ABSTRACT
This study is based on immunization programme in Etsako west local government area of Edo state. The purpose of this study is to ascertain the factors affecting the implementation of national programme on immunization in Etsako west local government area of Edo state. According to the world health organization, (WHO) the incidence of the eight deadly diseases namely poliomyelitis, diphtheria, tetanus, tuberculosis, yellow fever, hepatitis B, measles that easily kill children between 0-59 months of age are on the increase in many countries including Nigeria as a country. Etsako west local government area of Edo state is not left out and is yet to achieve hundred percent target responses since inceptisl in Nigeria in 1974. From the foregoing therefore, the researcher was prompted to work on this project with the following hypotheses.
- The awareness and responses to immunization programme in Etsako west local government area of Edo state
- The attitude of the people in the locality towards immunization programme i.e if they consider it important.
- The relationship between the health workers and the people in the locality and the people immunization programme..
- how the introduction of vaccine has actually reduce infant mortality rate in Etsako West
- It is important for all children to be immunized before the age of 5 years in the locality.
- Do people see immunization and vaccination at a regular interval helped to fight epidemic in Etsako West.
- The need to immunization children and women of child bearing in Etsako West.
- the effect of shortage of health personnel as compared to the Estako West
The researcher carried out the study on the responses of people to immunization in Etsako west local government area of Edo state. The subject selected for the study were mostly health personnel’s women especially those that visit the health centre and clinics including men whose residence are within the geographical location of this study various methods were employed in collecting data which include oral interview questionnaire, written interview and observation that were analyzed with use of percentage and discussed of finding. Conclusively, the researcher revealed that, there should be adequate dissemination of information to all citizens especially to the rural areas. Also the importance or benefits should be well stressed to the communities. If the objectives of national programme on immunization could be achieved.
TABLE OF CONTENT
Title of page…………………………………………………………….…….ii
Certification……………………………………………………………….….iii
Dedication……………….…………………………………………………….iv
Acknowledge………………………………………………………………….v
Abstract………………………………………………………………..………vi
CHAPTER ONE
- Introduction…………………………………………………………..1
1.1 Historical backgrounds…………………………..……………….8
1.2 Geography and population………………..…………………..8
1.3 Topography………………………………………………………………9
1.4 Climate and vegetation………………………….……………….9
1.5 People………………………………………………………………………9
1.6 Occupations………………………………………………………..…..9
1.7 Health facilities……………………………………………….…….10
18 Statement of problem……………………………………….…..10
1.9 Purpose of study…………………………………………………..12
1.10 Specific objective …………………………………….………..13
1.11 Hypothesis…………………………………………………………..14
1.12 Significance of he study……………………………………..15
1.13 Scope of the study………………………………………………16
1.14 Limitation of study…………………………..……………..….17
1.15 Definition of terms………………………………………………18
CHAPTER TWO
2.0 Review of related literature ……………………..…………21
2.1 Relevance of related interview to the study…………30
2.2 Good/objectives of national programme on immunization……………………………………………………………….31
2.3 Immunization. 5 years population and coverage…32
2.4 Strategies and activities……………………………………….35
2.5 Prevention of childhood diseases…………………………35
2.6 Identification of national programme on immunization……………………………………………………………….37
2.7 Conclusion and summary……………………………………..42
CHAPTER THREE
3.0 Methods and procedure………………………………………..45
3.1 Methods of data collection………………….………………..45
3.2 Population and sample size………………..………………..46
3.3 Oral interviews……………………………………..……………….47
3.4 Questionnaires…………………………………….………………..47
3.5 Sample questionnaires………………………………………….47
CHAPTER FOUR
4.0 Data analysis and discussion findings…………….……51
4.1 Distributions within the sample ……………………………52
4.2 Problem one………………………………….……………………….53
4.3 Immunization awareness between urban area and neighbouring villages…………………….……………………………54
4.4 Problems two…………………………..…………………………..54
4.5 Importance of immunization…………………………………55
4.6 Problem three………………………………….…………………….55
4.7 Payment for vaccines and services……..……………….56
4.8 Problem four…………………………………….…….………..…..56
4.9 Vaccination and infant death rate………………………..57
4.10 problems Six……………………………………………………….57
4.11 Importance of immunization to children below 5 years of age………………………………………………………………..58
4.12 Problem Seven…………………………………………………….58
