9
Journal of Health and Development Studies (Vol.08, No.01-2024)
Ngo Thi Thuy et al.
DOI: https://doi.org/10.38148/JHDS.0801SKPT23-058
ABSTRACT
Objectives: Describe the knowledge, attitudes, and practices of mothers with children under one year of
age on post-vaccination care and some related factors in Quang Ngai City, Quang Ngai province, in 2023.
Methods: A cross-sectional study, interviewing 345 mothers with children under 1-year-old in 08
communes and wards of Quang Ngai City, Quang Ngai province, from February to April 2023.
Results: Good knowledge achieved by mothers of children under one year of age on childcare after
vaccination was 62.0%. Good attitude and good practice of mothers on childcare after vaccination reached the
rate of 89.0% and 74.0%, respectively. The study found an association between the mothers’ good knowledge,
attitudes and educational level of mothers (OR=2.49 (1.58-3.91)), the mothers whose children experienced
adverse events after immunization (AEFI) (OR=2.57 (1.52-4.33)) or had siblings who had experienced
AEFI have significantly better knowledge of post-vaccination care (OR=3.74 (1.41-9.95)), the number of
communication channels also have positive influence to mother’s knowledge (OR=2.60 (1.23-5.52)).
Conclusions: Diversify forms of communication and further promote the role of health workers in
providing knowledge about the benefits of vaccination and how to detect and treat AEFI, focusing on
mothers with low levels of education.
Keywords: Knowledge, attitude, practice, adverse events after immunization.
Corresponding author: Ngo Thi Thuy
Email: tcmrquangngai2021@gmail.com
1
Center for Disease Control of Quang Ngai Province
2Hanoi University of Public Health
3
National Institute of Hygiene and Epidemiology
Knowledge, attitude, and practices of mothers with children under 1-year-
old regarding post-vaccination care and related factors in Quang Ngai
City, Quang Ngai province, 2023
Ngo Thi Thuy1*, Duong Kim Tuan2, Pham Quang Thai3
ORIGINAL ARTICLES
Submited: 15 July, 2023
Revised version received: 11 September, 2023
Published: 29 February, 2024
DOI: https://doi.org/10.38148/JHDS.0801SKPT23-058
INTRODUCTION
The vaccine in immunization is considered
safe, but the risk of adverse events after
immunization (AEFI) is a medical abnormality
that includes manifestations at the injection
site or at occurs after vaccination (1).
AEFI often occurs within the first 24 hours
following vaccination and healthcare workers
contribute significantly to vaccine safety
monitoring by being vigilant in recognizing and
reporting AEFI. Besides healthcare workers,
mothers play a vital role in early detection,
prevention, and management, reducing the
consequences of AEFI. Mothers need to
monitor their children after vaccination to
promptly identify any abnormal symptoms or
mild common reactions and quickly recognize
dangerous signs for timely intervention,
avoiding unfortunate complications and risks
(2) A study conducted by Pham Thi Ngoc
in Hai Phong City in 2021 yielded results:
There were still 12.7% of mothers who did
not keep their children for enough 30 minutes
10
Journal of Health and Development Studies (Vol.08, No.01-2024)
at the immunization site to monitor AEFI and
observe their children at home for 24 hours
after injection; 1.3% of mothers returned
home right after vaccination (3).
Therefore, the study was conducted to find out
the knowledge, attitude, and practice of mothers
with children under 1 year of age on taking care
of children after vaccination and some related
factors to the practice of mothers in Quang Ngai
City, Quang Ngai province in 2023.
METHODS
Study design: A cross-sectional study.
Study subjects: Mothers with children under
1-year-old in 08 communes and wards in
Quang Ngai city.
Selection criteria: Mothers of children under
one year of age were vaccinated with at least
01 dose of vaccine and agreed to participate
in the study.
Exclusion criteria: Mothers unable to
understand and answer interview questions.
Study site and time: This is carried out from
September 2022 to June 2023 in Quang Ngai city.
