THE PRESENT STATUS OF DOH IMMUNIZATION PROGRAM

IN IGOROT COMMUNITY

CHAPTER I

Infants have protection against certain diseases because antibodies have passed through
the placenta from the mother to the unborn child. After birth, breastfed babies get the
continued benefits of additional antibodies in breast milk. But in both cases, the protection
is temporary. (Webster)

Children who are not fully immunized are more susceptible to common childhood diseases.
The Expanded Program on Immunizationis one of the DOH Programs that has already been
institutionalized and adopted by all LGUs in the region. Its objective is to reduce infant
mortality and morbidity through decreasing the prevalence of six (6) communicable
diseases namely: TB, diphtheria, pertussis, tetanus, polio and measles.

Some parents may hesitate to have their kids vaccinated because they are worried that the
children will have serious reactions or may get the illness the vaccine is supposed to
prevent. Because the components of vaccines are weakened or killed and in some cases,
only parts of the microorganism are used, they are unlikely to cause any serious illness.
Some vaccines may cause mild reactions, such as soreness where the shot was given or
fever, but serious reactions are rare.

The risks of vaccinations are small compared with the health risks associated with the
diseases they are intended to prevent.

The World Health Organization says that there is a process whereby a person is made
immune or resistant to an infectious disease, typically by the administration of a vaccine.
Vaccines stimulate the body’s own immune system to protect the person against
subsequent infection or disease (WHO).It is a proven tool for controlling and eliminating
life-threatening infectious diseases and is estimated to avert over 2 million deaths each
year. It is one of the most cost-effective health investments with proven strategies that
make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly
defined target groups. It can be delivered effectively through outreach activities. It does not
require any major lifestyle change.

Barangay Health Workers in the Philippines serve as a main tool of the Department of
Health to connect with all residents in this country. Their roles are to disseminate
information among to residents particularly to the mothers about the implementation of
Department of Health and programs in order to promote alertness among the people as
well as the prevention of diseases.
The research study is carried out because of the social differences the researchers observed
during the initial interview with the residents of Igorot community. It was noticeable that
the residents were quite wary on our intention to conduct a study. The barangay officials
directed the researchers to look for the person who is in charge of the community. The fact
that the Igorot reside in the location for over 20 years, the person in charge stated that they
have been a problem with adherence to health programs. However, there was an obvious
change with regards to complying with the said problems.

Pedestal on the foregoing discussions, the researchers got interested in conducting a study
on the present status of DOH immunization program in Igorot community. This also serves
to identify the facilitating and the hindering factors in the delivery of immunization
program, determine the difficulties encountered in the implementation and to know the
strategies that can be undertaken to improve and sustain the immunization program in
Igorot Community.

This study also aims to help barangay health centers to fully implement and to set other
plans in order to fully implement the Immunization Program in Igorot Community, so that
mothers will be more aware in the improvement of their children’s growth.

Health Belief Model supports the study.

The Health Belief Model is commenced by Conner (1996), Marcus Lewis (2002),
Rosenstock (1974), and Becker (1978) it is a psychosomatic model that attempts to explain
and predict health behaviors of individual. Focusing on the attitudes and beliefs of
individuals does this. The Core Assumptions and Statements of Health belief model is based
on the understanding that a person will take a health-related action if that person: feels
that a negative health condition can be avoided, has a positive expectation that by taking a
recommended action, they will avoid a negative health condition, believes that they can
successfully take a recommended health action.

The HBM was spelled out in terms of four constructs representing the perceived threat and
net benefits: perceived susceptibility, perceived severity, perceived benefits, and perceived
barriers. These concepts were proposed as accounting for people's "readiness to act." An
added concept, cues to action, would activate that readiness and stimulate overt behavior.
A recent addition to the HBM is the concept of self-efficacy, or one's confidence in the
ability to successfully perform an action. Rosenstock added this concept and others in 1988
to help the HBM better fit the challenges of changing habitual unhealthy behaviors, such as
being sedentary, smoking, or overeating. The agreement of Complied Susceptibility is the
belief of chances of realizing a condition, which is theoretical to define population at risk,
risk levels and personalize risk based on a person's features or behavior. In Complied
Severity it is also a belief of how serious a condition and its consequences are and also
applied Specify consequences of the risk and the condition. In the Complied Benefits, the
belief is in the efficacy of the advised action to reduce risk or seriousness of impact and it is
applied to define action to take; how, where, when; clarify the positive effects to be
expected. While the Complied Barriers the belief of the tangible and psychological costs of
the advised action it is applied to Identify and reduce barriers through reassurance,
incentives, and assistance. Cues to Action are for Strategies to activate "readiness" it is to
provide how-to information, promote awareness, reminders. And the last concurrence is
Self-Efficacy it is confidence in one's ability to take action and it is also applied to provide
training, guidance in performing action.

