Effects Of Socioeconomic And Geographical Factors In The Utilization Of Immunization Services In Three Selected Local Government Areas Of Anambra State, Nigeria

Effects Of Socioeconomic And Geographical Factors In The Utilization Of Immunization Services In Three Selected Local Government Areas Of Anambra State, Nigeria
Abstract
This study focuses on the effects of socioeconomic and geographical factors in the utilization of immunization services using three selected local government areas of Anambra state, Nigeria as case study. The study further determine mothers level of knowledge about the immunization of under five children and the factors influencing mothers participation in immunization practice of under five children. The research adopted the survey descriptive design and with the aid of convenience sampling method, the researcher conveniently selected one hundred and fifty (150) participant where all respondent are mothers attending antenatal clinic and women of child bearing age in Anambra state. Self- structure questionnaire was issued to the respondent of which one hundred and forty-six (146) responses were retrieved whereas one hundred and forty-one (141) was validated and utilized for the study. The study made use of of descriptive analysis where data from field survey was analyzed using simple percentage, mean and standard deviation presented in frequencies and tables. Findings of the study therefore conclude that mothers’ has moderately adequate knowledge about the immunization of under five children. However, the socioeconomic and geographical factors influencing mothers participation in immunization practice of under five children include; Mother’s level of education, knowledge about benefit of immunization, safe means of transportation, distance to clinic and Waiting time. type of occupation and income. Consequently, the effect of these factors include Non-compliance with the National child immunization schedule, increase in spread of communicable diseases & infection of lower and upper respiratory tract , high rate of polio infected children which leads to disability, increase in child mortality, untimely uptake of vaccine and ineffective expanded programme on immunization. Therefore, it is recommended that ministry of health should be hold more immunization sessions for mothers which have less than five years children as well as social group meetings to exchange information at maternal and child health centers. And ministry of health should provide mothers with vaccination booklets explain the importance of vaccination, importance of vaccination card, routine doses and how to manage the side effects.
Chapter One
Introduction
1.1 Background of the study
In 1979 Nigeria’s Expanded Programme on Immunization (EPI) was initiated, and was placed within the Department of Public Health and Communicable Disease 1 Control of the Federal Ministry of Health (FMOH) . It was re-launched in 1984 due 2 to poor coverage. In 1996 it became the National Programme on immunization (NPI), launched by the then First Lady, Mrs Abacha. Following a review of EPI, Decree 12 of 1997 created NPI as a parastatal. NPI has a sole responsibility of supervising and 2 enhancing routine and supplemental immunizations in Nigeria. Routine immunization (RI) is provided largely through the public health system, with significant variations between the 36 States and Federal Capital Territory (FCT); 3 private or NGO providers are the source of up to one-third of RI in Anambra state. Public sector provision is by health staff based at facilities run by the 21 Local Government Areas (LGAs) who have a Primary Health Care Coordinator (PHCC), a Local immunization Officer and a Cold Chain Officer. These staff members are under the control of the Head of Local Govt Administration and are employees of the State Government (Ministry of Local Government and Local Government Service Commission). Routine immunizations are done at the fixed posts in the health centres, health posts, General hospitals and tertiary health facilities in the State. Supplemental immunizations in the State are aimed at boosting the immunization coverage and 22 mopping up missed opportunities. It also becomes imperative in epidemics. These supplemental immunizations are achieved through National immunization Days (NIDs), Local immunization Days (LIDs), immunization Plus Days (IPDs) and Child 2 Health Week.
