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1. About Industry
1.1 Introduction
India has been awarded a 'Polio Free' status by way of an official certification presented by the
World Health Organisation (WHO). India is among other countries in the South East Asian
region which have been certified as being free of the polio virus. India has been polio free since
January 2011, as per Mr Ghulam Nabi Azad, Minister for Health and Family Welfare,
Government of India.
The healthcare industry is potentially the world's largest industry with total revenues of
approximately US$ 2.8 trillion. In India as well, healthcare has emerged as one of the largest
service sectors constituting 5 per cent of the gross domestic product (GDP) and offering
employment to around 4 million people.
India's primary competitive advantage over its peers lies in its large pool of well-trained medical
professionals. Also, India's cost advantage compared to peers in Asia and Western countries is
significant - cost of surgery in India is one-tenth of that in the US or Western Europe.
Healthcare
The Indian heathcare industry, growing at a CAGR of 15% is expected to touch US$ 250 billion
by 2020.
Driving growth factors are rising population, increasing disposable income, increasing lifestyle
related health issues, cheaper treatment costs, thrust in medical tourism, improving health
insurance penetration, government initiatives and focus on public private partnership (PPP)
models.
Most Indian metros have hospitals with world-class infrastructure, processes and outcomes.
However, 70% of the healthcare infrastructure is confined to the top 20 cities of India. In order
to reach the remaining population, innovations both in healthcare products and delivery are
required.
Healthcare systems predominantly differ in means, methods and approach, but all confront
mediocre health outcomes and a steeply escalating cost curve that is unsustainable in the long
term. Offering affordable healthcare without compromising access to care or quality requires
innovative new products and care options.
Healthcare in India today provides existing and new players with a unique opportunity to
achieve innovation, differentiation and profits. In the next decade, increasing consumer
awareness and demand for better facilities will redefine the country’s second largest service
sector employer.PwC understands the healthcare system as well as the dynamics that drive it.
Ours is an industry aligned, market focused practice to provide greater value addition and more
effective solutions for our clients.
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1.2 Market size
The healthcare sector is growing at a 15 per cent compound annual growth rate (CAGR) and
grew from US$ 45 billion in 2008 to US$ 78.6 billion in 2012 and is expected to touch US$ 158.2
billion by 2017, according to a report by Equentis Capital.
India's per capita healthcare expenditure has increased at a CAGR of 10.3 per cent from US$
43.1 in 2008 to US$ 57.9 in 2011 and is expected to rise to $88.7 by 2015. The factors behind
the growth are rising incomes, better access to high-quality healthcare facilities and greater
awareness of personal health and hygiene, highlighted the report.
The private sector has emerged as a vibrant force in India's healthcare industry, lending it both
national and international repute. The private sector's share in healthcare delivery is expected
to increase from 66 per cent in 2005 to 81 per cent by 2015. Its share in hospitals and hospital
beds is estimated at 74 per cent and 40 per cent, respectively.
Investments
According to data released by the Department of Industrial Policy and Promotion (DIPP),
hospital and diagnostic centres attracted foreign direct investment (FDI) worth Rs 12,413.57
crore (US$ 2.02 billion) between April 2000 and July 2014.
Some of the major investments in the Indian healthcare industry are as follows:
 LifeCell, India's largest umbilical cord blood stem cell bank, plans to set up a public stem
cell bank at a cost of Rs 30 crore (US$ 4.9 million).
 Max India plans to dilute its stake in Max Healthcare in favour of its South African
partner Life Healthcare in an all-cash deal of about Rs 794 crore (US$ 129.76 million).
 TPG Capital is in advanced talks to invest up to Rs 900 crore (US$ 147.09 million) for a
minority stake in Manipal Health Enterprises (MHE).
 HLL Lifecare has teamed up with Tata Memorial Centre for constructing a modern
women and children cancer hospital at Parel in Mumbai.
 BlackBerry plans to launch a healthcare service that will integrate thousands of medical
devices to enable early detection of illnesses, in partnership with healthcare technology
firm NantHealth, as it looks beyond smartphones in the Indian market.
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1.3 Government Initiatives
The Ministry of Road, Transport and Highways, the Department of AIDS Control and Ministry of
Health and Family Welfare have signed a Memorandum of Understanding (MoU) with an
objective of providing HIV preventive services to transport sector workers.
The Central Government has requested the Government of Odisha for allotment of 25 to 30
acres of land for setting up a satellite centre of the All Indian Institute of Medical Sciences
(AIIMS) Bhubaneswar as a super specialty healthcare facility.
India and Maldives signed three agreements after delegation level talks between Mr Abdulla
Yameen Abdul Gayoom, President, Maldives, and Dr Manmohan Singh, the then Prime Minister
of India, on January 2, 2014. The pacts included a MoU on health cooperation.
The Union Cabinet has approved the proposal for setting up of National Cancer Institute (NCI)
at a cost of Rs 2,035 crore (US$ 332.62 million). NCI will be set up in the Jhajjar campus
(Haryana) of AIIMS, New Delhi. The project is estimated to be completed in 45 months.
Under the Union Budget 2014-15, some of the major initiatives taken by the Government of
India to promote the healthcare sector in India are as follows:
 Free Drug Service and Free Diagnosis Service to achieve 'Health For All'
 Two National Institutes of Ageing to be set up at AIIMS, New Delhi and Madras Medical
College, Chennai
 A national level research and referral Institute for higher dental studies to be set up
 AIIMS-like institutions in Andhra Pradesh, West Bengal, Vidarbha in Maharashtra and
Poorvanchal in UP. A provision of Rs 500 crore (US$ 81.71 million) made
 12 new government medical colleges to be set up
 15 Model Rural Health Research Centres to be set up for research on local health issues
concerning rural population
Road Ahead
The coming years will see great out-of-the-box thinking by the strategists in the field of
healthcare, beginning with the way healthcare is delivered.
To begin with, a rise in retail clinics, single speciality, secondary and tertiary care centres are
seen coming to the fore including the recent examples of NOVA day care, BEAMS and Apollo
clinics.
The tier II/III cities have suddenly become attractive to the healthcare players, especially
because of the tax sops and increasing disposable incomes among Indian families across the
country and dearth of quality healthcare infrastructure in these locations.
Specially focused on medical tourism, health cities are being designed and executed and
hospitals with bed strengths of 1500/2000 which were never heard in the private domain are
now coming to light.
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Technology will play a major role in bringing quality in healthcare, be it better nursing
communication systems, patient monitoring devices or telemedicine to provide low cost
diagnosis to remote patients, etc.
Companies like Blackberry, HCL and HP are already investing heavily in healthcare technology
and Google trying to ambitiously woo the consumers for a centralised healthcare database.
What is in store for the future of healthcare is limitless.
Public and private sector
According to National Family Health Survey-3, the private medical sector remains the primary
source of health care for 70% of households in urban areas and 63% of households in rural
areas. Reliance on public and private health care sector varies significantly between states.
Several reasons are cited for relying on private rather than public sector; the main reason at the
national level is poor quality of care in the public sector, with more than 57% of households
pointing to this as the reason for a preference for private health care.Other major reasons are
distance of the public sector facility, long wait times, and inconvenient hours of operation.The
study conducted by IMS Institute for Healthcare Informatics in 2013, across 12 states in over
14,000 households indicated a steady increase in the usage of private healthcare facilities over
the last 25 years for both Out Patient and In Patient services, across rural and urban areas.
National Rural Health Mission
A community health center in Kerala .
The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of
India. The goal of the NRHM was to provide effective healthcare to rural people with a focus on
18 states which have poor public health indicators and/or weak infrastructure.
Primary Care Secondary Care Tertiary Care. Gujarat offers holistic medicinal services and cost
effective treatment through various district hospitals, sub district hospitals and private specialty
hospitals. Most sought after super – specialties in the State include cardiology, neuro– surgery,
orthopedics, infertility treatment, joint replacement and eye surgeries. Share of primary care in
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the total healthcare market of Gujarat is around 75-80%. Secondary and tertiary care account
for 17% and 4% respectively of the total healthcare market. Market for tertiary care expected
to grow at a faster rate, due to rise in income levels, increasing adoption of health insurance
and rise in complex in-patient ailments (heart diseases, kidney ailments, cancer)Ministry of
Finance, 2006 The healthcare landscape in Gujarat is changing rapidly,The available medical
infrastructure and easily accessible healthcare facilities have improved the health of the
population of the State remarkably over the years. The State Government is taking several
initiatives to make Gujarat a Global healthcare destination. Gujarat is evolving in terms of
number of hospitals, healthcare centres, beds and are expected to continue a positive trend in
future. Doctor to patient ratio is 1:10 and nurse to patient ratio is 1:5 .
By the use of latest technical equipment, efficient health insurance, major corporate
investments and the services of highly skilled medical personnel, the Gujarat healthcare sector
has set itself on a boom Healthcare sector in the State has potential to grow at a much faster
rate in the foreseeable future and shall be numerous in providing healthcare facilities
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2. Major Players in Vaccination Industry
The renaissance in the vaccine market continues with strong growth and new prospects to continue to
grow this part of the market, which now stands at about $25 billion. Once a commodity market with low
margins, the vaccines on the market now include blockbusters and megablockbusters. New candidates
for vaccinating against cancers and HIV are also projected to hit the magic milestone. The market is
expected to return a compound annual growth rate of more than 8% through
2018, EvaluatePharma projects, with some segments like adult vaccines showing even better.
A big part of the growth in vaccine sales has been in the adult influenza market with the big focus on flu
prevention and an acceptance of adult vaccines. There is a chance that the results from the
demonstrably bad flu season in the U.S. this year may affect what happens next year. The Centers for
Disease Control and Prevention (CDC) recently noted that only 56% of people who received the jab were
protected from influenza, on the very low end of effectiveness spectrum. It was particularly ineffective
among the elderly, one of the key target groups. The results led CDC Director Dr. Thomas Frieden to
lament, "We simply need a better vaccine against influenza, one that works better and lasts longer."
Still, the FDA last year approved two quadrivalent, or four-strain, vaccines, Fluarix Quadrivalent from
GlaxoSmithKline ($GSK) and MedImmune's FluMistQuadrivalent. An FDA panel recently endorsed a
move to quadrivalents in the U.S., a decision that will help the influenza vaccine market grow. And that
doesn't take into account that the vaccination rate in the U.S. still remains below 50%.
For all of the new developments and growth, vaccines are a market primarily made up of a handful of
significant players, with another handful of small operators. In 2012, the top 5 vaccinemakers captured
more than 90% of vaccine sales, according to figures from analysts at EvaluatePharma.
 Sanofi
 Merck
 GlaxoSmithKline
 Pfizer
 Novartis
 SAP
1.Sanofi
Sanofi S.A. is a French multinational pharmaceutical company headquartered inParis, France, as of 2013
the world's fifth-largest by prescription sales. The company was formed as Sanofi-Aventis in 2004 by the
merger of Aventis and Sanofi-Synthélabo, which were each the product of several previous mergers. It
changed its name to Sanofi in May 2011.
Sanofi engages in the research and development, manufacturing and marketing of pharmaceutical
drugs principally in the prescription market, but the firm also develops over-the-counter medication.
The company covers 7 major therapeutic areas:cardiovascular, central nervous system,diabetes, internal
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medicine, oncology,thrombosis and vaccines (it is the world's largest producer of the latter through its
subsidiary Sanofi Pasteur)
2.MERCK
Merck is a leading company for innovative and top-quality high-tech products in healthcare, life
science and performance materials. Around 39,000 employees work in 66 countries to improve the
quality of life for patients, to further the success of our customers and to help meet global challenges.
Merck is the world's oldest pharmaceutical and chemical company. Since 1668 name has stood
for innovation, business success and responsible entrepreneurship. The founding family remains the
majority owner of the company to this day.
3. Types
 Whole-Organism Vaccines
 Purified Macromolecules as Vaccines
 Recombinant vaccine
 DNA vaccine
 Multivalent Subunit Vaccines
• A vaccine is a biological preparation that improves immunity to a particular disease. It contains
certain agents that not only resembles a disease-causing microorganism but it also stimulates
body’s immune sustem recognize the foreign agents.
