Acceptance And Uptake Of Childhood Immunization Among Mothers In The Society

Project and Seminar Material for Nursing (Science)

Acceptance And Uptake Of Childhood Immunization Among Mothers In The Society


Abstract


This study was thus, carried out to assess the acceptance and uptake of childhood immunization among mothers in Kaduna State. A cross-sectional descriptive study was conducted using multistage sampling technique; 379 eligible mothers/caregivers were recruited. Data collection was done using semi structured interviewer-administered questionnaire to obtain information from the respondents. Only 59 (15.6%) of these children were found to be fully immunized, evidenced by vaccination card history. Furthermore, among the respondents, majority (64.4%) had unsatisfactory knowledge while 55.36% and 54.0% exhibited poor perception and bad practices respectively, regarding routine immunization. Commonest source of information was radio (61.61%). Educational status and good perception of mothers were found to be associated with getting information on routine immunization within 12months prior to this study while Polygamous family setting, unsatisfactory knowledge and bad practices of mothers were independently associated with lack of information on routine immunization.In conclusion the research showed that mother‘s educational status, family setting, knowledge, perception and practices about immunization are important factors that influence access to routine immunization information which are ultimately predictors of full child immunization. It is therefore recommended that Kaduna state government should create convenient adult education classes to improve educational status of mothers and be committed to girl-child education. The state should intensify sensitization of mothers/caregivers on routine immunization using radio and television jingles through the Ministry of information to improve their knowledge and utilization of routine immunization service.

 


Table of Content


Preliminary Page(s)

  • Title Page
  • Declaration
  • Approval
  • Dedication
  • Acknowledgement
  • Abstract
  • Table of Content

Chapter One

1.0 Introduction

  • 1.1 Background to the Study
  • 1.2 Statement of Problem
  • 1.3 Research Objectives
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Definition of Terms
  • 1.8 Organization of Study

Chapter Two

2.0 Literature Review

  • 2.1 History of Immunization
  • 2.2 Benefits of Immunization
  • 2.3 National Program on Immunization (NPI) In Nigeria
  • 2.4 Immunization Schedule In Nigeria
  • 2.5 Factors Affecting Full Child Immunization
  • 2.5.1 Mothers’ Characteristics
  • 2.5.2 Child Characteristics
  • 2.5.3 Societal Cultural Background
  • 2.5.4 Religious and Political Influences
  • 2.5.5 Socio-Economic Status
  • 2.6 Access to Health Facilities
  • 2.7 Concept of Compliance
  • 2.8 Vaccine Coverage and Drop-Out Rate
  • 2.9 Sources of Information to Mothers/Caregivers on Routine Immunization in Nigeria
  • 2.10 Community Involvement and Communication of Information on Immunization

Chapter Three

3.0 Methodology

  • 3.1 Study Design
  • 3.2 Background of the Study Area
  • 3.3 Study Population
  • 3.4 Data Collection Techniques and Tools
  • 3.5 Statistical Analysis

Chapter Four

4.0 Results and Discussion

  • 4.1 Results
  • 4.2 Discussion

Chapter Five

5.0 Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • Appendix

Chapter One


1.0 Introduction

1.1 Background to the Study

Immunization is one of the safest and most effective interventions to prevent disease and early child death. Although, about three quarters of the world‘s child population is reached with the required vaccines, only half of the children in Sub-Saharan Africa get access to basic immunization. In recent years, many countries have employed a growing range of strategies to increase both the provision and utilization of immunization services. These experiences are in consonant with the Global Immunization Vision and Strategy (GIVS) of ―using a combination of approaches to reach everyone targeted for immunization.1

A substantial number of children worldwide do not complete immunization schedules because neither health services nor conventional communication mechanisms regularly reach their communities. In some communities, low immunization rates are associated with families living a long distance from health services, having little access or exposure to large- scale or local media, and low doctor- and nurse-patient ratios (e.g. slum-dwellers in the Philippines and South Africa, nomadic populations in Sub-Saharan Africa, and internal migrants in Brazil, Cameroon, and Mozambique). Underserved communities have consistently shown low immunization coverage.6Innovative outreach strategies are needed to particularly target children who are excluded or beyond the reach of immunization services.

