CHAPTER FOUR
RESULTS AND DISCUSSION
This chapter presents the results of the analysed data and their subsequent discussion under
the specific objectives of the study.
RESULTS
4.0 DEMOGRAPHIC CHARACTERISTICS
From table 4.1 below, the relationship of the child to the respondents were as follows:
majority 139(92.1%) of the participants were mothers whilst 5(3.3%) were fathers. Regarding
the age of children, majority 88(58.7%) fell within the age group 10-17 months whilst the
least 27(18.0%) fell within 24-59 months. With respect to the categorized number of children
for each Participant, majority 80(53.3%) of the participants had one child whilst 2(1.3%) had
six and above children. Regarding the ages of the respondents, some 71(47.3%) of the
respondents fell within the age 15-24 years whilst 3(2%) were above 45 years. Also, majority
81(54%) of the participants were married whiles 3(2%) were separated/widowed.
Furthermore, 83(55.3%) of the participants were Christians whilst and 3(2%) were Atheist.
The educational status of respondents were uneducated 47(31.3%) whiles those educated
were 101(67.3%). With their occupation, nearly 48(32%) were self-employed, with the least
two as Public/Civil Servants 13(8.7%) and other-Apprentice (16.0%). The predominant
ethnicity was Bono/Akan, representing 94(62.7%) with the least being others 5(3.3%).
Table 4.1: Demographic Characteristics
Frequency Percent
VARIABLES
(N=150) (%)
Relationship with child
Mother 139 92.7
Father 5 3.3
Caregiver 6 4.0
Age of the child
10 - 17 months 88 58.7
18 – 23months 35 23.3
24 – 59months 27 18.0
Number of children
1 80 53.3
2-3 55 36.7
4-5 13 8.7
6+ 2 1.3
Age of Respondent
15˗ 24 years 71 47.3
25˗ 34 years 65 43.3
35˗ 44 years 11 7.3
45+ years 3 2.0
Marital status:
Single 54 36.0
Married 81 54.0
Cohabitating 10 6.7
Other (Separated/Widowed) 5 3.3
Religious denomination
Christianity 83 55.3
Islam 59 39.3
Traditionalist 5 3.3
Other (atheist) 3 2.0
Educational level of respondent/caregiver
Primary 41 27.3
Middle ̸ JHS 20 13.3
SHS ̸ Voc. ̸ tech 29 19.3
Tertiary/Nursing/Poly 11 7.3
Non (illiterate 49 32.7
Occupation
Farming 38 25.3
Public/civil servant 13 8.7
Self employed 47 31.3
Unemployed 28 18.7
Other (Apprentice) 24 16.0
Table 4.1 cont’d: Demographic Characteristics
Ethnicity
Bono/Akan 94 62.7
Dagaati 13 8.7
Frafra 8 5.3
Kusaasi 2 1.3
Ewe 3 2.0
Dagomba 25 16.7
Other 5 3.3
Source: Field Data, 2022
4.1 PARENTAL KNOWLEDGE LEVEL ON VACCINATION
From table 4.2 below, 113(75.3%) out of the 150 have their children Vaccination/EPI
cards available. Review of the EPI card revealed that; 113(75.3%) have received at least
one vaccine, whiles 3(2%) have not received any of the mandatory childhood vaccines.
Again, 34(22.7%) have lost or could not find their children’s EPI Cards and gave oral
accounts on vaccination that the child has received at least one vaccine. The predominant
source of information for the respondents on vaccination was health workers representing
132(88%), whiles 12(8%), 2(1.3%), and 4(2.7%) for relatives/ family, mass media
(radio/TV) respectively. A good percentage 29.3% (44) have poor knowledge (0-2) on the
importance of childhood vaccination, the rest 98(65.3%) and 8(5.3%) have Fair/Somehow
(3-4) and Very Good (5+) knowledge respectively. Whereas 68.7% of the respondents did
not know the name of any childhood vaccine, but 31.3% have some level of knowledge
on the names of available childhood vaccines. Majority of the respondents 132(88%) did
not know the recommended age for them to complete their children vaccination, this was
recorded even in respondents with higher education, only 12% had knowledge on the
recommended age. A greater number, thus, 127 (84.7%) said their children have
experienced at least one AEFIs (with fever, pains and swollen at the injection site were
mostly reported). There was appreciable number 63 (42%) who knew at least one
vaccination schedule, whiles 58% said they do not know any of the schedules.
