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Approval Page …………………………………………………… i
Declaration ………………………………………………… ii
Dedication …………………………………………………. iii
Acknowledgement ………………………………………… iv
Table of contents …………………………………………. v
List of Tables ………………………………………………. viii
List of Figures ……………………………………………… x
Abbreviation ………………………………………………… xi
Abstract ……………………………………………………… xiii
Introduction————————————————— 1
1.1 Background of the study—————————— 1
1.2 Statement of the problem—————————– 3
1.3 Justification of the study—————————– 4
1.4 Objectives———————————————— 5
Literature Review——————————————– 6
2.1 Historical Perspective———————————- 6
2.2 Immunization schedule in Nigeria (see annex)—– 8
2.3 Factors that influence Immunization Coverage—- 8
2.4 Socio-economic status——————————— 10
2.5 Concern about vaccine safety and contraindications
To immunization—————————————– 11
2.6 Missed Opportunities———————————— 12
Subject, Materials and Methods————————— 15
3.1 General background (Map as annexed) study Area 15
3.2 Study Population—————————————- 16
3.3 Study Design——————————————— 16
3.4 Sample size determination—————————– 17
3.5 Sampling Technique———————————— 18
3.6 Data Collection (a) Questionnaire——————— 20
3.7 Data Entry and Analysis——————————- 21
3.8 Study Hypothesis and decision rules—————- 22
3.9 Ethical Consideration———————————- 22
3.10 Limitation of the study——————————— 23
3.11 Working Definitions———————————— 24
Results——————————————————— 27
4.0 Characteristics of the study population————- 27
Discussion—————————————————– 48
Conclusion—————————————————– 60
Recommendation———————————————- 62
Reference:—————————————————— 64
Appendix 1
Map of Anambra east LGA showing political wards— 76
Appendix 2
NPI routine immunization schedule for children
(less than 1 year)——————————————– 77
Appendix 3
List of political wards in Anambra East Local
Government———————————————— 78
Appendix 4
Questionnaire——————————————— 79
Ethical Approval—————————————— 80
Table 1: Biodermographic Variables of
the respondents———————————- 27
Table 2: Socio-cultural variables of the Mothers—— 29
Table 3: Sources of information on NPI—————– 31
Table 4: Proportion of mothers who know that NPI
vaccines protects against targeted diseases– 32
Table 5: Children who have suffered from a
vaccine preventable disease——————– 34
Table 6: Vaccination status of the children in
Anambra east LGA—————————— 35
Table 7: Vaccination card availability——————- 36
Table 8: Drop out rates according to vaccines
amongst the children—————————- 38
Table 9: Prevalence of missed opportunities———– 39
Table 10: Reason for not immunizing the children— 40
Table 11: Problems noticed in the children
following Vaccination—————————- 41
Table 12: Relationship between age of mother and
Immunization coverage of the children——- 42
Table 13: Relationship between occupation of
mothers and immunization coverage———- 43
Table 14: Relationship between immunization
status of children from mother’s response
and vaccination card ———————— 44
Table 15: Relationship between educational status
of mothers and Immunization coverage
of the Children ——————————- 45
Table 16: Relationship between Religious Practice
of mothers and vaccination coverage——- 46
Table 17: Relationship between development of side
effects after immunization and immunization
coverage—————————————— 47
Figure 1: Pie chart showing Immunization status—– 33
Figure 2: Bar chart showing percentage coverage
of the antigens from the vaccination cards– 37
AEFI – Adverse Event following Immunization
DPT – Diphtheria Pertussis Tetanus
FIC – Fully Immunized Child
GAVI – Global Alliance for Vaccines &
HBV – Hepatitis B Vaccine
IPDS – Immunization Plus Days
LGA – Local Government Area
LIDs – Local government Immunization Days
MDVP – Multi Dose Vial Policy
MV – Measles Vaccine
NDHS – Nigeria Demographic and Health Survey
NICS – Nigeria Immunization Coverage Survey
NIDs – National Immunization Days
NPC – National Population Commission
NPHCDA – National Primary Health Care Development
OPV – Oral Polio Vaccine
SIA – Supplemental Immunization Activities
SSPS – Statistical Package for Social Sciences
TT – Tetanus Toxoid
UNICEF – United Nations Children Fund
USAID – United States’ Agency for International
VPD – Vaccine Preventable Diseases
VVM – Vaccine Vial Monitor
WHO – World Health Organization
WPV – Wild Polio Virus.
– Chi-Square
Childhood immunization is a cost effective public health strategy.
Expanded Programme on immunization (EPI) services have been
provided in Anambra East local government area of Anambra State
mainly through the health facilities in the LGA.
The objective of this survey was to assess vaccination coverage and
its determinants in this rural suburb in Nigeria.
A cross-sectional survey was conducted in October 2010, which
included the use of interviewer-administered questionnaire to
assess knowledge of mothers of children aged 12-23 months on
childhood immunization and vaccination coverage of the children.
Survey participants were selected using a multistage sampling
method. Vaccination coverage was assessed by vaccination card
and material history. A child was said to be fully vaccinated if he or
she had received all the following vaccines: a dose of BCG, three
doses of OPV and DPT, and one dose of measles by the time he or
she was enrolled in the survey. Person chi-square (x2) test was
performed to identify determinants of full immunization status.