Sample size and sampling:
Sample Size: Formula for calculating sample size
for estimating a proportion with absolute precision.
n = Z2
(1 - /2)
p(1-p)
d2
n: is the sample size to be investigated; p: As the
percentage of mothers with good knowledge
and practice of taking care of their children
properly after vaccination, p = 0.358 (refer to
the study of author Nguyen Thanh Trung in
2016) (4); d: As absolute precision, choose
d=0.055; Take α= 0.05 (95% confidence), Z =
1.96. The formula returned n = 292 mothers,
we collected 345 valid questionnaires.
Sampling method: multi-stage sampling
method.
The data collection process included 2 stages.
In the first stage, two center wards were
chosen randomly (representative of the urban
and rural areas). In the second stage, we made
a list of all the children under 1-year-old and
selected subjects in the study sample by single
random method.
Data collection: The self-administered
questionnaire includes the following:
Knowledge consists of 8 sentences (30
points): Each correct answer is 01 point;
knowledge is achieved when ≥ 15 points.
Attitude consists of 06 sentences (30 points)
based on the Likert Scale, which divides
mothers’ attitudes into five response levels.
Post-injection includes strongly agree (5
points), agree (4 points), do not know (3
points), disagree (2 points), and strongly
disagree (1 point). Rating: Good attitude ≥
23 points (≥ 75%). The practice consists of
02 questions, 1 point for each correct idea,
and 2 points achieved when answering both
questions correctly.
Data analysis: Data entry using Epidata
3.1 software and processing on SPSS 20.0
software. Statistical analysis used χ2 test and
odds ratio (OR) to compare the proportions at
the significant level p<0.05.
Ethical approval: The study was conducted
after the official Decision No. 02/2022/
YTCC-HD3 of the Chairman of the Ethics
Committee – Hanoi University of Public
Health. When the study is finished, the results
will help the locality to have appropriate
management activities in vaccination work.
RESULTS
General information about research
subjects
Ngo Thi Thuy et al.
DOI: https://doi.org/10.38148/JHDS.0801SKPT23-058
11
Journal of Health and Development Studies (Vol.08, No.01-2024)
345 mothers participated in this study; 62.6%
had a high school diploma, college and
university degrees, and above. Housewives
accounted for 40.6%; the rest were civil
servants and other occupations such as
construction, trading, and freelance workers.
The majority of the respondents were above
30 years old (56.8%), lived in urban areas
(61.4), and had more than two children so far
(68.2%). 34,5% were under six months old.
Knowledge, attitude, and practice of
mothers regarding post-vaccination care
Ngo Thi Thuy et al.
DOI: https://doi.org/10.38148/JHDS.0801SKPT23-058
Table 1. Percentage of mothers with correct knowledge about common signs, severe
reactions and the consequences of severe responses after vaccination (n=345)
Knowledge Frequency
(n)
Percentage
(%)
Common signs
of reactions after
vaccination
Mild fever 307 89.0
Hypothermia 35 10.1
Swelling and pain at the injection site 182 52.8
Mild fussiness 225 65.2
Vomiting 34 9.9
Ulcer 52 15.1
Signs of severe
reactions after
vaccination
High fever (> 39ºC) 256 74.2
Prolonged crying for more than 30 minutes 161 46.7
Convulsion 243 70.4
Vomit/Low milk intake or refusal to
breastfeed 170 49.3
Difficulty breathing, cyanosis 261 75.7
Rash, bleeding, allergic reactions 126 36.5
Consequences of
severe reactions
after vaccination
Causing long-lasting consequences 102 29.6
Life threatening 114 33.0
Disability, weakened health 248 71.9
Dead 172 49.9
Table 1 shows that more than 50% of mothers
knew that the common manifestations of
post-vaccination reactions were swelling and
pain at the injection site, mild fussiness, fever;
fever was the most known 89% of mothers.
Shortness of breath/cyanosis, very high fever,
and convulsions are the most well-known
manifestations of severe reactions after
vaccination by mothers (75.7%, 74.2%, and
70.4%, respectively). Severe post-vaccination
reactions that were life-threatening and fatal
for infants were the most well-known by
mothers (72% and 50%),
In general, the majority of mothers with good
knowledge of AEFI achieved, accounting for
62.0%.