4.13 Vaccinations at intervals reduce frequency of epidemics………………………………………………………….………….59
4.14 problem eight………………………………………………………59
4.15 Immunization are meant for both children and women of child bearing age…………………………….………….60
4.16 Problem nine……………………………………………………..61
4.17 Personnel present compared with health centers in the L.G.A……………………………………………………………………..61
CHAPTER FIVE
Summary, Recommendation and Conclusion…………..65
- Summary……………………………………….……………..65
- Recommendation…………………………………………..66
- Conclusion………………………………………………………69
- References
CHAPTER ONE
1.0 INTRODUCTION
World widely, the concept of primary health care (PHC) originated from the concern which many world health organization (WHO) member countries showed about providing their rural and urban medication underserved population with essential health care. The almata declaration of 1978 UNICEF/WHO, 1978 defined primary health care as “essential health care based on practical, scientifically sound and socially acceptably methods and technology made universally accessible to individual and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of reliance and self determination. It forms an integral part both of the country’s health system of which is the central functions and main focus and of the overall social and economic development of the community. During the same conference, eight essential components of the primary health care were identified and one of these components was “immunization against the major infectious diseases”, to achieve health for all by the year 2000.
The world health organization (WHO) established the expanded programme on immunization (EPI) in 1971. the inclusion of immunization against the major infectious disease as one of the component of primary health care in the almata document of 1978 was a re-affirmation of the need to combat preventable diseases, especially in developing countries including Nigeria using vaccines. The expanded programme on immunization (EPI) thus had two major long term goals (WHO) 1976
- To immunize at least 80% of the susceptible population of children between ages of 0-24 month by 1990.
- To establish adequate surveillance system for the target diseases and the monitoring and evaluation system of expanded programme on immunization activities. Preventable diseases exact a tremendous tool in childhood illness, death and disability in the developing countries.
In July 1996, the programme was renamed national programme on immunization (NPI) to emphasize the country’s ownership of the programme. This was established under the national programme on immunization (NPI) decree of 12th august 1997 as a prostate of the federal ministry of health. World health organization has estimated that five million children die each year from the eight national programme on immunization target diseases. The programme is designed to protect children from 0-59 months against the occurrence of the following deadly diseases such as:
- Poliomyelitis
- Diphtheria
- Tetanus
- Tuberculosis
- Yellow fever
- Hepatitis B
- Measles
Service delivery system will be a key component to be addressed in order to improve routine immunization services. Other areas of focus include update of current immunization policy to include safety of injection and waste disposal management issues. Training of immunization personnel rehabilitation and expansion of vaccine supply and distribution, strengthening of surveillance system advocacy and social mobilization, collaboration with private sector will also be fostered. The inter-agency co-ordinating committee (ICC) will expand to include more members and will take part in mobilizing resources as well as monitoring plan, implementation and fund utilization. Yearly target for immunization coverage had been seen that will allow evaluation of the progress made.
The estimated budget for the implementation of the planned activities in US $678,501.11s.
However the annual plans derived from 5-years plan will provide more accurate figures for the yearly implementation of the programme activities.
In Etsako West Local Government of Edo States, national programme on immunization has progressed for fourteen years now. However, a number of constraints have slowed down the implementation of NPI. Some of these, according to the federal ministry of health and the state ministry of health include
- Low level of awareness
- Inadequate funding
- Inadequate vaccine
- Lack of adequate publicity and coverage
- Inadequate staffing
- Very little multisectional collaboration
- Physical inaccessibility
- Inadequate community participation
- Poor supervision
- Transportation
This research was therefore focused on identifying those factors that have been affecting the implementation of NPI in Etsako west local government area from the period of its inception in 1991 up to July 2011.