Scope and Limitations

The focus of this study is directed towards the present status of DOH immunization
program in Igorot community

This study deals with the Igorots’ present status of DOH program. The facilitating and
hindering factors in the delivery of immunization program, the difficulties encountered in
the implementation and the strategies that can do to improve and sustain the program
among Igorot community.

However, the researchers delimited the study to mothers ages eighteen to fifty that gave
birth from year 1987 up to the present year. The said year was chosen because
immunization program was intensified in 1986. The selection of the said minority group in
Barangay Pacdal Baguio city is brought about by the fact that they are poorer, less educated
and are generally in worse health than the rest of the population base on the local
government data. This locale is chosen to determine if the minority groups, specifically the
Igorot mothers, are complying in the immunization program of the Department of Health.

The researchers will conduct interview of the mothers of Barangay Pacdal as well as the
barangay and health officials, and tackle about the importance of immunization for the
improvement of their daily lives. The researches will also conduct survey on the
respondents’ awareness on immunization. However, the study will not tackle the
immunization beyond the scope of EPI. The research study delimited itself to five vaccines
provided to children ages zero to nine months namely BCG, DPT, OPV, Hepa B, and AMV.

The researchers will also conduct an interview to the selected Barangay and Health officials
who are specifically assigned to EPI in order to know their existing program.

The instrument used in the study was the modified questionnaire. This is to assess if the
respondents are subjecting to immunization program. The study will be focusing on the
answers provided by randomly selected respondents on the questionnaire. Thus, it is
limited to the results of the survey and some information, literatures and research studies
made that will be cited and reviewed. Any other further questions on the results of the
survey can be done in future studies and research.
 Facilitating and
hindering factors:
1. Level of
awareness Present status of DOH
2. Economic immunization
condition program
3. Political factors
4. Health
condition
5. Cultural Factors

Strategies to sustain
and improve the
Difficulties immunization
encountered in the program
implementation of
immunization

H1. The higher the facilitating and hindering factors, the higher the difficulties encountered
in the implementation of immunization.
H2. The higher the facilitating and hindering factors, the higher effect on present status of
DOH immunization program.

H3. The more facilitating and hindering factors, the more strategies to sustain and improve
the immunization program.

H4. The higherthe difficulties encountered in the implementation of immunization, the

more strategies to sustain and improve the immunization program.

H5. The presence of strategies to sustain and improve the immunization program, the
better status of DOH immunization program.

H6. The higherthe difficulties encountered in the implementation of immunization, the

worse status of DOH immunization program.

Definition of terms

To guide and for easy understanding of this study, the following operational definition of
terms was presented. The researchers have pre-defined them so it would not create some
degree of confusion on the part of the reader.

Igorot Community. It refers to the whole population of indigenous people residing at

Barangay Pacdal, Baguio City.

Igorot mothers. It refers to the mothers who are the respondents of the study. They are
indigenous ethnic group who reside in Barangay Pacdal, Baguio City.

Awareness. It is the state of mind in which the person is being informed and being
conscious about something in his surroundings.

Barangay health center. It refers to a place that houses a medical practice and offers health
services in Pacdal, Baguio City

Barriers of immunization. IN this study, it includes the undesirable effects and the reasons
why mothers do not get their children immunized.

Compliance. It is the act or process of submitting of the Igorot mothers to immunization

program

Immunization Program. This program is launched by the DOH for the prevention of six
major diseases extended from the hospital to communities.
Newborn. It refers to an infant from the time of complete delivery to nine months old
wherein immunization can be administered.

Population. It refers to the collection of people who are the respondents of the study

Public Health Worker. It refers to a person that is well-trained health care provider who
works for the government.

Quality of life. It is the general standard of life of residents of Barangay Wawa.

Vaccines. These are the solutions or substance used to immunize children to cause
artificially acquired active-passive immunity

CHAPTER II

Review of Related Literature and Studies

This chapter presents a review of Related Literature and suitable information congregated
from health related books, published articles and Internet, which grant relevant
information concerning this study. The researchers have gathered a research literature
derived from a second several sources to allow them to have tangible understanding and a
base of support of the research topic.

