EVALUATION OF THE IMMUNIZATION STATUS OF CHILDREN IN A RURAL SUBURB OF ANAMBRA STATE

ABSTRACT

Background

Childhood immunization is a cost effective public health strategy. Expanded Programme on immunization (EPI) services have been provided in Anambra East local government area of Anambra State mainly through the health facilities in the LGA.

Objective

The objective of this survey was to assess vaccination coverage and its determinants in this rural suburb in Nigeria.

Methods

A cross-sectional survey was conducted in October 2010, which included the use of interviewer-administered questionnaire to assess knowledge of mothers of children aged 12-23 months on childhood immunization and vaccination coverage of the children. Survey participants were selected using a multistage sampling method. Vaccination coverage was assessed by vaccination card and material history. A child was said to be fully vaccinated if he or she had received all the following vaccines: a dose of BCG, three

doses of OPV and DPT, and one dose of measles by the time he or she was enrolled in the survey. Person chi-square (x2) test was performed to identify determinants of full immunization status.

Results

250 mothers and 250 children (each mother had one eligible child) were included in the survey. 80 (32%) of the children were fully immunized while 112 (44.8%) were not immunized from the vaccination cards while with maternal history 86 (34.4%) were fully immunized, though this difference was not statistically significant P = 0.210 45 (26.5%) of 170 children who defaulted had visited a health facility since their last vaccination or since they attained appropriate age.

Majority of the children 109 (43.6%) received their vaccination in Public health facilities.
Chi-square test showed that mothers educational status (P = 0.004), religious denomination (P = 0.019) and child’s problem after immunization P = 0.012 were significantly associated with under immunization.

Conclusion / Recommendations

It is therefore concluded that despite all the efforts made by the government, the vaccination coverage in this rural suburb is still at a level that does not provide high protection (80%) against DPT/ OPV and even measles.
To improve on the low immunization coverage, attention should be paid to female education, health education, capacity building of the immunization service providers and supportive supervision.

CHAPTER ONE

Introduction

Background Of The Study

Immunization remains one of the most important public health interventions and a cost effective strategy to reduce both the morbidity and mortality associated with communicable diseases. Over two million deaths are prevented through immunization each year worldwide1. Despite this, vaccine preventable diseases remain the most common cause of childhood mortality with an estimated 3 million deaths each year2. Uptake of vaccination services depends
not only on provision of the services but also on other factors including knowledge and attitude of mothers3,4, density of health workers5, accessibility of vaccination centres and availability of safe needles and syringes.
Nigeria like many countries in Africa is making efforts to strengthen its health system especially routine immunization so as to reduce disease burden from vaccine preventable diseases (VPDs).

In 1979, Nigeria’s Expanded Programme on Immunization (EPI) was initiated6 (though created in 1974 by WHO, UNICEF and Rotary International as partners). It was relaunched in 1984 due to poor coverage7. In 1996 it became the National Programme on Immunization (NPI). Following a review of EPI Decree 12 of 1997, NPI was made a parastatal.

NPI has a sole responsibility of supervising and enhancing routine and supplemental immunization activities in Nigeria.
Routine immunization (RI) is provided largely through the public health system, with significant variation between the 36 states and Federal Capital Territory (FCT). In Anambra State, private or NGO providers are the source of up to one third of RI in Anambra State8.

Public sector provision is by health staff based at facilities run by the 21 Local Government areas (LGAs), the General hospitals run by the state government and the tertiary institution run by the federal government.
There is also supplemental immunizations done periodically in the state in the form of National Immunization days (NIDs), local immunization days (LIDs), immunization plus days (IPDs) and child health week all aimed at boosting immunization coverage and mopping up and reaching every child (including those not already reached) irrespective of their immunization status.

Statement Of The Problem

Globally, 2.5million children die every year from easily preventable infectious diseases. In the year 2000, measles resulted in 777,000 deaths and 2 million disabilities9. The expanded programme on immunization (EPI) when introduced experienced some initial success. However a few years after its inception, it became obvious that it was no longer achieving its stated objectives and had to be relaunched in 1984.

