Determinants Of Childhood Immunization In Idoha Community

Project and Seminar Material for Public Health

Determinants Of Childhood Immunization In Idoha Community


Abstract


This study is a cross sectional study aimed at evaluating practice and determinants of child hood immunization in Idoha. This study is focused on identifying why children don’t receive immunization, and factor that encourage or deter immunization practice in the community. A total of 400 respondents were systematically selected from five villages in the community. Analysis showed that372 (98.2%) of babies had BCG. 354 (93.2%) had OPV and 348 (91.6%) had HBVO. Majority of mothers knows that immunization is for protection against child hood illness. Most families in this village live below one dollar per month income. This however didn’t affect immunization status as most mothers with good knowledge and positive perception have their children complete their immunization. There is no known religious or cultural factors that deter immunization rather they encourage immunization practice.


Chapter One


Introduction

1.1 Background of the Study

Immunization remains one of the most important public health interventions and a cost effective strategy to reduce both the morbidity and mortality associated with infectious diseases. An estimated three million deaths are prevented through immunization each year worldwide.1 . In spite of this measures, vaccine preventable diseases remain the most common cause of childhood mortality in an estimated three million deaths each year.

Uptake of vaccination services is dependent not only on provision of these services but also on other factors including knowledge and attitude of mothers,3,4 density of health workers,5 accessibility to vaccination clinics and availability of safe needles and syringes.

Assessing immunization practice and coverage help to evaluate progress in achieving programme objectives and in improving service delivery.7 Such positive evidence is required for continuing support from donor-supported initiatives like global alliance for vaccine and immunization GAVI.7

National programme on immunization aims at delivering the primary immunization series to at least 90% of infants.8 However, inadequate levels of immunization against childhood diseases remain a significant public health problem and reasons for non-uptake of immunization services are poorly understood. Immunization coverage is non uniform throughout the country with rural area presenting significantly lower coverage9 and thus contributing to the circulation of wild measles and other immunization preventable disease10. The effectiveness of immunization programme in resource-poor setting can be influenced by factors such as coverage of health workers, the existence and quality of outreach services, the quality of the cold chain, the liaison of communities with health services, the existence of population movements and several other factors that are related to the vaccines in use, to health services or to communities. The relative effect of each

factor may vary according to geographical area.8,11-13 In the immunization programme exercise, the understanding of the local customs, believe and tradition is crucial to develop and implement appropriate solutions.

The growing slum population in the developing world is an increasing challenge. Reports show that 60% of individual who reside in most cities in the developing countries live in the urban slum.10 Most slum lack good access roads and are denied adequate health care due to unavailability of proper health care services.

New estimates in “Levels and trends in child mortality report 2015 UNICEF DATA,” that although the global progress has been substantial, 16 000 children under 5 still die every day. It equally shows that under-five deaths have dropped from 12.7 million per year in 1990 to 5.9 million in 2015. This is the first year the figure has gone below the 6 million mark.16

Vaccine preventable disease have caused more than 20 percent of death for children under the age of five years. From international comparative data Nigeria’s immunization coverage rates are among the worst in the world .17

A report revealed that in 2013, only 76% of Nigeria < 24 months receive all recommended vaccines while 24% of children in Nigeria were not vaccinated at all. This lead to a lot of children in Nigeria at risk of dying from vaccine preventable diseases.18

In 2009 Nigeria was listed among countries with the highest incidence of poliovirus cases in the world.


1.2 Statement of Problem

One of the important ways to reduce child morbidity and mortality from common vaccine presentable diseases is through immunization. Despite the immunization programme, vaccine preventable disease remain the most common cause of childhood mortality with estimated three million deaths each year..2

According to the centre for disease control and prevention, immunity to disease is achieved through the presence of antibodies to that disease in a person’s system. This in fact is the main justification for using vaccines to boost immunity and a primary focus of vaccine research and development.2


1.3 Justification

Child mortality rates plunge by more than half since 1990 but global MDG target was missed by wide margin asthe 53% drop in under-five mortality is not enough to meet the Millennium Development Goal of a two-thirds reduction between 1990 and 2015.16

Evaluating the determinants of immunization coverage provides evidence whether substantial progress towards achieving vaccination targets is being made. Such positive evidence is required for continuous support from donor-support initiative like global alliance for vaccine and immunization (GAVI).7

The routine immunization coverage against vaccine preventable disease are below targets of national level. It is important to identify the factors influencing full childhood immunization among children less than 5 years in Nigeria in order to reduce child mortality and morbidity.19Equally findings from this study will help policy makers in the planning and policy making on immunization and averting the menace of vaccine preventable disease in the state. Several reports have also shown that immunization rates in urban slums rural areas and inner cities are lower than urban cities.14, 15 The serious implication of low and unstable immunization coverage in Africa necessitate a closer look at immunization programmes among rural dwellers in our environment since their peculiar problems might contribute strongly to this low coverage.14 More so immunization as an important component of child care, yet children around the world are commonly not fully immunized. The goal of this research was to assess current immunization practices, perceived factors influencing immunization practice and identify strategies that might improve immunization rates.