Expanded Program on Immunization Philippines

The modern Expanded Program on Immunization (EPI) was launched in 1979 but
intensified in 1986. With government commitment, donor support, and involvement of
non-governmental organizations (NGOs) and civil society, the program attained
spectacular success quickly. Within a few years, the coverage in terms of children fully
immunized increased from 2% in 1986 to 62%. Routine EPI is distinguished from the
others interventions, such as National Immunization Days; whereas the former is a regular
monthly activity that provides vaccination against the six diseases, the latter is a campaign
done twice a year for eradicating a specific disease, such as polio. (Wikipedia)

Differing parental immunization behaviors may influence Racial/ethnic disparities in

childhood immunization coverage. Determining which behaviors differ can be beneficial to
eliminating these disparities

The Expanded Program on Immunization (EPI) in the Philippines began in July 1979. In
1986, they made a response to the Universal Child Immunization goal. The four major
strategies include: Sustaining high routine Full Immunized Child (FIC) coverage of at least
90% in all provinces and cities, Sustaining the polio-free country for global certification,
Eliminating measles by 2008, Eliminating neonatal tetanus by 2008(Webster).
Immunization against the major infectious diseases; prevention and control of locally
endemic diseases, at the special session of the Un General Assembly on Children (Morris
2002), major successes identified include the near elimination of polio and a reduction of
annual child deaths by nearly 3 million. As cited by Ball and Bindler, 2006, in spite of these
successes, Kofi Annan, the Un secretary General, said the world has failed to ensure
children’s rights to health care, education, and protection from violence – one in three
children suffers from malnutrition, one in four globally has never been immunized against
disease, and one in five never attended school. In addition, up to 25 million are involved in
child labor, including millions who are victims of sexual exploitation and trafficking
(Medical Mission Sisters 2002).

Full immunization refers to the child’s completion of BCG, 3 doses of DPT, 3 doses of
OPV and measles vaccine before he turns 1 year old. At this point, however, it is important
to note that immunity to a disease can only take effect upon completion of a full course as
in the case of DPT, Pertussis and tetanus.

Prevention of disease is one of the most important goals in childcare. During infancy
preventive measures can be carried out against infectious diseases. Parents should be
encouraged to keep their own records of immunization of their children.
Immunization vaccines are suspensions of whole or fractionated bacteria or viruses that
have been treated to make them non-pathogenic. Vaccines are given to induce an immune
response and subsequent immunity. Although vaccine development has been a major
factor in improving public health, no vaccine is completely effective or entirely safe (Burbe
2005).

Routine Schedule of Immunization

Every Wednesday is designated as immunization day and is adopted in all parts of the
country. Immunization is done monthly in barangay health stations, quarterly in remote
areas of the country. The standard routine immunization schedule for infants in the
Philippines is adopted to provide maximum immunity against the seven vaccine
preventable diseases in the country before the child's first birthday. The fully immunized
child must have completed BCG 1, DPT 1, DPT 2, DPT 3, OPV 1, OPV 2, OPV 3, HB 1, HB 2,
HB 3 and measles vaccines before the child is 12 months of age.
BCG or Bacillus Calmette – Guerine is given at birth or any time after birth. The number of
dose is 1 and the dose to be given to infant is 0.05 ml. Its route is intradermal and the site
for injection is right deltoid region of the arm. The reason why BCG is given it is because at
earliest possible age it protects the possibility of TB meningitis and other TB infections in
which infants are prone.
Diphtheria-Pertussis-Tetanus Vaccine is given 6 weeks after birth. The number of dose is 3
and the dose to be given is 0.5 ml. The minimum interval between doses is 4 weeks. Its
route is intramuscular and its site for injection is upper portion of thigh. It is given early
start with DPT reduces the chance of severe pertussis.
 Oral Polio Vaccine is given 6 weeks after birth. The number of dose is 3 and the dose to be
given is 2 – 3 drops. The minimum interval between doses is 4 weeks. Its route is oral and
the site is mouth. The reason why it is given its because of the extent of protection against
polio is increased the earlier the OPV is given.

Hepatitis B is given at birth. The number of dose is 3 and the dose to be given is 0.5
ml. The minimum interval between doses is 6 weeks interval from1st dose to 2nd dose, 8
weeks interval from 2nd dose to third dose. Its route is intramuscular and the site to be
injected is upper outer portion of thigh. Hepatitis B is given because at early start it
reduces the chance of being infected and becoming a carrier, it prevents liver cirrhosis and
liver cancer that are more likely to develop if infected with Hepatitis B early in life. About
9,000 die of complications of Hepatitis B. 10% of Filipinos have Hepatitis B infection.