The national programme on immunization particular reference to the basic strategies outlined for a successful implementation of NPI at the state and local government area levels.
The following area are;
- Funding
- Community participation
- Training
- Multi sectoral or management
- Extent of health education
- Supervisory
Were critically examined to see it they have been contributory factors to the implementation NPI in Etsako west local government area. The five year immunization figures by antigen were examined to ascertain performance so far in the local government area paying particular attention to the 2011 national immunization days (NIF 2011) campaign figures for Etsako west local government area as campaign have been found to enhance some immunization factors in (NPI) notably multi sectoral co-operation and community participation.
BACKGROUND OF THE STUDY
1.1 HISTORICAL BACKGROUND OF ETSAKO WEST LOCAL GOVERNMENT AREA OF EDO STATE
In Etsako west local government area of Edo State was from the defunct Etsako Local Government Area of Edo State in the year1991 with the administrative head Quarter at Auchi Town.
1.2 GEOGRAPHY AND POPULATION
Etsako West Local Government Area has an average population of 153,575. it is bounded in by the Etsako Central and East, Owan East, Akoko Edo, and Esan Central.
1.3 TOPOGRAPHY
The entire area is almost flat but with gentle rolling hills in areas like Iyora, Ayoweri, Apana etc.
1.4 CLIMATE AND VEGETATION
The climate is mild with average temperature of about 30%. Rainfall is between the months of march to October while the dry season wind start from October to march yearly. The land is more of rain forest than grassland.
1.5 PEOPLE
The area is heterogeneously made up of people from different tribe. They are very friendly and accommodating in nature. Majority are Muslim while few of them are Christian.
1.6 OCCUPATION
The people are predominantly farmers and their land is very rich in agriculture. At the same time, some individuals are trader and businessmen and few working classes.
1.7 HEALTH FACILITIES
There are total of fifteen static health facilities that carry out primary health care activities including national programme on immunization unit in the local government area. There are also one central hospital at Auchi. All these health facilities are in different wards in the local government area.
1.8 STATEMENT OF PROBLEMS
Decrease in immunization coverage to a significant level in Nigeria and in particular ETSAKO west local government area has become a major constraint in the implementation of national programme on immunization (NPI). The federal, state and local government embarked in the year 2011 on the eradication of deadly, communicable diseases. There is continuous death, afflictions and disability to both young and old from deadly communicable diseases which should have been controlled or prevented if the people were to respond positively to government call for immunization.
National programme on immunization is now a household talk in the county. From time to time, there are calls for immunization for one another. The researcher therefore decided to find out about the factors affecting the implementation of national programme on immunization in Auchi the headquarter of Etsako west local government area of Edo state the study intends to answer the following questions
- Does community participation in research quotation in Auchi affect the implementation of national programme on immunization
- Does the supervision of heads of health facilities and their staffs by the NPI manager affect the implementation of NPI in Auchi
- What is the knowledge, attitude and practice of health workers in Auchi or Uzariua clan?
- Does intersectoral and multisectoral collaboration affects the implementation of NPI in Etsako west local government area?
- Does health education of mothers in the LGA influence them to bring their children for immunization?
- Does funding affect the implementation of national programme on immunization in Etsako west local government area.
1.9 PURPOSE TO STUDY
The general objective of the study is to identify factors that affect the implementation of national programme on immunization in Auchi – Uzairue in Etsako west local government. The identified factors would be looked into with a view to use them as tools for strengthening NPI in the local government area in order to achieve universal child immunization (U.C.I) goal to 80% by the end of 2013 and improve primary health care implementation generally.
1.10 SPECIFIC OBJECTIVES
- To determine if the knowledge, attitude and practice of health workers area affect the implementation of NPI
- To determine the effect of community participation on NPI in Etsako west L.G.A.