1.4 Objectives of the Study

1.4.1 General Objective

To ascertain the determinants of childhood immunization in Idoha

1.4.2 Specific Objective
  1. To find out immunization status of children 0-5years in Idoha
  2. To determine mothers reasons for uptake and non uptake of immunization in Idoha
  3. To identify factors influencing uptake of immunization in Idoha
  4. To ascertain mothers knowledge of immunization in Idoha and its effect on immunization status
  5. To deduce the perception of mother on immunization in Idoha and its effect on status.
  6. To describe mothers suggestions on how to improve uptake of immunization in the community

Chapter Five


5.0 Discussion

5.1 Discussion, Conclusion and Recommendation

Despite the fact that childhood vaccinations are available free of cost and with growing awareness, the childhood immunization rate in Nigeria is not yet satisfactory. Children’s immunization status against several childhood diseases gives an indication on how much priority the children’s health is given in a country as Immunization programme is the essential interventions for protection of children from life threatening diseases.

Findings from this study identified that over 75% of participants had their babies immunized with all the vaccines. This though encouraging but higher percentage is needed owing to the importance of immunization to lives of these babies. This is in contrast to results from determinants of full child immunization among 12-23 months old in Nigeria using NDHS 2008 which showed that only about 22% of the children received full immunization.49Also 2006 national immunization coverage survey reported only 18% of children fully immunized aged 12-23 months at survey time.56

Other studies found that routine immunization coverage in Nigeria is one of the lowest national coverage rates in the world with 38% for 2005 and 50% 2006.57 Equally UNICEF documented that 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. This is even worse in poorer remote areas of developing countries, where only one in twenty children have access to vaccination.58A similar study in China showed that general immunization coverage for DPT, OPV and HepB among migrants were 57.6%, 64.0% and 52.2%, respectively.49

Almost all the respondents in the study admitted that immunization should start in first week of life. Some of the stated benefits of immunization include; preventing illness and death, reducing chances of dying early and to make child grow healthy and strong. The main reason for receiving each immunization dose was for prevention of illness/protection of child.This is an indication that even though the study was in rural area, they still have a good knowledge about immunization. This is encouraging and commendable. Also it may be responsible for the high uptake of immunization. A study on parents′ knowledge and attitudes on Childhood Immunization, Taif, Saudi Arabia had a similar finding. The majority of parents 672 (91.9%) knew the role of routine vaccination in protecting children from some infectious diseases and its complications. A considerable number of 635 (86.9%) parents knew the timing of the first dose in vaccination schedule.59Another study in Lagos, South west Nigeria found that almost all (93.8%) the respondents were aware of immunization and that immunization could prevent childhood illness (98.1%).

The population of Nigeria is largely rural, and the geographical distance of most rural areas tends to influence the availability and effectiveness of immunization campaigns across the country.42 Also accessibility to vaccination facilities, provision of childhood immunization services, and demand-related factors, such as the knowledge and attitude of mothers influence immunization uptake especially in rural areas.46 Equally, parents may not be willing to walk long distances due to regular absence of health workers or unavailability of vaccine at the health facility.52 These are in line with some of the main reason given by respondents in this study for the missed immunization doses including unavailability of drugs and bad road/transport issues.

Factors determining childhood vaccination uptake is complex. It is dependent on socioeconomic, demographic as well as supply and demand factors.61 Supply-related factors though important however, adequate supply of vaccines does not essentially translate into children immunization uptake. A study suggests that factors associated with vaccination uptake and acceptance is multi-dimensional emphasizing the need to eliminate the unnecessary inequities associated with norms and structural factors that may hinder increased vaccination uptake.

This study identified social reasons that hinder immunization to include: non availability of drugs, burial engagements, masquerades that disturb free movement of people, business/farming engagements and ignorance .No known religious and cultural beliefs that deter immunization. On the other hand the identified socio-cultural and religious reasons that encourage immunization includes; availability of drugs followed by prior community mobilization.