Table 4.2: Parental Knowledge Level on Vaccination
Frequency Percent
VARIABLES
(N=150) (%)
Child received any of the mandatory childhood vaccines
Yes 113 75.3
No 3 2.0
Yes (No Card) 33 22.7
Source of information on vaccination
Health workers 132 88.0
Relative/family 12 8.0
Friends 2 1.3
Social Media 0 0.0
Mass media (radio/ TV) 4 2.7
Knowledge Level on the Importance of Childhood Vaccination
Poor (0-2) 44 29.3
Fair/Somehow (3-4) 98 65.3
Very Good (5+) 8 5.3
Knowledge Level on Available Childhood Vaccines 0.0
Very Poor (don’t Know) 103 68.7
Poor (1-2) 37 24.7
Fair/Somehow (3-4) 8 5.3
Very Good (5+) 2 1.3
Knowledge on recommended age for child to complete
vaccination (Recommended age is 18months)
Yes 18 12.0
No 132 88.0
Knowledge on Adverse Event Following Immunization
Yes 127 84.7
No 23 15.3
Knowledge on vaccination schedule for any vaccines
Yes 63 42.0
No 87 58.0
Source: Field Data, 2022
From table 4.3 below, majority 129 (86%) of the respondents reported their children have
suffered at least Vaccine-Preventable Disease (i.e Diarrheal diseases-68%,
Pertussis/contagious cough or sneezes-10.7%, Tetanus-6% and Meningitis 2(1.3%), whereas
21(14%) said their children have never suffered any of the diseases.
Table 4.3: Vaccine-Preventable Disease Ever Suffered by Child
No.
Disease No. Suffered Disease Suffered
No, never suffered 21(14%) Meningitis 2(1.3%)
Measles 0 Tuberculosis 0
Yellow fever 0 Poliomyelitis 0
Haemophilus
Hepatitis B 0 0
Influenza Type B
16
Tetanus 9(6%) Pertussis
(10.7%)
Diarrheal diseases 102 (68%) Diphtheria 0
Source: Field Data, 2022
4.2 FACTORS INFLUENCING PATRONAGE OF CHILD IMMUNIZATION
In Table 4.4 below, the decision on whether to access EPI service or not was 127 (84.7%)
said they make the decision themselves, whiles the rest 23(15.3%) was decided by either their
husbands, mothers, siblings or friends. Only 8(5.3%), reported there are still some norms or
traditions in their communities which prohibit use of EPI services, but the rest 142(94.7%)
said there is no such traditions. Again, 2.7% said their religion prevents them from accessing
EPI services, with the rest (97.3%) responding no, only 7.3% of them had negative or bad
perception on effectiveness of the childhood vaccines. Furthermore, more than half 108(72%)
covered approximately 5Km or less distance to the vaccination centre or EPI service delivery
points, nevertheless, only few 42 (28%) covered between 6 to 11Km but when asked
whether distance to vaccination post has influence on their utilization, only few (20.7%) said
yes it has influence and 79.3% said no, because they knew the importance of vaccination to
their child.
However, a little above half (54.7%) use Motorbike/Okada as the means of transportation,
whiles the rest 15.3%, 1.3% and 28.7% use Car, Bicycle, and by foot/walking respectively.
Cost of transportation prevented 22.7% of them from utilizing EPI service but 77.3% said
cost did not influence them. Interestingly, 34 (22.7%) said they have ever been charged for
the new Maternal and Child Health Booklet/EPI card but not charged for vaccination
services. Among the 34 respondents who were charged, only 5(3.3%) said it has influence on
utilizing EPI services but 16 (10.7%) said no. Most of the respondents thus, 9 out of 10 (90%)
said they have never been told vaccines were unavailable during EPI session. Nonetheless, 15
(10%) of them reported otherwise.
