Knowledge, perceptions and practice of nurses on surveillance of adverse events following childhood immunization in Nairobi county, Kenya

Abstract

Although vaccines currently approved for routine childhood immunization are safe and effective, frequent Adverse Events Following Immunization often cause ill health and sometimes loss of public trust in immunization programs. Nurses are essential in AEFI surveillance. During the pre-licensure clinical trials, serious adverse events with low occurrence frequency go undetected due to limited number of enrolled subjects. In Nairobi County, only one Adverse Event Following Immunization has been reported since inception of Expanded Programme of Immunization. This study sought to assess nurses’ knowledge level, to establish their perception and to examine their practices towards surveillance of post-immunization adverse events within City Council of Nairobi Health Centers. A cross-sectional hospital-based survey study, using proportionate random sample from all the health facilities, involving nurses (n=274) working at city council of Nairobi health centers was done. Data was collected using self administered questionnaire. Data analysis was performed using SPSS version 20 (SPSS Inc, USA). Chi-square test was used to establish comparisons between categorical variables. Associations between knowledge, perception and practice levels were analyzed using correlation. Binary logistic regression was computed appropriately. 29.2% of the respondents had good knowledge on AEFI surveillance, while 32.1% of the respondents had good practice towards AEFI surveillance. 45.3% of the respondents had good perception towards AEFI surveillance. Respondents aged more than 49 years (43.3%, P=0.010) and those with at least 30 years of experience in nursing (41.3%, P=0.019) had good knowledge on AEFI surveillance. Respondents having Bachelors nursing degree (83.7%, P<0.0001) and those trained in AEFI surveillance (44.4%, P<0.0001) had good knowledge on AEFI surveillance. In addition, respondents having Bachelors nursing degree (88.6%, P<0.0001) and those with previous AEFI training (61.6%, P<0.0001) had good perception on AEFI surveillance. Respondents with Bachelors degree in nursing (85.7%, P<0.0001) and those with at least 30 years of experience in nursing (45.3%, P=0.026) had good practices on AEFI surveillance. In addition, respondents trained in AEFI (51.2%, P<0.0001) had good practices. Respondents trained in nursing at Bachelors degree level were 13.9 times more likely to have good knowledge (OR, 13.85; 95% CI, 4.39-46.66; P<0.0001), whereas those with previous AEFI training were 4.4 times more likely (OR, 4.38; 95% CI, 2.35-8.17; P<0.0001) to possess good knowledge on AEFI surveillance. Respondents having Bachelors degree nursing and those with training in AEFI were 8.9 (OR, 8.87; 95% CI, 2.82-27.69; P<0.0001) times and 3.7(OR, 2.18; 95% CI, 2.18-6.36; P<0.0001) times, respectively more likely to have good perception towards AEFI surveillance. Furthermore, those trained in AEFI were 5.7 (OR, 5.67; 95% CI, 3.68-10.43; P<0.0001) times more likely to have good practice on AEFI surveillance. Therefore, findings of this study demonstrated low knowledge, poor perception and poor practice level towards AEFI surveillance among nurses working at City Council of Nairobi Health Centers. This study illustrated knowledge and perceptions influence practice towards AEFI surveillance. Thus, information generated from this study might be valuable in informing policy review on immunization programs at the city council of Nairobi health Centers and enhance AEFI surveillance and consolidate the gains made in immunization coverage.