ABSTRACT
Immunization remains one of the most
successful and cost-effective public health interventions worldwide and it is
an essential instrument to improving childhood health thereby reducing
childhood mortality while also improving maternal health. The study examined
the factors associated
with incomplete immunization of children aged 9-23 months in rural areas of
Odeda Local Government, Area of Ogun State, Nigeria.
The study employed a cross-sectional
survey to generate quantitative data, and Focus Group Discussion for
qualitative data. Primary data were collected through a self-structured
questionnaire and Focus Group Discussion. A total of 422 mothers with children
of aged between 12-23 months were used for the study. Data was analyzed using
descriptive and inferential statistics.
Results
showed that the mean age of the respondents was 32 years, most of the respondent’s source information about
immunization from community health worker 93.8%, health facility 75.8%, and
media 64.7% and 39.8% from church. Almost all (99.5%) of the caregivers
reveals that immunization for babies begins at birth. Most (86.3%) of the
caregivers reveals that swelling on the site is one of the possible side
effects of immunization above half (52.1%) reveals fever is one of the possible
side effects of immunization. Correlation analysis reveals that there is
positive significant relationship between income (r = 0.265, p < 0.05) and
the attitude of caregiver towards immunization. Seasonal festivals (mean 2.61),
Bad roads leading to health centers (mean 2.24), Health workers do not have vaccine to give on
immunization days (mean 2.38) are some of the challenges faced by the rural
mothers. Chi square result showed that there is a significant relationship
between marital status (x = 73.300, p < 0.05), sex (x = 41.239, p <
0.05), religion (x = 34.330, p < 0.05), ethnicity (x = 33.694, p < 0.05),
relationship of the caregiver to the child (x = 23.152, p < 0.05),
educational level (x = 110.562, p < 0.05), employment status of the caregiver
(x = 19.629, p < 0.05), primary occupation (x = 64.916, p < 0.05),
secondary occupation (x = 20.475, p < 0.05) and the attitude of caregiver
towards immunization. From the
qualitative study, the migration of mothers from one place to another, children
in communities with no health facilities, bad roads, seasonal activities
falling on immunization days, long waiting time in the clinics, non-availability
of vaccines, lower household incomesare contributory factors to incomplete
immunization. The health workers reported that low turnout of mothers on
immunization days and incessant industrial actions embarked on by health
workers inhibit mothers from completing children’s immunizations.
The
study concluded that the major barriers that lead to
incomplete immunization in the study area includeSeasonal festivals, market
days falling on appointment days, bad roads leading to health centers, low
income and knowledge deficit on immunization.
It is therefore recommended that Government should
encourage the services of non-governmental organizations and funding agencies
by providing an enabling environment to facilitate grassroots child health
services.
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Immunization is basically the process of
fortifying a person’s immune system and making him or her resistant to an
infectious disease through the use of vaccine, has gone a long way, and its
importance cannot be downplayed. As recalled by Blackman (2008), a global
vaccination programme was instrumental to the drastic reduction in the
incidence of smallpox in the early 80’s. According to Plotkin, Orenstein, &
Offit (2008), “Vaccines – With the exception of safe water, no other modality,
not even antibiotics, has had such an effect on mortality reduction.”
Vaccination is one of the cheapest and safest methods of primary prevention. In
agreement to this, WHO (2015) asserted that immunization prevents about two to
three million deaths of children yearly through vaccines and an additional 1.5
million deaths could be avoided if global vaccination coverage improves. It
ensures safety of children, (especially those of them who are below five years
of age) against the childhood deadly diseases, some of which include tetanus,
poliomyelitis, diphtheria, hepatitis B, tuberculosis, yellow fever, measles and
pneumonia.
Many public health agencies, including the
Centre for Disease Control and Prevention (2013) had ranked immunization as one
of the topmost discoveries in the field of Medicine owing to its proven
effectiveness. It is also seen as an important landmark in Public Health since
it checkmates the transmission of disease process thereby affording children
and adults the opportunity to remain free of deadly diseases and enjoy good
quality of life. As a result, the World Health Organisation and American
Academy of Paediatrics recommended a series of immunizations starting
immediately after birth. The initial series for children is completed by the
time they reach the age of two, but booster vaccines are required for certain
diseases, such as diphtheria and tetanus, in order to maintain adequate
protection (Blackman, 2008).