Measles Vaccine is given 9 months. The number of dose is 1 and the dose to be given is 0.5
ml. Its route is subcutaneous and the site to be injected is upper outer portion of the arm. It
is given because At least 85% of measles can be prevented by immunization at this age
(Webster).
The recommended schedule for immunization is updated at least annually to reflect new
vaccines and the need for repeat immunization. The advisory Committee on Immunization
Practices (ACIP) of the Centers for Disease Control, The American Academy of Pediatrics
(AAP), and the American Academy of family Practitioners (AAFP) collaborate to provide a
uniform vaccination schedule.
Since its inception in the 1970's, EPI in the Western Pacific has greatly evolved in many
areas. While EPI initially focused on building sustainable routine immunization systems to
protect children against common childhood diseases through administration of vaccines
during infancy, achieving by 1988 less than 80% coverage of children receiving the basic
set of vaccines, in 1988, when the WHO World Health Assembly (WHA) and the Western
Pacific RCM endorsed resolutions to eradicate poliomyelitis (WHA 41.28 and
WPR/RC39.R15), WPR - EPI embraced a new era of eradication, elimination and
accelerated control of specific diseases and as a result of those efforts, the last indigenous
case of poliomyelitis occurred in 1997 and poliomyelitis eradication was certified on 29
October 2000.

The poliomyelitis-free status has been maintained since although several episodes of
imported wild poliovirus occurred and vaccine derived polioviruses (VDPV) emerged in
areas of low coverage. None of these events though resulted in sustained poliovirus
transmission.
Measles had declined substantially in the Region over the past 25 years and most countries
had attained the 90% disease reduction goal set by the 1989 WHO World Health Assembly
due to high routine coverage with measles vaccine. The introduction of hepatitis B vaccine
into the routine immunization program of all countries was almost achieved, with
Cambodia and Lao PDR scheduled for September 2001. Neonatal tetanus (NT) had been
eliminated in all but five countries of the Region.
In this context regional measles the Regional Committee Meeting (RCM), WHO’s governing
body in the Western Pacific, established elimination and hepatitis B control goals in 2003
and a target year of 2012 was endorsed by the RCM in 2005.

Focusing on providing hepatitis B vaccine birth dose and a second dose measles vaccine
was perceived as offering new opportunities to complete the whole schedule. In the
broader context of generally strengthening routine immunization services and health
systems additional vaccine preventable diseases could be averted, and by fostering
collaboration with mother and child health services further contributions can be made to
reducing childhood mortality as well as maternal mortality, the latter mainly through
prevention of tetanus. Both will support achieving the important respective Millennium
Development Goals (MDG).

Since the regional twin goals were established, efforts are also being made at regional and
national levels to prepare countries to take informed decisions on introduction and
expansion of new and underutilized vaccines against Haemophilia influenza type b (Hib),
Streptococcus pneumoniae, Rotavirus, rubella, and Japanese encephalitis (JE). Introduction
of new and expansion of underutilized vaccines will offer additional opportunities to
reduce childhood deaths and progressively protected more people from vaccine
preventable diseases.

These new initiatives, build on the established routine immunization systems and the
specific regional goals of measles elimination and hepatitis B control by 2012 (WHO).

General Principles in Infants / Children Immunization

Because measles kills, every infant needs to be vaccinated against measles at the age of 9
months or as soon as possible after 9 months as part of the routine infant vaccination
schedule. It is safe to vaccinate a sick child who is suffering from a minor illness (cough,
cold, diarrhoea, fever or malnutrition) or who has already been vaccinated against measles.

If the vaccination schedule is interrupted, it is not necessary to restart. Instead, the

schedule should be resumed using minimal intervals between doses to catch up as quickly
as possible. Vaccine combinations (few exceptions), antibiotics, low-dose steroids (less
than 20 mg per day), minor infections with low fever (below 38.5º Celsius), diarrhoea,
malnutrition, kidney or liver disease, heart or lung disease, non-progressive
encephalopathy, well controlled epilepsy or advanced age, are not contraindications to
vaccination. Contrary to what the majority of doctors may think, vaccines against hepatitis
B and tetanus can be applied in any period of the pregnancy.

