Factors Affecting Completion Of Childhood Immunization Series Among Mothers In Ofagbe Community, Isoko North Local Government Area, Delta State

Project and Seminar Material for Nursing (Science)

Factors Affecting Completion Of Childhood Immunization Series Among Mothers In Ofagbe Community, Isoko North Local Government Area, Delta State


Abstract


This study was carried out to examine the factors affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State. The study was specifically set to determine the extent of childhood immunization coverage in Ofagbe Community, Isoko North Local Government Area, Delta State, ascertain the level of childhood immunization completion among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State, and investigate the affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprised of mothers in Ofagbe Community, Isoko North Local Government Area, Delta State. In determining the sample size, the researcher purposefully selected 147 respondents and 141 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. The hypotheses was tested using Chi-square Statistical tool. The result of the findings reveals that there is poor childhood immunization coverage in Ofagbe Community, Isoko North Local Government Area, Delta State. Likewise, the level of completed childhood immunization among mothers in Ofagbe Community is low. Furthermore, the study revealed factors such as income level, educational background, distance from the routine immunization service point, ability to take decisions independently, and religious affiliation affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State. Therefore, it is recommended that there is need for government to ensure health sector reforms based on community needs, through addressing factors that are known to influence mothers/care givers decision to vaccinate their children such as women education, cost of health care (immunization) services, wealth index and religious affiliations. To mention but few.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 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

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 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

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background of the Study

The World Health Organization (WHO, 2009) stated that immunization is one of the most important public health interventions and cost-effective strategies to reduce child mortality and morbidity associated with childhood infectious diseases. Immunization is also a good strategy to reach vulnerable populations (WHO, 2009).

Immunization is reported to prevent an estimated 2 to 3 million deaths each year worldwide (WHO, 2009). The year 2014 marked the 40th anniversary of the WHO’s Expanded Program on Immunization (EPI), which was established to ensure equitable access to routine immunization (RI) services (CDC, 2015). The WHO (2009) has stated that “vaccines have the power not only to save, but also to transform lives – giving children a chance to grow up healthy, go to school, and improve their life prospects” (WHO, 2009). Strong RI was among the strategies for the Global Polio Eradication Initiative, which further underscored the importance of childhood immunization in preventing infant and childhood morbidity, mortality, and disabilities (WHO, 2009).

Children and infants in Nigeria are more likely to die than children in any other region of Nigeria, based on neonatal, postneonatal, infant, childhood and under5 mortality rates (National Population Commission Nigeria [NPCN] & ICF Macro, 2013). Infant mortality is 43% higher in rural areas (86 deaths per 1,000 live births) than in urban areas (60 deaths per 1,000 live births), and the urban-rural difference is more prominent in the under-5 mortality category (NPCN & ICF Macro, 2013). Regional differences range from as low as 90 deaths per 1,000 live births in South West Nigeria to as high as 185 deaths per 1,000 live births in North West Nigeria. According to the NPCN and ICF Macro (2013), mortality rates are significantly higher among male children than female children for all categories of mortalities.

Nigeria and four other countries (India, Democratic Republic of Congo, Pakistan, and China), which make up about one third of the world’s population, accounted for half of the overall number of under-5 deaths worldwide in 2010 (WHO, 2015). In Nigeria, about 700,000 children died before their fifth birthday (Riedmann, 2010). Providing safe and effective vaccines reduces the high burden of communicable diseases in African countries and helps to meet the health-related millennium development goals (WHO, 2015). Vaccine-preventable diseases contribute significantly to morbidity and mortality; an estimated 4 million people die each year from diseases for which vaccines are available (WHO, 2015). Pneumonia and diarrhea disease account for approximately 34% of the global 10.4 million deaths among children less than 5 years of age (WHO, 2015). With effective immunization, many of these deaths could be prevented. Globally, invasive pneumococcal disease has recently been shown to cause the deaths of 826,000 children aged 1 to 59 months, while rotaviruses are the most common cause of severe diarrheal disease in young children (WHO, 2015). According to the WHO (2015), an estimated 527,000 children under 5 years, most of whom live in low-income countries, die each year from vaccine-preventable rotavirus infections.

Other vaccine-preventable diseases include meningococcal meningitis and septicemia caused by various serogroups of Neisseria meningitides, which cause epidemics with excessive morbidity and mortality among children and young adults even where adequate medical services are available in countries located in the African meningitis belt (WHO, 2015). In 2017, Nigeria reported a severe epidemic of meningococcal meningitis with a total 1407 suspected cases (epid. week 11) and a case fatality rate (CFR) of 15% from 40 LGAs in 5 states since December 2016 (WHO, 2017). This was similar to an outbreak experienced in 1996, with 109,580 recorded cases and 11,717 deaths, giving a case CFR of 10.7% overall (Mohammed et al., 2000). Yellow fever, a viral disease that caused major epidemics in Africa and the Americas in the past, is now a serious public health issue again, despite the availability of a vaccine for 60 years (WHO, 2008).