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Disease or pathogen Type of vaccine
Viral particles
Hepatitis A
Influenza
Measles
Polio (Sabin)
Polio (Salk)
Rabies
Rotavirus
Varicella zoster (chickenpox)
Yellow fever
Inactivated
Inactivated
Live attenuated
Live attenuated
Inactivated
Inactivated
Live attenuated
Live attenuated
Live attenuated
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4. Litrature Review
1. A research on “Factors Influencing Parents’ Decision on Their Children's Vaccination against
Seasonal Influenza:A Systematic Review” by MENG Yue ,Master of Public Health,The
University of Hong Kong(August 2013).
Parental intention and uptake of seasonal influenza vaccination in pediatric population were
generally not satisfactory and varied largely across regions. Addressing the determinants that
are important for parents' decision on their children's vaccination is vital for effectively
improving immunization coverage. Based on HBM, TIB and the TRA, the influencing factors
extracted from current literature were integrated into a comprehensive framework. The
framework proposes that the parents’ intention to vaccinate their children against seasonal
influenza is influenced by demographic variables, attitude towards seasonal influenza
vaccination, knowledge and perception of influenza/influenza vaccine, social norms (cues to
action and subjective norms), emotion, and past behavior/experience; easy access to
vaccination facilities as a facilitating condition additionally determine the possibility of turning
intention into actual behavior.
2. A Study on “Acceptance of Human Papillomavirus Vaccine by Adolescent Girls and Their
Parents” in Turkey by AyseKilic, Memnun Seven, GultenGuvenc, AygulAkyuz, SevalCiftci.
The aim of this study was to identify the opinions of Turkish adolescent girls and their parents
about HPV vaccination and the consistency
The study indicates that an appropriate background has been partially provided about the
acceptability of the vaccine between parents and their daughters in Turkey. However, the vast
majority of adolescent girls and parents are indecisive or reluctant about HPV vaccination. This
study also showed that the decisions of adolescents about vaccination may be affected by the
opinions of the parents.
3. A Research on ‘African American parents' attitudes toward HPV vaccination ” by
Thompson VL , Arnold LD, Notaro SR.
Among parents knowledgeable about HPV, vaccination status was significantly affected by
whether a pediatrician had recommended the vaccine. There were no significant differences in
demographic characteristics or sociocultural attitudes between the parents who had vaccinated
their daughters and those who had not, although more of the parents who had vaccinated
daughters were worried about STIs.
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4. Research on “Application of the Theory of Reasoned Action in Parents Intention to
Vaccinate Their Daughters Against HPV” by Corina Cuevas Renaud, RomeroPerea, Florencia
Evelin .
The results showed the need to work on the behavioral cognitive and medicine
approaches on negative attitudes, subjective norms and prejuicios that limit public to reach the
target population.
Attitudes have the highest ratio and negative prediction. It is possible to say that the R value in
the model came out very low due to a lack of information about what is HPV, how it spreads,
the vaccine’s consequences and the parents’ fear about this issue.
Only in Mexico City this vaccination campaign is performed, their citizens are considered more
knowledgeable and trend-setting all over Mexico, but there are prejudices and inadequate
information and fear associated with those thoughts, that do not allow access the vaccine
against HPV to young girls.
5. A research on Attitudes, Beliefs and Behaviors of Parents towards Childhood
Immunizations by University of North Texas Health Science Center at Fort Worth.
Over the past twenty-eight years parental concerns regarding vaccine safety have been
escalating. These uncertainties with vaccine safety have begun to translate into tangible
decisions for a mounting number of parents by their choice not to vaccinate their children.
Many of these parents naively believe the assumption that their decision only impacts their
individual families. In actually, public health officials are observing the compounding
consequences of each of these “individual” decisions. One of the most visible consequences is
the decrease in herd immunity which protects many of the most vulnerable individuals in a
community. Although this decreasein herd immunity can be directly attributed to this emergent
movement, parents choosing not to vaccinate appear to become even more concrete in their
belief even when they are presented with this scientific evidence of their decisions.
Understanding the reckoning behind this deep-seated view is important for researchers
attempting to develop programs to encourage vaccination coverage among these high risk
populations.
6. BLACK PARENTS’ BELIEFS, ATTITUDES, AND HPV VACCINE INTENTIONS:
A MEDIATION MODEL by JENNIFER BRYER
Conclusions that may be drawn from this study of 262 Black parents include the
following theoretical relationships:
1. A significant relationship exists between parental vaccine attitudes and parental HPV vaccine
intention.
2. A significant relationship exists between HPV vaccine beliefs and parental vaccine attitudes.
3. Parental vaccine attitudes mediate the relationship between HPV vaccine beliefs and
parental HPV vaccine intention.
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7. Parents' attitudes and behaviours towards recommended vaccinations in Sicily, Italy by
Maria Anna Coniglio, Marco Platania, Donatella Privitera, Giuseppe Giammanco and
SarinaPignato.
This study suggests that health information by Family Paediatricians is significantly associated
with parental acceptance of recommended vaccinations.
8. A Research on Irish mothers’ intentions to have daughters receive the HPV vaccine by
Amanda Fahy B.A., Deirdre M. Desmond Ph.D.
Study concluded that The current study is the first to investigate HPV vaccine acceptability
among Irish mothers. Awareness of HPV was low; nonetheless, mothers reported
strong interest in HPV vaccination for their daughters and favourable attitudes towards
vaccination in general. HPV vaccine uptake intentions were uniquely predicted by attitudes and
normative beliefs. Both peer groups and medicalprofessionals may play an important role in
promoting HPV vaccine acceptance. Attitude was the dominant predictor of behavioural
intention. Both positive and negative messages affect attitudes regarding vaccination. If HPV
vaccination is to be promoted parents will require education regarding the benefits and safety
of the vaccine.
9. A research onMothers and vaccination: knowledge, attitudes,
and behaviour in Italy by I.F. Angelillo,1 G. Ricciardi,2 P. Rossi,3 P. Pantisano,4 E. Langiano,5
& M. Pavia.
Overall, 57.8% of mothers were aware about all four mandatory vaccinations for infants
(poliomyelitis, tetanus, diphtheria, hepatitis B). The results of a multiple logistic regression
analysis showed that this knowledge was significantly greater among mothers with a higher
education level and among those who were older at the time of the child's birth. Respondents'
attitudes towards the utility of vaccinations for preventing infectious diseases were very
favourable. Almost all children (94.4%) were vaccinated with all three doses of diphtheria ±
tetanus (DT), oral poliovirus vaccine ( OPV), and hepatitis B. The proportion of children
vaccinated who received all three doses of OPV, DT or diphtheria±tetanus±pertussis(DTP), and
hepatitis B vaccines within 1 month of becoming age-eligible ranged from 56.6% for the third
dose of hepatitis B to 95.7% for the first dose of OPV. Results of the regression analysis
performed on the responses of mothers who had adhered to the schedule for all mandatory
vaccinations indicated that birth order significantly predicted vaccination nonadherence,
since children who had at least one older sibling in the household were significantly less likely
to be age-appropriately vaccinated. The coverage for the optional vaccines was only 22.5% and
31% for measles±mumps±rubella and for all three doses against pertussis, respectively.
Education programmes promoting paediatric immunization, accessibility, and follow-up should
be targeted to the entire population.
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10. JANELLE HIGHLAND, MA researched onParental Decision Making and Childhood
Vaccination
Applied to vaccination choice, these theories and models can inform how and why parents
make their choices. Vaccination is in most cases an effective and safe means of preventing the
spread of infectious diseases, but for parents the decision that they make can be complicated.
Parental vaccination decision is influenced by multiple factors. The perceived susceptibility of
their child to illness, the perceived safety and efficacy of vaccines, their personal past
experiences with vaccination and the experiences of others, the advice of professionals, their
personal health beliefs, etc. all have an impact on a parent’s decision. Making decisions on the
behalf of their children can be difficult, and many parents whether they support vaccination or
not decide to err on the side of caution, be it choosing to vaccinate or deciding not to.
11. Parental Knowledge, Attitudes, and Behaviours towards Human Papillomavirus
Vaccination for Their Children: A Systematic Review from 2001 to 2011 by Kristina
Trim,NaushinNagji,Laurie Elit,
The percentage of parents who heard about HPV rose over time (from 60% in 2005 to 93% in
2009), as did their appreciation for the HPV infection and cervical cancer link (from 70% in 2003
to 91% in 2011). During the FDA approval, there was a stronger vaccine awareness but it has
waned. The same pattern is seen with parents whose children received the HPV vaccine (peak
at 84% in 2010 and now 36% in 2011) or the intention to vaccinate (peak at 80% in 2008 and
now 41% in 2011).
12. The Role of Attitudes About Vaccine Safety, Efficacy, and Value in Explaining Parents’
Reported Vaccination BehaviorbyKatherine Hart LaVail(Phd) and Allison Michelle
Kennedy(MPH).
Confidence in the value of vaccines is a helpful predictor of parent-reported vaccination
behavior. Attitudinal constructs of confidence in the safety and efficacy of vaccines failed to
account for additional significant variance in parents’ vaccination behaviors. Future research
should assess the role of vaccine knowledge and tangible barriers, such as access and cost, to
further explain parents’ vaccination behaviors.
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4.2 Significance of Study
The topic that has been selected is “A study on the early parents behaviour towards
vaccination in city of anand.”
This is the area of selection where the government is focusing more on the topic.
Parents are not much aware about the effect of not vaccinating their child .
By this survey we would get more information about the behavious of parents for vaccination
of their infant child.
After the survey the report may help the officials and even the early parents by,
 The recommended immunization schedule designed to protect infants and children
early in life, when they are most vulnerable and before they are exposed to potentially
life-threatening diseases.
 Checking the schedule for the age or age range when each vaccine or series of shots is
recommended. Or create a personalized schedule that shows the recommended dates
for child. If child has missed any shots, use the catch-up scheduler tool to see
recommended vaccination dates for the missed or skipped vaccines. See child’s doctor
with any questions.
 Why there is the need of vaccination ?
-To prevent infants from common communicable disease.
-To prevent infants from disease if parents transfer to different place because
geographic variations may attract diseases.
4.3 Research Methodology
Problem Statement
“A study on the early parents behaviour towards vaccination in city of anand.”
Objective
1. To measure the awareness of vaccination in minds of Early parents in anand city.
2. To study the different sources from where the information of vaccination is gathered by early
parents.
3. To determine the most preferred place for vaccination by parents.
4. To segment early parents on the basis of behaviour towards vaccination.
5. To study perceptions of early parents regarding vaccinations.
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Hypothesis
1. There is no significant relationship of income and place selected for vaccination.
2. There is no significant difference in the sources of gaining information about vaccination among
the respondents of Anand.
4.4 Research Design
Sr No. Measurement Particulars
1 Sample size 400 Respondents
2 Type of sampling Purposive Sampling
3 Sampling unit Early parents in the city (having child’s age between 0-2
years)
4 Area of research conducted Anand city
5 Type of research Descriptive research design
6 Data collection method Survey method
7 Tools for data collection Questionnaire (structured)
8 Sources of Data Primary Data & Secondary Data
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DEMOGRAPHIC PROFILE (MALE-FEMALE)
Gender
Total
Percentage
(%)Male Female
Age 20 to 25 years 50 48 98 23
26 to 30 years 83 107 190 44.6
31 to 35 years 68 52 120 28.16
>35 years 12 6 18 4.22
Total 213 213 426
Education S.S.C. 6 4 10 2.34
H.S.C. 25 72 97 22.76
Diploma 31 10 41 9.62
Graduate 114 108 222 52.11
Post-Graduate 26 15 41 9.62
Others 11 4 15 3.52
Total 213 213 426
Occupation Business 45 9 54 12.67
Agriculture 12 0 12 2.81
Professional 19 11 30 7.04
Salaried (Services) 132 35 167 39.2
Housewife/person 5 155 160 37.55
Total 213 213 426
Location Anand 157 174 331 77.69
Nadiad 56 39 95 22.3
Total 213 213 426
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Q2 : How did you get information about Vaccination?
Table2 : Reference Group
reference group * Gender Crosstabulation
Count
Gender
Totalmale female
TV 2 7 9
Newspaper 8 18 26
friends 8 6 14
family 10 40 50
doctor 185 142 327
Total 213 213 426
Image1 : Reference Group
Interpretation:
It is observed that most of respondent (327) 77% get information through Doctor/Pediatrition. While 50
respondents get information through Family and rest of the respondent get information by friends,
newspaper and TV.