There are very few true contraindication and precaution conditions. Only two of these
conditions are generally considered to be permanent: severe (anaphylactic) allergic
reaction to a vaccine component or following a prior dose of a vaccine, and encephalopathy
not due to another identifiable cause occurring within 7 days of pertussis vaccination.
Only the diluents supplied by the manufacturer should be used to reconstitute a freeze-
dried vaccine. A sterile needle and sterile syringe must be used for each vial for adding the
diluents to the powder in a single vial or ampoule of freeze-dried vaccine.

The only way to be completely safe from exposure to blood-borne diseases from injections,
particularly hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency
virus (HIV) is to use one sterile needle, one sterile syringe for each child (Webster).

Care for Vaccines

To ensure the optimal potency of vaccines, careful attention is needed in handling practices
at the country level. These include storage and transport of vaccines from the primary
vaccine store down to the end-user at the health facility, and further down at the outreach
sites. Inappropriate storage, handling and transport of vaccines won’t protect patients and
may lead to needless vaccine wastage.
A "first expiry and first out" (FEFO) vaccine system is practiced to assure that all vaccines
are utilized before its expiry date. Proper arrangement of vaccines and/or labeling of
expiry dates are done to identify those close to expiring. Vaccine temperature is monitored
twice a day (early in the morning and in the afternoon) in all health facilities and plotted to
monitor break in the cold chain. Each level of health facilities has cold chain equipment for
use in the storage vaccines, which included cold room, freezer, refrigerator, transport box,
vaccine carriers, thermometers, cold chain monitors, ice packs, temperature monitoring
chart and safety collector boxes. (http://en.britanicca.org)

EFFECTS IF NOT VACCINATED

Although vaccines have dramatically reduced the number of people who get infectious
diseases and the complications these diseases produce, the viruses and bacteria that cause
vaccine-preventable diseases and death still exist. Without vaccines, epidemics of vaccine-
preventable diseases would return.

Physical effects

If we were to discontinue polio vaccination, immunity to polio would decline, leading to the
risk of polio epidemics similar to those that occurred in the past.

Stopping measles vaccination would probably lead to massive epidemics similar to those
that occurred in the pre-vaccine era. Between 1989 and 1991, the number of reported
measles cases rose sharply, with >55,000 cases, 11,000 hospitalizations and 120 deaths
reported. The major cause of the outbreak was low rates of vaccination among preschool
children.
Before Haemophilus influenza type B immunization, Hib was the most common cause of
bacterial meningitis in U.S. infants and children. Before the vaccine, there were about
20,000 invasive Hib cases annually. About two-thirds were meningitis. Without
vaccination, this disease would likely cause the same amount of disease and deaths that it
caused before the vaccines were developed.
Before pertussis immunizations were available, nearly all children developed pertussis. In
the United States, prior to pertussis immunizations, between 150,000 and 260,000 cases of
pertussis were reported each year with up to 9,000 pertussis-related deaths. If we stopped
giving pertussis vaccine in the U.S., we would experience a massive resurgence of disease. A
recent study found that, in eight countries where immunization coverage was reduced,
incidence rates of pertussis surged to 10-100 times the rates in countries where
vaccination rates were sustained.

While rubella is usually mild in children and adults, up to 90 percent of infants born to
mothers infected with rubella during the first trimester of pregnancy will develop
congenital rubella syndrome, resulting in heart defects, cataracts, mental retardation and
deafness. If immunity to rubella were to decline, rubella would return, resulting in
pregnant women becoming infected and giving birth to infants with CRS.

The above information covers five of the 10 vaccine-preventable diseases against which
children are routinely vaccinated. Stopping vaccination would also cause major increases in
diphtheria, tetanus, hepatitis B, varicella and mumps (Rosenthal, 2010).

Emotional effects

As parents, you have to make important decisions every day concerning your children.
Some of these decisions are easy, and others require a great deal of time and research.
Whether or not to vaccinate your children is a very personal decision. If you choose not to
vaccinate, it's extremely important that you understand the risks associated with this also.
Not only could this affect your child, but it could affect other families as well.

POINTERS TO REMEMBER ON IMMUNIZATION

Every child deserves to be given the benefits of immunizationprotection based on

immunization law.No vaccine gives 100% protection. They go hand in hand with
goodhygiene and other measures for disease prevention. Recommended series of
immunization must be completed foradequate protection.Booster doses are important to
maintain continuous protectionagainst the diseases.Interruption of schedule does not
interfere with final immunity nor does it necessitate contraindication to
vaccination.Malnutrition, minor respiratory infections, moderate fever, coughand diarrhea
do not constitute contraindications to vaccinations.