The Expanded
Programme on Immunization (EPI) was launched by WHO in 1974 (Itimi, Dienye & Ordinioha, 2015), with a recommendation that every country
should not only adopt it but also develop strategies to ensuring its absolute
implementation, so that no child is left out. In Nigeria, EPI was
launched in 1979 and re-launched in 1984 (Antai, 2009). The main EPI service
delivery strategies are; the static services/routine immunization services at
health facilities (public and private), outreach services to communities
without access to health facilities, mass campaigns in high-risk populations,
reaching every district approach targeting hard-to-reach districts, generalized
periodic national immunization days (NIDs), supplemented immunization
activities (SIAs) organized for missed opportunities and drop-outs, and home
visits, (WHO, 2005). According to the current schedule, a child is considered
fully vaccinated if he has received a BCG vaccination, 3 doses of pentavalent
vaccines, (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b (Hib)),
at least 3 doses of oral polio vaccine, 1 dose of Inactivated Polio vaccine
(IPV), 1 dose of measles vaccine and 1 dose of yellow fever vaccines. Since the launch of EPI, developing countries
like Nigeria, have struggled to meet the various immunization coverage targets
and deadlines set by WHO, there was an encouraging coverage, which later became
unsustainable especially in the rural places (Blackman, 2008).
The Millennium Development Goal (MDG) 4,
whose target was to reduce by two thirds, between 1990 and 2015, the under-five
mortality rate (U5MR), was 191 deaths per 1000 live births in 1990 but this was
reduced to 89 deaths per 1000 live births in 2014, though this is still short
of the 2015 target of 64 deaths per 1000 live birth by 28%, MDG – End Point
Report (Ogenyi & Toure,2015). Infant mortality rate was estimated at 91
deaths per 1000 live births in 1990, stood at 58 death per 1000 live birth in
2014, this is still short of the 2015 target of 30 deaths per 1000 live births
(Ogenyi & Toure, 2015). A decrease in the number of under-5 deaths and
infants deaths caused by vaccine preventable diseases in every WHO region,
would result in a corresponding decline in the global under-five mortality
rate, this would in turn contribute towards achievement of Sustainable
Development Goal (SDG) 3, with target 3.2 being to end preventable deaths of
new-borns and children under 5 years of age, with all countries aiming to
reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5
mortality to at least as low as 25 per 1,000 live births by 2030 (UN, 2015)
Many studies have
reported various reasons for the difficulty in immunization coverage in
Nigeria. Odusanya, Alufohai, Meurice, & Ahonkhai,
(2008) Identified health system factors such as nature of health facility and
maternal knowledge as reasons for low coverage among a rural population in Edo
State. Inadequate levels of immunization against childhood diseases also remain
a significant public health problem in resource-poor areas of Nigeria (Abdulraheem,
Odajole, Jimoh, & Oladipo, (2011)).
It is therefore important to determine why many women in
some developing countries like Nigeria do not complete the routine immunization
schedule for their children, despite the fact that these vaccines are the
safest method of primary prevention of childhood deadly diseases.This study is
therefore designed to examine the factors associated with incomplete
immunization of children aged 9-23 months in rural areas of Odeda local
government, Odeda area of Ogun State, Nigeria .
1.2 Statement of the Problem
Immunization is one of the most successful and
cost-effective public health interventions worldwide, preventing several
serious childhood diseases (Hu, Li, Chen, Chen, & Qi, 2013). In developing
countries, childhood diseases which occurs in both urban and rural area are
major public health concern. The major problem lies not in that these diseases
are not preventable, but that the vaccines, by which the lives of millions of
children worldwide could have been saved, are not fully embraced by many
mothers in Nigeria including Odeda Local Government Area in Ogun State, with
target 3.2 being to end preventable deaths of new-borns and children under 5
years of age, with all countries aiming to reduce neonatal mortality to at
least as low as 12 per 1,000 live births and under-5 mortality to at least as
low as 25 per 1,000 live births by 2030 (UN, 2015)
More specifically, several findings have identified
children of rural areas in Nigeria as being susceptible to incomplete
immunization. Itimi, et al., (2015) reported a dropout rate of above 70% in rural area of
Bayelsa State, Nigeria. Adebayo, Oladokun & Akinbami (2012) also lamented
that rate of immunization completion is suboptimal in a rural community in
South-western Nigeria. Nigeria has one of the world’s poorest
immunization coverage rates, resulting in infants and under-5’s morbidity and
mortality from easily vaccine preventable diseases (WHO, 2015a).
1.3 Objective of the Study
The general objective of this study is to
examine the factors associated with incomplete immunization of children aged
9-23 months in rural areas of Odeda Local Government Area of Ogun State. The
specific objectives are to:
1.
assess
the rural caregivers knowledge on Childs immunization;
2.
ascertain
the level of readiness of the rural caregivers on immunization of their
children against these killer diseases;
3.
assess
the rural caregivers’ attitudes towards immunization of their children and
4.
determine
the challenges faced by these rural caregivers in completing immunization for
their children.