A study on determinants of Childhood Immunization in India had a similar finding of mass media promoting immunization uptake. According to the study media exposure (Radio and TV) has a significantly positive effect on immunization as chance of full immunization is higher when mothers’ have regular media exposure compared to children whose mothers are not.50,63 Finding from other studies indicate that mothers who attend ANC and give birth at health facility are more likely to fully vaccinate their children as antenatal clinic is a means for women to be aware of immunization programme.49-51,64,65A study done in Niger Delta area of Nigeria also revealed that there was an association between the place of delivery and immunization status of a child.66 In a study conducted in Nigeria most of the mothers interviewed (65.7%) got their awareness of immunization at the antenatal clinics.57This collaborates our finding that Ignorance hinders immunization uptake.66Misconception on immunization in Northern Nigeria led to decrease in immunization uptake in 2003 in the area. They tagged immunization a plan by outsiders (enemies of Islam) to reduce the Muslim population through fortification of vaccine. Also they thought it is another strategy to transmit HIV virus, which would reduce the population of Muslims.

The current study showed that there was statistically significant association between mothers age and uptake of immunization but not statistically significant for age of child, marital status, family income. This is supported by some studies but contrast to findings from a host of other studies: mothers education,49-51,67region of residence,50,67 number children aged less than 5 years,50 religion,52,68 residence,52 mother’s occupation,49,52mother’s age,52,67, household wealth,49,67,69 Distance to facility.51,60,67,70 Other studies have found no difference in vaccination rates with respect to socio-economic status.71 Sex of baby.56,70Sex of the child predict the immunization status of the child in societies where gender inequality is prevalent. For instance in Bangladesh, females are 0.84 times less likely to be fully vaccinated than male children.48But in a study done in Nigeria in 2009, there was no significant relationship between sex and full immunization status.

Other identified factors includes; Skepticism on medical information, inadequate support from healthcare providers, poor health structures, poor transportation means and poor accessibility to immunization facilities.72

Moreover, some people lack access to vaccination as a result of social barriers, lack of information or inspiration to get vaccinated

The study identified maternal education as a predictor of immunization uptake as that had completed secondary education were about 2.8 times and tertiary education 2.8 times likely to uptake complete immunization than those that completed primary education and below. Mother aged 30 and above years were about 1.6 times likely to uptake complete immunization than those aged < 30 years. The influence of age on mother to child immunization could be because older mothers knows the effect and importance of immunization than young mothers.

A study using data from NDHS 2008 had it that children of mothers aged 45 and above about 1.8are more likely to be fully immunized compared to children born to mothers aged 15-24. The same study documented that mother’s level of education had a significant positive influence on the odds of the child being fully immunized.. Children born to parents with primary level of education are about 1.4 times more likely to receive full immunization than children born to mothers with no education, while children born to mothers with secondary and higher are about 1.8 times more likely to receive full immunization than children of mothers with no education. Immunization uptake increases as the mother’s education increases. This is expected as this empowers the mothers both in knowledge and economically. It will help influence their decisions about health of their children ignoring the cultural and religious deterrents. Equally barriers like transportation fare can be taken care of
by such mothers.

Some of the suggested ways mothers in this community be helped and encouraged to present their children for immunization and on time includes regular availability of drugs, health education/enlightenment, manpower improvements and Incentives/rewards. These are not quite strange as they are some of the factors identified from this study and other previous studies as militating against uptake of immunization. These suggestions if well addressed will improve immunization uptake and ultimately promote lives of our children


5.2 Conclusion

There was over two third complete immunization uptake and almost all the respondents admitted that immunization should start in first week of life. Some benefits of immunization include; preventing illness, death and to make child grow healthy and strong. The main reason for receiving each immunization dose was for prevention of illness/protection of child while for the missed immunization doses including unavailability of drugs, bad road/transport issues, mother or baby being sick , ignorance. Educational level of mother was a predictor of complete immunization uptake. Some of the suggested ways mothers in this community be helped and encouraged to present their children for immunization and on time includes regular availability of drugs, health education/enlightenment, availability of dedicated and well trained staff(man power improvements) and Incentives/rewards. These suggestions if well addressed will improve immunization uptake and ultimately promote lives of our children


5.3 Recommendation

  1. There is need for educational empowerment of mothers since it has been identified as a predictor of complete immunization uptake. Equally it will address the problem of ignorance.
  2. Mass mobilization and mass media sensitization need to be enhanced to achieve the desired immunization uptake
  3. Drugs (Vaccines) should always be made available since it a major identified reason for missed doses of immunization.
  4. Social amenities like good roads and other good means of transport should be made readily available to address the issues arising from such.
  5. Religious issues and cultural issues like beliefs should be supported since they don’t deter immunization
  6. Incentives like Insecticide Treated Nets can be provided as incentive or gift for those that complete immunize their babies
  7. Dedicated and well trained staff should be employed and used in administering of Immunization/vaccination

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