12
Journal of Health and Development Studies (Vol.08, No.01-2024)
Ngo Thi Thuy et al.
DOI: https://doi.org/10.38148/JHDS.0801SKPT23-058
Figure 1. Percentage of mothers’ attitudes about childcare after vaccination
In figure 1, 89% of mothers have a good
attitude about AEFI, which: The results in
the above table show that 61.2% of mothers
mother confirm vaccination is very necessary,
and 38.6% of mothers agree that vaccination
is important. 15.7% and 38% of women
strongly agree and agree that all vaccines
have side effects or adverse reactions after
vaccination respectively. 55.9% of mothers
said that the reaction is preventable after
vaccination, but 13% thought it could not
be prevented. Commenting on their role
in preventing and managing post-injection
AEFI, 28.4% of mothers confirmed that it
is very important, and only 2.6% think their
role is not important. Regarding the necessity
of monitoring children after vaccination
at vaccination centers for 30 minutes after
vaccination, 53.3% of mothers strongly agree,
and 45.5% of mothers agree. Continuing to
monitor at home for at least 24 hours has the
strong agreement of 46.1% of mothers and
the agreement of 51.6% of mothers. A total
of 97.4% of mothers either agree or strongly
agree with the idea of monitoring the child for
at least 30 minutes at the vaccination center
and continuing to monitor at home for at least
24 hours after vaccination.
Table 2. Mother’s practice on keeping immunization records and providing information
to health workers before vaccination.
Information Frequency
(n)
Percentage
(%)
Keep your child’s
immunization record
Have 337 97.7
Have not 8 2.3
Provide health workers
with information about
the child
Child’s current health 321 93.0
Child’s medical history 207 60.0
Child’s birth history 149 43.2
History of drug/vaccine allergy 216 62.6
Reaction occurred in previous vaccination 213 61.7
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Journal of Health and Development Studies (Vol.08, No.01-2024)
Table 3. Mother’s practice on childcare after vaccination
Ngo Thi Thuy et al.
DOI: https://doi.org/10.38148/JHDS.0801SKPT23-058
Table 2 shows most mothers kept their
children’s immunization records (97.7%).
When asked about the child’s health status
before vaccination, mothers tended to talk
about the child’s current health the most
(93.0%), followed by the history of drug /
vaccination allergy (62.6%), history of
reactions occurring in previous injections
(61.2%) and medical history of children
(60%).
Information Frequency
(n)
Percentage
(%)
Monitoring children
after vaccination at CHC
< 30 minutes 51 14.8
> 30 minutes 294 85.2
Reasons for
monitoring children at
the injection site for
<30 minutes (n=51)
Busy don’t have enough time 39 76.5
There are no seats 4 7.8
Don’t know that need to stay 30 minutes to
monitor the child 6 11.8
Seeing that the child has no unusual problems 42 82.4
Monitor children’s
health at home
< 24 hours 64 18.6
> 24 hours 281 81.4
Reasons for
monitoring children’s
health at home < 24
hours (n=64)
Do not have time 53 82.8
Don’t know what to follow 1 0.4
Seeing that the child has no abnormal problems
49 92.5
Caring for children
with fever (n=205)
Wear loose, airy clothes 123 60.0
Use fever-reducing medicine when you
have a fever 119 58.0
Wipe/apply with warm water 133 64.9
Using folk medicine, traditional medicine
8 3.9
Give your child more water and milk to
drink/feed 101 49.3
Do nothing 2 1.0
Take care of children
when there is swelling,
redness, pain at the
injection site (n=194)
Hot compress 23 11.8
Cold compress 37 19.1
Clean the injection site well with clean water 76 39.2
Do not apply, or put anything on the
injection site 104 53.6
Do nothing 52 26.8
In this table, after vaccination, 85.2%
of mothers let their children stay at the
monitoring station for 30 minutes or more.
About 14.8% of mothers let their children
go home before 30 minutes, because they
don’t see any problems with their children
(82.4%) and don’t have enough time (76.5%).
After returning home, 18.5% of mothers did
not monitor their children for more than 24
hours; the main reason was that 92.5% did