Despite the comprehensive WHO/United Nations Children’s Fund (UNICEF) measles mortality-reduction strategy and the measles initiative, a partnership of international organizations supporting measles mortality reduction in Africa, and despite the global measles mortality reduction, measles remains an important cause of death in children under 5 years in some sub-Saharan countries (Grais et al., 2007). The inability to give at least a dose of measles vaccine remains the principal reason for high measles mortality (Grais et al., 2007). Immunization appears to be a highly effective public health intervention that has the capacity to drastically reduce the disease burden, disability, and death from vaccine-preventable diseases as well as reduce economic waste especially in developing countries (WHO, 2009).

In light of the need to reduce the high morbidity and mortality rate among children, especially those under 5 years, from vaccine-preventable diseases, the present study addressed the factors affecting completion of childhood immunization in Nigeria.


1.2 Statement of the Problem

In Nigeria, the EPI was developed based on the WHO’s guidelines. A child is considered fully vaccinated if he or she has received bacille Calmette-Guerin (BCG) vaccination against tuberculosis; three doses of vaccine to prevent diphtheria, pertussis, and tetanus; at least three doses of polio vaccines; a dose of measles vaccine; and a yellow fever vaccine before the first birthday (NCPN & ICF Macro, 2014). The North West and south south region of Nigeria has the lowest vaccination coverage compared to the other five geopolitical regions of the country, as evidenced by 52% of children fully immunized in the South East and South West compared to south south and North West.
Several small-sample hospital-based studies have been conducted in Nigeria on coverage of routine antigens; however, there is a paucity of data from community-based studies with appropriate sampling technique and large sample size in the North West region (Gidado et al., 2014). There are also data gaps on the association between the parents’/caregivers’ cultural factors such as their ability to take decisions independently, religious affiliation, and tribe/ethnicity, and the completion or noncompletion of routine immunization schedules. The current study also addressed the association between the parents’/caregivers’ place of residence (rural/urban), distance from the immunization routine service point, the cost of transport, session plan, and cost of immunization services, and the completion or noncompletion of RI.


1.3 Objectives of the Study

The major objective of this study is to examine the factors affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State. While other specific objectives are:

  1. Determine the extent of childhood immunization coverage in Ofagbe Community, Isoko North Local Government Area, Delta State.
  2. Ascertain the level of childhood immunization completion among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State.
  3. Investigate the affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State.

1.4 Research Questions

The following research questions will be answered in this study:

  1. What is the extent of childhood immunization coverage in Ofagbe Community, Isoko North Local Government Area, Delta State?
  2. What is the level of completed childhood immunization among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State?
  3. What are the affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State?

1.5 Research Hypotheses

  • Ho: The level of childhood immunization series completion among mothers in Ofagbe Community is low
  • Ha: The level of childhood immunization series completion among mothers in Ofagbe Community 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 the factors affecting the immunization completion.

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 the factors affecting completion of childhood immunization series.


1.7 Scope of the Study

The broad objective of this study borders on evaluation of the factors affecting completion of childhood immunization series among mothers. Geographically, this study will be carried out in Ofagbe Community, Isoko North Local Government Area, Delta State.


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

Knowledge:

Awareness or familiarity gained by experience of a fact or situation.

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.

Vaccination:

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.


Chapter Five


Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the factors affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was to examine the factors affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State. The study was specifically set to determine the extent of childhood immunization coverage in Ofagbe Community, Isoko North Local Government Area, Delta State, ascertain the level of childhood immunization completion among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State, and investigate the affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 141 responses were validated from the enrolled participants where all respondent are mothers in Ofagbe Community, Isoko North Local Government Area, Delta State.


5.3 Conclusions

In the light of the analysis carried out, the following conclusions were drawn.

  1. There is poor childhood immunization coverage in Ofagbe Community, Isoko North Local Government Area, Delta State. Likewise, the level of completed childhood immunization among mothers in Ofagbe Community is low.
  2. Factors such as income level, educational background, distance from the routine immunization service point, ability to take decisions independently, and religious affiliation affecting completion of childhood immunization series among mothers in Ofagbe Community, Isoko North Local Government Area, Delta State.

5.4 Recommendations

In view of the above findings the following recommendations are hereby made;

  1. There is need for government to ensure health sector reforms based on community needs, through addressing factors that are known to influence mothers/care givers decision to vaccinate their children such as women education, cost of health care (immunization) services, wealth index and religious affiliations.
  2. There is need to target parents / care givers that were identified to be less likely to complete their children’s immunization schedules (priming mothers, grand multiparas, very young mothers and mother older than 35yaers of age) with health education package appropriate to their cultural background to help increase their vaccination uptake.
  3. There is need for programs like the Intensification of Routine Immunization Services piloted by the NPHCDA in Nigeria in collaboration with World Health Organization (WHO) and United Nations Children’s Funds (UNICEF) in some very high risk states / LGAs (Based on PEI Program) in Nigeria. This will go a long way in improving immunization uptake.

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