, as can be seen in figure below,

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the number of confirmed cases of diphtheria in Malaysia rise to 28 cases, including 5 deaths;
Kedah nine (9) cases with one (1) death, Negeri Sembilan seven (7) cases and with no deaths,
Sabah five (5) cases with three (3) death, Melaka three (3) cases with one (1) death, Penang two
(2) cases and with no deaths, Selangor and Perak each one (1) cases and no deaths.
Figure 1.1: The prevalence of vaccine preventable diphteria infection in Malaysia
According to MOH press statement on july 2016 out of 5 death cases 2 of them have been
comform not being given any vaccine for diptheria. And another 3 not comform taking vaccine
or not. This showed that wujudnye child who was not given vaccine and end up with mortality,
very sad to hear that parent putting the child life high risk due to unknown problems, why they
are unvaccinate or undervaccinate their child. So this study is clearly want to assess parent level
of awereness and practice toward their child vaccination because improved understanding of
the association between vaccine refusal and the epidemiology of these diseases is important to
make sure that good approach can be use to prevent unvaccinated or undervaccinated as well
as eredacating again the disease that have been completely eradecating before.
0
2
4
6
8
10
3 2 1
5
9
7
1
1
0
0
3
1
0
0
The reported cases of diphteria in
Malaysia in August 2016
CASES MORTALITY

6. 6
1.2 Problem Statement
Awareness on the importance of vaccination varies among parents in this country. Some think
vaccinations are just a government's regulation that must be met by parents. Some also believed
vaccination would affect their child's physical and mental development. In addition, there are
various practical level among parents in the scope of child vaccination. Some of working
parents feel the vaccination appointments with a doctor is difficult and as such, they are often
delay and skip certain doses of the vaccine for their children, while some parents who have
financial difficulties do not feel the need for vaccines to their children as a main priority. As a
result of poor knowledge and practice among parents, the children become victims as they are
not getting the benefits of vaccination and thus prone to vaccine preventable diseases.
1.3 Objective of the Study
A) General objective:
To evaluate parental knowledge and practice toward child immunization
B) Specific objectives:
There are three specific objectives to be achieved in this proposed study:
i) To determine the level of parental knowledge regarding child immunization
ii) To assess the depth of practice of child immunization among the parents
iii) To compare between parent’s knowledge and the practice of child immunization

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1.4 Significance of the Study
This study will improve the awereness on the importance of children vaccination or
immunization among parents and the community. This study helps to detect common reasons
of parents for not vaccinate their child. The result could be used to plan for designing effective
public education programs or measures that can help parents to make the right decisions about
their children’s health and wellbeing. Those with inadequate knowledge and practices regarding
immunization need to be targeted to maintain and improve immunization coverage. In addition
the present study could be useful source of review for others (individual, group, organization
both governmental and non-governmental) who wants to intervene based on the results obtained
or who wants to do further researches to answer questions that are not answered in this study.
1.5 Operational definition
Assessment:
 It is the organized systematic and continuous process of collecting data from parent
regarding vaccination/ immunization.
Knowledge:
 It denotes the awareness or information that the Parent posses regarding
vaccination/immunization.
Parent:
 A person who are holding responsibility to look after the child and make a decision for
vaccination
Practice:
 Refer to the action taken by parent to vaccinate the child following the recommended
schedule

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CHAPTER 2: LITERATURE REVIEW
2.1 Introduction
Vaccine is a very important compenant of preventing communicable disease. It is a well known
medical intervention from many country to reduce mortalty and morbility rate mong children.
It’s proven on eradication, elimination and reduce the number of cases of childhood
communicable disease significantly (Awadh et al., 2014). Vaccination had saved three million
child’s life but still another three millon live loss from vaccine preventable disease (Ehreth,
2003). This could be due to parental complience to vaccinate the child which cause them unable
to fight the infectious disease. Parental decisions regarding immunization are very important
for increasing the immunization rate and compliance and for decreasing any possible
immunization errors. Parents’ knowledge and practices regarding immunization are the major
factors that contribute to their vaccination decisions. A lot of investment done by government
to acchive 100% vaccine’s coverage of immunization including malaysia. Since 1950s
government has given the vaccine for free of charge to the public people as well as was
introduced immunization program(Awadh et al., 2014)
2.2 Immunization
Immunization is the process whereby a person is made immune or resistant to an infectious
disease, typically by the administration of a vaccine. Vaccines stimulate the body's own immune
system to protect the person against subsequent infection or disease. (CDC, 2016)
Meanwhile Vaccine is a special preparation of antigenic material that can be used to stimulate
the development of antibodies and thus confer active immunity against a specific disease or