0
50
100
150
200
250
300
350
Reference Group
Frequency
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Q3 : Do you know about the side effects of Vaccination?
Table3 : Side effects of Vaccination
Gender
Totalmale female
Side effects of vaccination yes 178 140 318
no 35 73 108
Total 213 213 426
Image2 : Side effects of Vaccination
Interpretation:
It is observed that 318 (74%) respondents are aware about the side effects of vaccination while 108
26%) respondents are still not aware about the side effects of vaccination.
318
108
Side effects of Vaccination
Yes
No
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Q4 : Are you aware about immunization schedule?
Table4 : Awarness of Immunization Schedule
Gender
Totalmale female
awarness of
immunization
schedule
yes 199 200 399(93%)
no 14 13 27(7%)
Total 213 213 426
Image3 : Awarness of Immunization Schedule
Interpretation:
From the above chart we can concluded that 399 (93%)respondents out of 426 are having awareness of
immunization schedule, while 27 respondents are not having awareness of immunization schedule.
399
27
Awarness of Immunization Schedule
Yes
No
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Q5 : Do you know about the mandatory Vaccination for your children?
Table5 : Mandatory Vaccination of child
Mandatory vacc of child * Gender Crosstabulation
Count
Gender
Totalmale female
Mandatory vacc of
child
yes 202 178 380(89%)
no 11 35 46(11%)
Total 213 213 426
Image4 : Mandatory Vaccination of child
Interpretation:
From the above graph we can concluded that 380 (89%)respondents have knowledge about the
mandatory vaccination of child while 46 (11%)respondents have no knowledge about the mandatory
vaccination of child.
380
46
0 100 200 300 400
Yes
No
Mandatory Vaccination of child
Frequency
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Q6 : How did you get information about Vaccination?
Table6 : Information of Vaccines
$Vaccination Frequencies
Responses
Percent of
CasesN Percent
childrena
Awarness of vacc_polio 419 23.2% 99.3%
Awarness of
vacc_hepatitisB
344 19.0% 81.5%
Awarness of
vacc_pentavalant typhoid
182 10.1% 43.1%
Awarness of vacc_typhoid 397 21.9% 94.1%
Awarness of vacc_rota
virus
310 17.1% 73.5%
Awarness of vacc_measles 157 8.7% 37.2%
Total 1809 100.0% 428.7%
a. Dichotomy group tabulated at value 1.
Interpretation:
Most of respondents are highly aware about vaccine of polio, HPB, Typhoid and Rota
Virus.While there is less awareness found in respondents regarding measles and
Pentavalent Vaccines compare to other Vaccine.
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Q7 : “Has your child received all of the vaccines that are recommended for children up to his/her age?”
Table7 : Received all vaccines upto his age
Received all vaccines upto his age
Sr.
No. Particulars Frequency %
1 Yes 393 92.25
2 No 33 7.74
Total 426 100
Image5 : Received all vaccines upto his age
Interpretation:
From the above graph we can concluded that 393 (92%)respondent’s children have received all vaccines
that are recommended for children up to his/ her age, while 33 respondent’s children are not received
all vaccines up to his/her age.
0
50
100
150
200
250
300
350
400
Yes No
393
33
Received all vaccines upto his age
Frequency
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Q8 : “Do you agree or disagree with the following statements?” (LIKERT SCALE)
Table8 : Likert Scale
Statements N Mean
Childhood vaccines are important for my 426 4.8427
Childhood vaccines are effective. 426 4.8310
Vaccination are not necessary 426 1.5939
Vaccination has always side effects 426 2.0164
Vaccination are costly 426 3.6643
Govt. Campaigns for vaccination are not effective 426 2.8239
Mandatory Vaccination should be available at all hospitals. 426 4.1526
Vaccination ensures good health of your children 426 4.7770
Vaccination protects the child from various communicable diseases 426 4.7653
I will never go to govt hospitals for vaccination 426 2.9507
Nearness of the campaign is important 426 3.9085
Private hospitals are costly 426 3.9953
I do have a family doctor 426 3.6643
Private hospitals vaccination services are effective then govt. hospitals 426 3.9178
Doctor's presence at the time of vaccination is appreciated 426 4.0962
Nearness of the campaign is less important 426 2.3897
Vaccinations are economic in govt hospital 426 3.7207
Doctors availability in private hospital is more than govt. hospital 426 3.8286
Puja , havan are effective then vaccination 426 1.4742
Family beliefs are hurdles to visit the doctor for vaccination 426 1.6948
23
Interpretation:
The likert scale statements are having the mean values as shown above.
24
Q9 : Overall, have you found decisions relating to having your child immunized very easy, easy, don't
know, difficult or very difficult to make?
Table9 : Decision Relating to immunizing the child
decision relating to immunizing the child * Gender Crosstabulation
Count
Gender
Total
%
male female
decision relating to
immunizing the child
Very Easy 19 20 39 9
Easy 96 109 205 48
dont know 57 42 99 23
diificult 34 24 58 14
Very difficult 7 18 25 6
Total 213 213 426 100
1 2 3 4 5
Very Easy______________________________________________Difficult
Image6 : Decision Relating to immunizing the child
Interpretation:
From the above graph we can say that 39(9%) respondents take decision very easily
relating o immunizing the child while 205(48%) respondents are easily take decision, 99
(23%)respondents don’t know or neutral about decisions, 58 respondents felt difficulty
to take decision and 25 respondents felt very difficult to take decision.
25
Q10 : Why have these decisions been difficult?
Table10 : Why have these decisions been difficult
Why have these decisions been difficult
%Sr.
No. Particulars Frequency
1 Possible side effects 3 0.7
2 Controversial/conflicting evidence 9 2.11
3 Not so important 5 1.18
4 Not enough information 406 95.31
5 No such place near to your house 3 0.7
Total 426 100
Image7 : Why have these decisions been difficult
Interpretation:
Above graph considered that 406(95.31%) respondents feel difficult decision because of not enough
information while rest of the respondents felt because of near location ,side effects and is not so
important.
0 100 200 300 400 500
Possible side effects
Controversial/conflicting…
Not so important
Not enough information
No such place near to your…
3
9
5
406
3
Why have these decisions been
difficult
Frequency
26
Q11 : Your Preferred Place for Vaccination
Table11 : Preffered Place for Vaccination
Preffered Place for
Vaccination %
Sr.
No. Particulars Frequency
1
Govt.
Hospitals 105 24.64
2
Pvt.
Hospitals 254 59.62
3 Sub center 8 1.87
4 PHC 59 13.86
Total 426 100
Image8 : Preffered Place for Vaccination
Interpretation:
It is considered that 254(59.62%) respondents prefer Pvt. Hospitals for vaccination , while 105(24.64%)
respondents prefer Hospitals, 59 (13.86%)respondents preferred PHC and respondents are like to
preferred sub center.
105
254
8
59
Preffered Place for Vaccination
Govt. Hospitals
Pvt. Hospitals
Sub center
PHC
27
Q12 : Have any of the following been a problem or obstacle for you when making decisions about
immunizing your child?
Table12 : Problem in immunizing the child
Problem in immunizing the child
%Sr.
No. Particulars Frequency
1
Contradictory
information 26 6.10
2
Cost of the
vaccination 149
34.97
3 Lack of information 229 53.75
4 DK/NR 22 5.16
Total 426 100
Image9 : Problem in immunizing the child
Interpretation:
Above graph concluded that 229 (53.75%) respondents are facing difficulty while taking decision about
immunizing their child due to lack of information, 149 respondents are facing problem due to cost, 26
respondents are facing problem due to contradictory information and 22 respondents are facing
difficulty due to DK/NR.
26
149
229
22
0
50
100
150
200
250
Contradictory
information
Cost of the
vaccination
Lack of
information
DK/NR
Problem in immunizing the child
Frequency
28
Q13 : Would you like to go in Govt. Campaign for vaccination?
Table13 : Like to go in Government campaign
Like to go in government campaign * Gender
Crosstabulation
Count
Gender
Totalmale female
Like to go in
government campaign
yes 148 143 291(68
%)
no 65 70 135(32
%)
Total 213 213 426
Image10 : Like to go in Government campaign
Interpretation:
It is considered that 291 respondents are like to go in Govt. Campaign, while 135 respondents are not
interested to go in Govt. Campaign.
291
135
Like to go in Government campaign
Yes
No
29
Q14 : Why have these decisions been easy?
Table14 : Why have these decisions been easy
Why have these decisions been easy
%Sr.
No. Particulars Frequency
1 Possible side effects 45 10.56
2 Doctor's Advice 309 72.53
3 Government campaign 33 7.74
4 Past experience 36 8.45
5
Child had negative
reactions 3
0.7
Total 426 100
Image11 : Why have these decisions been easy
Interpretation:
From the above graph we can say that 309(72.53%) respondents believed that because
of doctor’s advice these decisions becomes easy ,45 respondents are believed that due
to side effects , 36 respondents are believed that due to past experience , 33
respondents are believed due to Govt. Campaign.
0
100
200
300
400
45
309
33 36 3
Why have these decisions been
easy
Frequency
30
Q15 : Variation in the scheduled vaccination period
Table15 : Variation in Scheduled vaccination Period
Variation in Scheduled vaccination
Period
%
Sr. No. Particulars Frequency
1 On time 369 86.61
2 < a week 41 9.62
3 <a month 11 2.58
4 > a month 5 1.17
Total 426 100
Image12 : Variation in Scheduled vaccination Period
Interpretation:
It is considered that out of 426 respondents, 369(86.61%) respondents are going for vaccination on time
while 41 respondents are going within a week , 11 respondents are going within a month and 5
respondents are going after on month.
369
41
11 5
Variation in Scheduled vaccination
Period
On time
< a week
<a month
> a month
31
HYPOTHESIS:
1.Null Hypothesis (H0): There is no dependency in the awarness towards Vaccinations & the
City of Respondent
Alternate Hypothesis (H1): There is dependency in the awarness towards Vaccinations & the
City of Respondent
2. Null Hypothesis (H0): Perception towards going in govt. campaign is independent of gender.
Alternate Hypothesis (H1): Perception towards going in govt. campaign is dependent of
gender.
3. Null Hypothesis (H0): There is no significant relationship of income and place selected for
vaccination.
Alternate Hypothesis (H1): There is a significant relationship of income and place selected for
vaccination.
4. Null Hypothesis (H0): There is a relation between dual working parents & the scheduled
vaccination of child
Alternate Hypothesis (H1): There is no relation between dual working parents & the scheduled
vaccination of child
5. Null Hypothesis (H0): Perception towards Private hospitals vaccination is dependent to the
gender
Alternate Hypothesis (H1): Perception towards Private hospitals vaccination is independent to
the gender
32
1. Null Hypothesis (H0): There is no dependency in the awarness towards Vaccinations & the
City of Respondent
Alternate Hypothesis (H1): There is dependency in the awarness towards Vaccinations & the
City of Respondent
Sum of Squares df Mean Square F Sig.
Awarness of vacc_polio Between Groups .033 2 .017 1.019 .362
Within Groups 6.852 423 .016
Total 6.885 425
Awarness of
vacc_hepatitisB
Between Groups 1.187 2 .593 3.859 .022
Within Groups 65.029 423 .154
Total 66.216 425
Awarness of
vacc_pentavalant typhoid
Between Groups .940 2 .470 1.926 .147
Within Groups 103.304 423 .244
Total 104.244 425
Awarness of vacc_typhoid Between Groups .105 2 .053 .827 .438
Within Groups 26.921 423 .064
Total 27.026 425
Awarness of vacc_rota
virus
Between Groups .936 2 .468 2.370 .095
Within Groups 83.478 423 .197
Total 84.413 425
Awarness of vacc_measles Between Groups 1.021 2 .511 2.202 .112
Within Groups 98.117 423 .232
Total 99.138 425
33
2. Null Hypothesis (H0): Perception towards going in govt. campaign is independent of gender.
Alternate Hypothesis (H1): Perception towards going in govt. campaign is dependent of
gender.
Group Statistics
Gender N Mean
Std.
Deviation
Std. Error
Mean
Like to go in
government campaign
male 213 1.3192 .49664 .03403
female 213 1.3521 .52571 .03602
34
3.Null Hypothesis (H0): There is no significant relationship of income and place selected for
vaccination.
Alternate Hypothesis (H1): There is a significant relationship of income and place selected for
vaccination.