1.4 Research
Questions
The research questions that guided this study
are:
1. How knowledgeable are the rural caregivers
about child immunization?
2. What is the level of readiness of these rural
caregivers in immunizing their children against these killer diseases
3.
What
are the rural caregivers’ attitudes towards immunization of their children
against these killer diseases?
4.
What
are the challenges faced by these rural caregivers in completing immunization
for their children?
1.5
Hypotheses
H01 There is significant relationship between
the socio-demographic characteristics of
caregivers and incomplete immunization of their children against the
killer diseases.
H02 There is significant association between the
rural caregivers’ knowledge on
Immunization and the rural caregivers’ readiness to immunize their
children.
1.6 Scope of the Study
This study determined the factors associated with incomplete
immunization of children
aged 9 to 23 months within Odeda rural areas in Ogun State, Nigeria
1.7 Justification for the
Study
Immunization has been reported to be
instrumental to the improvement of childhood healththereby reducing child
mortality while also improving maternal health. Nnenna, Davidson,Babatunde (2013)
reported that active immunization has turned many childhood diseasesinto
distant memories among industrialized countries. Unfortunately this is not the
case indeveloping countries including Nigeria. After all the effort put in
place to immunise all children that should be immunised, the under 5 mortality
rate was 89 deaths per 1000 livebirth in 2014 while infant mortality rate stood
at 58 deaths per 1000 live births in 2014
(MDG, End Point Report 2015). Hence, for
immunization to be effective in Nigeria, all the children must undergo complete
immunization. In 2015, WHO announced that polio was no longer endemic in
Nigeria as there was no reported case of wild polio virus (WPV) in Nigeria
since 24 July 2014, which brought the country and the African region closer
than ever to being certified polio-free (WHO, 2015d). This was the first time
Nigeria was able to interrupt transmission of wild poliovirus that thus led to
the removal of the country from the list of nations with wild polio
transmission (WHO, 2015d). Two new cases of WPV was recently detected in two
Nigerian children from Borno State from surveillance activities shows a
possible reintroduction or reemergence of the virus (Dore, 2015; WHO, 2015d,
2016b).
Obiajunwa and Olaogun (2013) reported that
many Nigerian children default in their immunization schedule before their
first birthday. More specifically, several findings have identified children of
rural areas in Nigeria as being susceptible to incomplete immunization. For
instance, Itimi, et al., (2015)
reported a dropout rate of above 70% in rural area of Bayelsa State,
Nigeria. Akutteh (2011) explained that
the protective functions of the vaccines are lost when their prescribed regimen
is not followed, this explains why the incidences of childhood killer diseases
are often reported in rural areas. Much has been done to improve vaccination
acceptance in rural places without sustainable improvement, where the
caregivers accept to vaccinate their children, they mostly defaulted by not
following the immunization schedule due to parents’ socioeconomic
characteristics and health care service provider related factors (Tagbo, Eke, Omotowo, Onwuasigwe, Onyeka,
Mldred, 2014).
Despite the
various immunization programs and campaigns put in place by the government, the
problem still persisted with much little improvement posing a challenge to the
country health care delivery system. Odeda Local Government Area in Ogun State
is reported to be one of the rural areas still having unimmunised children.
Therefore, in light of this, it was considered important to determine the
factors associated with incomplete vaccination of children in the rural areas
in Odeda Local Government area of Ogun State. The study will also provide
additional resources that may be used in strategic planning and intervention of
childhood immunization in the Local Government.
1.8 Operational Definitions of
Terms
Complete (full) immunization: refers to the childhood immunization status
once a child has received all recommended vaccines, including BCG, three doses
of pentavalent, and three doses of polio and measles vaccines by the age of 12
months.
Incomplete (partial) immunization/Defaulter: refers to the childhood immunization status
if the child missed at least one of the recommended vaccines at a particular
time.
Fully
vaccinated child: A child between 12–23 months old who received one BCG,
at least three doses of pentavalent, three doses of OPV, a dose of IPV, three
doses of PCV, a dose of measles vaccine and a dose of yellow fever.
Partially
vaccinated child: This refers to a child who missed at least one dose of the eight
vaccines.
Unvaccinated
child: This refers to a child who does not
receive any dose of the eight vaccines.
Vaccinated
child: This refers to a child who takes at least one dose of the eight
vaccines.
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