The absolute contraindications to immunization are:Measles and OPV vaccines are

most sensitive to heat. They must bestrictly maintained at -15 – 20 Vaccines is safe and
effective with mild side effects aftervaccination.
Giving doses of a vaccine at less than 4 weeks interval may lessen the anti body response.
Lengthening the interval leads to higher antibody levels.Practice FEFO first expiry first out
rule, and 1 syringe one needleone child policy must strictly implement. (DOH)

Awareness

Besides life, the mother has another gift to her newborn, the immunity from
diseases that the mother acquired. But few months later, the newborn loses this immunity
thus; it is imperative to comply with child immunization (Ladewig, London, and Davidson
2006).

It is important to protect babies and young children from some of the most common
infectious diseases. Unarguably, vaccination against infectious diseases is one of the most
profound and successful medical breakthroughs of all time. The American Academy of
Pediatrics understands that parents may have questions and concerns about vaccines and
during the campaign strives to allay fears and enlighten people about the benefits of
immunizations. It is believed that by providing health teaching and information
dissemination, that people will not be so frightened or against childhood vaccinations.
While there are risks and side effects with vaccinations, nothing can be as bad as watching
a child endure physical suffering due to an otherwise preventable disease. By informing
and raising public awareness about the benefits of immunizations during childhood, it is
hoped that people will be more likely to have their child vaccinated.

Effect of awareness

It was found that there was a high level of awareness about polio disease and a low level of
knowledge of route of poliovirus transmission. Reluctance in the release of children for
polio immunization was found to be due to many rounds of national immunization days,
fear of polio vaccine over dose and polio vaccine contamination with harmful pathogens.
These results suggest the need for public enlightenment to create greater awareness about
the safety of the vaccine and the goal of polio eradication initiative, which is polio
eradication.

One reason that measles outbreaks occur is because of an increase in the number of un-
immunized children. This can, in turn, set back past gains made to ensure at least 90%
immunization coverage in the community population. It is necessary to provide additional
vaccinations to many children, because about 15% of children do not receive immunity
after their initial vaccination at 9 months of age and, therefore, require a booster vaccine
later in childhood.
Vaccines have eradicated small pox, eliminated wild poliovirus in the U.S. and significantly
reduced the number of cells of measles, diphtheria, rubella, pertussis, and others, but
despite these efforts, today tens of thousands of people in the U.S. still die from these and
other vaccine preventable diseases. The expanded program on immunization started by the
WHO in 1974 has improved coverage for BCG, DPT, polio and measles to about 80% of
children in developing countries including Pakistan although childhood immunization has
reduced the impact of major infectious disease markedly. Despite extreme efforts and
allocation of a big budget for immunization program still we have not eradicated the
poliomyelitis from our society.

This clearly signifies that immunization coverage in Pakistan needs improvement. There
are so many factors behind this issue. The awareness of immunization in paramedical
persons is one of them. Considering the fact it had been decided to conduct a study about
awareness of immunization among paramedical students. This will help us identify the
underlying problem and later steps should be taken to solve it by educating the
paramedical community.

HINDRANCES

Barriers faced by those needing immunization primarily fall into 3 categories: lack of
knowledge about immunizations, fears about vaccine safety, and logistical problems that
limit access to immunization services.

Lack of knowledge about immunizations can exist on many levels. Demand for
immunization requires that the recipient or parent be aware of the threat of vaccine-
preventable diseases, and know that vaccine is available, effective, and safe. In the 1996
Medicare Current Beneficiary Survey, the top reasons for why adults had not received
pneumococcal or influenza vaccines were lack of knowledge that the vaccines were
recommended and concerns about safety.

In a study of 20-month-old children in Olmstead County, Minnesota, parental confusion

regarding the immunization schedule, fear of vaccine side effects, and delays due to
children’s illnesses contributed to delayed immunization. Although the parents in this
study also cited long waits and inconvenient office hours as barriers, these were not
associated with delayed immunization. New mothers who expected to encounter barriers
to immunization were more likely to have incompletely immunized infants at 7 months of
age, compared with mothers who did not anticipate barriers. In this urban cohort, poverty
had less impact on immunization rates than did perceived barriers.