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number of diseases. It is usually given by injection but may be introduced into the skin through
light scratches; for some diseases (e.g. polio), oral vaccine is available. Many vaccines are
produced by culturing bacteria or viruses under conditions that lead to a loss of their virulence
but not of their antigenic nature. Other vaccines consist of specially treated toxins (toxoids) or
of dead bacteria that are still antigenic.
There are three types of vaccine use immunization which are live attenuated vaccine ,
Inactivated vaccine and Toxoid vaccine. Live attenuated vaccine is uses pathogen that are active
but have reduced virulence so they don’t cause disease. It Is the process of reducing the
virulence of the virus. It contains replicating microbes that can stimulate a strong immune
response due to the large number of antigen molecules. Meanwhile Inactivated vaccine can be
either whole agent vaccine produced with deactivated but whole microbes, or subunit vaccines
safer than live vaccines. Several doses usually required because there is no multiplication in the
body. The reaction do not resemble those of the natural disease and usually follow soon after
inoculation.Toxoid vaccine ia a chemically or thermally modified toxins used to stimulate
active immunity. It is useful for some bacterial disease e.g. Tetanus, Diphtheria. It require
multiple doses because they possess few antigenic determinants. When a child is given a
vaccine, they actually receives that part of the “weakened” or infectious organism that has been
killed and inactived that is able to stimulate child’s body to produce antibodies against it. These
antibodies then protect child against the disease and the protection is virtually life long. For
maximum protection and effectiveness of the vaccine given, immunisations should be
administered at specific ages. The vaccines most commonly recommended by doctors for
children are: DTaP, MMR, Varicella, Hepatitis B, Hepatitis A, IPV (Polio), Hib, Influenza,
Meningitis, and Pneumonia. The Hib or Haemophilus influenzae vaccine is used to prevent
bacterial meningitis. The HPV vaccination is new, added to the list of vaccines recommended
by the CDC in 2006 and is recommended for girls ages 11-12 and catch-up vaccination between

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ages 13-26. These vaccinations, excluding HPV, are commonly administered at a period
starting at birth through the first two years of a child’s life with additional vaccination given at
older ages for groups of children with health needs that require additional vaccination or catch-
up vaccination for those who didn’t receive vaccines at early ages.
Vaccination choice and behaviors among parents varies. Parents may decide to fully vaccinate
all of their children, choose to vaccinate their children with certain vaccines and to exclude
others, vaccinate just some of their children, or decide that they will not vaccinate at all. Some
parents may also choose to modify the vaccination schedule, deciding to delay vaccination until
their children are older. Modification of the vaccination schedule is often due to concerns about
the safety of vaccination or concerns about the health of a child. Below is a chart that lists the
latest mandatory vaccinations recormended in Malaysia, including HPV, and the regular
schedule for the vaccinations.
Table 2.1:Immunazation schedule 2016

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2.3 Vaccine preventable diseases
The outbreaks of vaccine-preventable diseases often occur as a result of non-immunization or
underimmunization among children and adults, as well as from exposure to infections brought
into the country by unvaccinated travelers who visit and return from high-risk or endemic
regions (McNair McKenzie, 2014). In this country, the recent cases of children death due to
diphtheria, a vaccine preventable disease found out two of the cases involved unvaccinated
childs. The child should receive most of the childhood immunisations before their second year
of life. These will protect the child against 10 major diseases which is tuberculosis, polio,
measles, mumps, rubella (German measles), pertussis (whooping cough), diphtheria, tetanus,
diseases caused by Haemophilus influenza (Hib) and hepatitis B. Immunisations also are
available against a host of other communicable diseases including chicken pox, diarrhoea,
influenza, rabies, meningococcal meningitis, pneumococcal infection and hepatitis A.
2.4 Vaccine Refusal
Many childhood vaccine-preventable diseases have been effectively controlled nowadays
(Whitney, Zhou, Singleton, Schuchat, & Centers for Disease Control and Prevention (CDC),
2014). However, recent outbreaks of vaccine-preventable diseases in some countries including
Malaysia have prompted clinicians, public health officials, politicians, the media, and the public
to pay greater attention to the growing phenomenon of vaccine refusal (Yang & Silverman,
2015). In some previous studies, vaccine refusal has been associated with outbreaks of invasive
Haemophilus influenzae type b (Hib) disease, varicella, pneumococcal disease, measles, and
pertussis (Phadke, Bednarczyk, Salmon, & Omer, 2016).
Vaccine refusal is reflects concern about the decision to vaccinate oneself or one children .There
are a number of factors that contribute to the refusal among parents which include both medical