1.2 Statement of the Research Problem
Since they were first introduced in 1956, immunization activities in Nigeria have been 1 characterised by intermittent successes and failures. The expanded programme on immunization (EPI) introduced in 1979 with the aim of providing immunization services to children aged 0 – 23 months, experienced some initial success. However, a few years after the programme started, it became obvious that it was no longer 2 achieving its stated objectives and had to be re-launched in 1984. As a result of concerted efforts of the Federal Ministry of Health, State agencies, and International Organizations, Nigeria attained universal childhood immunization (UCI) 2 with 81.5 percent coverage for all antigens in 1990. The success was not to last long and by 1996, immunization coverage had declined substantially to less than 30 percent for DPT3 and 21 percent for the three doses of oral poliovirus vaccine 2 (OPV). The situation has become even worse since then despite considerable donor and Federal Government efforts to improve the provision and promotion of immunization services. Today, coverage rates for the various childhood vaccines in Nigeria are among the 3 lowest in the world. Nigeria is now considered the greatest threat to the global eradication of polio and there is an urgent need to address the problems facing 3 immunization activities in the country and increase coverage. Research in other parts of the world has shown that social factors, economic factors, community and systemic factors affect immunization coverage. These factors are potentially modifiable. Anambra State, centrally located in the south eastern zone of the Federal Republic of Nigeria is not immune to the catalogue of problems facing immunization uptake in Nigeria. Since the mid-1990s, Anambra State has continued to witness fluctuations in immunization coverage for all vaccine-preventable diseases and this has had grave consequences on children’s health and survival. Data from the 2003 National Immunization Coverage Survey reveal a very gloomy picture with only 12.7 percent of children aged 12-23 months receiving full immunization service. Of great significance and concern is the emerging status of Nigeria as the country with the highest number of Wild Polioviruses (WPV) in the world. Increased widespread transmission of the WPV was reported in the highly endemic States of Kano, Katsina, Jigawa, Kaduna and Bauchi, while a fresh outbreak of WPV was confirmed in Kebbi. Of epidemiological importance to Anambra State is the recent incident of WPV outbreak in the neighbouring state of Enugu. Against this background, the goal of this study is to provide data that would assist programme staff and policy makers to design strategic interventions to improve immunization coverage in Anambra State in particular and Nigeria in general.
1.3 Rational for the Study
Routine immunization against DPT, measles, polio and TB is proven to be one of the most cost-effective interventions for reducing childhood illness and mortality, especially with the addition of other vaccines such as CSM and yellow fever in 1 endemic areas and TT injections for pregnant women and yet national coverage in Nigeria for full immunization is less than 13%, one of the lowest rates in the world, 4 even lower than many countries in conflict, such as DRC. Some states in northern Nigeria have coverage rates below 1%, and the average for the whole North West Zone is just 4%. These coverage figures are much worse than in the neighbouring countries of Benin, Niger, Chad and Cameroon. Both the Nigeria Demographic and Health Survey (NDHS 2003), conducted by the National Population Commission, and the Nigeria Immunization Coverage Survey (NICS 2003), conducted by the National 8 Programme on Immunization (NPI), provide the same irrefutable evidence. Nigeria’s performance on routine immunization has continued to decline since the high point achieved around 1990.
Vaccine-preventable deaths in Nigeria, one child in five dies before its fifth birthday. This represented about 872,000 childhood deaths in 2002. Vaccine-preventable diseases (VPDs) account for 4 about 22% of deaths, therefore over 200,000 children a year are dying needlessly of VPDs. Various well meaning researchers have conducted credible studies with a view to unraveling the root cause of this decline in immunization uptake. This research study in three selected Local Government Areas in Anambra State is at discovering the possible local causes of this decline in immunization uptake in Anambra State. The result of this research is meant to inform the health policy makers of the state on areas of hence enhance rational resource allocation. The public will benefit from this research as the result when published will show statistically the state of immunization activities in these selected LGAs.
1.4 Objectives of the Study
The main aim of the study is to examine the effects of socioeconomic and geographical factors in the utilization of immunization services in three selected local government areas of Anambra state, Nigeria. Other aims of this study are:
- Determine mothers level of knowledge about the immunization of under five children.
- Determine the socioeconomic and geographical factors influencing mothers participation in immunization practice of under five children.
- To determine the effects of socioeconomic and geographical factors in the utilization of immunization services
1.5 Research Questions
The following research questions will be answered in this study:
- What is the level of mothers’ knowledge about the immunization of under five children?
