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MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH MANYVANH VONGSY KNOWLEDGE AND PRACTICE REGARDING THE ADNINISTRATION OF THE PENTAVALENT VACCINE AMONG HEALTH CARE WORKER IN VIENTIAN CAPITAL, LAO PDR, 2019 MASTER OF PUBLIC HEALTH CODE: 8720701 HANOI, 2020 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH MANYVANH VONGSY KNOWLEDGE AND PRACTICE REGARDING THE ADNINISTRATION OF THE PENTAVALENT VACCINE AMONG HEALTH CARE WORKER IN VIENTIAN CAPITAL, LAO PDR, 2019 MASTER OF PUBLIC HEALTH CODE: 8720701 SUPERVISOR: VANPHANOM SYCHAREUN, MD, PhD DEAN OF THE FACULTY OF PUBLIC HEALTH UNIVERSITY OF HEALTH SCIENCE MINISTRY OF HEALTH VIEANTIANE, LAO PDR HANOI, 2020 i ACKNOWLEDGEMENTs This independent study would not have been possible without the help and support of many people I am very thankful to the Ministry of Health of the Lao PDR, the LEARN project, the University of Health Science (UHS), and the Hanoi University of Public Health (HUPH) for funding and providing support during my period of study at the UHS in Laos and the HUPH in Vietnam The help of the Xaythany District Hospital is also gratefully acknowledged for allowing me to study at the UHS and the HUPH My sincere and deep gratitude goes to my advisors Dr Vanphanom Sychareun, PhD (Dean, Faculty of Public Health of Laos), and Dr Do Thi Hanh Trang, PhD (Department of Disaster Management, Faculty of Environmental and Occupational Health Hanoi University of Public Health) for their valuable advice, as well as their constant supervision and encouragement throughout the challenging time of completing my dissertation I would like to express my sincere gratitude to Dr Kongmany Chaleunvong for his kind suggestions and valuable comments with respect to data analysis I would like to acknowledge the valuable comments and encouragement from Prof Bui Thi Thu Ha who was the examination chair of my Independent Study Committee I wish to thank Dr Nguyen Ngoc Bich, and Dr Alongkone Phengsavanh, who were members of the study committee I am most grateful to the headmaster, teachers and students of Vientiane High School who kindly accepted to help and participate in this research This study could not have been completed without their generous assistance I am grateful to all the lecturers, teachers, coordinators and all staff of the UHS and the HUPH for their continuous assistance and helpful advice ii I would like to thank my classmates for their kindness during the period of my studies at the UHS and the HUPH Finally, I would like to thank my family for their love, understanding, support, and encouragement during the time I studied at the UHS and the HUPH Ms Manyvanh VONGSY iii Contents ACKNOWLEDGEMENTS i LIST OF TABLES vi ABSTRACT viii INTRODUCTION RESEARCH QUESTION RESEARCH OBJECTIVES CHAPTER 1: LITERATURE REVIEW 1.1 Definitions 1.2 Situation of pentavalent immunization in Laos and the world 1.3 Knowledge and practice among health care workers and their importance 1.4 Determinants of knowledge and practice regarding child immunization 11 CHAPTER 2: METHOD 19 2.1 Study design 19 2.2 Study location 19 2.3 Study population 20 Quantitative research 20 2.4 Sampling method 20 Qualitative method 21 2.5 Data collection 22 Quantitative data collection 22 Qualitative data collection 22 2.6 Study instruments 23 2.7 Variables 24 2.8 Measures for outcomes 24 2.9 Data analysis 26 2.10 Ethical approval 28 CHAPTER RESULTS 30 3.1 Background information of participants 30 iv 3.1.1 Work experience 31 3.2 Description of knowledge 32 3.2.1 Knowledge of possible precautions and contraindications to vaccinations 32 3.2.2 Knowledge of health care workers on doses and routes of administration 33 3.2.3 Knowledge of health care workers on time of vaccine administration 34 3.2.4 Knowledge of health care workers on side effects of the pentavalent vaccine 35 3.2.5 Overall knowledge of health care workers regarding children’s immunization 37 3.3 Description of practice 37 3.3.1 Practice relating to preparatory steps 37 3.3.2 Practice relating to general vaccine measure 39 3.3.3 Practice relating to specific measures for the pentavalent vaccine 40 3.3.4 Overall vaccination practice of health care workers 40 3.4 Association of knowledge and practice of HCWs regarding the pentavalent vaccine 41 3.5 Determinant of knowledge regarding the pentavalent vaccine 42 3.5.1 Association between individual factors and knowledge 42 3.5.2 Association between organization factors and knowledge 43 3.6 Determinant of practice regarding the pentavalent vaccine 44 3.6.2 Association between organization factors and practice 45 3.7 