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or non-medical exemptions. The latter include religious exemptions, i.e. if a parent feels that
immunizations conflict with their religious or spiritual beliefs (e.g. objection to the use of fetal
tissue in the production of some vaccines), or personal belief exemptions, if a parent objects to
immunizations for moral or philosophical reasons (e.g. objection to the use of non-natural
products or the total number of vaccines to be administered). Sometimes it is difficult to
distinguish between purely religious or philosophical objections to immunization and safety
concerns about vaccines that manifest as nonmedical exemptions. In the United States, an
outbreak of measles in late 2014 highlighted vaccine refusal and related disease outbreaks
(Phadke et al., 2016). Approximately half the cases were among unvaccinated persons, most of
whom were eligible for vaccination yet intentionally remained unvaccinated (CDC, 2015). In
Malaysia, a number of vaccine preventable diseases had re-appeared recently and caused death
in some cases (Ministry of Health, Malaysia, 2016) which have alarmed how serious it can be
when the community, especially parents neglect their child vaccination or simply refuse
because of their belief or misconcepts they learned from rumours or social media.

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2.5 Knowledge and vaccination practice
A descriptive study was conducted to evaluate knowledge attitude, and behavior of 841 Italian
mothers regarding the immunization. Over all 28.5% of mothers were aware about Hib
vaccination. Respondent’s attitude towards the utility of vaccination was favourable only for
22.5%. The results of a multiple logistic regression analysis showed that the knowledge was
significantly greater among mother with a higher education level and among those who were
older at the time of childbirth. Study emphasized the need for health education programmes
for promoting immunization of under five children. (Angelillo et al., 1999)

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CHAPTER 3: METHODOLOGY
3.1 Design of the study
Study design is quantitative and cross-sectional study. Cross-sectional study used to determine
or uncover association between conditions or factors at one point in time. In this case, cross-
sectional study involving 30 parents from Aman Perdana Residents. The factors involved in
the data collection were Knowledge level and factor influence parental vaccination.
The samples were chosen through stratified random sampling. A total about 458 parent
reside in the Taman Aman Perdana, klang, only 30 parent were randomly selected from these
resident and screened for their eligibility to participate in this study. The inclusion criteria of
the participants are (i) aged between 20 and 55 years old and (ii) have a child at least 1 child.
Exclusions criteria were parent who are (i) age more than 55 years old and (ii) Parent who are
not having a child.
3.2 Study variable
The dependent variable adopted in this study was the knowledge and practice of the mother
toward child immunization .Therefore,demographic data of parent include age, religion,
education level, occupation and family income were use as indipendent variables.

15. 15
3.3 Samples
3.3.1 Study Location
The present study was conducted in Taman Aman Perdana with permission sought from the
Kpj HealthCare University College. Taman Aman Perdana is a housing estate in the town of
Kapar in Klang.
3.3.2 Target Population and sample selection
Data collection was carried out by distributing questionnaire to the parents. The population of
this study was selected in 3 catogeries of residential; bungalow house, single story terrace and
flat house residents, In order to presume their range of income and level of education as well.
3.4 Instrumentation
The Questionnaire data concerns on parent knowledge and practice of child vaccination, there
will be there part for respondent to fill in which is:
Part I: regarding parent demographic data.
Part II: Consist of questions to assess the knowledge of parent regarding child immunization
Part III: Consists of question to find out parent practice on child immunization.
Thirty questionnaires were printed and distributed to the respondant as follow:
1. Ten questionnaires for banglow house residents
2. Ten questionnaires for single story terrace residents
3. Ten questionnaires for flat house residents

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3.5 Inclusion and exclusion criteria
The inclusion criteria of the participants are (i) aged between 18 and 55 years old and (ii)
have a child more than one child. Exclusions criteria were parent who are (i) age less than 18
and more than 55 years old and (ii) Parent who are not having a child.
3.6 Data analysis
All data obtained from the questionnaires will be analysed by using Statistical Packages for
Social Sciences (SPSS) version 23.0 for Windows with the statistical significance value of
<0.05. Demographic data will be analyses using descriptive statistics. Meanwhile Microsoft
excel 2007 will be used for inserting and organizing the collected data in which worksheet will
be prepare using this software. Data will be analyzed according to the objectives of the study
using descriptive and inferential statistics and will be presented in the form of graphs, tables
and diagrams.
Descriptive statistics
 Frequency and Percentage will be used to describe the distribution of parent according to
demographic characteristics.
 Similarly, Parent level of knowledge were also assess by using frequency and percentage.
Inferential Statistics
 Chi-Square test will be used to determine the association of knowledge and practice of
parent with demographic characteristics.