Income
Observed N Expected N Residual
<5000 11 85.2 -74.2
5000-10000 50 85.2 -35.2
10001-25000 262 85.2 176.8
25001-50000 77 85.2 -8.2
>50000 26 85.2 -59.2
Total 426
preferred place for vaccination
Observed N Expected N Residual
govt. hospital 105 106.5 -1.5
private hospital 254 106.5 147.5
sub centre 8 106.5 -98.5
PHC 59 106.5 -47.5
Total 426
35
Test Statistics
Income
preferred place
for vaccination
Chi-Square 487.967a
316.592b
df 4 3
Asymp. Sig. .000 .000
a. 0 cells (.0%) have expected frequencies
less than 5. The minimum expected cell
frequency is 85.2.
b. 0 cells (.0%) have expected frequencies
less than 5. The minimum expected cell
frequency is 106.5.
36
4. Null Hypothesis (H0): There is a relation between dual working parents & the scheduled
vaccination of child
Alternate Hypothesis (H1): There is no relation between dual working parents & the scheduled
vaccination of child
Group Statistics
Working
Parents N Mean Std. Deviation
Std. Error
Mean
Variation in scheduled
vaccination period
single working 366 1.1885 .49654 .02595
dual working 56 1.1607 .68162 .09109
37
5.Null Hypothesis (H0): Perception towards Private hospitals vaccination is dependent to the
gender
Alternate Hypothesis (H1): Perception towards Private hospitals vaccination is independent to
the gender
Private hospitals vaccination services are effective then govt. hospitals *
Gender Crosstabulation
Count
Gender
Totalmale female
Private hospitals
vaccination services are
effective then govt.
hospitals
strongly disagree 15 12 27
dis agree 130 112 242
neutral 38 47 85
agree 21 29 50
strongly agree 9 13 22
Total 213 213 426
38
CLUSTER ANALYSIS
Initial Cluster Centers
Cluster
1 2 3
Childhood vaccines are
important for my
2.00 2.00 4.00
Childhood vaccines are
effective.
1.00 5.00 1.00
Vaccination are not
necessary
1.00 2.00 2.00
Vaccination has always
side effects
3.00 2.00 1.00
Vaccination are costly 4.00 3.00 2.00
Govt. Campaigns for
vaccination are not
effective
1.00 5.00 1.00
Mandatory Vaccination
should be available at all
hospitals.
2.00 2.00 5.00
Vaccination ensures good
health of your children
1.00 5.00 2.00
Vaccination protects the
child from various
communicable diseases
1.00 2.00 4.00
I will never go to govt
hospitals for vaccination
3.00 2.00 1.00
Nearness of the campaign
is important
4.00 3.00 5.00
Private hospitals are costly 1.00 5.00 2.00
39
I do have a family doctor 2.00 2.00 4.00
Private hospitals
vaccination services are
effective then govt.
hospitals
1.00 5.00 5.00
Doctor's presence at the
time of vaccination is
appreciated
1.00 2.00 4.00
Nearness of the campaign
is less important
3.00 2.00 2.00
Vaccinations are
economic in govt hospital
4.00 3.00 1.00
Doctors availability in
private hospital is more
than govt. hospital
1.00 5.00 5.00
Puja , havan are effective
then vaccination
2.00 2.00 2.00
Family beliefs are hurdles
to visit the doctor for
vaccination
1.00 5.00 4.00
40
Iteration Historya
Iteration
Change in Cluster Centers
1 2 3
1 4.643 4.590 5.143
2 .180 .418 .137
3 .141 .297 .000
4 .000 .000 .000
a. Convergence achieved due to no or small
change in cluster centers. The maximum
absolute coordinate change for any center
is .000. The current iteration is 4. The
minimum distance between initial centers is
9.327.
41
Final Cluster Centers
Cluster
1 2 3
Childhood vaccines are
important for my
2.55 2.41 3.48
Childhood vaccines are
effective.
2.41 4.01 1.86
Vaccination are not
necessary
2.13 2.85 2.29
Vaccination has always
side effects
2.41 3.55 1.86
Vaccination are costly 2.54 2.90 2.08
Govt. Campaigns for
vaccination are not
effective
2.44 4.12 1.86
Mandatory Vaccination
should be available at all
hospitals.
2.57 2.36 2.62
Vaccination ensures good
health of your children
2.07 3.72 2.08
Vaccination protects the
child from various
communicable diseases
2.18 2.43 3.69
I will never go to govt
hospitals for vaccination
2.41 3.55 1.86
Nearness of the campaign
is important
2.60 2.43 2.62
Private hospitals are costly 2.10 3.83 2.08
I do have a family doctor 2.55 2.41 3.48
42
Private hospitals
vaccination services are
effective then govt.
hospitals
2.14 3.25 2.62
Doctor's presence at the
time of vaccination is
appreciated
2.18 2.43 3.69
Nearness of the campaign
is less important
2.07 3.27 2.08
Vaccinations are
economic in govt hospital
2.88 3.19 1.86
Doctors availability in
private hospital is more
than govt. hospital
2.16 3.36 2.62
Puja , havan are effective
then vaccination
2.50 2.83 2.08
Family beliefs are hurdles
to visit the doctor for
vaccination
2.12 3.30 3.48
Number of Cases in each
Cluster
Cluster 1 228.000
2 112.000
3 86.000
Valid 426.000
Missing .000
43
ANOVA
Sum of Squares df Mean Square F Sig.
Childhood vaccines are
important for my
Between Groups 2.268 2 1.134 1.415 .244
Within Groups 338.871 423 .801
Total 341.138 425
Childhood vaccines are
effective.
Between Groups 4.279 2 2.140 1.769 .172
Within Groups 511.479 423 1.209
Total 515.758 425
Vaccination are not
necessary
Between Groups 1.264 2 .632 .903 .406
Within Groups 295.919 423 .700
Total 297.183 425
Vaccination has always
side effects
Between Groups .931 2 .466 .457 .634
Within Groups 431.428 423 1.020
Total 432.359 425
Vaccination are costly Between Groups .875 2 .437 .566 .568
Within Groups 326.947 423 .773
Total 327.822 425
Govt. Campaigns for
vaccination are not
effective
Between Groups 4.232 2 2.116 1.686 .186
Within Groups 530.822 423 1.255
Total 535.054 425
Mandatory Vaccination
should be available at all
hospitals.
Between Groups .525 2 .262 .356 .701
Within Groups 311.785 423 .737
Total 312.310 425
Vaccination ensures Between Groups 5.600 2 2.800 2.828 .060
44
good health of your
children
Within Groups 418.879 423 .990
Total 424.479 425
Vaccination protects the
child from various
communicable diseases
Between Groups 1.438 2 .719 .956 .385
Within Groups 317.926 423 .752
Total 319.364 425
I will never go to govt
hospitals for vaccination
Between Groups .931 2 .466 .457 .634
Within Groups 431.428 423 1.020
Total 432.359 425
Nearness of the
campaign is important
Between Groups .072 2 .036 .052 .950
Within Groups 294.961 423 .697
Total 295.033 425
Private hospitals are
costly
Between Groups 4.218 2 2.109 1.995 .137
Within Groups 447.246 423 1.057
Total 451.465 425
I do have a family doctor Between Groups 2.268 2 1.134 1.415 .244
Within Groups 338.871 423 .801
Total 341.138 425
Private hospitals
vaccination services are
effective then govt.
hospitals
Between Groups 1.698 2 .849 .920 .399
Within Groups 390.518 423 .923
Total 392.216 425
Doctor's presence at the
time of vaccination is
appreciated
Between Groups 1.438 2 .719 .956 .385
Within Groups 317.926 423 .752
Total 319.364 425
Nearness of the Between Groups 1.131 2 .565 .753 .472
45
campaign is less
important
Within Groups 317.733 423 .751
Total 318.864 425
Vaccinations are
economic in govt
hospital
Between Groups 2.335 2 1.167 1.202 .302
Within Groups 410.785 423 .971
Total 413.120 425
Doctors availability in
private hospital is more
than govt. hospital
Between Groups .891 2 .445 .451 .637
Within Groups 417.635 423 .987
Total 418.526 425
Puja , havan are
effective then
vaccination
Between Groups .989 2 .494 .609 .544
Within Groups 343.509 423 .812
Total 344.498 425
Family beliefs are
hurdles to visit the
doctor for vaccination
Between Groups .890 2 .445 .449 .639
Within Groups 419.432 423 .992
Total 420.322 425
46
FACTOR ANALYSIS
Communalitiesa
Initial Extraction
Childhood vaccines are
important for my
1.000 .943
Childhood vaccines are
effective.
1.000 .900
Vaccination are not
necessary
1.000 .713
Vaccination has always
side effects
1.000 .940
Vaccination are costly 1.000 .912
Govt. Campaigns for
vaccination are not
effective
1.000 .890
Mandatory Vaccination
should be available at all
hospitals.
1.000 .878
Vaccination ensures good
health of your children
1.000 .883
Vaccination protects the
child from various
communicable diseases
1.000 .879
I will never go to govt
hospitals for vaccination
1.000 .940
Nearness of the campaign
is important
1.000 .818
Private hospitals are costly 1.000 .868
I do have a family doctor 1.000 .943
47
Private hospitals
vaccination services are
effective then govt.
hospitals
1.000 .881
Doctor's presence at the
time of vaccination is
appreciated
1.000 .879
Nearness of the campaign
is less important
1.000 .750
Vaccinations are
economic in govt hospital
1.000 .883
Doctors availability in
private hospital is more
than govt. hospital
1.000 .861
Puja , havan are effective
then vaccination
1.000 .940
Family beliefs are hurdles
to visit the doctor for
vaccination
1.000 .857
Extraction Method: Principal Component Analysis.
a. Only cases for which Working Parents = dual
working are used in the analysis phase.
48
Findings and Results
 It is observed that mostly respondent (327) 77% get information through
Doctor/Pediatrition. While 50 respondents get information through Family and rest of
the respondent get information by friends, newspaper and TV.
 It is observed that 318 (74%) respondents are aware about the side effects of vaccination while
108(26%) respondents are still not aware about the side effects of vaccination.
 399 (93%) respondents out of 426 are having awareness of immunization schedule, while 27
respondents are not having awareness of immunization schedule.
 380 (89%) respondents have knowledge about the mandatory vaccination of child while 46
(11%)respondents have no knowledge about the mandatory vaccination of child.
 Most of respondents are highly aware about vaccine of polio, HPB, Typhoid and Rota Virus.
While there is less awareness found in respondents regarding measles and Pentavalent Vaccines
compare to other Vaccine.
 393 (92%) respondent’s children have received all vaccines that are recommended for
children up to his/ her age, while 33 respondent’s children are not received all vaccines
up to his/her age.
 39(9%) respondents take decision very easily relating o immunizing the child while 205(48%)
respondents are easily take decision, 99 (23%) respondents don’t know or neutral about
decisions, 58 respondents feel difficult to take decision and 25 respondents feel very difficult to
take decision.
 406(95.31%) respondents feel difficult decision because of not enough information while
rest of the respondents felt because of near location, side effects and is not so
important.
 It is considered that 254(59.62%) respondents prefer Pvt. Hospitals for vaccination,
while 105(24.64%) respondents prefer Hospitals, 59 (13.86%) respondents preferred
PHC and respondents are like to preferred sub center.
 From overall respondents 229 (53.75%) respondents are facing difficulty while taking decision
about immunizing their child due to lack of information, 149 respondents are facing problem
due to cost, 26 respondents are facing problem due to contradictory information and 22
respondents are facing difficulty due to DK/NR.
 It is considered that 291(68%) respondents are like to go in Govt. Campaign, while
135(35%) respondents are not interested to go in Govt. Campaign.
 From overall respondents 309(72.53%) respondents believed that because of doctor’s advice
these decisions becomes easy ,45 respondents are believed that due to side effects , 36
respondents are believed that due to past experience , 33 respondents are believed due to
Govt. Campaign.
 It is considered that out of 426 respondents, 369(86.61%) respondents are going for
vaccination on time while 41 respondents are going within a week, 11 respondents are
going within a month and 5 respondents are going after one month.
49
Limitations
 The Research was limited to Anand and Nadiad city Only.
 Biased Response From Respondents.
