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 incomes are 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 include Seasonal 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.
Keywords: Factors, children, immunization, incomplete, rural area
Word Count: 488
TABLE OF CONTENTS
Content Page
Title Page i Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables ix
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 3
1.3 Objective of the Study 3
1.4 Research Questions 4
1.5 Hypotheses 4
1.6 Scope of the Study 4
1.7 Justification for the Study 4
1.8 Operational Definition of Terms 6
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction 7
2.1 History of immunization 7
2.1.1 Active and Passive immunization 8
2.1.2 Immunization schedule 9
2.1.3 Mothers’ immunization status for tetanus toxoid vaccines 11
2.1.4 Immunization and Child Survival in Nigeria 11
2.1.5 Protective Potential of the Vaccines 12
2.1.6 Childhood Vaccine-Preventable Diseases and Vulnerability 12
2.1.7 The major reasons for immunization failure 14
2.2 Launching and implementation EPI 15
2.2.1 Implementing EPI 15
2.2.2 EPI Service Delivery Strategies In Nigeria 17
Content Page
2.2.3 EPI performance 18
2.2.4 Adverse effects of EPI vaccines 19
2.3 Factors affecting full child immunization 20
2.3.1 Characteristics of the mother 21
2.3.2 Access to health facilities 22
2.3.3 Characteristics of the child 22
2.4 Case studies on immunization of children globally and
also in Nigeria 23
2.5 Theoretical Framework 24
2.6 Conceptual Model: Health Belief Model 26
CHAPTER THREE: METHODOLOGY 27
- Research Design 27
- Population 27
- Sample size and sampling Technique 28
3.4 Instrument 29
3.5 Method of Data Collection 29
3.6 Method of Data Analysis 32
3.7 Measurement of Variables 32
3.8 Ethical Consideration 33
3.9 Validity and Reliability of the Instrument 33
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS 35
4.0 Introduction 35
4.1 Socio-demographic characteristics of the caregivers 35
4.2 Rural caregivers’ knowledge on immunization of child 37
4.3 Level of readiness of the caregivers to immunize their children 38
against the killer diseases
Content Page
4.4 Attitude towards immunization 41 4.5 Challenges faced by rural caregivers in completing
immunization for their children 42
4.6 Hypotheses of the Study 44
4.7 Discussion 44
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
- Summary 52
- Conclusion 53
5.3 Recommendations 53
5.4 Limitation of Study 53
REFERENCES 55
APPENDIX I 65
APPENDIX II 70
LISTS OF TABLES
Table Page
- New immunization Schedule of NEPAL 10
2: Measurement of variables 32
- Distribution based on socio-demographic characteristics of the rural women 33
- Demographic characteristics of the respondents child 36
- Rural caregivers’ knowledge on immunization of child 38
6 Level of readiness of rural caregivers to immunize their children 41
- Attitude towards immunization 42
- Challenges faced by the rural caregivers in completing immunization for
their children 44
- Chi-square relationship between the socio-demographic characteristics of the
rural pregnant women and their attitude towards immunization. 45
- Correlation relationship between the socio-demographic characteristics of the 46
rural mothers and their attitude towards immunization.
- Level of readiness and attitude towards immunization 46
- Correlation analysis result of challenges faced rural caregiver and 46
Attitude towards immunization of their child.
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).
- 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:
- assess the rural caregivers knowledge on Childs immunization;
- ascertain the level of readiness of the rural caregivers on immunization of their children against these killer diseases;
- assess the rural caregivers’ attitudes towards immunization of their children and
- determine the challenges faced by these rural caregivers in completing immunization for their children.
- Research Questions
The research questions that guided this study are:
- How knowledgeable are the rural caregivers about child immunization?
- What is the level of readiness of these rural caregivers in immunizing their children against these killer diseases
- What are the rural caregivers’ attitudes towards immunization of their children against these killer diseases?
- 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 health thereby reducing child mortality while also improving maternal health. Nnenna, Davidson, Babatunde (2013) reported that active immunization has turned many childhood diseases into distant memories among industrialized countries. Unfortunately this is not the case in developing 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 live birth 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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