Table 4.4: Factors Influencing Patronage of Child Immunization
Frequenc
Percent
VARIABLES y
(N=150) (%)
Who make decides for utilization of EPI services
Myself (respondent) 127 84.7
Husband 11 7.3
My mother 2 1.3
Mother in-law 5 3.3
Siblings 1 0.7
Friends 3 2.0
Other (other relative) 1 0.7
Traditions/norms that prohibit use of EPI services
Yes 8 5.3
No 142 94.7
Religion prevents accessing EPI 150 100.0
Yes 4 2.7
No 146 97.3
Perception on safety of EPI
Positive (good) 139 92.7
Negative (bad) 11 7.3
Distance to vaccination centre or delivery point
Less 1Km 23 15.3
2-5Km 85 56.7
6-10Km 39 26.0
Above 11Km
3 2.0
Table 4 Cont’d Factors Influencing Patronage of Child Immunization
Influence of distance on utilization of EPI services
Yes 31 20.7
No 119 79.3
Means of transportation to vaccination post
Car 23 15.3
Motorbike/Okada 82 54.7
Bicycle 2 1.3
Walk/by Foot 43 28.7
Does the cost of transportation prevent utilizing the
services
Yes 34 22.7
No 116 77.3
Ever been charged for vaccination services
Yes (New MCHRB/EPI card) 21 14.0
No 129 86.0
Influence of charges on utilization of services
Yes 5 3.3
No 16 10.7
Never been Charged 129 86.0
Influence of unavailability of vaccines on utilization of services 0.0
Yes 11 7.3
No 4 2.7
Vaccines always available during my visit 135 90.0
Sources: Field Data, 2022
4.3 INFLUENCE OF STAFF ATTITUDE ON IMMUNIZATION SERVICES
From Table 4.5 below, majority (92%) of the respondents said always start service delivery
on time as scheduled, but 8% said do not start as schedule. Also, 88.7% of them confirmed
that providers always give enough information on vaccination with less than 1% (thus 0.7%)
who said they were never given information. Only 14% of the respondents perceived nurses
as unfriendly whiles 5.3% were neutral on their response, this means generally, nurses were
perceived by the respondents as friendly (80.7%). 30.7% reported they have ever been
assaulted verbally or emotionally by EPI staff. Twenty-three (23) of the respondents (15.3%)
had ever reported AEFIs to health facility, out of 23, 21(91.3%) were satisfied with the
management with just 2(8.7%) unsatisfied. Lastly, 23.3% of the respondents said the conduct
of nurses or EPI service providers sometimes prevent them from accessing EPI services
whiles 76.7% said it does not prevent them.
Table 4.5: Influence of Staff Attitude on Immunization Services
Frequency Percent
VARIABLES
(N=150) (%)
Do staff start service delivery on time as scheduled
Yes 138 92.0
No 12 8.0
Providers give enough information on vaccination
Always 133 88.7
Sometimes 15 10.0
Rarely 1 0.7
Never 1 0.7
How Caregivers Perceive Vaccinators
Friendly 78 52.0
Very friendly 43 28.7
Not friendly 21 14.0
Neutral 8 5.3
Assaulted verbally or emotionally by EPI staff
Yes 46 30.7
No 104 69.3
Caregiver ever reported any AEFIs to health facility
Yes 23 15.3
No 127 84.7
Rating the management of the AEFIs by staff
Very good 18 12.0
Good 3 2.0
Moderate 0 0.0
Bad 2 1.3
Very bad 0 0.0
Never Reported 127 84.7
Conduct of EPI staff prevent Caregivers from accessing EPI
Yes 35 23.3
No 115 76.7
Source: Field Data, 2022
4.4 VACCINATION STATUS OF THE CHILDREN
From table 4.6 below, only 116(77.3%) had their children vaccination cards and 22.7% being
lost/not found by the respondents. The EPI visits per the vaccination card were 40.7% made
3-4 visits, 23.3% making 5+ and 1.3% did not make any visits although they have the EPI
card because it was the new Maternal and Child Health Records booklet which contains
ANC, Delivery and PNC. Meanwhile, 22.4% had no vaccination card for verification.
Table 4.6: Vaccination Status of the Children
Frequency Percent
VARIABLES
(N=150) (%)
Possession/availability of vaccination card
Yes 116 77.3
No 34 22.7
Number of EPI visits
0 2 1.3
1-2 18 12.0
3-4 61 40.7
5+ 35 23.3
No card 34 22.7
Source: Field Data, 2022
From table 4.7, a detailed review of the EPI card revealed that, out of the 116 cards available,
BCG recorded the highest, fully vaccinated children (98.3%), followed by OPV (93.1%),
DPT/HiB/HepB (94.8%) and Measles-2 and Meningitis A recording the lowest of 82.3%
fully vaccinated. It could be concluded from the above that, the number of fully vaccinated
reduces as the children grows. Only 2 (1.7%) of the children have never been vaccinated with
any antigen because they gave birth in a rural community without health facility.
Table 4.7: Vaccination Status Per EPI Card Reviewed (N=116)
No. of Vaccination/EPI Card
Children (N=116)
Antigen
Recommend Due for this Unvaccinate
(Vaccine Fully Partially
ed Doses Antigen d
Type)
(Vaccine) Fre Fre
% % Freq. %
N=116 q. q.
Bacille
98.
1 116 Calmette 114 0 0.0 2 1.7
3
Guerin (BCG)
93.
4 116 OPV 108 0 0.0 2 1.7
1
DPT/HiB/ 94.
3 116 110 4 3.4 2 1.7
HepB 8
Pneumococcal 94.
3 116 110 4 3.4 2 1.7
vaccine 8
2 116 Rotavirus 110 94. 4 3.4 2 1.7
vaccine 8
94.
1 116 Yellow Fever 109 5 4.3 2 1.7
0
Measles/ 94.