Nigeria attained universal childhood immunization (UCI) with 81.5 percent coverage for all antigens in 1990, but the success was not to last long and by 1996, immunization coverage had declined substantially to less than 30 percent for DPT-3 and 21 percent for the doses of oral polio virus (OPV).

The situation had continued worsening, that presently the coverage rates of the various childhood vaccines in Nigeria are among the lowest in the world.

The above scenario has been playing itself out in Anambra State. Anambra State has continued to witness fluctuation in immunization coverage for all vaccine preventable diseases with its attendant increase in the incidence of the diseases.

Data from the 2008 National Immunization Coverage Survey shows that only about 23 percent of children aged 12-23 months received full immunization nationally, though this is almost double the value of 13% from the 2003 figure.

Justification Of The Study

Assessing immunization coverage helps to evaluate progress in achieving programme objectives and in improving service delivery10. In addition, evaluation of immunization coverage provides evidence whether substantial progress towards achieving vaccination targets is being made. Such positive evidence is required for continuing support from donor-supported initiative like Global alliance for vaccines and immunization (GAVI)11. It is also expected that findings from the study will help further research work on this topic thereby bridging the gap in knowledge, attitude and practice of the people on immunization.

It is in addition believed that findings will equip policy makers in the planning and policy making on immunization and averting the menace of vaccine preventable diseases in the LGA as there have been recorded outbreaks of measles and a confirmed case of Wild Polio Virus (WPV). It is equally noted that not much work has been done in this field in this locality.

Objectives

General: To determine the Immunization coverage of children aged 12-23 months living in a rural locality (Anambra East Local Government area).

Specific Objectives

To assess immunization coverage levels of children aged 12- 23 months in a rural area of Anambra State.
To assess mother’s knowledge, attitude and practice on childhood immunization.
To identify any missed opportunities among the children.
To identify the factors that are associated with inadequate coverage among the children.

…

CHAPTER TWO

2.0 Literature Review

2.1 Introduction

The review of relevant literature is the main topic of this chapter. A literature review covers theoretical and methodological contributions to a certain issue in addition to the state of knowledge at the time of writing. It provides information about the state of the art in relation to the subject you are writing about. It examines the body of work on the chosen subject. The literature evaluation in this study comprises the …

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TABLE OF CONTENTS
PRELIMINARY PAGES

Title page
Approval page
Dedication
Acknowledgement
Table of Contents
Abstract
CHAPTER ONE
Introduction 1
1.1 Background of the study 1
1.2 Statement of the problem 3
1.3 Justification of the study 4
1.4 Objectives 5
CHAPTER TWO
Literature Review 6
2.1 Historical Perspective 6
2.2 Immunization schedule in Nigeria (see annex) 8
2.3 Factors that influence Immunization Coverage − 8
2.4 Socio-economic status 10
2.5 Concern about vaccine safety and contraindications to immunization 11
2.6 Missed Opportunities 12
CHAPTER THREE
Subject, Materials and Methods 15
3.1 General background (Map as annexed) study Area 15
3.2 Study Population 16
3.3 Study Design 16
3.4 Sample size determination 17
3.5 Sampling Technique 18
3.6 Data Collection (a) Questionnaire 20
3.7 Data Entry and Analysis 21
3.8 Study Hypothesis and decision rules 22
3.9 Ethical Consideration 22
3.10 Limitation of the study 23
3.11 Working Definitions 24
CHAPTER FOUR
Results 27
4.0 Characteristics of the study population 27
CHAPTER FIVE
Discussion 48
CHAPTER SIX
Conclusion 60
Recommendation 62
Reference: 64
APPENDIX 1
Map of Anambra east LGA showing political wards 76
APPENDIX 2
NPI routine immunization schedule for children (less than 1 year) − 77
APPENDIX 3
List of political wards in Anambra East Local Government 78
APPENDIX 4
Questionnaire 79
Ethical Approval 80

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