AWARENESS AND ACCEPTANCE OF IMMUNIZATION PROGRAMS BY MOTHERS OF CHILDREN WITHIN THE AGES OF 0 TO 5 YEARS

1.1 Introduction

Immunization is one of the public health programmers that prevent disease in society. Vaccination is the most common technique used in immunization. It entails the administration of a vaccine into the human body in order to stimulate an individual’s immune system against bacteria, viruses, parasites and fungi. Vaccines are defined as biological preparation intended to produce immunity against a disease by exciting the production of antibodies. Vaccines are safe and effective; however, adverse reactions may develop following a vaccine and the process of immunization itself. Immunization today saves more than three million lives a year. However, millions of children still do not have access to basic immunization and die from diseases that can be prevented by available vaccines (WHO, 2013).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

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1.2 Background of Study

In 20th century, in developing world, it does not only prevent about three million children deaths annually, but also has the potential to prevent additional two million deaths if coverage improves. Immunization coverage has remained low in Nigeria, although the government provides vaccines freely. The programme immunization is described as the process by which disease carrying organisms that is part not infected with disease is purposely introduced into human body system for it to produce anti-bodies and protect itself from the real version of the disease (Onuzulike, 2008).

The World Health Organization (WHO) states that many children die all over the world especially in developing nations due to measles, hepatitis B, Hemophilia influenza, whooping cough, tetanus, diphtheria and polio. Children have a low level of immunity due to an undeveloped immune system. Therefore, children are more prone to microbial infection. Children need to be immunized at a certain age, in order to ensure that they have a good ability to fight against infection (Omer Qutaiba Bader Aldeen Allela, October, 2017).

It is obvious that immunization is one of the most cost-effective public health interventions for reducing global child morbidity, mortality and life time disabilities (Lee, 2003) (Chen et al, 2004). Worldwide, immunization prevents more than 2.5 million child deaths each year (WHO/UNICEF and World Bank, 2009, WHO 2009). Global public health has greatly improved through the widespread use of vaccines, preventing millions of childhood hospitalizations and deaths each year rating immunization as a number one public health intervention (CDC, 2010 CDC 2009). Before the advent of immunization programs, infectious diseases such as measles, diphtheria, smallpox and pertussis were leading causes of child mortality (Stern et al., 2005). Tetanus toxoid vaccine is given to pregnant women to prevent against neonatal tetanus, which can be a major cause of infant deaths (KDHS 2014).

In the United States there has been a remarkable achievement in the control of vaccine preventable diseases resulting in decline in morbidity and mortality associated with vaccine preventable diseases (CDC 2010). In Africa, there has been tremendous improvement in the overall immunization coverage, though at a relatively slower rate (WHO 2004, WHO 2014). However, some African countries like Ghana, Morocco and Gambia have registered success in reaching coverage of over 90% (Ghana News Agency 2012, WHO 2014, UNICEF, 2014). The introduction of the immunization programme has led to continual reduction of vaccine preventable disease incidence.

Despite the remarkable achievements and improvements in immunization services, the agenda remains largely unfinished with large numbers of children (24 million) remaining unreached, unvaccinated or under-vaccinated (WHO, UNICEF & World Bank 2009). One-fifth of the world’s children which is about 22.4 million infants, are not immunized against VPD and 70 percent of these children come from 10 countries, Nigeria being one of them (WHO/UNICEF 2014), (UNICEF/WHO 2011), (UNICEF Australia 2013).

One of the causes of high mortality rates in Nigeria are vaccine-preventable diseases. Previous studies have explored factors associated with implementation of childhood immunization programs, however most of these studies focused on the demand side factors. Some of the most cited demand-side factors that have been shown to influence functioning of immunization programs include parity, household income, ethnicity, place of delivery, mother’s level of education, distance to health facility, culture, religion, age and forgetfulness of guardian due to preoccupation with other activities, (Abdulraheem et al 2011., Bbaale, 2013,Barman et al, 2009) (Bates, 1994) (Calhoun et al., 2014) (Kariuki, 2004) (Mutua et al., 2011, Maina et al,. 2013, Ndiritu et al. 2007, Njeru, 2011, Ophori et al, 2014, Odusanya, et al 2003).

There are relatively few studies examining supply-side factors influencing implementation of childhood immunization programs in the Nigerian context, particularly in predominantly rural areas. This study aims to fill this gap. The relatively poor health indices and large size of the county makes it a reasonable choice for understanding the factors influencing implementation of immunization programs in primary healthcare facilities in Nigeria.