- What the socioeconomic and geographical factors influencing mothers participation in immunization practice of under five children?
- What are the effects of socioeconomic and geographical factors in the utilization of immunization services?
1.6 Significance of the Study
This study will be significant to the society as the findings of this study will show the importance of immunization to children is, its effects and the perception of mothers towards immunization and as such will know the shortcomings and determine if more actions should be taken.
Additionally, healthcare providers will use it as a literature review. This means that healthcare providers who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review.
Invariably, the result of the study contributes immensely to the body of academic knowledge with regards to mothers’ knowledge and attitude towards immunization.
1.7 Scope of the Study
This study focuses on the effects of socioeconomic and geographical factors in the utilization of immunization services. This study will be carried out in three selected local government areas of Anambra state, Nigeria.
1.8 Limitations of the Study
In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.
Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.
1.1 Definition of Terms
Mothers:
A mother is the female parent of a child. Mothers are women who inhabit or perform the role of bearing some relation to their children, who may or may not be their biological offspring.
Vaccine:
A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins.
Immunization:
This is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism.
Chapter Five
Summary, Conclusions and Recommendations:
5.2 Summary of the Study
This study focuses on the effects of socioeconomic and geographical factors in the utilization of immunization services using three selected local government areas of Anambra state, Nigeria as case study. The study further determine mothers level of knowledge about the immunization of under five children and the factors influencing mothers participation in immunization practice of under five children.
The research adopted the survey descriptive design and with the aid of convenience sampling method, the researcher conveniently selected one hundred and fifty (150) participant where all respondent are mothers attending antenatal clinic and women of child bearing age in Anambra state. Self- structure questionnaire was issued to the respondent of which one hundred and forty-six (146) responses were retrieved whereas one hundred and forty-one (141) was validated and utilized for the study. The study made use of of descriptive analysis where data from field survey was analyzed using simple percentage, mean and standard deviation presented in frequencies and tables.
5.3 Conclusions
The increasing effects of communicable diseases among young children of under five years of age has led to the aggressive process of prevention all over the world. Apart from personal hygiene and environmental sanitation that have been copiously employed to reduce the incidence and prevalence of many communicable diseases, immunization programme is the most common and active strategy to prevent many communicable diseases with the use of vaccines to build immunity among young children because of their vulnerability. Immunization has been said to be a proven tool for controlling and eradicating communicable diseases all over the word. It has been reported that a number of serious childhood diseases have thereby been successfully eradicated. However Many children living in rural communities in Nigeria are not reached by routine immunization services because of several limiting factors of which is one due to geographical and other sociocultural factors such as transportation problem and level of awareness among others.
Findings of the study therefore conclude that
- Mothers’ has moderately adequate knowledge about the immunization of under five children.
- The socioeconomic and geographical factors influencing mothers participation in immunization practice of under five children include; Mother’s level of education, knowledge about benefit of immunization, safe means of transportation, distance to clinic and Waiting time. type of occupation and income.
- The effect of these factors include Non-compliance with the National child immunization schedule, increase in spread of communicable diseases & infection of lower and upper respiratory tract , high rate of polio infected children which leads to disability, increase in child mortality, untimely uptake of vaccine and ineffective expanded programme on immunization
5.4 Recommendation
The following recommendations were proffered with respect to the findings of the study;
- Ministry of Health should be hold more immunization sessions for mothers which have less than five years children as well as social group meetings to exchange information at maternal and child health centers.
- Ministry of Health should provide mothers with vaccination booklets explain the importance of vaccination, importance of vaccination card, routine doses and how to manage the side effects.
- Mothers knowledge, attitude, and practice of immunization and vaccine-preventable diseases needs to be improved constantly by providing health education and health promotion interventions.
- Target should be the entire population, and educational programmes promoting immunization and parental motivation, accessibility, and follow-up should be instituted.
- Increase and improvise the awareness classes for mothers and religious leaders on immunization.


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