Multivariate logistic regression analysis of factors associated with a knowledge of the pentavalent vaccine 48 3.8 Multivariate logistic regression analysis of factors associated with the practice of the pentavalent vaccine………………………………………………………….49 CHAPTER 52 DISCUSSION 52 CONCLUSION 61 RECOMMENDATIONS 62 REFERENCES 63 ANNEXES 69 v Abbreviations and Acronyms AEFI Adverse Events Following Immunization CDC Centers for Disease Control and Prevention DTP3 Diphtheria-Tetanus-Pertussis three-in-one vaccine EPI Expanded Program on Immunization Hib B Haemophilus influenzae Type B Hep B Hepatitis B HCWs Health Care Workers HCPs Health Care Providers PHCPs Primary Health Care Providers PCU Primary Care Unit SDG Sustainable Development Goal VRE Vaccine safety Related Event vi List of Tables Table 3.1 Socio-demographic characteristics of participants………………………29 Table 3.2 Work related experiences of participants … ………………………….31 Table3.3 Knowledge of possible precautions and contraindications to vaccinations …………………………………………………………………………………… 32 Table 3.3.1 Knowledge of health care workers on doses and routes of administration 32 Table3.3.2 Knowledge of health care workers about the time for vaccine administration………………………………………………………………………34 Table 3.3.3 Knowledge of health care workers about side effects……… ………35 Table 3.4 Preparatory steps……… ………………………………………… .37 Table3.5 General vaccine measures……………………… …………………… 39 Table 3.6 Specific measures for the pentavalent vaccine……………………… 40 Table 3.7 Association of knowledge and practice of HCWs regarding the pentavalent vaccine ………… ……………………………………………………41 Table 3.8 Socio-demographic characteristics associated with a knowledge regarding the pentavalent vaccine 42 Table 3.9 Association between organizational factors and knowledge 44 Table 3.10 Socio-demographic characteristics associated with the practice of the pentavalent vaccine 46 Table 3.11 Association between organizational factors of practice 47 Table 3.12 Multivariate logistic regression analysis of factors associated with knowledge and the pentavalent vaccine ………………………………………… 50 vii Table 3.13 Multivariate logistic regression analysis of factors associated with the practice of the pentavalent vaccine …………… ……………………………… 52 Figure 3.1 Overall knowledge of health care workers regarding children’s immunization…………… ……………………………………………………… 37 Figure 3.2 Overall vaccination practice of HCWs……………………… ………41 viii Abstract The pentavalent vaccination is an essential, cost-effective public health measure to reduce preventable, premature, child mortality and childhood morbidity The pentavalent vaccination contributes to lowering the spread of vaccine-preventable diseases Health care workers’ knowledge and practices with the use of the pentavalent vaccination are influential factors in preventing pentavalent vaccine failures One of the main reasons parents accept immunization for their children is that it is recommended by health care providers This fact underlines the important role of health care providers in increasing parents’ confidence in immunization by dealing with their concerns, answering their questions and convincingly resolving their doubts The aim of this study is to assess the knowledge and practice of providing pentavalent vaccines and their related factors among health care workers This was a cross-sectional analytical study, using the mixed-method approach that combines qualitative and quantitative methods This study was conducted in nine district hospitals and 33 health centers in Vientiane Capital In total, 184 health care workers were involved in the study and 12 HCWs were involved in the in-depth interviews The quantitative data was entered using the EpiData programme and analyzed using the Stata 14.1 programme Descriptive and inferential statistics were applied to determine the factors associated with the knowledge and practice of pentavalent vaccines A thematic analysis was applied for the qualitative data From among the 184 respondents, the results showed that under two thirds of them (63.3%) had a poor knowledge of the pentavalent vaccine and that slightly less than two thirds of health care workers (65.7%) had a good practice of the pentavalent vaccine The findings from the in-depth interviews which were also supported by the quantitative method showed that the HCWs in this study had a poor knowledge of the side effects of pentavalent vaccines as they had incorrect answers about the severe side effects of pentavalent vaccines such as analphylactic shock and the loss of appetite after receiving the pentavalent vaccine
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