Immunization has saved the lives of more children than any other medical intervention in the last 50 years. Vaccines are safe, simple and one of the most cost-effective ways to save and improve the lives of children worldwide. However, many children in developing countries lack access to vaccines often because they live in hard-to-reach communities and are among the most marginalized members of the community. Vaccines ensure that all children, no matter their circumstances, have a shot at a healthy life Children in East Africa regions continue to lose their lives to vaccine-preventable diseases such as measles, which remains the bigger killer.

Therefore, in Ovia North East Local Government Area of Edo State where the research was carried out, the activities that was conducted is to know the Awareness and Acceptance of Immunization Programs by Mothers of Children within the Ages of 0 to 5 Years in Okada Community.

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1.3 Statement of Problems

Investigation revealed that immunization program is a key strategy for prevention of child and neonatal deaths and lifetime disabilities. Immunization prevents 2.5 million child deaths each year (WHO, 2009). Despite the global improvement in vaccine coverage that has seen 84% of children around the world receiving this life-saving intervention, 10 million children in low and middle level countries die before reaching age of five (Arevshatia et al, 2007) (WHO, 2014). Full immunization potential has not yet been realized in many countries where 22.4 million Children around the globe are not fully immunized. Majority of not fully immunized children 70% are from 10 countries, Nigeria being one of them (WHO/UNICEF 2014).

Low immunization coverage remains a challenge even in a committed country like Nigeria. This study sought to identify intervention targets for improving immunization coverage by investigating Awareness and Acceptance of Immunization Programs by Mothers of Children within the Ages of 0 to 5 Years, Nigeria. The focus was to identify factors contributing to missed immunization and ways to reduce the number of missed opportunities for immunization at the health facilities. Much effort has been made to provide vaccines through the GAVI alliance, enabling states to acquire the recommended vaccines.

In Nigeria for instance, vaccines are made freely available to the public, yet over 20 percent of Nigerian children are not immunized each year. There is a need to identify strategies for improving implementation of vaccination programs in the country, particularly at primary health care level in predominantly rural areas and this study aimed to fill this gap.

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1.4 Aim and Objectives of Study

The aim of the study is to examine the Awareness and Acceptance of Immunization Programs by Mothers of Children within the Ages of 0 to 5 Years using Okada Community in Ovia North East Local Government Area of Edo State as a case study. In achieving this aim, the following specific objectives were laid out as follows:

1. To find out the extent to which the mother’s age influences the practice of immunization against childhood killer diseases;
2. To examine the knowledge and attitude of mothers towards immunization against childhood killer diseases;
3. To investigate the immunization practice of mothers against childhood killer diseases; and
4. To determine whether the mother’s educational level influences the practice and acceptance of immunization against childhood killer diseases.

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1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• What is the extent to which the mother’s age influences the practice of immunization against childhood killer diseases?
• What is the knowledge and attitude of mothers towards immunization against childhood killer diseases?
• What is the immunization practice of mothers against childhood killer diseases?
• To what extent does mothers’ educational level influence the practice of immunization against childhood killer diseases?

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1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is no significant factor influencing the knowledge and attitude of mothers towards immunization against childhood killer diseases
• H1: There is a significant factor influencing the knowledge and attitude of mothers towards immunization against childhood killer diseases

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1.7 Significance of Study

The findings of this study are of great significance to immunization program managers and policy makers in geographical areas with large rural populations. It provides a basis for rational interventions to improve vaccine delivery in primary healthcare facilities, improve vaccination coverage indices and reduce the burden of childhood infectious diseases. The results are of benefit to the county health management team by providing actionable information relevant for planning and policy making to improve delivery of childhood vaccines in the county.

This study contributes to the broader literature addressing how to improve implementation of childhood immunization programs in rural areas by providing an empirical analysis of challenges faced by program implementers. Specifically, this study seeks to contribute to the literature related to the identification of intervention targets for increasing the effectiveness of immunization programs in primary healthcare facilities in Southern Nigeria.

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1.8 Scope of Study

This scope of this research is focused on the Awareness and Acceptance of Immunization Programs by Mothers of Children within the Ages of 0 to 5 Years.

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1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

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1.10 Definition of Terms

The following terms were used in the course of this study:

Immunization: Is the process by which an individual’s immune system is stimulated through exposure to an immunogenic agent known as vaccine (a substance that stimulates the immune system is said to be immunogenic)

Implementation: Is a specified set of activities designed to put a plan or strategy into practice. In this study, it refers to the set of activities put together in the immunization program to ensure that children are vaccinated and thereby increase immunization coverage.