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3.7 Study limitation
The number of sample for this study is limited to 30 and only questionnaire method was used
for data collection due to time constrain.
3.8 Ethical Consideration
The study has underwent approval by ethical committee of Kpj university College. All
respondents were informed clearly about the study procedures, informed of the purposes of the
study and the importance of information given by them. Selected participants will be informed
that their participation in this study was voluntary and they could withdraw at any time, their
confidential data were kept private, and that none of them will be identified in any publications
arising from the study (Appendix 1).

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CHAPTER 4: RESULTS
4.1 Demographic assessment
Data from questionnaires were analyzed by using SPSS Version 23.0. The analysis focus
mainly on the educational background and income of parents versus their knowledge and
practices toward child immunization. The age groups of parents involved in this study fall into
one of three groups: (i) <25 years old; (ii) 25-35 years old; and (iii) 35-45 years old. Out of 30
participants, majority were in the second age group (25-35 years old) and followed by younger
and elder parents respectively (Figure 4.1).
Figure 4.1 Pie chart showing the partition of age groups among parents surveyed in this study.
In terms of educational bacground, most parents seems to underwent tertiary educational level
with majority were a diploma holder (43%) followed by upper (SPM) and lower (PMR)
secondary school qualifications with percentage of 27% and 13% respectively, degree holder
(10%) and Master holder (7%). No participants in this study were from doctoral qualificaation
level (Figure 4.2).
33%
40%
27%
Age group of parents
<25 years
25-35 years
35-45 years

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Figure 4.2 Bar graph referring the educational background of parents participated in this study
Apart from age group and educational background, another factor that has been shown in a
number of previous studies to influence parents’ decision to vaccinate their children was belief
or religion. For example, some Muslims believed that vaccines are manufactured using
substance linked to porcine biological tissues and thus refuse it at the first place regardless the
consequences they could face from the refusal. In this study, most of the participants were
Muslims and followed by Buddhist and Hindhu as shown in Figure 4.3. Their practices toward
child vaccination will be discussed later.
Monthly family income of each respondents was also included in the questionnaire as economic
statuses played significant roles in determining one’s actions toward his or her child health and
well being. Data collected in this study respondents are almost equally divided into four income
categories since the questionnaires were distributed equally to high-end and low-end residential
area. Seven out of thirty (23%) total respondents came from a low economic class family with
monthly family income of less than RM1500 per month (Figure 4.4).
13.3%
26.6%
43.3%
10%
6.6%
0
0 2 4 6 8 10 12 14
PMR
SPM
DIPLOMA
DEGREE
MASTER
DOCTORAL
Frequency

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Figure 4.3 Chart depicting the religion or belief of the participants shows that Muslims are the
majority followed by Buddhists and Hinduists
Figure 4.4 Monthly family income shows respondents were well categorized into four separate
income range.
73.3%
13.3%
13.3%
0, 0%
Religion of the participants
Islam
Buddha
Hindu
Others
23.3%
20%
30%
26.6%
Monthly income of the respondents
<RM1500
RM1500-3000
RM3000-5000
>RM5000

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4.3 Knowledge on child vaccination
All respondents seemed to know what the vaccination or immunization is in general. However
not everyone was able to describe correctly what is the main benefits of child vaccination. As
shown in Figure 4.5, most of them (60%) understood that vaccines are given to prevent
infections but few (17%) thought it is a therapy used to cure infections while there were also
respondents (13%) who simply admitted they have no idea what it is for and even two
respondents (7%) believed vaccine is a drug to enhance children’s physical growth; and a
supplement for babies, respectively.
Figure 4.5 Assessment on the respondents’ knowledge regarding the benefits of child vaccination
Upon further explanation on the benefits, all respondents are able to name at least one disease
preventable by vaccine listed in the questionnaire and mostly picked measles as the answer.
When asked whether they ever heard a child having problems related with vaccination, mostly
(23/30) answered ‘no’ and only 8/30 of the respondents answered ‘yes’. Those who answered
‘yes’ further explained their answer by stating paralyzed (n=1), became deaf (n=3), fever (n=3)
and swelling (n=1) as the consequences, respectively.
17%
60%
13%
7%
0
2
4
6
8
10
12
14
16
18
20
To cure infections To prevent infections I don't know Others
Benefits of vaccination