Although the federally-funded Vaccines for Children Program (VFC) has funded
immunizations for uninsured and Medicaid-insured children since its inception in 1994,
not all underinsured children can visit their usual source of health care and receive these
vaccines at no cost. Thus families who might qualify for free vaccinations may face other
barriers such as transportation problems, fragmented records, or other related barriers in
an attempt to avoid the barrier of cost. Even parents of low-income children who can
receive their immunizations through a VFC program at their usual source of care may not
be aware of this program, in which case they will continue citing cost as a barrier to
immunization (Burns, 2005).

Although transportation was an acknowledged problem for some, overall the respondents
said that parents who want to have their children immunized should not find
transportation to be a significant barrier. Some parents expressed previous frustration
when they took their child to be vaccinated according to schedule, but were refused
because the child had a cold or other illness. Many women mentioned that local,
neighborhood immunization sites such as grocery stores or mobile vans might increase the
immunization rate.

Common deficiencies in immunization practices and patient barriers are similar to those
encountered internationally. These include not immunizing at sick visits, not providing for
‘walk-in’ immunizations, not making immunization available during evenings and
weekends, failing to perform immunization screening at every visit and having no formal
reminder or tracking systems. Patient barriers include cost, parental attitudes, language
barriers, transportation and patient mobility. Provider barriers are lack of availability of
immunization records (immunization tracking), low reimbursement rates, problems with
keeping small volumes of vaccines, record-keeping problems and their own failure to
counsel parents about the importance of immunization, to immunize at sick visits and to
screen for immunization status at all visits.

CHAPTER III

DESIGN
Descriptive research was used

PARTICPANTS

Respondents of the study are mothers age eighteen to fifty that gave birth from year 1987
up to the present year. The said year was chosen because immunization program was
intensified in 1986.

Other participants are the Barangay and Health Officials who are assigned in Expanded
Immunization Program.

INSTRUMENT
The instrument used in the study was the modified questionnaire base on ----- as tool for
the Igorot mothers.
Different interview guide was used for the Barangay Health Officials who are assigned in
the Immunization program.

PROCEDURE
A letter of permission was given to Barangay Captain. After his approval one of the
Barangay Health Official assisted us in conducting our survey in the Igorot Community.
There’s a series of activity conducted by the researcher in order to get the respondents
attention to focus on the survey.

CHAPTER IV

Table 1. Frequency distribution of respondents according to age

The age bracket of undermined has the highest frequency which is 33 and a
corresponding percentage of 59% of the total population. On the other hand, age
bracket of 44-49 years old has the lowest frequency which 1, or 2% of the total
population
Age Group Frequency
Percentage
20-25 11 20
26-31 4 7
32-37 4 7
38-43 3 5
44-49 1 2
Undermined 33 59
Total 56 100

Table 2. Frequency distribution of respondents according to civil status

 Married respondents has the highest frequency of 47 or 83.9% of the total
population. There are only a few widowed and single respondents, consisting of 5 or
8.9% of the total population and 4 or 7.1% respectively

Frequency Percent
Single 4 7.1
Married 47 83.9
Widowed 5 8.9
Total 56 100.0

Table 3. Frequency distribution of respondents according to educational attainment

Majority of the respondents are elementary undergraduate which has a
frequency of 54 or 96.4%. While respondents who reached college undergraduate
are only 2 or 3.5% of the population

Frequency Percent
Elementary Undergraduate 54 96.4

College Undergraduate 2 3.6

Total 56 100.0

Table 4. Frequency distribution of respondents according to number of children

In terms of the number of children in the family with 3-4 children got the
highest frequency which is 23 or 41.1%. While family with no child got the lowest
frequency which 1 or 1.8% of the total population

Frequency Percent
No Child 1 1.8
1 - 2 children 17 30.4
3 - 4 children 23 41.1
5 - 6 children 9 16.1
7 - 8 children 4 7.1
5 2 3.6
Total 56 100.0
Table 5. Frequency distribution of respondents according to monthly income
Majority of the family who got the highest frequency of monthly income has
a frequency of 33 or 58.9%. While the family who got the lowest frequency got 1 or
1.8% of the total population

Frequency Percent
Below P1000 1 1.8
P1, 000 - P2, 999 22 39.3
P3, 000 - 4,999 33 58.9
Total 56 100.0