- To determine the effect of health education of mothers on national programme on immunization
- To assess the level of community mobilization towards the implementation of NPI in Etsako west local government area
- To assess the effect of supervision of head of facilities and their staff on the implementation of national programme on immunization in Etsako west.
- To identify the effect of intersectoral and multisectoral collaboration on the implementation of national programme on immunization.
1.11 HYPOTHESIS
The researcher seeing the factors affecting the implementation of national programme on immunization in Etsako west L.G.A design this investigation to test the following hypothesis.
- Do urban areas get information easier and faster than rural areas?
- Do people in the locality consider national programme on immunization important.
- Does the relationship between the health workers in the area help to improve the programme in the locality?
- Have the introduction of Vaccine helped to reduce infant mortality.
- It is important for all the children should be immunized before the age of 5-years
- People who are vaccinated at suitable interval have resistance against epidemic.
- Immunization is meant for children and women of child bearing age.
- There are shortage of health personnel as being compared to the number of health centers in the locality.
1.12 SIGNIFICANCE OF THE STUDY
The world health organization (WHO) pronounced using the federal ministry of health by the decree 12 of 1977 to totally eradicate the communicable diseases by the year 2008. there fore the importance of this study lies in the fact that children make the community, the society therefore be assured against the deadly communicable diseases that is so prevalent in our environment.
The study therefore would be of importance to the people who mainly as a result of ignorance and superstition refuse immunization it would also be useful to the health units on how to improve the present ways of enlightenment on immunization in the local government area. The finding and recommendation of this research is also expected to help the state and federal government (ministry of health) in planning for the future.
1.13 SCOPE OF STUDY
The area under study is Etsako west local government area of Edo state. The subjects that will be used in the study will be based on randomly selected men across the community. Some women of child bearing age, people who are educated and those without former education, religious practioners, traditional and various health personnel.
1.4 LIMITATION OF STUDY
Limitation faces all work undertaken by human being. This study can not be an exemption. This major limitation of this study is finance, following unnecessary increment of education level (school fees) by the state government, this result to unbalanced financially backwardness to purchase requirement. This singular factor affected my movement from place to place. The work was always put in suspension pending when money is available for me to continue. Another factor that hinders the research project was the unfriendly weather condition.
1.15 DEFINITION OF TERMS
(1). Primary health care (PHC): As defined by alma-ata conference (WHO) and (UNICEF)
(1. Primary health care is an essential health care make universally accessible to individuals and families in the community, based on practical scientifically sound and socially acceptable methods and technology, through their full participation and at a cost that the community and country can afford to maintained every state of their development in the spirit of self-reliance and self determination.
(2). COMMUNITY: This is the collection of people living together, sharing common values, customs and the frame work of action in some form of social organization and cohesion regarding how to adapt to changing environments/ conditions which include primary health care strategy.
(3). National programme on immunization (NPI): This is the programmed designed to immunize children in the age group of 0-59 months (under 5 years) against the eight deadly diseases namely;
- Tuberculosis
- Tetanus
iii. Whooping cough
- Diphtheria
- Poliomyelitis
- Measles
vii. Hepatitis B (HBV)
viii. Yellow fever.
This also includes immunization of women of child bearing age from 15-49 years.
(4). Community participation: this is a process of assuming responsibility by individuals and families for their health and welfare and those of the community voluntarily. This leads them to develop capacity to contribute to the development of their community.
(5). Immunization: immunization, process of administering vaccines to stimulate the body’s immune response against disease that could otherwise impaired one’s health or that of the entire community is one of the most important achievement of modern medicine
(6). Vaccines: this is any material alive, killed or toxoid used to produce immunity against a disease
(7). Health Education: this is any combination of teaching learning experiences designed to predispose, allow, enable and reinforce voluntary adaptations of behaviour conducive to good health.
(8). Mortality: this is the number proportion of persons within a community dying from disease
(9). Morbidity: this is the number /proportion of persons within a community with illness from disease.
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