1 116 109 5 4.3 2 1.7
Rubella 0
82. 14.
1 62 Measles 2 51 9 2 3.2
3 5
82. 14.
1 62 Meningitis A 51 9 2 3.2
3 5
Source: Field Data, 2022
Table 4.8 below shows vaccination status as per respondents orally accounted due to
unavailable EPI card as seen in Table 4.8, all children (100%) have received at least one dose
of each of the 9 vaccines (meaning no child was unvaccinated). The results were: BCG-
100%; DPT/HiB/HepB and Pneumococcal-50% each; the least were Measles-2 and
Meningitis A-32.4% each. Interestingly, most of respondents have forgotten or do not know
the vaccines given to their children since they were no EPI card to verify, nonetheless, all of
them (100%) remembered their children were given BCG at birth.
Table 4.7: Vaccination Status Per Oral Account by Respondents (N=34)
No. of Oral Account (No EPI Card)
Children N=34
Recom Due for Antigen Don’t
Unvaccinate
m. this (Vaccine Fully Partially Know/Forg
d
Doses Antigen Type) ot
(Vaccine) Freq Freq Freq Freq
N=34 . % . % . % . %
Bacille
100.
1 34 Calmette 34 0 0.0 0 0.0 0 0.0
0
Guerin (BCG)
32.
4 34 OPV 16 47.1 11 0 95.2 7 20.6
4
DPT/HiB/ 23.
3 34 17 50.0 8 0 69.2 9 26.5
HepB 5
Pneumococcal 32.
3 34 17 50.0 11 0 95.2 6 17.6
Vaccine 4
Rotavirus 35. 103.
2 34 18 52.9 12 0 4 11.8
vaccine 3 8
1 34 Yellow Fever 19 55.9 0 0.0 0 0.0 15 44.1
Measles/
1 34 19 55.9 0 0.0 0 0.0 15 44.1
Rubella
1 28 Measles 2 11 32.4 0 0.0 9 0.0 8 23.5
1 28 Meningitis A 11 32.4 0 0.0 9 0.0 8 23.5
Source: Field Data, 2022
Table 4.9 below shows some of the reasons for not vaccinating or partially vaccinating. Most
reasons given were: Too busy with other tasks (89 times), Vaccines not available (39 times),
and Time of vaccination inconvenient (31 times). However, some of the respondents gave
multiple reasons for not fully vaccinating their child.
Table 4.8: Reason for not vaccinated or partially vaccinated
Reason for not vaccinated or partially
Frequency
vaccinated
Time of vaccination inconvenient 31
Too busy with other tasks 89
Child was sick/ill 5
Unavailability of vaccination team 9
Vaccines not available 39
Travelled 24
Vaccination not necessary 1
Fear of AEFIs 16
Religious reasons 0
Source: Field Data, 2022
Table 4.10 below shows the number of Antigens that were defaulted as per vaccination
card reviewed. These are vaccines administered to the children but not at the
recommended age. The vaccines that recorded high defaulter rates were Measle-2 and
Meningitis A (40.5%), Yellow Fever and Measles/Rubella (35.3%), with BCG not
defaulted. It was concluded from this table that, the average defaulter rate for all vaccines
was 31%.
Table 4.9: Number of Antigens Defaulted Per Vaccination Card
Defaulted Per
Vaccination/EPI Card
Required Schedule (in
Antigen (Vaccine Type) (N=116)
Weeks)
Defaulte
% Defaulted
d (Freq.)
0 (At Birth) Bacille Calmette Guerin 0 0.0
(BCG)
At Birth (0), 6, 10, 14 Oral Polio Vaccine (OPV) 39 33.6
6, 10, 14 DPT/HiB/HepB 34 29.3
6, 10, 14 Pneumococcal vaccine 34 29.3
6, 10 Rotavirus vaccine 34 29.3
36 Yellow Fever 41 35.3
36 Measles/Rubella 41 35.3
72 Measles 2 47 40.5
72 Meningitis A 47 40.5
Average Defaulted 36 31.0
Source: Field Data, 2022
In table 4.11 below, the respondents gave some recommendations for improving EPI service.
The following recommendations were given by the study subjects; Increase the number of
health workers (68.7%), Improve availability of drugs and supplies (42%), The health
workers should respect the women/clients (23.3%), and need for an ambulance during
emergencies (1.3%).
Table 4.10: Recommendation for improving EPI services in the Community
Response Frequency Percent
N=150 (%)
Increase the number of health workers 103 68.7
Improve availability of drugs and supplies 63 42.0
The health workers should respect the women 35 23.3
We need an ambulance 2 1.3
Other 15 10.0
Source: Field Data, 2022