Evaluation Of Immunization Coverage In Dokodza Primary Health Care Center In Bida Local Government Area Of Niger State
This study was carried out onthe evaluation of immunization coverage in Dokodza primary health care center in Bida local government area of Niger State.The study was specifically set todetermine the level of immunization coverage in Bida Local government Area, determine the factors affecting immunization coverage and effectiveness, determine major cause of missed opportunity in immunization, and ascertain factors challenging immunization coverage. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of healthcare workers in Dokodza primary health care center in Bida local government area of Niger State. In determining the sample size, the researcher conveniently selected 65 respondents and 50 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables and mean scores. While the hypotheses were tested using Chi-square statistical tool. The result of the findings reveals that there is a low level of immunization coverage in Bida Local government Area.Furthermore the result of the findings reveals that the factors affecting immunization coverage and effectiveness include; maternal knowledge, maternal outcome expectation, maternal attitude, maternal self-efficacy and environmental factors. Therefore, it is recommended that more rural health facilities are required in rural communities especially the very hard to reach areas, equipped with solar powered refrigerators to helppreserve vaccines which must be kept at a particular temperature. To mention but a few.
Table of Content
- Title Page
- Table of Content
- List of Tables
- 1.1 Background of the Study
- 1.2 Statement of the Problem
- 1.3 Objective of the Study
- 1.4 Research Questions
- 1.5 Research Hypothesis
- 1.6 Significance of the Study
- 1.7 Scope of the Study
- 1.8 Limitation of the Study
- 1.9 Definition of Terms
- 1.10 Organisations of the Study
Review of Literature
- 2.1 Conceptual Framework
- 2.2 Theoretical Framework
- 2.3 Empirical Review
- 3.1 Research Design
- 3.2 Population of the Study
- 3.3 Sample Size Determination
- 3.4 Sample Size Selection Technique and Procedure
- 3.5 Research Instrument and Administration
- 3.6 Method of Data Collection
- 3.7 Method of Data Analysis
- 3.8 Validity of the Study
- 3.9 Reliability of the Study
- 3.10 Ethical Consideration
Data Presentation and Analysis
- 4.1 Data Presentation
- 4.2 Analysis of Data
- 4.3 Answering Research Questions
- 4.4 Test of Hypotheses
- 4.5 Discussion of Findings
Summary, Conclusion and Recommendation
- 5.1 Summary
- 5.2 Conclusion
- 5.3 Recommendation
1.1 Background of the Study
Globally, over three million deaths are recorded annually from vaccine preventable diseases, while more than two million deaths are delayed through immunization processes2,3. The implication is that there are more childhood mortality resulting from vaccine preventable diseases than is being prevented by vaccine4 . The Expanded Programme on Immunization (EPI) which was established in 1974 through a World Health Assembly resolution (resolution WHA27.57) has the mandate to ensure that all children around the globe are immunized with life-saving vaccines following the success of the global smallpox eradication programme5 . The first diseases targeted by the EPI were diphtheria, whooping cough, tetanus, measles, poliomyelitis and tuberculosis.
Immunization is the process whereby a person is offered protection from or is made resistant to an infectious disease, typically by the administration of a vaccine. Vaccines act by stimulating the body’s immune system to protect the person against subsequent infections or diseases. Immunization is regarded as one of the most successful and cost‑effective public health interventions which averts about 3 million deaths annually and has the potential, if coverage improves, of saving the lives of an additional 1.5 million children annually (Araoye 2014).
As part of the child survival programs, the Expanded Program on Immunization (EPI) was created in 1974 by the WHO with UNICEF and Rotary International as partners. The EPI was created with the purpose of expanding immunization services beyond smallpox to the following six preventable diseases: diphtheria, measles, pertussis, poliomyelitis, tetanus, and tuberculosis. Immunization can be routine or supplemental (taking the form of immunization campaigns). Routine immunization refers to the nationally scheduled regular administration of vaccine dosages to infants at specified ages. Children are usually taken to the health facility by their parents or caregivers to receive age‑appropriate doses of antigens. In most developing countries, immunization is carried out on specific days of the week to reduce vaccine wastage since the vaccines are supplied in multi‑dose vials to reduce cost. The main aim of routine immunization is to deliver a complete scheduled number of doses of potent vaccines in a timely, safe and effective way to all children and women, ultimately inducing immunity against the targeted diseases (Awosika 2015).
Vaccine‑preventable diseases contribute significantly to under‑five mortality. Maternal and neonatal tetanus, measles, and rubella can be prevented by vaccines, but they continue to afflict children around the world. Measles, a virus that attacks the respiratory tract, is one of the most contagious diseases known. In 2013, as high as about 84% of children around the world were reported as immunized against measles. However, 367 children worldwide die from measles daily despite the availability of a safe, effective, and affordable vaccine.
Nigeria like many other countries in Africa is making efforts to strengthen its health system so as to achieve adequate routine immunization to reduce the burden of VPDs. Factors, such as lack of political will, lack of motivation, poor level of education and awareness and poor infrastructure, have been contributed to the low level of immunization coverage in Nigeria. Other factors associated with poor immunization coverage in resource‑limited countries, as depicted in a multi‑level analysis involving 24 African countries, including high community illiteracy rates, high country fertility rates and living in urban areas. At the individual level, however, the low level of immunization can be linked to the poorest households, uneducated parents, parents with no access to the media and/or with low health‑seeking behaviors. In Nigeria, immunization coverage is still low. Nigeria recorded an abysmal national routine immunization coverage of 12% in 2003 and 36% in 2006 (Awosika 2015). In 2009, Nigeria accounted for about 3.5 million (14%) of the 23.2 million children worldwide who did not receive three doses of diphtheria, tetanus toxoids and pertussis (DPT) vaccine during their 1st year of life. Despite the improvement in global immunization coverage, about 16% of the worlds’ children had not completed the 3‑dose DTP‑3) series by 2013. The estimated 2013 global DTP‑3 coverage among children aged <12 months, which is a key indicator of immunization program performance was 75% in the World Health Organization (WHO) African Region and 84% worldwide. In 2013, approximately 6.2 million children under the age of five died worldwide, and 3 million of these deaths occurred in Sub‑Saharan Africa. In 2009, WHO estimated that if global vaccine coverage increased to 90% by 2015, then approximately two million deaths of children under the age of five would be prevented. However, due to the EPI, childhood immunization coverage in the WHO African Region is improving, even if still sub‑optimal in many areas.