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4.4 Practice towards immunization
The main focus question in this category was whether they had their child vaccinated and
suprisingly four (13%) said ‘no’ (Figure 4.6). When asked the reason behind their decision
mostly chosen time inconvenience as the main excuse. It is unclear however whether they
omitted few or completely all vaccinations mandatory for all Malaysian citizens. Even some of
those answered (n=9) ‘yes’ admitted they skipped some vaccinations as scheduled due to time
constrains or simply forget to go for repeated dose (Figure 4.7).
Figure 4.6 The pie chart above shows the number of respondents who did not send their child for
vaccination (red) and those who did (blue).
86.6%
13.3%
Vaccination among respondents'
children
Yes
No

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Figure 4.7 Respondents’ excuses for not completing their child vaccination schedule
Finally regarding the awareness on vaccination respondents were asked whether their
healthcare provider explained on the importance of vaccination. More than half (53%) chosen
‘no’ as their answer. They were then asked how did they get information regarding vaccinations
and mostly picked at least one source as the answer. Overall, the majority of respondents chosen
parenting magazines and internet as their primary sources of information, followed by doctors,
other parents, books, public health nurses, and alternative medicine provider.
4.5 Association between parental knowledge and practice toward child vaccinations
Parental knowledge and judgement toward child vaccination was determined by assessing their
responds in few related questions such as ‘What is the purpose of vaccination?’ and ‘choose
disease(s) preventable by vaccination’ as well as ‘have you ever heard child having a problem
following vaccination..’. These knowledge based questions were analyzed for association with
their practice toward child vaccination. As seen in Table 4.1, all parents who understood that
3
1
5
0 1 2 3 4 5 6
FORGET TO GO FOR REPEATED DOSE
UNAWARE THE NEED TO RETURN
TIME INCONVENIENCE
Reasons for incomplete vaccinations

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vaccination is used to prevent future infections (17/30) did send their child for vaccination and
even those who have slight misconception (6/30), i.e. thought vaccine is a medicine to cure an
infection also did have their child vaccinated. However, two out of three respondents who had
no idea what is the purpose of vaccination did not send their child for vaccination (2/30) and
another two respondents who totally have misconcept idea about vaccination did not vaccinated
their child as well (p<0.05).
Table 4.1 Cross-tabulation between parental knowledge on vaccination purpose and their practice
Practice
X2
p-value
Have you
vaccinated your
child?
Yes No
Knowledge
Purpose of child vaccination
To cure
infections
6 0
14.75 0.002
To
prevent
infections
17 0
I do not
know
3 2
Others 0 2
While it is significant that better knowledge affect parental practices toward child vaccination,
the negative side effects of vaccination seemed not too influencing their decision to vaccinate
their children. Five out of 30 respondents who claimed they ever heard of children suffering
paralyzed, deafness, fever or swelling following vaccination did send their child for vaccination
(Table 4.2).

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Table 4.2 Parents perceived information on child vaccination
Practice
X2
p-value
Have you
vaccinated your
child?
Yes No
Knowledge
Did you ever heard child having
problems following vaccination?
Yes 5 0
0.923 0.337
No 21 4

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CHAPTER 5: DISCUSSION
5.1 Parental demographic background versus child vaccination
Overall, the respondents of this study could be grouped into those with high, medium and
low family income. Second category is age group, i.e. <25 years old, 25-35 years old and 35-
45 years old. Third category is religion which encompassed Islam, Buddha and Hindu and lastly
educational level, i.e. secondary school, diploma, degree and postgraduate level. When data
have been collected and analysed, it is found that four out of 30 total respondents admitted they
did not vaccinated their child. The data reveals the background of them. All of them were
Muslims with highest educational level of diploma. Three of them are less than 25 years old
and one is within 25-35 years old. In terms of family income, one of them have monthly family
income of more than RM5000 per month, two are within RM3000-RM5000 income range and
another one fall into group of RM1500-RM3000 monthly. None of them came from a group of
family income less than RM1500 or low class group. This is strongly suggest that neither family
income nor educational level define the refusal for vaccination among the community. This
finding is almost similar to the study done by Salmon et al. (2005). The most strong reason for
parents not vaccinating their child in this study is religion or belief as well as age of the parents.
As previously mentioned, some Muslim people believe that vaccines are not produced
complying to their Syariah law and uses non-halal component during the manufacturing
process.
In fact, although there are vaccines produced by using porcine tissue components there
are always options for vaccines that have been certified halal by the authorized body. However,
this information may not reach to some peoples regardless of their economic statuses or
educational level, causing them to believe the wrong information or rumours. To tackle this,

