A Study Of The Activities Of National Programme On Immunization And Child Mortality

A Study Of The Activities Of National Programme On Immunization And Child Mortality

Abstract

The Cumulative Sum (CUSUM) Control Chart was widely used in manufacturing industries to monitor process performance, set up standard for the operational parameters, maintaining standard and monitor for improvement. In this study, CUSUM Scheme is designed and implemented to evaluate the performance of programmes on immunization considering vaccination activities and deaths recorded as a result of outbreak of some selected diseases.

Also, retrospective analysis was used to determined the occurrence of local maxima or minimum value as observed from the CUSUM chart; regression analysis and analysis of covariance were carried out to determine the expected death rate as a result of outbreak of some selected diseases; and the use of analysis of Covariance to determine the mean difference between the ratio of death to vaccination and their incidence rate in three senatorial districts of kogi state.

The data used was collected from Kogi State Ministry of Health, Lokoja. In this research work, It was observed that CUSUM Chart technique is more sensitive at detecting small shift in vaccination and death level in Kogi State. The retrospective study shows that the immunization programme has a positive impact in kogi state, because there was quality improvement in the vaccine administration in the State, this helps to reduce child mortality rate to the minimum level. Also, the regression and analysis of covariance indicate that there was mean difference between the ratios of death to vaccination in all the senatorial districts of kogi state.

Chapter One

Introduction

1.1 Background to the Study

Over the years, Immunization hasbeena major effect on child‘s death and physical deformity reduction and is one of the most powerful and cost-effective of all health interventions. It prevents debilitating illness, disability and saves millions of lives every year. It is also a key to achieving the Millennium Development Goals (MDGs) designed and agreed by world leaders in 2000 to reduce poverty and improve human development. The contribution of immunization isespecially critical in achieving the goal to reduce deaths among children of underfive years old (MDG, 2014). Immunization have the power not only to save, but also to transformlives; giving children a chance to grow up healthy, go to school and improve their life prospects. When vaccines are combined withother health interventions such as vitamin A supplementation, provision of deworming medicine and bednets to prevent malaria, immunization becomes a major force for child survival.

However, despite the importance of Immunization inrecent years, millions of children are not immunized, exposing them to physical defects or premature death., (UNICEF, 2008).Many researches has been carried out in order to examine immunization coverage and acceptance,having discovererd Nigeria has high underfive (5) child mortality rate, with Northern Nigeria having lowimmunization coverage of 30.7% and highimmunization coverage of 45% in Southern Nigeria by National Demographic and Health Survey (NDHS 2003). In a study Abdulrahman, (2011)noted that pressing emphasis on Partial immunizationcoverage against children mortality which is a significant public health problem especially in rural areas of Nigeria, the reasons for partial immunization and factors responsiblefor missed opportunitiesare poorly understood and littledata is availableto explain the phenomenon that could help support thedecision making of mothers.

Abdulrahman et al are of the view that Parentsobjection, disagreement or concern about immunization safety, long distance walking,and long waiting time at the health facility, are the most common reasons for missed immunization. Oluwadere (2009) also noted, for the poor immunization coverage are the salient issues which include ignorance and social cost of access to the service, the quality of the immunization service, availability to the remote areas, health personnel commitment, and consistent availability.He futher stated that the extended Programme on immunization introduced in 1979 with the aim of providingroutine immunization to children less than the age of two, recorded initial but intermittent successes; The optimum level was recorded yearly 1990s with the country achieving universalchildhood immunization of 81.5 percent coverage,meanwhile since that period of success,Nigeria has witnessed gradual but consistentreduction in immunization coverage.

By 1996, theNational Coverage Data showed less than 30% coverage for the entire vaccines (NDHS 1999) from 1999 this has reduced to 16.8% for all immunizations and by 2003, it was 12.9% (Babalola and Olabisi2004). This figure is consistent with the 2003National immunization Coverage Survey figure,it is the lowest in the world and explains the poor health status of children in the country and the worst in west Africa.In another claim by The MICS (2007) for Nigeria it shows that there are real disparities in coverage of all types or levels of vaccination along rural-urban and North-South partitions of the country and along levels of education and wealth status. The coverage is low in rural areas, in the North, among children with mothers with less education and among children in the poorest wealth.

Fears regarding routine immunization are expressed in many parts of Nigeria. Fathers of partially immunised children in Muslim rural communities in Lagos State see hidden motives linked with attempts by non-governmental organisations (NGOs) sponsored by unknown enemies in developed countries to reduce the local population and increase mortality rates among Nigerians. Belief in a secret immunization agenda is prevalent in Jigawa, Kano and Yobe States, where many believe activities are fuelled by Western countries determined to impose population control on local Muslim communities.Lack of confidence and trust in routine immunization as an effective health interventions appears to be relatively common in many parts of Nigeria. For many, immunization is seen to provide at best only partial immunity. The widespread misconception that immunization can prevent all child mortality reduces trust because when, as it must, immunization fails to give such protection, faith is lost in immunization as an intervention, for any and all diseases.

1.2 Statement of the Problem

Immunization is among the most efficient tool for promoting individual and public health and it is one of the most powerful and cost-effective of all health interventions. It eradicates diseases completely, control mortality, morbidity and complications. Immunization programmes are estimated to prevent almost 6million deaths annually worldwide and greatly reduce the burden of infectious diseases (Andre, 2015). Immunization is one of the most cost- effective health investmentswith proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities and does not require any major lifestylechange(WHO/Sergei Deshevoi 2013).Immunization it is also a way of protecting individualsagainst serious diseases. Once we have been immunised, our bodies are better able to fight these diseases if we come into contact with them.

