ABSTRACT
Childhood immunization has played a big role in universal child survival; it has been used to eradicate infectious communicable illnesses and also in the control of epidemics and outbreaks in many parts of sub-Saharan Africa. With most health initiative researches in Nigeria focusing on rural areas, Informal settlements have always been overlooked when it comes to health improvement efforts by stakeholders. The study objectives were : To establish the influence of level of knowledge and attitude towards measles and the vaccination status; To establish the influence of mother perception on immunization on knowledge and attitude towards measles and the vaccination status; To determine the influence of mothers practices on knowledge and attitude towards measles and the vaccination status; To determine the influence of access to healthcare services on knowledge and attitude towards measles and the vaccination status of their children 0 – 23 months in Sokoto Metropolis, Nigeria. The study site is in Sokoto Metropolis, Nigeria. A descriptive research design was used for this study. Pre-test of the research instrument was done in Sokoto settlement using 10% of the study sample size.. Quantitative data was collected through questionnaires. The study used SPSS version 22 to establish the descriptive and inferential results regarding the mean, frequencies, standard deviation, regression and correlation. The results were presented in form of tables. The findings revealed that 91.8% of mothers had taken their children for vaccination at the appropriate age and had complied to the immunization schedule. Only 67.8% of the respondents knew the age at which vaccination was to start. Only 73.2% of respondents could mention diseases prevented by immunization and most mothers 56% got information on immunization from healthcare workers. The test of independence at significance level of 0.01 results showed that the main determinants of compliance to immunization were level of knowledge (R² = 0.033, df = 1, P<0.003), access to health services (R² = 0.192, df= 1, P<0.0001), mother perception (R² = 0.289, df=1, P<0.0001 and mother practices (R² = 0.002, df=1, P<0.854). The concept of childhood immunization schedule needs to be incorporated in the education curricula, programs for non-formal education and adult literacy programs, this will help magnify the importance of immunization and as well as show the demerits not complying with immunization schedule as well as harmful consequences of incomplete immunization. Perception of mothers can be improved by training and educating mothers on importance of knowledge and attitude towards measles and the vaccination status of their children.
CHAPTER ONE
INTRODUCTION
1.1 Background of the study
Childhood immunization has played a big role in universal child survival. Immunization has been used to eradicate infectious communicable illnesses and also in the control of epidemics and outbreaks in many parts of sub-Saharan Africa. An estimated 2 to 3 million people worldwide die from vaccine-preventable diseases yearly (WHO, 2018).
In Africa, vaccine-preventable diseases such as Tetanus, Diphtheria, Tuberculosis, Pneumonia and Whooping cough, in combination are the leading causes of death in children under 60 months. (WHO, 2018).Vaccination has proven potential in averting millions of deaths and it is a safety net against many diseases if the recommended levels are embraced and followed.
In Nigeria, 12 vaccinations are given according to the national childhood immunization schedule to be completed by 9 months. The Ministry of Health Nigeria (MOH) stipulates that a child is considered fully vaccinated when they have received a vaccination regimen of one dose of Measles, one dose of Tuberculosis (BCG), three doses of Diphtheria, Pertussis, and Tetanus (DPT) and three doses of oral Polio vaccine. As a low middle-income country, Nigeria does not have enough resources and manpower to enhance vaccination services against a rapidly increasing population; this has resulted in persistent coverage gaps in immunization countrywide (A Kariuki, 2014).
A study by Djesika A, Steven B, Shukri M., (2014) found that informal settlements in Sokoto Metropolis lag behind in health indicators; in comparison to formal areas in Sokoto Metropolis and other regions in the country.
The study further found that failure by the national government to identify informal settlements as distinct from other urban areas in national censuses hampers health intervention efforts in informal settlements. Informal settlements are always overlooked when it comes to improvement efforts by the government and humanitarian organizations. This has resulted in most research efforts on poverty reduction and health improvements focusing on rural areas, (Djesika et al., 2014).
Sheillah Simiyu, Sandy Cairncross & Mark Swilling.,(2015) noted that informal settlements are greatly under-sampled in national and sub-national surveys. Homogenization of data trends between wealthier urban localities and informal settlements leads to a false presentation of the true situation in Sokoto Metropolis. Sokoto Metropolis is a high risk metropolis in reference to immunization diseases, in order to improve compliance with immunization schedules in Sokoto Metropolis and in particular in informal settlements, there is a need to study how mothers comply with immunization schedule guidelines.
The study focused on children under 23 months because WHO, (2018) recommends that 0-23 months is the best age bracket to vaccinate children. The age between 0 – 23 months is when a child’s body produces the best possible reaction to a vaccine. A child who has been vaccinated is likely to suffer from less serious complications and milder symptoms from a disease they have been vaccinated against in comparison to a child who is yet to be vaccinated.
1.2 Statement of the problem
African Population Health Research Council [APHRC] in 2018 found that under-five mortality in Sokoto informal settlements was about 3.6 times higher than that of Sokoto as a whole with vaccine-preventable illnesses playing a great role in the outcomes. Blessing, Tilahun, Catherine and Alex., (2016) also found that in the period 2012 - 2013, the under-five mortality rate in Sokoto informal settlements was higher than all other estimates for Sokoto Metropolis and national levels. This therefore raised the need to investigate what influences compliance to immunization schedule among the mothers in the informal sectors in Sokoto Metropolis.
