Журнал «Здоровье ребенка» 1 (60) 2015

Introduction:

Immunization is one of the most effective methods of preventing infectious diseases. Young children due to the high risk of morbidity and mortality is the target group of vaccination [1-2]. But one of the problems of modern vaccination is increasing of the number of parents’, who refuse vaccinate their children [3]. The growth of negative attitudes towards children’s immunization exist, despite of obvious medical and social effectiveness of vaccination [4, 5, 6, 7].

The problem of the parents’ negative attitude to vaccination is especially important for Ukraine. During last years the level of vaccination coverage in some regions of the state became lower than protective level due to increasing the number of parents who refuse to vaccinate their children [8].

Pediatricians are responsible for the children’s preventive vaccination implementation; communication with parents and conducting health education work among them. So the doctor-patient’s relationship and the quality of health education work connected with the meaning of vaccination for children’s protection against infectious diseases are the important factors that involve at parents attitude to immunization of their children.

Purpose: we wanted to determine the interrelation between personal attitudes of doctors to immunization, quality of their health education work and level of immunization in their districts for definition of health and educational activities that will suppose positive parents’ attitude towards immunization.

Materials and Methods:

We interviewed 52 pediatricians of different ages, with varying degrees of experience and qualification and 170 parents.

The physician’s questionnaire consists of 32 questions divided into the following parts:

1) personal data; 2) attitude to their work and the time spent for self-education; 3) vaccination history of the doctors’ children; 4) attitude to immunization; 5) knowledge of the main immunology issues; 6) directions of health education work among parents (3 issues).

Questionnaire for parents contained questions about their attitude to immunization and trust in pediatrician. Statistical analysis of the results was conducted using the software SPSS Statistica 17.0, "Statgraf", "Matstat".

Results and discussion:

The interview of physicians showed that the vast majority of them (88.2%) have a positive attitude towards immunization, 9.8% of physicians have uncertain attitude to immunization and only 2% - negative. Among the interviewed physicians 89.1% have children, including 95.7% physicians who vaccinated their children according to national calendar and 4.3% physicians who did not do it due to the medical contraindications. This data confirms the high confidence in active immunization among doctors.

All interviewed doctors actively conducted health education activities, aimed at improving vaccination coverage among children, using one or more of the following methods: 1) conversations with parents (93.9%); 2) giving information lists (65.3%); 3) reminding about vaccination by telephone (87.8%); 4) motivational posters about immunization in places where parents waiting for physician (94.5%).

When comparing the level of vaccination coverage among children in particularly districts and methods of health education, which were used in each district, we found that the distribution of information lists more important than other methods but this difference is not statistically significant. So parents’ attitude to immunization is more dependent on trust in physician than the intensity of doctors motivation work.

Some negative influence on immunization coverage of children doctors make unconsciously, unnecessarily increasing the number of temporary and permanent medical contraindications to vaccination. According to our research, all doctors follow existing contraindications, but 50.5% unnecessary delayed vaccination and 64.7% of physicians attributed to contraindications disease, which actually aren’t contraindications.

Conclusions:

1. The vast majority of physicians (88.2%) have a positive attitude to immunization. Among physicians who have children 95.7% vaccinated all their children, and other (4.3%) did not do it due medical contraindications, which confirms the high confidence in active immunization among doctors.

2. We determined a direct correlation between the degree of trust in the physician and parents’ positive attitude to immunization. This data shows the importance of physicians as carriers of positive information about immunization and significant impact of the quality of the relationship "doctor-patient" on the parents’ attitude to vaccination.

3. We found that the most effective is a comprehensive health education activity that includes explanatory conversations with parents, information lists for each parent, information material about vaccination in areas where parents waiting for physician.

4 More than 50% of physicians expand the list of temporary and permanent contraindications for the active immunization and exaggerate the frequency of adverse events after vaccination.