Similarly, anti-vaccination information and/or refusal to get children immunized is not new in the world. Historically, populations have rejected immunization due to concerns about vaccine safety as well as political, cultural, and religious reasons.7Today, trust and acceptance of immunization faces two new formidable challenges. Firstly, a global, fast-paced communication environment makes it possible for negative publicity and anti-immunization positions to be disseminated quickly worldwide. Localized opposition (e.g., polio campaigns in India and Nigeria), negative publicity surrounding vaccine safety (e.g., MMR vaccination in the UK), and suspected or real adverse events following immunization are more likely to attract wide media coverage, and spread through the Internet.8,9 Secondly, increased democratization promotes debates about individual and community rights and choice. Today, democratization offers an environment more conducive to the emergence of challenges to government-mandated programs such as immunization. In a growing ―rights‖ environment in both the developed and developing world, national programs like immunization are more vulnerable to being questioned.6
There is an ever widened gap in access to vaccines between developed and developing countries in the past decades. More vaccines have become available, but most developing countries cannot afford the newer vaccines, lack well-functioning systems to deliver them, and have inadequate surveillance systems or study data to determine the burden of disease to motivate decision-makers to adequately fund them. A number of vaccines such as hepatitis B, yellow fever, and haemophilus influenza type B (Hib) are under-utilized due to inadequate funding from Ministries of Health, overstretched health systems, and weak demand from health providers and caregivers6 (who lack sufficient knowledge about the efficacy of specific vaccines and are unaware of the burden of vaccine-preventable diseases or the availability of vaccines).

The induction of immunity by applying vaccine in children is among the most cost-effective health interventions to reduce child mortality, morbidity, and disability in the world.10 This is achieved through a routine vaccination schedule for children in Nigeria which are given starting from birth, and are being completed before one year of life by all children as it obtained elsewhere.11 BCG and OPV0 are administered at birth, while three doses of OPV and pentavalent vaccines (which protect against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B disease) are given at interval of four-week duration; at 6, 10 and 14 weeks, and measles vaccine is given at the age of nine months.12Nigerian government introduced pentavalent vaccine into her routine immunization schedule recently (2012).

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 (VPDs). Such efforts include provision of the vaccines and personnel through the NPHCDA, private or NGO providers‘, community based participation and the media.


1.2 Statement of Problem

Only 10% of children in the North West Nigeria are fully immunized, compared to 52% of children in the South East and South regions despite the numerous vaccination campaigns in place18.This may be due to social and cultural practices that restrict most women from obtaining basic information on immunization in the North.25The low routine immunization coverage in the study area has favored the transmission of wild polio virus with high cases of poliomyelitis. Immunity gap by this low immunization coverage favors the emergence and transmission of some vaccine preventable diseases like measles.18

According to the WHO, the persistence of vaccine-preventable diseases in Nigeria can largely be attributed to the under-utilization of available vaccines,19 and knowledge gaps by the mothers/caregivers which underscores low compliance with vaccination schedules; [many parents are not fully aware of the benefits of vaccination and as a result do not immunize their children against vaccine preventable diseases]. Also, relative distance of communities to the health centers may not allow complete immunization schedules to take place because neither health services nor conventional communication mechanisms regularly reach these communities; which is the case in nomadic communities in Nigeria.

The above scenario is the situation found in Kaduna State, where the inability of the nomadic communities to be reached and participate fully in the RI and SIAs was the reason advanced by the Kaduna State Government for the outbreak of poliovirus as witnessed in 2012. The cases were reported in Birnin Gwari, Ikara, Igabi, Kubau and Zaria Local Governments.20Similarly; rejection of immunization due to concerns about vaccine safety as well as political, cultural, and religious reasons have also been identified to limit effective utilization of routine immunization.


1.3 Research Objectives

The main aim of this study is to assess the acceptance and uptake of childhood immunization among mothers in the society using a cases study of Kaduna state. The specific objectives are as follows;

  1. To assess the knowledge and perception of childhood immunization among mothers in Kaduna State
  2. To determine the sources of information on childhood immunization among mothers in Kaduna State
  3. To determine the acceptance of childhood immunization among mothers in Kaduna State
  4. To assess the factors that influence the uptake of childhood immunization among mothers in Kaduna State

1.4 Research Questions

  1. What is the level of knowledge and perception of childhood immunization among mothers in Kaduna State?
  2. What are the sources of information on childhood immunization among mothers in Kaduna State?
  3. What is the level of acceptance of childhood immunization among mothers in Kaduna State?
  4. What are the factors that influence the uptake of childhood immunization among mothers in Kaduna State?

