Immunization is one of the most cost effective public health interventions, childhood immunization services is provided free by Nigeria government through the Primary Health Care Development Agency. Despite the successes recorded over the years, routine immunization coverage has remained low in our rural communities and a major challenge in reducing childhood morbidity and mortality in our country. The objective of this study was to assess the routine immunization coverage and its determinants in Alimosho Health Centerfield, Alimosho LGA of Lagos state Nigeria.

A cross–sectional community based study conducted between February and May 2015.

A total number of 100 mothers or caretakers and their infant whose ages were between 12-23 months old, participated in this study. The mean age of the mothers was 28.1±7.032. The levels of knowledge of the mothers on the various aspects of routine immunization was poor (8.3%) but their attitudes towards modern immunization was good (86.6%). The full immunization coverage was low (35.5%) and factors that were significantly associated with full immunization of infant were maternal education status of mothers. Mothers who got information from health care workers were 0.411 times more likely to fully immunize their infant than those who got their information from others sources.

A better health education, appropriate information dissemination and strengthening of communication skills among the health care workers could assist in improving immunization coverage in the community.

1.1 Background of study
Immunization is the process whereby a person is made immune or resistant to an infectious disease typically by the administration of a vaccine. Vaccines stimulate the body‟s own immune system to protect the person against subsequent infection or disease.1,2

The history of vaccination started way back in 1796 when a British physician Edward Jenner performed an experiment and discovered that inoculation of a person with relatively harmless disease agent could protect the person from a more dangerous disease, the process he called vaccination which was derived from the Latin word for cow “vacca”. Immunization has been found to be a proven tool for controlling and even eradicating disease and one of the greatest achievements in the field of preventive medicine was intensified Immunization campaign carried out by the World Health Organization (WHO) from 1967 to 1977 that led to eradication of smallpox in 1980.3,4

Eradication of poliomyelitis is within reach. Since Global Polio Eradication Initiative in 1988, infections have fallen by 99%, and some five million people have escaped paralysis.

There are two main strategies for administration of vaccines, Routine Immunization (RI) and Supplemental Immunization Activities (SIA). RI is a set of vaccinations in a schedule regimen administered to infant in their first year of life. These vaccines, protects against the six childhood diseases (Tuberculosis, Diphtheria, Tetanus, Pertussis, Poliomyelitis and Measles) which is complementary in the reduction of childhood morbidity and mortality occurring from Vaccine Preventable Diseases (VPDs).

The World Health Organization (WHO) established the Global Expanded Program on modern Immunization (EPI) in 1974 to ensure that all infant had access to routinely recommended vaccines (with global focus on the six childhood vaccine preventable diseases) which was endorsed by Nigeria government. The vaccines are Bacille - Calmette Guerin vaccine (BCG), Diphtheria - Pertussis Tetanus - vaccine (DPT), Oral Polio vaccine (OPV) and Measles - Containing vaccine (MCV). Since then, substantial progress has been made in reducing vaccine preventable morbidity and mortality. The global coverage with third dose of DPT (DPT3) increased from less than 5% in 1974 to 79% by 2005.5

However, and in spite of the successes recorded, millions of infant (1/5 of world infant) especially those in less developed countries were found not to be fully vaccinated in their first year of life. Therefore, the WHO and United Nations Children‟s Fund (UNICEF) developed the Global Immunization Vision and Strategy (GIVS) in 2005 with the goal of reaching a sustained national DPT3 coverage of 90% in all countries6 and by extension improving the national immunization programs and decrease VPDs associated with morbidity and mortality.

In Nigeria, the Federal Government through the Federal Ministry of Health (FMOH) has pursued an active immunization programme and has given necessary priority to its immunization programme. The EPI was initiated in 1979; it was restructured and re- named National Programme on modern Immunization (NPI) in 1997 which functioned as an agency under FMOH. However, the health sector reform of May, 2007, merged NPI with the National Primary Health Care Development Agency (NPHCDA). Government provide immunization services and potent vaccines free to all population at risk of VPDs.7

This is achieved through the NPHCDA and the other tiers of government (States and Local Government Areas). Currently, there is a level of Federal Government commitment to immunization of infant at the presidential, ministerial and at agency levels.8

RI is provided through public health system, private or NGO providers. The public sector provision is by health staff based at facilities which are run by LGAs.

Immunization rate in northern Nigeria, is one of the lowest in the world, the percentage of fully immunized infants is said to be less than 1% in Jigawa state.9,10 The reasons advanced for such low coverage among others are; a highly ineffective and deteriorated primary health care service, limited resources for health services, rumours of the safety of the polio vaccine and subsequent campaigns disrupted routine immunization services.