Conclusion
From the research we have found that different factors that affects the parents beliefs, attitude,
perception towards the vaccination. Some facts that have been revealed from the research are , most of
parents are familiar with infant immunization & is observed that government campaigns are effective in
creating awareness about vaccination programs, some of them are rota virus , polio vaccines. The most
effective campaign was of eradicating the smallpox.
Demographic factors such as age , gender, occupation, education , & income status highly affect the
parents beliefs, attitude, perception & their decision regarding vaccination .
More over there is a need of improving the government campaigns & mandatory vaccinations should be
available at all the hospitals.

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Comprehensive study on Vaccination and Parents behaviour

  • 1. 1 1. About Industry 1.1 Introduction India has been awarded a 'Polio Free' status by way of an official certification presented by the World Health Organisation (WHO). India is among other countries in the South East Asian region which have been certified as being free of the polio virus. India has been polio free since January 2011, as per Mr Ghulam Nabi Azad, Minister for Health and Family Welfare, Government of India. The healthcare industry is potentially the world's largest industry with total revenues of approximately US$ 2.8 trillion. In India as well, healthcare has emerged as one of the largest service sectors constituting 5 per cent of the gross domestic product (GDP) and offering employment to around 4 million people. India's primary competitive advantage over its peers lies in its large pool of well-trained medical professionals. Also, India's cost advantage compared to peers in Asia and Western countries is significant - cost of surgery in India is one-tenth of that in the US or Western Europe. Healthcare The Indian heathcare industry, growing at a CAGR of 15% is expected to touch US$ 250 billion by 2020. Driving growth factors are rising population, increasing disposable income, increasing lifestyle related health issues, cheaper treatment costs, thrust in medical tourism, improving health insurance penetration, government initiatives and focus on public private partnership (PPP) models. Most Indian metros have hospitals with world-class infrastructure, processes and outcomes. However, 70% of the healthcare infrastructure is confined to the top 20 cities of India. In order to reach the remaining population, innovations both in healthcare products and delivery are required. Healthcare systems predominantly differ in means, methods and approach, but all confront mediocre health outcomes and a steeply escalating cost curve that is unsustainable in the long term. Offering affordable healthcare without compromising access to care or quality requires innovative new products and care options. Healthcare in India today provides existing and new players with a unique opportunity to achieve innovation, differentiation and profits. In the next decade, increasing consumer awareness and demand for better facilities will redefine the country’s second largest service sector employer.PwC understands the healthcare system as well as the dynamics that drive it. Ours is an industry aligned, market focused practice to provide greater value addition and more effective solutions for our clients.
  • 2. 2 1.2 Market size The healthcare sector is growing at a 15 per cent compound annual growth rate (CAGR) and grew from US$ 45 billion in 2008 to US$ 78.6 billion in 2012 and is expected to touch US$ 158.2 billion by 2017, according to a report by Equentis Capital. India's per capita healthcare expenditure has increased at a CAGR of 10.3 per cent from US$ 43.1 in 2008 to US$ 57.9 in 2011 and is expected to rise to $88.7 by 2015. The factors behind the growth are rising incomes, better access to high-quality healthcare facilities and greater awareness of personal health and hygiene, highlighted the report. The private sector has emerged as a vibrant force in India's healthcare industry, lending it both national and international repute. The private sector's share in healthcare delivery is expected to increase from 66 per cent in 2005 to 81 per cent by 2015. Its share in hospitals and hospital beds is estimated at 74 per cent and 40 per cent, respectively. Investments According to data released by the Department of Industrial Policy and Promotion (DIPP), hospital and diagnostic centres attracted foreign direct investment (FDI) worth Rs 12,413.57 crore (US$ 2.02 billion) between April 2000 and July 2014. Some of the major investments in the Indian healthcare industry are as follows:  LifeCell, India's largest umbilical cord blood stem cell bank, plans to set up a public stem cell bank at a cost of Rs 30 crore (US$ 4.9 million).  Max India plans to dilute its stake in Max Healthcare in favour of its South African partner Life Healthcare in an all-cash deal of about Rs 794 crore (US$ 129.76 million).  TPG Capital is in advanced talks to invest up to Rs 900 crore (US$ 147.09 million) for a minority stake in Manipal Health Enterprises (MHE).  HLL Lifecare has teamed up with Tata Memorial Centre for constructing a modern women and children cancer hospital at Parel in Mumbai.  BlackBerry plans to launch a healthcare service that will integrate thousands of medical devices to enable early detection of illnesses, in partnership with healthcare technology firm NantHealth, as it looks beyond smartphones in the Indian market.
  • 3. 3 1.3 Government Initiatives The Ministry of Road, Transport and Highways, the Department of AIDS Control and Ministry of Health and Family Welfare have signed a Memorandum of Understanding (MoU) with an objective of providing HIV preventive services to transport sector workers. The Central Government has requested the Government of Odisha for allotment of 25 to 30 acres of land for setting up a satellite centre of the All Indian Institute of Medical Sciences (AIIMS) Bhubaneswar as a super specialty healthcare facility. India and Maldives signed three agreements after delegation level talks between Mr Abdulla Yameen Abdul Gayoom, President, Maldives, and Dr Manmohan Singh, the then Prime Minister of India, on January 2, 2014. The pacts included a MoU on health cooperation. The Union Cabinet has approved the proposal for setting up of National Cancer Institute (NCI) at a cost of Rs 2,035 crore (US$ 332.62 million). NCI will be set up in the Jhajjar campus (Haryana) of AIIMS, New Delhi. The project is estimated to be completed in 45 months. Under the Union Budget 2014-15, some of the major initiatives taken by the Government of India to promote the healthcare sector in India are as follows:  Free Drug Service and Free Diagnosis Service to achieve 'Health For All'  Two National Institutes of Ageing to be set up at AIIMS, New Delhi and Madras Medical College, Chennai  A national level research and referral Institute for higher dental studies to be set up  AIIMS-like institutions in Andhra Pradesh, West Bengal, Vidarbha in Maharashtra and Poorvanchal in UP. A provision of Rs 500 crore (US$ 81.71 million) made  12 new government medical colleges to be set up  15 Model Rural Health Research Centres to be set up for research on local health issues concerning rural population Road Ahead The coming years will see great out-of-the-box thinking by the strategists in the field of healthcare, beginning with the way healthcare is delivered. To begin with, a rise in retail clinics, single speciality, secondary and tertiary care centres are seen coming to the fore including the recent examples of NOVA day care, BEAMS and Apollo clinics. The tier II/III cities have suddenly become attractive to the healthcare players, especially because of the tax sops and increasing disposable incomes among Indian families across the country and dearth of quality healthcare infrastructure in these locations. Specially focused on medical tourism, health cities are being designed and executed and hospitals with bed strengths of 1500/2000 which were never heard in the private domain are now coming to light.
  • 4. 4 Technology will play a major role in bringing quality in healthcare, be it better nursing communication systems, patient monitoring devices or telemedicine to provide low cost diagnosis to remote patients, etc. Companies like Blackberry, HCL and HP are already investing heavily in healthcare technology and Google trying to ambitiously woo the consumers for a centralised healthcare database. What is in store for the future of healthcare is limitless. Public and private sector According to National Family Health Survey-3, the private medical sector remains the primary source of health care for 70% of households in urban areas and 63% of households in rural areas. Reliance on public and private health care sector varies significantly between states. Several reasons are cited for relying on private rather than public sector; the main reason at the national level is poor quality of care in the public sector, with more than 57% of households pointing to this as the reason for a preference for private health care.Other major reasons are distance of the public sector facility, long wait times, and inconvenient hours of operation.The study conducted by IMS Institute for Healthcare Informatics in 2013, across 12 states in over 14,000 households indicated a steady increase in the usage of private healthcare facilities over the last 25 years for both Out Patient and In Patient services, across rural and urban areas. National Rural Health Mission A community health center in Kerala . The National Rural Health Mission (NRHM) was launched in April 2005 by the Government of India. The goal of the NRHM was to provide effective healthcare to rural people with a focus on 18 states which have poor public health indicators and/or weak infrastructure. Primary Care Secondary Care Tertiary Care. Gujarat offers holistic medicinal services and cost effective treatment through various district hospitals, sub district hospitals and private specialty hospitals. Most sought after super – specialties in the State include cardiology, neuro– surgery, orthopedics, infertility treatment, joint replacement and eye surgeries. Share of primary care in
  • 5. 5 the total healthcare market of Gujarat is around 75-80%. Secondary and tertiary care account for 17% and 4% respectively of the total healthcare market. Market for tertiary care expected to grow at a faster rate, due to rise in income levels, increasing adoption of health insurance and rise in complex in-patient ailments (heart diseases, kidney ailments, cancer)Ministry of Finance, 2006 The healthcare landscape in Gujarat is changing rapidly,The available medical infrastructure and easily accessible healthcare facilities have improved the health of the population of the State remarkably over the years. The State Government is taking several initiatives to make Gujarat a Global healthcare destination. Gujarat is evolving in terms of number of hospitals, healthcare centres, beds and are expected to continue a positive trend in future. Doctor to patient ratio is 1:10 and nurse to patient ratio is 1:5 . By the use of latest technical equipment, efficient health insurance, major corporate investments and the services of highly skilled medical personnel, the Gujarat healthcare sector has set itself on a boom Healthcare sector in the State has potential to grow at a much faster rate in the foreseeable future and shall be numerous in providing healthcare facilities
  • 6. 6 2. Major Players in Vaccination Industry The renaissance in the vaccine market continues with strong growth and new prospects to continue to grow this part of the market, which now stands at about $25 billion. Once a commodity market with low margins, the vaccines on the market now include blockbusters and megablockbusters. New candidates for vaccinating against cancers and HIV are also projected to hit the magic milestone. The market is expected to return a compound annual growth rate of more than 8% through 2018, EvaluatePharma projects, with some segments like adult vaccines showing even better. A big part of the growth in vaccine sales has been in the adult influenza market with the big focus on flu prevention and an acceptance of adult vaccines. There is a chance that the results from the demonstrably bad flu season in the U.S. this year may affect what happens next year. The Centers for Disease Control and Prevention (CDC) recently noted that only 56% of people who received the jab were protected from influenza, on the very low end of effectiveness spectrum. It was particularly ineffective among the elderly, one of the key target groups. The results led CDC Director Dr. Thomas Frieden to lament, "We simply need a better vaccine against influenza, one that works better and lasts longer." Still, the FDA last year approved two quadrivalent, or four-strain, vaccines, Fluarix Quadrivalent from GlaxoSmithKline ($GSK) and MedImmune's FluMistQuadrivalent. An FDA panel recently endorsed a move to quadrivalents in the U.S., a decision that will help the influenza vaccine market grow. And that doesn't take into account that the vaccination rate in the U.S. still remains below 50%. For all of the new developments and growth, vaccines are a market primarily made up of a handful of significant players, with another handful of small operators. In 2012, the top 5 vaccinemakers captured more than 90% of vaccine sales, according to figures from analysts at EvaluatePharma.  Sanofi  Merck  GlaxoSmithKline  Pfizer  Novartis  SAP 1.Sanofi Sanofi S.A. is a French multinational pharmaceutical company headquartered inParis, France, as of 2013 the world's fifth-largest by prescription sales. The company was formed as Sanofi-Aventis in 2004 by the merger of Aventis and Sanofi-Synthélabo, which were each the product of several previous mergers. It changed its name to Sanofi in May 2011. Sanofi engages in the research and development, manufacturing and marketing of pharmaceutical drugs principally in the prescription market, but the firm also develops over-the-counter medication. The company covers 7 major therapeutic areas:cardiovascular, central nervous system,diabetes, internal
  • 7. 7 medicine, oncology,thrombosis and vaccines (it is the world's largest producer of the latter through its subsidiary Sanofi Pasteur) 2.MERCK Merck is a leading company for innovative and top-quality high-tech products in healthcare, life science and performance materials. Around 39,000 employees work in 66 countries to improve the quality of life for patients, to further the success of our customers and to help meet global challenges. Merck is the world's oldest pharmaceutical and chemical company. Since 1668 name has stood for innovation, business success and responsible entrepreneurship. The founding family remains the majority owner of the company to this day. 3. Types  Whole-Organism Vaccines  Purified Macromolecules as Vaccines  Recombinant vaccine  DNA vaccine  Multivalent Subunit Vaccines • A vaccine is a biological preparation that improves immunity to a particular disease. It contains certain agents that not only resembles a disease-causing microorganism but it also stimulates body’s immune sustem recognize the foreign agents.