One of the reasons why informal sector dwellers in Sokoto Metropolis experience high mortality from conditions that are preventable by immunization is because health interventions in Nigeria focus on the rural population. According to Catherine Kyobutungi, Abdhalah, Kasiira, Ziraba, Alex Ezeh and Yazoumé Yé.,(2008) it is important to focus on the health of Sokoto’s informal settlements dwellers since their health outcomes are worse than the health outcomes of rural dwellers.
In present times most diseases are easily treatable with antibiotics making mothers reluctant to immunize their children (WHO, 2015). APHRC (2018) found that many mothers in Sokoto Metropolis take their children for only the first two rounds of immunization and fail to complete the full immunization schedule. In Nigeria, childhood vaccinations services are voluntary and free at public health centers, but still immunization rates remain below the WHO targets of 90%, with only 74.4% of children below 5 years in Sokoto Metropolis being fully immunized (KDHS, 2014).
A lack of clear understanding of the advantages of vaccination and suspicion of national health services among mothers are possible contributing factors to noncompliance with childhood immunization schedule in Nigeria. To fully eradicate some diseases from informal areas in Sokoto Metropolis, adherence to immunization schedule must be observed to keep the herd immunity against vaccine preventable diseases high.
1.3 Justification
When obtained at the correct time immunization increases protection of children from vaccine preventable illnesses and decreases the outbreak of diseases (Patience et al., 2018). Compliance to immunization schedule is pivotal in ensuring that population reap the full benefit of immunization. At the same time compliance may be influenced by many factors including the care givers’ level of knowledge on the importance of immunization to their children. This study therefore sought to determine mother’s compliance with childhood immunization schedule among mothers of children 0 – 23 months in Sokoto Metropolis, Nigeria. The study focused on children aged 0-23 months because recent studies by WHO, (2018) confirm that this is the best age bracket to vaccinate children, because this is when a child’s body produces the best possible reaction to a vaccine.
A large percentage of mothers in present times have never met someone with Polio or Whooping cough, with vaccine-preventable illnesses being less common and infrequent in today’s populations, some mothers view vaccination as less urgent despite having general knowledge of the importance of immunization (Shelly, 2014).
In Nigeria, various studies have researched and published information on different aspects of immunization and immunization coverage in different regions of the country. However, these studies have been limited to local geographic areas and in rural areas. Kariuki (2014) and Catherine, et al., 2008, proposed further research be done to reduce immunization dropout rates in urban informal settlements in Nigeria hence providing a gap for this study.
1.4 Research Questions
I. What is the influence of mother’s level of knowledge and attitude towards measles and the vaccination status of their children aged under-five in Sokoto Metropolis, Nigeria?
II. What is the influence of mothers’ perception on knowledge and attitude towards measles and the vaccination status of their children aged under-five in Sokoto Metropolis, Nigeria?
III. What is the influence of mother practices on knowledge and attitude towards measles and the vaccination status of their children aged under-five in Sokoto Metropolis, Nigeria?
IV. What is the influence of access to health services on knowledge and attitude towards measles and the vaccination status of their children aged under-five in Sokoto Metropolis, Nigeria?
1.5 Null Hypotheses
H01– Mother’s knowledge, perception, practices and access to health services have no influence on knowledge and attitude towards measles and the vaccination status of their children 0 – 23 months in Sokoto Metropolis, Nigeria.
1.6 Research Objectives
The overall objective of the study is to assess knowledge and attitude towards measles and the vaccination status of their children 0-23 months in Sokoto Metropolis, Nigeria.
1.6.1 Specific Objectives
I. To determine the influence of level of knowledge and attitude towards measles and the vaccination status of their children 0 – 23 months in Sokoto Metropolis, Nigeria.
II. To determine the influence of mother perception on immunization on knowledge and attitude towards measles and the vaccination status of their children 0-23 months in Sokoto Metropolis, Nigeria.
III. To determine the influence of mothers practices on knowledge and attitude towards measles and the vaccination status of their children 0 – 23 months in Sokoto Metropolis, Nigeria.
IV. To determine the influence of access to healthcare services on knowledge and attitude towards measles and the vaccination status of their children 0 – 23 months in Sokoto Metropolis, Nigeria.
1.7 Delimitation and limitation
Recall bias was a problem as some mothers failed to accurately recall what vaccines their children received. Self-reported data was accepted from mothers in the absence of an immunization card. From the study 84.3% of the respondents had their children’s immunization cards.
1.9 Significance of the study
This study will be of great importance to: The Nigerian government since it is responsible in health service provision and formulating policies that look to strengthen health care delivery in informal settlements. The data from this study will be vital for health planning, reducing stress on health facilities and preventing disease outbreaks. The study will be important to humanitarian organizations in setting emergency thresholds and target areas for child health interventions. Parents and mothers of children living in informal settlements will benefit from this study since it will enable mothers to understand the importance of childhood immunization. Like any other research, the findings will be a good reference for future studies on improving healthcare for children in Nigeria.
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Item Type: Project Material | Size: 66 pages | Chapters: 1-5
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