27. 27
the government, especially the Ministry of Health should intensify their campaign to promote
child vaccination in every possible way including by using the social media. The Muslim
authorized bodies also should stand firm to promote the benefits of child vaccination in
preventing future infections which is parallel to the teachings of Islam. Younger parents also
tend to take thing for granted when it comes to vaccination (Awadh et al., 2014). This could
happen when nobody is providing good advise to them on every important things they need to
know upon becoming parent. Younger parents are also busier with work commitment since they
are just entering career phase and could be harder for them to apply for leaves, i.e. to bring their
child for vaccination.
Apart from that, data from this study also shown some respondents did vaccinate their
child but the process is not completed. The main reason of this were (i) unaware of the need to
return for the subsequent dose(s), followed by (ii) time inconvenience and (iii) forget to go for
repeated dose(s). There are a number of possible causes that make parents fail to complete child
vaccination schedule. For example, they could be left unaware if the clinicians or nurses they
attended never remind or explain to them thoroughly on the vaccination matter especially when
they are not from healthcare or medical field. Even though they are given vaccination book or
card to complete sometimes they just do not have time to go through it and over time they will
forget. In this context, clinicians, staff nurses or public health nurses should be more
informative when dealing with parents especially those young parents. Time inconvenience is
mainly due to the lack of commitment among the parents themselves. Even though they are
working parents but there are lots of clinics which provide vaccination services open until night.
However, the parents have to take leaves or time-off from duty should they choose to go to
government clinics over private clinics since the former does not operate after working hours.
Such situation may happen to a parent with low family income as they could not afford to pay

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the vaccination charges in private clinics and eventually they might skip one or two
appointments set during working hours.
Although some parents surveyed in this study knew that there are some isolated cases
when vaccines cause negative side effects to the child such as paralyzed, deafness or high fever,
most of them realized that benefits of vaccination weighing out its risks although in reality there
is only very little or no risk when children being vaccinated nowadays. This awareness is
something good and shows the spread of messages on the importance and benefits of child
vaccination in the community.
5.2 Recormendation for better practice of child vaccination
As been disscussed earlier the religion and belief play an important role in parents’ decision to
vaccinate their child. As such, the burden on vaccination refusal should not be handed totally
on Ministry of Health. Religion public figures or authorized bodies should taking part in
reducing the number of unvaccinated child. In this case, the Ministry of Health could plan for
more effective strategies with Jabatan Kebajikan Islam Malaysia (JAKIM) to convince parents
to better comply with their child vaccination and thus avoiding mortality due to vaccine
preventable diseases. In terms of side effects to the child, there are always improved method
from time to time in every aspects of vaccination such as manufacturing, delivery, and storage
in order to fully eliminate the risks. To date, there is a method of combining vaccines in a single
injection which confers various benefits to the child and parents (Partridge & Yeh, 2003). Such
method is undoubtedly less painful because less injections will be given to the child and parents
also will be more convenient since they do not have to frequently visit the clinics. Besides, it
will also benificial to parents who are likely to forget next vaccination dates, thus ensuring
much better compliance. As well, the campaingns on vaccination should stress on the type of

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vaccines currently used by the MOH which is acellular organism type. This type causes no side
effects like pain, fever and sweeling to the child and thus the parents do not have to worry on
the negative consequences. This will further enhance the success of the country’s vaccination
programme and the universal protection of all of our children.
5.3 Conclusion
Although the majority of parents understand the benefits of immunization and support its use,
many parents have important misconceptions that could erode their confidence in vaccines. A
systematic educational effort addressing common misconceptions is needed to ensure informed
immunization decision-making.
Physicians, nurses, and other providers of primary care have a unique opportunity to educate
parents because parents see us as the most important source of information about
immunizations.

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APPENDICES