  • 8. 8 Disease or pathogen Type of vaccine Viral particles Hepatitis A Influenza Measles Polio (Sabin) Polio (Salk) Rabies Rotavirus Varicella zoster (chickenpox) Yellow fever Inactivated Inactivated Live attenuated Live attenuated Inactivated Inactivated Live attenuated Live attenuated Live attenuated
  • 9. 9 4. Litrature Review 1. A research on “Factors Influencing Parents’ Decision on Their Children's Vaccination against Seasonal Influenza:A Systematic Review” by MENG Yue ,Master of Public Health,The University of Hong Kong(August 2013). Parental intention and uptake of seasonal influenza vaccination in pediatric population were generally not satisfactory and varied largely across regions. Addressing the determinants that are important for parents' decision on their children's vaccination is vital for effectively improving immunization coverage. Based on HBM, TIB and the TRA, the influencing factors extracted from current literature were integrated into a comprehensive framework. The framework proposes that the parents’ intention to vaccinate their children against seasonal influenza is influenced by demographic variables, attitude towards seasonal influenza vaccination, knowledge and perception of influenza/influenza vaccine, social norms (cues to action and subjective norms), emotion, and past behavior/experience; easy access to vaccination facilities as a facilitating condition additionally determine the possibility of turning intention into actual behavior. 2. A Study on “Acceptance of Human Papillomavirus Vaccine by Adolescent Girls and Their Parents” in Turkey by AyseKilic, Memnun Seven, GultenGuvenc, AygulAkyuz, SevalCiftci. The aim of this study was to identify the opinions of Turkish adolescent girls and their parents about HPV vaccination and the consistency The study indicates that an appropriate background has been partially provided about the acceptability of the vaccine between parents and their daughters in Turkey. However, the vast majority of adolescent girls and parents are indecisive or reluctant about HPV vaccination. This study also showed that the decisions of adolescents about vaccination may be affected by the opinions of the parents. 3. A Research on ‘African American parents' attitudes toward HPV vaccination ” by Thompson VL , Arnold LD, Notaro SR. Among parents knowledgeable about HPV, vaccination status was significantly affected by whether a pediatrician had recommended the vaccine. There were no significant differences in demographic characteristics or sociocultural attitudes between the parents who had vaccinated their daughters and those who had not, although more of the parents who had vaccinated daughters were worried about STIs.
  • 10. 10 4. Research on “Application of the Theory of Reasoned Action in Parents Intention to Vaccinate Their Daughters Against HPV” by Corina Cuevas Renaud, RomeroPerea, Florencia Evelin . The results showed the need to work on the behavioral cognitive and medicine approaches on negative attitudes, subjective norms and prejuicios that limit public to reach the target population. Attitudes have the highest ratio and negative prediction. It is possible to say that the R value in the model came out very low due to a lack of information about what is HPV, how it spreads, the vaccine’s consequences and the parents’ fear about this issue. Only in Mexico City this vaccination campaign is performed, their citizens are considered more knowledgeable and trend-setting all over Mexico, but there are prejudices and inadequate information and fear associated with those thoughts, that do not allow access the vaccine against HPV to young girls. 5. A research on Attitudes, Beliefs and Behaviors of Parents towards Childhood Immunizations by University of North Texas Health Science Center at Fort Worth. Over the past twenty-eight years parental concerns regarding vaccine safety have been escalating. These uncertainties with vaccine safety have begun to translate into tangible decisions for a mounting number of parents by their choice not to vaccinate their children. Many of these parents naively believe the assumption that their decision only impacts their individual families. In actually, public health officials are observing the compounding consequences of each of these “individual” decisions. One of the most visible consequences is the decrease in herd immunity which protects many of the most vulnerable individuals in a community. Although this decreasein herd immunity can be directly attributed to this emergent movement, parents choosing not to vaccinate appear to become even more concrete in their belief even when they are presented with this scientific evidence of their decisions. Understanding the reckoning behind this deep-seated view is important for researchers attempting to develop programs to encourage vaccination coverage among these high risk populations. 6. BLACK PARENTS’ BELIEFS, ATTITUDES, AND HPV VACCINE INTENTIONS: A MEDIATION MODEL by JENNIFER BRYER Conclusions that may be drawn from this study of 262 Black parents include the following theoretical relationships: 1. A significant relationship exists between parental vaccine attitudes and parental HPV vaccine intention. 2. A significant relationship exists between HPV vaccine beliefs and parental vaccine attitudes. 3. Parental vaccine attitudes mediate the relationship between HPV vaccine beliefs and parental HPV vaccine intention.
  • 11. 11 7. Parents' attitudes and behaviours towards recommended vaccinations in Sicily, Italy by Maria Anna Coniglio, Marco Platania, Donatella Privitera, Giuseppe Giammanco and SarinaPignato. This study suggests that health information by Family Paediatricians is significantly associated with parental acceptance of recommended vaccinations. 8. A Research on Irish mothers’ intentions to have daughters receive the HPV vaccine by Amanda Fahy B.A., Deirdre M. Desmond Ph.D. Study concluded that The current study is the first to investigate HPV vaccine acceptability among Irish mothers. Awareness of HPV was low; nonetheless, mothers reported strong interest in HPV vaccination for their daughters and favourable attitudes towards vaccination in general. HPV vaccine uptake intentions were uniquely predicted by attitudes and normative beliefs. Both peer groups and medicalprofessionals may play an important role in promoting HPV vaccine acceptance. Attitude was the dominant predictor of behavioural intention. Both positive and negative messages affect attitudes regarding vaccination. If HPV vaccination is to be promoted parents will require education regarding the benefits and safety of the vaccine. 9. A research onMothers and vaccination: knowledge, attitudes, and behaviour in Italy by I.F. Angelillo,1 G. Ricciardi,2 P. Rossi,3 P. Pantisano,4 E. Langiano,5 & M. Pavia. Overall, 57.8% of mothers were aware about all four mandatory vaccinations for infants (poliomyelitis, tetanus, diphtheria, hepatitis B). The results of a multiple logistic regression analysis showed that this knowledge was significantly greater among mothers with a higher education level and among those who were older at the time of the child's birth. Respondents' attitudes towards the utility of vaccinations for preventing infectious diseases were very favourable. Almost all children (94.4%) were vaccinated with all three doses of diphtheria ± tetanus (DT), oral poliovirus vaccine ( OPV), and hepatitis B. The proportion of children vaccinated who received all three doses of OPV, DT or diphtheria±tetanus±pertussis(DTP), and hepatitis B vaccines within 1 month of becoming age-eligible ranged from 56.6% for the third dose of hepatitis B to 95.7% for the first dose of OPV. Results of the regression analysis performed on the responses of mothers who had adhered to the schedule for all mandatory vaccinations indicated that birth order significantly predicted vaccination nonadherence, since children who had at least one older sibling in the household were significantly less likely to be age-appropriately vaccinated. The coverage for the optional vaccines was only 22.5% and 31% for measles±mumps±rubella and for all three doses against pertussis, respectively. Education programmes promoting paediatric immunization, accessibility, and follow-up should be targeted to the entire population.
  • 12. 12 10. JANELLE HIGHLAND, MA researched onParental Decision Making and Childhood Vaccination Applied to vaccination choice, these theories and models can inform how and why parents make their choices. Vaccination is in most cases an effective and safe means of preventing the spread of infectious diseases, but for parents the decision that they make can be complicated. Parental vaccination decision is influenced by multiple factors. The perceived susceptibility of their child to illness, the perceived safety and efficacy of vaccines, their personal past experiences with vaccination and the experiences of others, the advice of professionals, their personal health beliefs, etc. all have an impact on a parent’s decision. Making decisions on the behalf of their children can be difficult, and many parents whether they support vaccination or not decide to err on the side of caution, be it choosing to vaccinate or deciding not to. 11. Parental Knowledge, Attitudes, and Behaviours towards Human Papillomavirus Vaccination for Their Children: A Systematic Review from 2001 to 2011 by Kristina Trim,NaushinNagji,Laurie Elit, The percentage of parents who heard about HPV rose over time (from 60% in 2005 to 93% in 2009), as did their appreciation for the HPV infection and cervical cancer link (from 70% in 2003 to 91% in 2011). During the FDA approval, there was a stronger vaccine awareness but it has waned. The same pattern is seen with parents whose children received the HPV vaccine (peak at 84% in 2010 and now 36% in 2011) or the intention to vaccinate (peak at 80% in 2008 and now 41% in 2011). 12. The Role of Attitudes About Vaccine Safety, Efficacy, and Value in Explaining Parents’ Reported Vaccination BehaviorbyKatherine Hart LaVail(Phd) and Allison Michelle Kennedy(MPH). Confidence in the value of vaccines is a helpful predictor of parent-reported vaccination behavior. Attitudinal constructs of confidence in the safety and efficacy of vaccines failed to account for additional significant variance in parents’ vaccination behaviors. Future research should assess the role of vaccine knowledge and tangible barriers, such as access and cost, to further explain parents’ vaccination behaviors.
  • 13. 13 4.2 Significance of Study The topic that has been selected is “A study on the early parents behaviour towards vaccination in city of anand.” This is the area of selection where the government is focusing more on the topic. Parents are not much aware about the effect of not vaccinating their child . By this survey we would get more information about the behavious of parents for vaccination of their infant child. After the survey the report may help the officials and even the early parents by,  The recommended immunization schedule designed to protect infants and children early in life, when they are most vulnerable and before they are exposed to potentially life-threatening diseases.  Checking the schedule for the age or age range when each vaccine or series of shots is recommended. Or create a personalized schedule that shows the recommended dates for child. If child has missed any shots, use the catch-up scheduler tool to see recommended vaccination dates for the missed or skipped vaccines. See child’s doctor with any questions.  Why there is the need of vaccination ? -To prevent infants from common communicable disease. -To prevent infants from disease if parents transfer to different place because geographic variations may attract diseases. 4.3 Research Methodology Problem Statement “A study on the early parents behaviour towards vaccination in city of anand.” Objective 1. To measure the awareness of vaccination in minds of Early parents in anand city. 2. To study the different sources from where the information of vaccination is gathered by early parents. 3. To determine the most preferred place for vaccination by parents. 4. To segment early parents on the basis of behaviour towards vaccination. 5. To study perceptions of early parents regarding vaccinations.