1.5 Research Hypothesis

HO1: There is no significance between knowledge of childhood immunization and acceptance/uptake among mothers in Kaduna State


1.6 Significance of the Study

Different studies have shown that knowledge gaps underlie low compliance with vaccination schedules. Mothers/Caregivers are less likely to complete immunization schedules if they are poorly informed about the need for immunization, logistics (time, date, and place of vaccination), and the appropriate series of vaccines to be followed. Although knowledge in itself is insufficient to create demand, poor knowledge about the need for vaccination and when the next vaccination is due is a good indicator of poor compliance.6

Tracking, evaluating and assessing the type and quality of information received by mothers would provide a vital tool for understanding routine immunization gaps in the study area.

Thus, it is important to conduct this study to examine the associations between knowledge, perception and the information mothers/care givers receive aside their socio-demographic factors because when up-to-date, complete, and scientifically valid information about vaccines is available, parents can make informed decisions. For example, they need to have access to accurate evidence-based information so that they understand the risks of non vaccination, the importance of community immunity, and the actual risks of complications.23 Without this information, many mothers may develop a false sense of security and regard immunizations as unimportant.


1.7 Definition of Terms

Knowledge:

A familiarity, awareness or understanding of someone or something, such as facts, information, description or skills which is acquired through experience, education or learning.

Immunization:

A process whereby a vaccine is injected or introduced into a child to confer immunity to the child against a specific disease.

Infant Immunization Coverage:

The percentage of children under one year (12 months old) who have been vaccinated.

Perception:

A way of regarding, understanding or interpreting something; a mental impression.

Acceptance:

The actual application of childhood immunization.


1.8 Organization of Study

The study comprises of 5 chapters. In chapter one, the concepts are introduced and the problem of the study is established with the research objectives and questions. Chapter two presents the literature review while chapter three presents the research methodology. The fourth chapter presents the results and discussion, and the last chapter presents the conclusion and recommendation.


Chapter Five


5.0 Summary, Conclusion and Recommendation

5.1 Summary

The study was carried out to assess the acceptance and uptake of childhood immunization among mothers in the society using Kaduna as a case study. A total of 379 questionnaires were administered based on the sample size determined and the response rate was 100%. From the study, access to quality information on immunization by mothers or caregivers has a direct effect on awareness and vaccination rates. This study found majority of children whose mothers were interviewed were between age 16-19months old (43.01%), females (53.30%) with birth order 2-5 (62.80%).


5.2 Conclusion

Majority of respondents have unsatisfactory knowledge (64.4%) and perception (55.4%) towards routine immunization and analysis proved that mother‘s educational status, family setting, knowledge, perception and practices about immunization are important factors that influence access to RI information which are ultimately predictors of full child immunization. This study found the main source of information within 12 months prior to study to be via radio. Accepting polio vaccine during campaigns and not routine immunization, taking concoctions and praying in place of vaccine, delivering outside the hospital setting and not completing immunization schedule were some of the bad practices of majority (54%) of mothers/caregivers in Kaduna State. This also was found to be associated with poor access to information on immunization.


5.3 Recommendation

The following recommendations were made based on the findings from this study.

  1. The Kaduna State Ministry of Education and Agency for Mass Education should collaborate to improve the literacy level of the people
  2. State Ministry of Education should create convenient adult education classes to improve educational status of mothers
  3. Kaduna State government should divert resources specially for girl-child education in the state
  4. It is recommended that all Health Centers and Health Personnel should encourage and educate the parents about the values and benefits of the vaccination and vaccine preventable diseases and its consequences to children’s health
  5. Kaduna state government, through the Ministry of Information should intensify sensitization of mothers/caregivers to improve their knowledge on Routine Immunization through Radio and Television jingles
  6. Local government authority should provide the parents with some health information by distributing printed materials such as brochures, pamphlets and leaflets in local languages.

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