However, the researcher as an auxilliary nurse observed that from 1999 to date, the rate at which under-five children in Lokoja Local Government, Kogi State are dying is at an increase. This is evident by the Department of Health of the said Local Government in the year 2015, whichdocumented that the rate of children‘s death in the village is worrisome. Similarly Kabir (2012) and Sani (2013) indicated that the children death ranging from 1-5yrs of age in villages around Zaria are increasing, Gwanda Village is one of such villages and many of the children in the village suffer physical deformities such as deafness and dumbness, loss of limbs, brain damage among others.

Researchers such as Sunday (2009), Anas (2011) and Ghali (2012), conducted researches about child death and physical deformities from the perspective of access to good food, portable drinking water, environmental hygine respectively. To the best of the researcher‘s knowledge none of the previous studies looked at the above problem from the perspective of compliance to Health Care Information, particularly immunization programme.
This study investigated the effect of immunization programme on child mortality with the aid ofChatman‘s Theory of Normative Behavior as a theoritical framework.

1.3 Research Question

1. What is the perception of children mortality by mothers of under-five childrenin Lokoja Local Government, Kogi State?
2. How do mothers of children in Lokoja Local Government perceive immunization programme as a preventive and control meassure to children mortality?
3. What is the perception of mothers of under-five children on immunization programmein Kogi?

1.4 Objectives of the Study

1. To examine the perception of children mortality by mothers of under-five childrenin Lokoja Local Government.
2. To explore mothers of under-five children perception on immunization programme as a preventive meassure ofchildren mortality in Lokoja Local Government.
3. To identify how mothers of underfive children perceive immunization programme in Lokoja Local Government.

1.5 Significance of the Study

This study will help check mate the increase in children‘s deaths and physical defects rate due to perception of immunization programme based on socio-cultural practicesin Lokoja Local Government Kogi State, using Chatman‘s Theory of Normative Behavior to better understandthe Perception on immunization programme among mothers.

The study will serve as a body of knowledge that can also be used by stakeholders such as; Government officials, information professionals, policy makers, international organization such as world Health Organization and UNICEF to design immunization programmes, strategies and plan of actions, thereby increasing acceptance of immunization which will in turn promote children‘s health.

Similarly, the work will also serve as a reference material or literature to those that embark on a similar research work to prevent child death because they are the leaders of tomorrow.

1.6 Scope and Delimitation

This study specifically investigated the efficacy of Chatman‘s theory of Normative Behavior in accounting immunization programme behavior among illitrates mothers of under-five children and never allow them to be immunize in Lokoja Local Government, Kogi state.

1.7 Operational Defination of Terms

Immunization:

Is the process by which a child is made immune or resistance to any of the children mortality known to be deadly or cause physical defects to the child (infectious diseases).

Immunization Programme:

Refers to information that are produce to explain both the benefits, and risks how and where to get the services to the recipients, that is to the mothers.

Chapter Five

Findings, Conclusion and Recommendation

5.1 Summary of the Major Findings

Based on the data collected and analyzed for this study, the following were the major findings:

Participants perceive children mortality as diseases of smallchildren, diseases caused by Jinns and Witch Craft, and diseases with lifetime threat to children.

Participants don‘t believe immunization can cure children mortality, that it happens bydestiny, whilst also been suspicious and are affraid of the adverse effects of immunization.

Prticipants alsoperceive immunization programme as irrelevant together with community based health service and mass media as participants sources of immunization programme.

Participants are living within the chatman (2000) notions of small world context.

Small world is a social environments where individuals live and work, bound together by shared interests and expectations, information needs and behaviors.

5.2 Conclusion

Based on the findings, this study concluded that mothers of under-five in Lokoja, Local Government perceive children mortality as diseases of small children from experience and diseases with lifetime threats to children. Participants also believe children mortality are caused by Jinns and Witch Craft and has no cure medically, happens according to destiny. Hence, Allah is sufficent in all deaths and physical deformities He alone heals, nothing else not even the so called immunization, little better with traditinal medicines. participants are also suspicious about immunization programs entirely, the use of forcein administering vaccines by health workers, mass media(radio), village head and the whitemen are also believed to be spreading irrelevant informationThis according to them did not tally with what they already known about children mortality and their cure. From these findings, participants are living within the chatman (2000) notions of small world context. Small world is a social environment where individuals live and work, bound together by shared interests and expectations, information needs and behaviors.

They also suggest that the most important members of the small world are the insiders and attarched many possible values to community members. These socio- cultural practices and religious beliefs makes mothers ofunderfive childrento stereotype the entire programme asbogus.

5.3 Recommendations

The mothers of underfive children in Lokoja, Local Government, Kogi State should be enlightened more on children mortality and its dangers to child‘s well being, discouranging their traditional beliefs.

Health workers in Lokoja Local Government should be properly trained and beequiped with more persuation skills and strategies that will help influence attitudinalchange. And also introduce some palliatives in health care dilivery by the Local Government Authority.

There should be continous campaign by the Lokoja Local Government, through the public library and incorporation of more strategic Health commuincation approaches that can help shape mothers‘s perception positively in Lokojua and queries should also be address by qualified personels.

The gate keepers of the community should be involved in all aspects of the immunization program, eg. Iman, Village Head, influencial person among the community members, given the fact that, as a social type community they only accept information that comes from within.

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