  • 14. 14 Hypothesis 1. There is no significant relationship of income and place selected for vaccination. 2. There is no significant difference in the sources of gaining information about vaccination among the respondents of Anand. 4.4 Research Design Sr No. Measurement Particulars 1 Sample size 400 Respondents 2 Type of sampling Purposive Sampling 3 Sampling unit Early parents in the city (having child’s age between 0-2 years) 4 Area of research conducted Anand city 5 Type of research Descriptive research design 6 Data collection method Survey method 7 Tools for data collection Questionnaire (structured) 8 Sources of Data Primary Data & Secondary Data
  • 15. 15 DEMOGRAPHIC PROFILE (MALE-FEMALE) Gender Total Percentage (%)Male Female Age 20 to 25 years 50 48 98 23 26 to 30 years 83 107 190 44.6 31 to 35 years 68 52 120 28.16 >35 years 12 6 18 4.22 Total 213 213 426 Education S.S.C. 6 4 10 2.34 H.S.C. 25 72 97 22.76 Diploma 31 10 41 9.62 Graduate 114 108 222 52.11 Post-Graduate 26 15 41 9.62 Others 11 4 15 3.52 Total 213 213 426 Occupation Business 45 9 54 12.67 Agriculture 12 0 12 2.81 Professional 19 11 30 7.04 Salaried (Services) 132 35 167 39.2 Housewife/person 5 155 160 37.55 Total 213 213 426 Location Anand 157 174 331 77.69 Nadiad 56 39 95 22.3 Total 213 213 426
  • 16. 16 Q2 : How did you get information about Vaccination? Table2 : Reference Group reference group * Gender Crosstabulation Count Gender Totalmale female TV 2 7 9 Newspaper 8 18 26 friends 8 6 14 family 10 40 50 doctor 185 142 327 Total 213 213 426 Image1 : Reference Group Interpretation: It is observed that most of respondent (327) 77% get information through Doctor/Pediatrition. While 50 respondents get information through Family and rest of the respondent get information by friends, newspaper and TV. 0 50 100 150 200 250 300 350 Reference Group Frequency
  • 17. 17 Q3 : Do you know about the side effects of Vaccination? Table3 : Side effects of Vaccination Gender Totalmale female Side effects of vaccination yes 178 140 318 no 35 73 108 Total 213 213 426 Image2 : Side effects of Vaccination Interpretation: It is observed that 318 (74%) respondents are aware about the side effects of vaccination while 108 26%) respondents are still not aware about the side effects of vaccination. 318 108 Side effects of Vaccination Yes No
  • 18. 18 Q4 : Are you aware about immunization schedule? Table4 : Awarness of Immunization Schedule Gender Totalmale female awarness of immunization schedule yes 199 200 399(93%) no 14 13 27(7%) Total 213 213 426 Image3 : Awarness of Immunization Schedule Interpretation: From the above chart we can concluded that 399 (93%)respondents out of 426 are having awareness of immunization schedule, while 27 respondents are not having awareness of immunization schedule. 399 27 Awarness of Immunization Schedule Yes No
  • 19. 19 Q5 : Do you know about the mandatory Vaccination for your children? Table5 : Mandatory Vaccination of child Mandatory vacc of child * Gender Crosstabulation Count Gender Totalmale female Mandatory vacc of child yes 202 178 380(89%) no 11 35 46(11%) Total 213 213 426 Image4 : Mandatory Vaccination of child Interpretation: From the above graph we can concluded that 380 (89%)respondents have knowledge about the mandatory vaccination of child while 46 (11%)respondents have no knowledge about the mandatory vaccination of child. 380 46 0 100 200 300 400 Yes No Mandatory Vaccination of child Frequency
  • 20. 20 Q6 : How did you get information about Vaccination? Table6 : Information of Vaccines $Vaccination Frequencies Responses Percent of CasesN Percent childrena Awarness of vacc_polio 419 23.2% 99.3% Awarness of vacc_hepatitisB 344 19.0% 81.5% Awarness of vacc_pentavalant typhoid 182 10.1% 43.1% Awarness of vacc_typhoid 397 21.9% 94.1% Awarness of vacc_rota virus 310 17.1% 73.5% Awarness of vacc_measles 157 8.7% 37.2% Total 1809 100.0% 428.7% a. Dichotomy group tabulated at value 1. Interpretation: Most of respondents are highly aware about vaccine of polio, HPB, Typhoid and Rota Virus.While there is less awareness found in respondents regarding measles and Pentavalent Vaccines compare to other Vaccine.
  • 21. 21 Q7 : “Has your child received all of the vaccines that are recommended for children up to his/her age?” Table7 : Received all vaccines upto his age Received all vaccines upto his age Sr. No. Particulars Frequency % 1 Yes 393 92.25 2 No 33 7.74 Total 426 100 Image5 : Received all vaccines upto his age Interpretation: From the above graph we can concluded that 393 (92%)respondent’s children have received all vaccines that are recommended for children up to his/ her age, while 33 respondent’s children are not received all vaccines up to his/her age. 0 50 100 150 200 250 300 350 400 Yes No 393 33 Received all vaccines upto his age Frequency
  • 22. 22 Q8 : “Do you agree or disagree with the following statements?” (LIKERT SCALE) Table8 : Likert Scale Statements N Mean Childhood vaccines are important for my 426 4.8427 Childhood vaccines are effective. 426 4.8310 Vaccination are not necessary 426 1.5939 Vaccination has always side effects 426 2.0164 Vaccination are costly 426 3.6643 Govt. Campaigns for vaccination are not effective 426 2.8239 Mandatory Vaccination should be available at all hospitals. 426 4.1526 Vaccination ensures good health of your children 426 4.7770 Vaccination protects the child from various communicable diseases 426 4.7653 I will never go to govt hospitals for vaccination 426 2.9507 Nearness of the campaign is important 426 3.9085 Private hospitals are costly 426 3.9953 I do have a family doctor 426 3.6643 Private hospitals vaccination services are effective then govt. hospitals 426 3.9178 Doctor's presence at the time of vaccination is appreciated 426 4.0962 Nearness of the campaign is less important 426 2.3897 Vaccinations are economic in govt hospital 426 3.7207 Doctors availability in private hospital is more than govt. hospital 426 3.8286 Puja , havan are effective then vaccination 426 1.4742 Family beliefs are hurdles to visit the doctor for vaccination 426 1.6948
  • 23. 23 Interpretation: The likert scale statements are having the mean values as shown above.
  • 24. 24 Q9 : Overall, have you found decisions relating to having your child immunized very easy, easy, don't know, difficult or very difficult to make? Table9 : Decision Relating to immunizing the child decision relating to immunizing the child * Gender Crosstabulation Count Gender Total % male female decision relating to immunizing the child Very Easy 19 20 39 9 Easy 96 109 205 48 dont know 57 42 99 23 diificult 34 24 58 14 Very difficult 7 18 25 6 Total 213 213 426 100 1 2 3 4 5 Very Easy______________________________________________Difficult Image6 : Decision Relating to immunizing the child Interpretation: From the above graph we can say that 39(9%) respondents take decision very easily relating o immunizing the child while 205(48%) respondents are easily take decision, 99 (23%)respondents don’t know or neutral about decisions, 58 respondents felt difficulty to take decision and 25 respondents felt very difficult to take decision.
  • 25. 25 Q10 : Why have these decisions been difficult? Table10 : Why have these decisions been difficult Why have these decisions been difficult %Sr. No. Particulars Frequency 1 Possible side effects 3 0.7 2 Controversial/conflicting evidence 9 2.11 3 Not so important 5 1.18 4 Not enough information 406 95.31 5 No such place near to your house 3 0.7 Total 426 100 Image7 : Why have these decisions been difficult Interpretation: Above graph considered that 406(95.31%) respondents feel difficult decision because of not enough information while rest of the respondents felt because of near location ,side effects and is not so important. 0 100 200 300 400 500 Possible side effects Controversial/conflicting… Not so important Not enough information No such place near to your… 3 9 5 406 3 Why have these decisions been difficult Frequency
  • 26. 26 Q11 : Your Preferred Place for Vaccination Table11 : Preffered Place for Vaccination Preffered Place for Vaccination % Sr. No. Particulars Frequency 1 Govt. Hospitals 105 24.64 2 Pvt. Hospitals 254 59.62 3 Sub center 8 1.87 4 PHC 59 13.86 Total 426 100 Image8 : Preffered Place for Vaccination Interpretation: It is considered that 254(59.62%) respondents prefer Pvt. Hospitals for vaccination , while 105(24.64%) respondents prefer Hospitals, 59 (13.86%)respondents preferred PHC and respondents are like to preferred sub center. 105 254 8 59 Preffered Place for Vaccination Govt. Hospitals Pvt. Hospitals Sub center PHC
  • 27. 27 Q12 : Have any of the following been a problem or obstacle for you when making decisions about immunizing your child? Table12 : Problem in immunizing the child Problem in immunizing the child %Sr. No. Particulars Frequency 1 Contradictory information 26 6.10 2 Cost of the vaccination 149 34.97 3 Lack of information 229 53.75 4 DK/NR 22 5.16 Total 426 100 Image9 : Problem in immunizing the child Interpretation: Above graph concluded that 229 (53.75%) respondents are facing difficulty while taking decision about immunizing their child due to lack of information, 149 respondents are facing problem due to cost, 26 respondents are facing problem due to contradictory information and 22 respondents are facing difficulty due to DK/NR. 26 149 229 22 0 50 100 150 200 250 Contradictory information Cost of the vaccination Lack of information DK/NR Problem in immunizing the child Frequency
  • 28. 28 Q13 : Would you like to go in Govt. Campaign for vaccination? Table13 : Like to go in Government campaign Like to go in government campaign * Gender Crosstabulation Count Gender Totalmale female Like to go in government campaign yes 148 143 291(68 %) no 65 70 135(32 %) Total 213 213 426 Image10 : Like to go in Government campaign Interpretation: It is considered that 291 respondents are like to go in Govt. Campaign, while 135 respondents are not interested to go in Govt. Campaign. 291 135 Like to go in Government campaign Yes No
  • 29. 29 Q14 : Why have these decisions been easy? Table14 : Why have these decisions been easy Why have these decisions been easy %Sr. No. Particulars Frequency 1 Possible side effects 45 10.56 2 Doctor's Advice 309 72.53 3 Government campaign 33 7.74 4 Past experience 36 8.45 5 Child had negative reactions 3 0.7 Total 426 100 Image11 : Why have these decisions been easy Interpretation: From the above graph we can say that 309(72.53%) respondents believed that because of doctor’s advice these decisions becomes easy ,45 respondents are believed that due to side effects , 36 respondents are believed that due to past experience , 33 respondents are believed due to Govt. Campaign. 0 100 200 300 400 45 309 33 36 3 Why have these decisions been easy Frequency
  • 30. 30 Q15 : Variation in the scheduled vaccination period Table15 : Variation in Scheduled vaccination Period Variation in Scheduled vaccination Period % Sr. No. Particulars Frequency 1 On time 369 86.61 2 < a week 41 9.62 3 <a month 11 2.58 4 > a month 5 1.17 Total 426 100 Image12 : Variation in Scheduled vaccination Period Interpretation: It is considered that out of 426 respondents, 369(86.61%) respondents are going for vaccination on time while 41 respondents are going within a week , 11 respondents are going within a month and 5 respondents are going after on month. 369 41 11 5 Variation in Scheduled vaccination Period On time < a week <a month > a month
  • 31. 31 HYPOTHESIS: 1.Null Hypothesis (H0): There is no dependency in the awarness towards Vaccinations & the City of Respondent Alternate Hypothesis (H1): There is dependency in the awarness towards Vaccinations & the City of Respondent 2. Null Hypothesis (H0): Perception towards going in govt. campaign is independent of gender. Alternate Hypothesis (H1): Perception towards going in govt. campaign is dependent of gender. 3. Null Hypothesis (H0): There is no significant relationship of income and place selected for vaccination. Alternate Hypothesis (H1): There is a significant relationship of income and place selected for vaccination. 4. Null Hypothesis (H0): There is a relation between dual working parents & the scheduled vaccination of child Alternate Hypothesis (H1): There is no relation between dual working parents & the scheduled vaccination of child 5. Null Hypothesis (H0): Perception towards Private hospitals vaccination is dependent to the gender Alternate Hypothesis (H1): Perception towards Private hospitals vaccination is independent to the gender
  • 32. 32 1. Null Hypothesis (H0): There is no dependency in the awarness towards Vaccinations & the City of Respondent Alternate Hypothesis (H1): There is dependency in the awarness towards Vaccinations & the City of Respondent Sum of Squares df Mean Square F Sig. Awarness of vacc_polio Between Groups .033 2 .017 1.019 .362 Within Groups 6.852 423 .016 Total 6.885 425 Awarness of vacc_hepatitisB Between Groups 1.187 2 .593 3.859 .022 Within Groups 65.029 423 .154 Total 66.216 425 Awarness of vacc_pentavalant typhoid Between Groups .940 2 .470 1.926 .147 Within Groups 103.304 423 .244 Total 104.244 425 Awarness of vacc_typhoid Between Groups .105 2 .053 .827 .438 Within Groups 26.921 423 .064 Total 27.026 425 Awarness of vacc_rota virus Between Groups .936 2 .468 2.370 .095 Within Groups 83.478 423 .197 Total 84.413 425 Awarness of vacc_measles Between Groups 1.021 2 .511 2.202 .112 Within Groups 98.117 423 .232 Total 99.138 425
  • 33. 33 2. Null Hypothesis (H0): Perception towards going in govt. campaign is independent of gender. Alternate Hypothesis (H1): Perception towards going in govt. campaign is dependent of gender. Group Statistics Gender N Mean Std. Deviation Std. Error Mean Like to go in government campaign male 213 1.3192 .49664 .03403 female 213 1.3521 .52571 .03602
  • 34. 34 3.Null Hypothesis (H0): There is no significant relationship of income and place selected for vaccination. Alternate Hypothesis (H1): There is a significant relationship of income and place selected for vaccination. Income Observed N Expected N Residual <5000 11 85.2 -74.2 5000-10000 50 85.2 -35.2 10001-25000 262 85.2 176.8 25001-50000 77 85.2 -8.2 >50000 26 85.2 -59.2 Total 426 preferred place for vaccination Observed N Expected N Residual govt. hospital 105 106.5 -1.5 private hospital 254 106.5 147.5 sub centre 8 106.5 -98.5 PHC 59 106.5 -47.5 Total 426
  • 35. 35 Test Statistics Income preferred place for vaccination Chi-Square 487.967a 316.592b df 4 3 Asymp. Sig. .000 .000 a. 0 cells (.0%) have expected frequencies less than 5. The minimum expected cell frequency is 85.2. b. 0 cells (.0%) have expected frequencies less than 5. The minimum expected cell frequency is 106.5.