Table 6. Relationship between Age and Facilitating and hindering factors

There is a direct significant relationship between political factors and cultural

factors. This implies that as the age of the respondents increases their perception on
immunization tends to increase also while the rest of the factors are not significant.
Facilitating and (Age) Verbal 2-tailed Verbal
hindering Pearson Interpretation interpertation
factors correlation
Self Concept 0.13 positive 0.34 Not significant
negligible
correlation
Political factors 0.29 positive 0.03 Significant
negligible
correlation
Health condition 0.23 positive 0.09 Not significant
negligible
correlation
Cultural factors 0.29 positive 0.03 Significant
negligible
correlation
Table 7. Relationship between Civil status and Facilitating and hindering factors
There is a positive negligible correlation between civil status and cultural
factor. This implies that married women are strongly influenced by the cultural
factor than single women

Facilitating (Civil Verbal 2-tailed Verbal

and hindering status) Interpretation interpertation
factors Pearson
correlation
Self concept -0.4 negative 0.76 Not Significant
negligible
correlation
Political -0.4 negative 0.76 Not Significant
factors negligible
correlation
Health 0.6 positive 0.63 Not Significant
condion negligible
correlation
Cultural 0.28 positive 0.03 Significant
factors negligible
correlation

Table 8. Relationship between Educational Attainment and Facilitating and

hindering factors
There is no significant relationship between educational attainnment and
the factors influencing immunization program

Facilitating (Educational Verbal 2-tailed Verbal

and Attainment) Interpretation Interpretation
hindering Pearson
factors correlation

Self concept 0.04 positive 0.75 Not

negligible Significant
correlation
Political 0.09 positive 0.52 Not
factors negligible Significant
correlation
Health -0.10 negative 0.47 Not
condition negligible Significant
correlation
Cultural -0.21 negative 0.13 Not
factors negligible Significant
correlation
Table .9 . Relationship between Number_of_Children and Facilitating and hindering
factors
There is no significant relationship between the number of children and
the factors influencing immunization program

Facilitating (Number of Verbal 2-tailed Verbal

and children) Interpretation Interpretation
hindering Pearson
factors correlation

Self concept -0.10 negative 0.45 Not

negligible Significant
correlation
Political 0.15 positive 0.28 Not
factors negligible Significant
correlation
Health -0.05 negative 0.71 Not
condition negligible Significant
correlation
Cultural -0.20 negative 0.15 Not
factors negligible Significant
correlation

Table 10. Relationship between MFI and Facilitating and hindering factors

There is negative neglible correlation between MFI and cultural factors. This
implies that respondents who are low income earners were greatly influenced by the
immunization program of the DOH than those who earned more
Facilitating and (MFI) Verbal 2-tailed Verbal
hindering Pearson Interpretation Interpretation
factors Correlation

Self concept -0.11 negative 0.43 Not

negligible Significant
correlation
Political factors -0.08 negative 0.55 Not
negligible Significant
correlation
Health condition -0.25 negative 0.06 Not
negligible Significant
correlation
Cultural factors -0.43 negative 0.00 Significant
negligible
correlation
 Recommendation/Conclusion

Recopmmendation:

1. The Local Government in partnership with DOH should look into the accessabilty of the igorot tribe
to avail free immunization for their children. Igorot people may have more difficulty obtaining free
immunization due to lack of knowledge and lack of access to health care facilities

2. The Local Government should be more sensitive to the language barriers among Igorot tribe .They
demonstrated that language barriers and the inability to comprehend immunization programs led
to poor compliance and underuse of services

3. The DOH should be more vigilant on the inappropriate health education materials written at an
advanced reading level along with confusing immunization schedules that can contribute to
inadequate immunization based on the fact that Igorot people are almost all elementary graduates

4. DOH should provide health education to Igorot parents because education can be used to
disregards beliefs and increase comprehension of immunization recommendations.
5. The Local Government/DOH should provide cultural competency training among Igorot people.
Strategies to reach Igorot populations should be culturally relevant. It may be useful to provide
training in cultural competency to Igorot who are actively working with a community so that they
can learn more about the differences within and across communities
6. The Local Government/DOH should utilized Media advertising for information dissemination it is
a fact to have an effective tool for reaching Igorot community. Media can be used to address
specific concerns and this may contribute to increased immunization rates among the children of
Igorot
7. The Local Government/DOH should develop a community-based programs. Trained Igorot
leaders can be successful at mobilizing parents to fully immunize their children, specifically to
those Igorot parents where routine approaches have failed. Common outreach strategies utilized
by community-based organizations may take the form of informal presentations to groups

Conclusion:

Based on the results of the study it revealed that there is no significant relationship
between facilitating and hindiring factors, strategies to sustain and improve the immunization
program and difficulty encountered in the implementation of the immunization