1.2 Statement of the Problem
Immunization of children against childhood preventable diseases has remained one of the most important cost effective and public health strategies to reduce childhood preventable morbidity and mortalities arising from infectious diseases. In Nigeria, the initial immunization schedule of the Expanded Programme on Immunization prescribed five visits to receive one dose of Bacille Calmette Guerin (BCG), four doses of oral polio vaccine, three doses of diphtheria, pertussis and tetanus vaccine, and one dose of measles vaccine. According to Sanou et al. (2009), WHO projected that complete vaccination should reach at least 90% of children at the country level and 80% in sub-areas by the year 2010. One of the most current national surveys conducted in Nigeria in 2013 to assess the immunization coverage for children born within five years before the survey actually reported that the full immunization coverage for Nigerian children is 25% (National Population Commission and ICF Macro, 2013). This is quite low compared to the WHO expectation for 2010, despite the huge resources being committed. It therefore, provoked ones thought and thus raises concerns to conduct evaluation of immunization coverage in Dokodza primary health care center in Bida Local Government Area of Niger State.
1.3 Objectives of the Study
The main aim of the study is to conduct evaluation of immunization coverage in Dokodza primary health care center in Bida Local Government Area of Niger State. Other aims of this study are:
- Determine the level of immunization coverage in Bida Local government Area.
- Determine the factors affecting immunization coverage and effectiveness Bida Local government Area.
- To determine major cause of missed opportunity in immunization Bida Local government Area.
- To ascertain factors challenging immunization coverage Bida Local government Area.
1.4 Research Questions
The following research questions will be answered in this study:
- What is the level of level of immunization coverage in Bida Local government Area?
- What are the factors affecting immunization coverage and effectiveness in Bida Local government Area.?
- What are major cause of missed opportunity in immunization in Bida Local government Area.?
- What are the variable hindering immunization coverage in Bida Local government Area.
1.5 Research Hypotheses
The following null hypotheses will validate this study:
- Ho: The level of immunization coverage in Bida Local government Area is Low.
- Hi: The level of immunization coverage in Bida Local government Area is high.
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
The broad objective of this study borders on evaluation of immunization coverage in Dokodza primary health care center in Bida Local Government Area of Niger State. The study further provoked ones thought and raises concerns to identify the factors that may be responsible for missed opportunity in immunization in Bida Local government Area and variable hindering immunization coverage in Bida Local government Area.
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. In this study we did not take into consideration the validity of vaccines as at when they were taken • Our data were collected on the premises of routine immunization, as such the study did not consider the immunization given during Supplementary Immunization Activities (SIA) • The study design is cross-sectional, so causal effect could not be established.
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.
1.9 Definition of Terms
Awareness or familiarity gained by experience of a fact or situation.
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.
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.
Vaccination 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.
1.10 Organization of the Study
The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.
Summary, Conclusions and Recommendations:
This chapter summarizes the findings on the evaluation of immunization coverage in Dokodza primary health care center in Bida local government area of Niger State. The chapter consists of summary of the study, conclusions, and recommendations.
5.2 Summary of the Study
In this study, our focus was onthe evaluation of immunization coverage in Dokodza primary health care center in Bida local government area of Niger State. The study was specifically carried out to determine the level of immunization coverage in Bida Local government Area, determine the factors affecting immunization coverage and effectiveness, determine major cause of missed opportunity in immunization, and ascertain factors challenging immunization coverage.
The study adopted the survey research design and randomly enrolled participants in the study. A total of 50 responses were validated from the enrolled participants where all respondent are healthcare workers in Dokodza primary health care center in Bida local government area of Niger State.
In the light of the analysis carried out, the following conclusions were drawn.
- There is a low level of immunization coverage in Bida Local government Area.
- The factors affecting immunization coverage and effectiveness include; maternal knowledge, maternal outcome expectation, maternal attitude, maternal self-efficacy and environmental factors.
- The major cause of missed opportunity in immunization comprised of failure to simply check status and immunize all eligible children that come to the facility for one reason or the other, poor knowledge of contraindications of vaccination, waiting time, educational status, and distance to clinic.
- The factors challenging immunization coverage in Bida Local government Area are lack of political will and commitment, Paucity of funds, poor community participation and vaccine stock-outs.
With respect to the findings and the aim of this study, the researchers therefore recommend that;
- Maternal literacy level is built up through adult education outreaches, especially in the rural areas.
- More rural health facilities are required in rural communities especially the very hard to reach areas, equipped with solar powered refrigerators to helppreserve vaccines which must be kept at a particular temperature.
- Making more vaccines available at immunization centres especially for the routine immunization programmes.
- Increase in advocacies by health workers on the purpose and need for immunizing children against preventable deadly diseases.
- These advocacies could be propagated through the mass media, village meetings and religious centres.
- Rural health workers posted to rural health centres should be encouraged to live within the jurisdiction of their posting area.
- The use of SMS to remind mothers/care givers of immunization schedules especially those who delivered in the health facilities should be exploited.
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