  • 36. 36 4. Null Hypothesis (H0): There is a relation between dual working parents & the scheduled vaccination of child Alternate Hypothesis (H1): There is no relation between dual working parents & the scheduled vaccination of child Group Statistics Working Parents N Mean Std. Deviation Std. Error Mean Variation in scheduled vaccination period single working 366 1.1885 .49654 .02595 dual working 56 1.1607 .68162 .09109
  • 37. 37 5.Null Hypothesis (H0): Perception towards Private hospitals vaccination is dependent to the gender Alternate Hypothesis (H1): Perception towards Private hospitals vaccination is independent to the gender Private hospitals vaccination services are effective then govt. hospitals * Gender Crosstabulation Count Gender Totalmale female Private hospitals vaccination services are effective then govt. hospitals strongly disagree 15 12 27 dis agree 130 112 242 neutral 38 47 85 agree 21 29 50 strongly agree 9 13 22 Total 213 213 426
  • 38. 38 CLUSTER ANALYSIS Initial Cluster Centers Cluster 1 2 3 Childhood vaccines are important for my 2.00 2.00 4.00 Childhood vaccines are effective. 1.00 5.00 1.00 Vaccination are not necessary 1.00 2.00 2.00 Vaccination has always side effects 3.00 2.00 1.00 Vaccination are costly 4.00 3.00 2.00 Govt. Campaigns for vaccination are not effective 1.00 5.00 1.00 Mandatory Vaccination should be available at all hospitals. 2.00 2.00 5.00 Vaccination ensures good health of your children 1.00 5.00 2.00 Vaccination protects the child from various communicable diseases 1.00 2.00 4.00 I will never go to govt hospitals for vaccination 3.00 2.00 1.00 Nearness of the campaign is important 4.00 3.00 5.00 Private hospitals are costly 1.00 5.00 2.00
  • 39. 39 I do have a family doctor 2.00 2.00 4.00 Private hospitals vaccination services are effective then govt. hospitals 1.00 5.00 5.00 Doctor's presence at the time of vaccination is appreciated 1.00 2.00 4.00 Nearness of the campaign is less important 3.00 2.00 2.00 Vaccinations are economic in govt hospital 4.00 3.00 1.00 Doctors availability in private hospital is more than govt. hospital 1.00 5.00 5.00 Puja , havan are effective then vaccination 2.00 2.00 2.00 Family beliefs are hurdles to visit the doctor for vaccination 1.00 5.00 4.00
  • 40. 40 Iteration Historya Iteration Change in Cluster Centers 1 2 3 1 4.643 4.590 5.143 2 .180 .418 .137 3 .141 .297 .000 4 .000 .000 .000 a. Convergence achieved due to no or small change in cluster centers. The maximum absolute coordinate change for any center is .000. The current iteration is 4. The minimum distance between initial centers is 9.327.
  • 41. 41 Final Cluster Centers Cluster 1 2 3 Childhood vaccines are important for my 2.55 2.41 3.48 Childhood vaccines are effective. 2.41 4.01 1.86 Vaccination are not necessary 2.13 2.85 2.29 Vaccination has always side effects 2.41 3.55 1.86 Vaccination are costly 2.54 2.90 2.08 Govt. Campaigns for vaccination are not effective 2.44 4.12 1.86 Mandatory Vaccination should be available at all hospitals. 2.57 2.36 2.62 Vaccination ensures good health of your children 2.07 3.72 2.08 Vaccination protects the child from various communicable diseases 2.18 2.43 3.69 I will never go to govt hospitals for vaccination 2.41 3.55 1.86 Nearness of the campaign is important 2.60 2.43 2.62 Private hospitals are costly 2.10 3.83 2.08 I do have a family doctor 2.55 2.41 3.48
  • 42. 42 Private hospitals vaccination services are effective then govt. hospitals 2.14 3.25 2.62 Doctor's presence at the time of vaccination is appreciated 2.18 2.43 3.69 Nearness of the campaign is less important 2.07 3.27 2.08 Vaccinations are economic in govt hospital 2.88 3.19 1.86 Doctors availability in private hospital is more than govt. hospital 2.16 3.36 2.62 Puja , havan are effective then vaccination 2.50 2.83 2.08 Family beliefs are hurdles to visit the doctor for vaccination 2.12 3.30 3.48 Number of Cases in each Cluster Cluster 1 228.000 2 112.000 3 86.000 Valid 426.000 Missing .000
  • 43. 43 ANOVA Sum of Squares df Mean Square F Sig. Childhood vaccines are important for my Between Groups 2.268 2 1.134 1.415 .244 Within Groups 338.871 423 .801 Total 341.138 425 Childhood vaccines are effective. Between Groups 4.279 2 2.140 1.769 .172 Within Groups 511.479 423 1.209 Total 515.758 425 Vaccination are not necessary Between Groups 1.264 2 .632 .903 .406 Within Groups 295.919 423 .700 Total 297.183 425 Vaccination has always side effects Between Groups .931 2 .466 .457 .634 Within Groups 431.428 423 1.020 Total 432.359 425 Vaccination are costly Between Groups .875 2 .437 .566 .568 Within Groups 326.947 423 .773 Total 327.822 425 Govt. Campaigns for vaccination are not effective Between Groups 4.232 2 2.116 1.686 .186 Within Groups 530.822 423 1.255 Total 535.054 425 Mandatory Vaccination should be available at all hospitals. Between Groups .525 2 .262 .356 .701 Within Groups 311.785 423 .737 Total 312.310 425 Vaccination ensures Between Groups 5.600 2 2.800 2.828 .060
  • 44. 44 good health of your children Within Groups 418.879 423 .990 Total 424.479 425 Vaccination protects the child from various communicable diseases Between Groups 1.438 2 .719 .956 .385 Within Groups 317.926 423 .752 Total 319.364 425 I will never go to govt hospitals for vaccination Between Groups .931 2 .466 .457 .634 Within Groups 431.428 423 1.020 Total 432.359 425 Nearness of the campaign is important Between Groups .072 2 .036 .052 .950 Within Groups 294.961 423 .697 Total 295.033 425 Private hospitals are costly Between Groups 4.218 2 2.109 1.995 .137 Within Groups 447.246 423 1.057 Total 451.465 425 I do have a family doctor Between Groups 2.268 2 1.134 1.415 .244 Within Groups 338.871 423 .801 Total 341.138 425 Private hospitals vaccination services are effective then govt. hospitals Between Groups 1.698 2 .849 .920 .399 Within Groups 390.518 423 .923 Total 392.216 425 Doctor's presence at the time of vaccination is appreciated Between Groups 1.438 2 .719 .956 .385 Within Groups 317.926 423 .752 Total 319.364 425 Nearness of the Between Groups 1.131 2 .565 .753 .472
  • 45. 45 campaign is less important Within Groups 317.733 423 .751 Total 318.864 425 Vaccinations are economic in govt hospital Between Groups 2.335 2 1.167 1.202 .302 Within Groups 410.785 423 .971 Total 413.120 425 Doctors availability in private hospital is more than govt. hospital Between Groups .891 2 .445 .451 .637 Within Groups 417.635 423 .987 Total 418.526 425 Puja , havan are effective then vaccination Between Groups .989 2 .494 .609 .544 Within Groups 343.509 423 .812 Total 344.498 425 Family beliefs are hurdles to visit the doctor for vaccination Between Groups .890 2 .445 .449 .639 Within Groups 419.432 423 .992 Total 420.322 425
  • 46. 46 FACTOR ANALYSIS Communalitiesa Initial Extraction Childhood vaccines are important for my 1.000 .943 Childhood vaccines are effective. 1.000 .900 Vaccination are not necessary 1.000 .713 Vaccination has always side effects 1.000 .940 Vaccination are costly 1.000 .912 Govt. Campaigns for vaccination are not effective 1.000 .890 Mandatory Vaccination should be available at all hospitals. 1.000 .878 Vaccination ensures good health of your children 1.000 .883 Vaccination protects the child from various communicable diseases 1.000 .879 I will never go to govt hospitals for vaccination 1.000 .940 Nearness of the campaign is important 1.000 .818 Private hospitals are costly 1.000 .868 I do have a family doctor 1.000 .943
  • 47. 47 Private hospitals vaccination services are effective then govt. hospitals 1.000 .881 Doctor's presence at the time of vaccination is appreciated 1.000 .879 Nearness of the campaign is less important 1.000 .750 Vaccinations are economic in govt hospital 1.000 .883 Doctors availability in private hospital is more than govt. hospital 1.000 .861 Puja , havan are effective then vaccination 1.000 .940 Family beliefs are hurdles to visit the doctor for vaccination 1.000 .857 Extraction Method: Principal Component Analysis. a. Only cases for which Working Parents = dual working are used in the analysis phase.
  • 48. 48 Findings and Results  It is observed that mostly respondent (327) 77% get information through Doctor/Pediatrition. While 50 respondents get information through Family and rest of the respondent get information by friends, newspaper and TV.  It is observed that 318 (74%) respondents are aware about the side effects of vaccination while 108(26%) respondents are still not aware about the side effects of vaccination.  399 (93%) respondents out of 426 are having awareness of immunization schedule, while 27 respondents are not having awareness of immunization schedule.  380 (89%) respondents have knowledge about the mandatory vaccination of child while 46 (11%)respondents have no knowledge about the mandatory vaccination of child.  Most of respondents are highly aware about vaccine of polio, HPB, Typhoid and Rota Virus. While there is less awareness found in respondents regarding measles and Pentavalent Vaccines compare to other Vaccine.  393 (92%) respondent’s children have received all vaccines that are recommended for children up to his/ her age, while 33 respondent’s children are not received all vaccines up to his/her age.  39(9%) respondents take decision very easily relating o immunizing the child while 205(48%) respondents are easily take decision, 99 (23%) respondents don’t know or neutral about decisions, 58 respondents feel difficult to take decision and 25 respondents feel very difficult to take decision.  406(95.31%) respondents feel difficult decision because of not enough information while rest of the respondents felt because of near location, side effects and is not so important.  It is considered that 254(59.62%) respondents prefer Pvt. Hospitals for vaccination, while 105(24.64%) respondents prefer Hospitals, 59 (13.86%) respondents preferred PHC and respondents are like to preferred sub center.  From overall respondents 229 (53.75%) respondents are facing difficulty while taking decision about immunizing their child due to lack of information, 149 respondents are facing problem due to cost, 26 respondents are facing problem due to contradictory information and 22 respondents are facing difficulty due to DK/NR.  It is considered that 291(68%) respondents are like to go in Govt. Campaign, while 135(35%) respondents are not interested to go in Govt. Campaign.  From overall respondents 309(72.53%) respondents believed that because of doctor’s advice these decisions becomes easy ,45 respondents are believed that due to side effects , 36 respondents are believed that due to past experience , 33 respondents are believed due to Govt. Campaign.  It is considered that out of 426 respondents, 369(86.61%) respondents are going for vaccination on time while 41 respondents are going within a week, 11 respondents are going within a month and 5 respondents are going after one month.
  • 49. 49 Limitations  The Research was limited to Anand and Nadiad city Only.  Biased Response From Respondents. Conclusion From the research we have found that different factors that affects the parents beliefs, attitude, perception towards the vaccination. Some facts that have been revealed from the research are , most of parents are familiar with infant immunization & is observed that government campaigns are effective in creating awareness about vaccination programs, some of them are rota virus , polio vaccines. The most effective campaign was of eradicating the smallpox. Demographic factors such as age , gender, occupation, education , & income status highly affect the parents beliefs, attitude, perception & their decision regarding vaccination . More over there is a need of improving the government campaigns & mandatory vaccinations should be available at all the hospitals.