KNOWLEDGE OF VACCINE PREVENTABLE DISEASES AND CHILDCARE PRACTICES AMONG PRESCHOOL CAREGIVERS IN IBADAN, OYO STATE

Abstract

Preschool caregivers spend substantial time with children who have inherent susceptibility to preventable diseases particularly vaccine preventable diseases (VPDs). Childcare practices by the caregivers impact on the morbidity and mortality patterns of vaccine preventable diseases (VPDs). Previous studies on knowledge of VPDs, childcare practices and management of childhood diseases focused on mothers (primary caregivers). This study explored the roles of secondary caregivers (preschool caregivers) in disease prevention. It examined their knowledge of VPDs and childcare practices related to disease prevention in preschools. A cross-sectional survey with an explorative component was conducted among 799 preschool-caregivers whom were selected using a multi-stage sampling technique. Five Local government areas (LGAs) areas namely Ibadan North, Northwest, Northeast, Southeast, Southwest (Ibadan municipality) were purposively selected from the 33 LGAs in Ibadan. One settlement representing a community was then selected by simple random technique from selected wards of each of the five LGAs. All consenting caregivers in the preschools within the selected communities were interviewed. Data was collected using semi-structured questionnaires. The socio-demographics; knowledge on six VPDs and childcare practices were studied. Practice variables were reported in proportions. Bivariate analysis hi-square test was used to determine associations between variables at a significance level of p<0.05. Computing composite knowledge scores involved allotting a point for correct responses and no point for both wrong and 'don't know' responses. Practice score was computed using a 3point likert scale in which - 'always' was allotted 2 points; 'sometimes'- 1point; and never had no point. Maximum scores were 94 and 80 points for VPDs and childcare practices respectively. Mean scores derived were used as cut-off points for categorizing main outcome variables into good or poor status. Respondents' mean age was 33.7 ± 9.5 years. Tertiary education 552(69.1%) accounted for the highest educational level attained by the respondents. Of this, NCE holders were 335 (41.9%). Majority 594(74.3%) of caregivers did not have pre-employment childcare training. Only 71(8.9%) of caregivers affirmed to having in- service training which most of the time internally organized by the school administration twice yearly. Only 99(12.4%) mentioned that pre-employment medical screening was done. Likewise seven hundred and one (87.7%) responses claimed not to have rountine medical check-ups in the centres. Results on immunization practice showed that although, 649 (81.2%) of the respondents reported vaccination as the best preventive approach for VPDs, 139( 17.4%) mixed vaccines with local herbs while 11(1.4 %) opted for local herbs alone. Majority 605(75.7%) affirmed that they 'communicate the importance of immunization with parents always; 586 (73.3%) supported immunization exercises in the preschools. For check children's immunization status as prerequisite to school entry, proportion was 414 (51.8%). Other practices assessed :- Breast milk were reported to be warmed before feeding the children in only 59 (7.4%) of 201 respondents. A few 133 (16.6%) taste while 44 (5.5%) chew food to soften it before feeding. Force feed rate is (109) 13.6 %. Classrooms are averagely cleaned twice per day. Respondents 551 (69.0%) had good knowledge of VPDs above the mean knowledge score of 42.7 ± 13.6 but poor childcare practice was 453(56.7%). Knowledge of VPDs was significantly associated with good practice (p <0.004).Consistently, educational status, previous affiliation with healthcare facility, training of the respondents and job designation predicted the two outcome variables. For wholly impactful approach in the prevention of VPDs, this study provides evidence for emphasis on stricter pre -employment certifications/ processes, mandatory regular medical checks, training interventions (outreaches) and monitoring of preschool care-givers' practices. It equally proposes for a review of the educational curriculum at the training institutions for preschool caregivers. Review should focus on case scenarios and practical hands on- appreciation of disease control measures relevant to preschools. Since the schools encourage immunization activities, immunization records check can be made mandatory in preschools.