250 mothers and 250 children (each mother had one eligible child)
were included in the survey. 80 (32%) of the children were fully
immunized while 112 (44.8%) were not immunized from the
vaccination cards while with maternal history 86 (34.4%) were fully
immunized, though this difference was not statistically significant
P = 0.210 45 (26.5%) of 170 children who defaulted had visited a
health facility since their last vaccination or since they attained
appropriate age.
Majority of the children 109 (43.6%) received their vaccination in
Public health facilities.
Chi-square test showed that mothers educational status
(P = 0.004), religious denomination (P = 0.019) and
child’s problem after immunization P = 0.012 were
significantly associated with under immunization.
It is therefore concluded that despite all the efforts made by the
government, the vaccination coverage in this rural suburb is still at
a level that does not provide high protection (80%) against DPT/
OPV and even measles.
To improve on the low immunization coverage, attention should
be paid to female education, health education, capacity building of
the immunization service providers and supportive supervision.
Immunization remains one of the most important public health
interventions and a cost effective strategy to reduce both the
morbidity and mortality associated with communicable diseases.
Over two million deaths are prevented through immunization each
year worldwide1
. Despite this, vaccine preventable diseases remain
the most common cause of childhood mortality with an estimated 3
million deaths each year2
. Uptake of vaccination services depends
not only on provision of the services but also on other factors
including knowledge and attitude of mothers3,4, density of health
, accessibility of vaccination centres and availability of
safe needles and syringes.
Nigeria like many countries in Africa is making efforts to
strengthen its health system especially routine immunization so as
to reduce disease burden from vaccine preventable diseases
In 1979, Nigeria’s Expanded Programme on Immunization (EPI)
was initiated6
(though created in 1974 by WHO, UNICEF and
Rotary International as partners). It was relaunched in 1984 due to
poor coverage
. In 1996 it became the National Programme on
Immunization (NPI). Following a review of EPI Decree 12 of 1997,
NPI was made a parastatal.
• NPI has a sole responsibility of supervising and enhancing
routine and supplemental immunization activities in Nigeria.
• Routine immunization (RI) is provided largely through the
public health system, with significant variation between the
36 states and Federal Capital Territory (FCT). In Anambra
State, private or NGO providers are the source of up to one
third of RI in Anambra State8
Public sector provision is by health staff based at facilities run by
the 21 Local Government areas (LGAs), the General hospitals run
by the state government and the tertiary institution run by the
federal government.
There is also supplemental immunizations done periodically in the
state in the form of National Immunization days (NIDs), local
immunization days (LIDs), immunization plus days (IPDs) and
child health week all aimed at boosting immunization coverage and
mopping up and reaching every child (including those not already
reached) irrespective of their immunization status.
Globally, 2.5million children die every year from easily preventable
infectious diseases. In the year 2000, measles resulted in 777,000
deaths and 2 million disabilities9
. The expanded programme on
immunization (EPI) when introduced experienced some initial
success. However a few years after its inception, it became obvious
that it was no longer achieving its stated objectives and had to be
relaunched in 1984.
Nigeria attained universal childhood immunization (UCI) with 81.5
percent coverage for all antigens in 1990, but the success was not
to last long and by 1996, immunization coverage had declined
substantially to less than 30 percent for DPT-3 and 21 percent for
the doses of oral polio virus (OPV).
The situation had continued worsening, that presently the
coverage rates of the various childhood vaccines in Nigeria are
among the lowest in the world.
The above scenario has been playing itself out in Anambra State.
Anambra State has continued to witness fluctuation in
immunization coverage for all vaccine preventable diseases with its
attendant increase in the incidence of the diseases. Data from the
2008 National Immunization Coverage Survey shows that only
about 23 percent of children aged 12-23 months received full
immunization nationally, though this is almost double the value of
13% from the 2003 figure.
Assessing immunization coverage helps to evaluate progress in
achieving programme objectives and in improving service
delivery10. In addition, evaluation of immunization coverage
provides evidence whether substantial progress towards achieving
vaccination targets is being made. Such positive evidence is
required for continuing support from donor-supported initiative
like Global alliance for vaccines and immunization (GAVI)11. It is
also expected that findings from the study will help further
research work on this topic thereby bridging the gap in knowledge,
attitude and practice of the people on immunization.
It is in addition believed that findings will equip policy makers in
the planning and policy making on immunization and averting the
menace of vaccine preventable diseases in the LGA as there have
been recorded outbreaks of measles and a confirmed case of Wild
Polio Virus (WPV). It is equally noted that not much work has been
done in this field in this locality.
General: To determine the Immunization coverage of children aged
12-23 months living in a rural locality (Anambra East Local
Government area).
• Specific Objectives
1. To assess immunization coverage levels of children aged 12-
23 months in a rural area of Anambra State.
2. To assess mother’s knowledge, attitude and practice on
childhood immunization.
3. To identify any missed opportunities among the children.
4. To identify the factors that are associated with inadequate
coverage among the children


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