There is also problem of confidence and trust by the public in the health services resulting from the poor state of the facilities and low standard of delivery and there is low demand for immunization at the family and community level due to lack of understanding of its value. Therefore, socio-demographic factor, knowledge, attitude and practice of mothers/ care givers are important factors to successful routine immunization coverage. This study intends to look at these factors as it affects routine immunization coverage in Alimosho Health Centerfield rural in Alimosho, Lagos State, Nigeria.

1.2 Problem Statement
Vaccine preventable diseases (VPDs) such as tuberculosis, poliomyelitis, measles, diphtheria, Pertussis and tetanus still contribute significantly to under-five morbidity and mortality in sub Saharan Africa despite global successes recorded in immunization coverage and in Nigeria, the disease accounted for 872,000 representing 22% of under- five mortality in 2002.10 The national immunization coverage for infant aged 12-23 months that are fully immunized was 25%11 which is far below the national coverage of 90% and community coverage of 80% recommended by the WHO. The proportion of these infant who received all the recommended vaccines (i.e. fully immunized) varied between the geographical zones of the country with the highest coverage of 43% in the south eastern and south western region while the north western zone has the lowest coverage of 9. 6% and the north central zone have coverage of 26 .9%. Lagos state has coverage of 23.0% as fully immunized, 10.9% of infant aged 12-23 months were not immunized in 2013.11

The resultant effects of this low immunization coverage are outbreaks of VPDs (including Measles and diphtheria), persistent transmission of Wild Poliovirus (WPV), emergence and circulation of Vaccine Derived Polio virus (cVDPV) which constitute a significant threat to the attainment of the Millennium Development Goals (MDGs) in Nigeria. Factors that contribute to this low coverage of immunization among others, are weakness in the health system, difficulty in delivery of vaccines through an infrastructure and logical support system which is often overloaded, lack of understanding about the importance of vaccines among populations in the community. Others includes failure to actively demand access to immunization services, unsubstantiated rumours about safety, short fall in funding needed to reach the needed immunization goals and overshadowing influence of supplemental immunization activities (SIAs).

Since the establishment of immunization programme in1979, Nigeria has been making efforts to reduce the burden of VPDs through strengthening of its health system in general and routine immunization in particular, outreaches and supplemental immunization activities (SIAs) in form of Immunization plus days (IPDs) for administration of polio vaccine and measles follow up campaigns are been conducted at community levels. The results of these efforts are the improvement in the immunization coverage as reported in NDHS 2013; however, the country is still faced with a significant risk of not meeting MDG4 target. There is still paucity of knowledge on the factors affecting routine immunization in our community particularly in the north.

As result of inadequate knowledge on the factors that affects the uptake of routine immunization in the community, further research is needed to find out the causes of low routine immunization coverage among Alimosho Health Centerfield in Alimosho LGA of Lagos State. Findings from the study could help in reducing child morbidity and mortality in our communities and by extension Nigeria.

1.3 Research Questions
1. What are the levels of knowledge of women on modern Immunization in Alimosho Health Centerfield?

2. What are the attitudes of women on modern Immunization in the community?

3. What is the coverage for various Immunization antigens among infant 12-23 months old Alimosho Health Centerfield?

4. What are the socio-demographic factors of women affecting Immunization in Alimosho Health Centerfield LGA?

1.4 Research Objectives
General objective

To identify the attitude mothers towards modern immunization among infant aged 12- 23 months in Alimosho Health Centerfield, Alimosho LGA.

Specific objectives
1. To assess the levels of knowledge of women regarding Immunization in Alimosho Health Centerfield

2. To assess the attitude of mothers or care giver regarding Immunization in Alimosho Health Centerfield.

3. To determine coverage for the various Immunization antigens among infant 12-23 months old in Alimosho Health Centerfield.

4. To determine the socio–demographic factors that affects routine immunization coverage among infant aged 12 -23 months in Alimosho Health Centerfield.

1.5 Significance of the Study
In spite of the effectiveness of vaccines in the prevention of VPDs, compliance of parents to the schedules of routine immunization has continued to be a problem in many areas leading to low Immunization. In the North central region, Lagos State is reported to be one with least Immunization in 201311 and based on the measles surveillance report for the year 2013, a total of 2,580 of measles cases were reported in the state (all the 25 LGAs involved). All the reported cases in Alimosho LGA were from Okabere ward, which could be a reflection of poor Immunization among rural communities. In addition there is paucity of data on routine immunization in the area; the study is undertaking to better appreciate the true routine immunization situation in the community and to also find out some of the factors that are associated with low Immunization in the community. More so, findings from the study will help policy makers to improve RI services and by extension to reduce the morbidity and mortality associated with VPDs in rural communities.

1.6 Limitations of study
Recall bias is possible limitation to this study because accuracy of information on child immunization status given by mothers without immunization card could not be verified.

Another limitation is the willful misstatement by women as the statement cannot be verified.

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