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
1.1 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.
1.2 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.
1.3 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.
1.4 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.
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Item Type: Project Material | Size: 78 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
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