ABSTRACT
Introduction: Immunization is a key approach that can be successfully employed to reduce deaths and illnesses among children. Immunization presently averts an estimated 3 million Deaths annually for children aged under five. Nigeria Expanded Program on Immunization has a stipulated immunization schedule guideline that should be adhered to for effective immunization of children under five years
Objective: The study was to assess the knowledge, attitude, and practices of mothers/caregivers towards immunization of children under five years in Abia State teaching hospital Aba Abia state.
Methodology: A descriptive cross-sectional study was conducted in Abia State teaching hospital facility Among 116 participants. The Respondents were interviewed through structured questionnaires. Data were analyzed by Social Statistical Package for Social Scientists (SPSS). Descriptive findings were presented in tables frequencies, percentages and while inferential statistics used a logistic regression test to measure the association between independent and dependent variables. P- Values equal to or less than 0.05 were considered statistically significant.
Results: A total of 116 mothers/caretakers were enrolled in the study. The results showed that most of the participants (73.3%) had insufficient knowledge of immunization. The majority of the mothers/caregivers (53.4%) had unfavourable attitude toward immunization. Moreover, the majority of participants (77.6%) had poor practices towards immunization. Mothers/caregivers who attained secondary or higher level of education were 4.28 times more likely to have sufficient knowledge about immunization than housewives, male child were 3.67 times more likely to favourable attitude and married mothers 4.28 times.
Conclusions and recommendations: A confidence interval of 95% was adopted thus setting significant thresholds at 0.05 implying any threshold less than 0.05 was significant in affecting Knowledge, attitude and practices towards childhood immunization. The results indicated that there was a statistical significant association between knowledge and attitude such as, educational level (p=0.003), marital status (p=0.008), sex of the child (p=0.003).
The study recommends that health workers should sensitize the mothers about important and good practices of immunization and the dangers of not following the immunization schedule.
CHAPTER ONE
INTRODUCTION
1.0.Introduction
This chapter presents the background of the study, problem statement, justification and significance of the study, research questions, objectives, general objective, specific objectives, and conceptual framework.
1.1 Background to the study
Globally, in developed countries, such as the United Kingdom and Japan, due to well-funded and developed laboratory health systems, with increased levels of monitoring as well as provision of equipment and resources, health staff often do not encounter many factors which affect the effective conducting of immunization outreaches (Kamimura, Ashby, Myers, Nourian, & Christensen, 2015). However, in under-developed countries such as Venezuela and Paraguay, health staff encounter many factors which affect health workers conducting immunization outreaches including lack of guidelines, lack of resources, and poor funding among others (Page & Taraciuk Broner, 2020).
Immunization is an important tool for controlling and eliminating life-threatening infectious diseases and is estimated to prevent between 2 and 3 million deaths each year (Mekonnen, Gelaye, Were, & Tilahun, 2020). An estimated 19.4 million children around the world still do not complete full vaccinations every year, and out of these, approximately two-thirds of all unvaccinated children live in developing countries(Chan, Soelar, Md Ali, Ahmad, & Abu Hassan, 2018). Vaccine-preventable diseases contribute significantly to morbidity and mortality; an estimated 4 million people die each year from diseases from which vaccines are available (WHO, 2015). Diarrhea and Pneumonia diseases account for approximately 34% of the world's
10.4 million deaths in children less than 5 years of age (WHO, 2015). Globally, Invasive pneumococcal disease has shown recent because the deaths of 826,000 Children aged 1 to 59 months and rotaviruses are the highest cause of severe diarrheal disease in children under five years (WHO, 2015).
Immunization remains the single most feasible and cost-effective way of ensuring that all children enjoy their rights to survival and good health. Immunization is the best way of curbing immunizable childhood diseases like poliomyelitis, Measles, mumps, rubella, diphtheria, tuberculosis, and hepatitis. It is also significant that these children get the full dose of these vaccines. For example, according to World Health Organization (WHO) guidelines, children are considered fully vaccinated with Diphtheria, Pertussis Tetanus 3rd Dose (DPT3) when they have received three doses of pentavalent vaccine DPT-Hep-B-Hib by the age fourteen weeks(Gentle, 2019). Considering this, incomplete immunization of children 6 to 14 weeks can be defined as children who missed at least one dose of the three doses of the vaccine to the United Nations Expanded Program for Immunization (UNEPI) guidelines (Saleh et al., 2018).
Regional perspective: In Sub-Saharan African countries, conducting childhood immunization in static and outreaches differs greatly and is affected by various factors. For example, in Ethiopia and Nigeria, the factors affecting the management of laboratory services include the inadequate provision of supplies and resources such as testing kits, unreliable electricity, and poorly maintained and serviced laboratory equipment among others (Thomas, 2015). Similarly, in East African countries including Kenya and Tanzania, many factors affect health workers in conducting childhood immunization and these include lack of resources such as running water in facilities, inadequate and poorly maintained equipment, inadequate infrastructure, and understaffing among others (Shobowale, Onyedibe, Adegunle, & Elikwu, 2017)
In Nigeria, The ministry of health reports that the coverage of immunization for children is below that planned in the standards development goals. The Ministry of Health (MoH) recommends the provision of accessible, efficient, and quality immunization outreaches. However, conducting childhood immunization is greatly affected by various factors including poorly set up services, inadequate staffing, and provision of resources such as vehicles for the transport of staff and vaccines, and lack of fridges for effective cold chain management among other factors (Ochan, Aaron, Aliyu, Mohiuddin, & Bamaiyi, 2018).
1.2 Problem Statement
Immunization against these diseases is one way that can eliminate these diseases and reduce infant mortality rates that have been high in the past decades. However, complete immunization of all children in most sub-Saharan countries has not been achieved. In Nigeria, for example, the set target for childhood immunization in Nigeria as of 2020/2021, 96% for DPT-HepB-HiB -3, 89% for measles, and 35% for under 5 vitamin A (MOH, 2022). However, in that same year, the vaccine coverage of DPT-Hib-Heb-3 dropped by 6.3%, and measles dropped by 12.5 %. In addition, coverage in Abia state was not satisfactory, evidenced by a DPT-HepB-HiB-3 coverage of 85%, and a drop of rubella measles coverage by 15.1% (MOH, 2022).
Several factors affect immunization uptake and among these are the knowledge, and attitudes of parents towards immunization of children under 5 years. This is because mothers/caregivers have the primary obligation to take these children to obtain immunization services and any insufficiencies in knowledge and attitudes would see them have a poor practice of taking their children for immunization. For example, Mothers who think that immunizing their children is associated with severe adverse events will be less likely to take their children for immunization. In addition, mothers/caregivers who are not aware of the benefits of fully vaccinating their children are less likely to take their children to complete the vaccines (McKee & Bohannon, 2016). The diversity of cultures, inadequate sensitization, poor infrastructure, and inadequate provision of vaccines also create a gap for the emergency of poor attitudes and practices towards immunization. Inadequate immunization in maternal and child health and well-being (Reid & Fleck, 2014). Low coverage of childhood immunizations creates pathways to disastrous outbreaks of diseases like measles, pertussis, diphtheria, yellow fever, and polio (Reid & Fleck, 2014). These outbreaks can claim a number of both adults and young children and impair the future of many countries.
To develop the best strategies and ultimately increase immunization coverage in Abia state, and in Nigeria at large, the knowledge attitudes and practices of mothers/caretakers towards immunization of children must be examined. This study, therefore, seeks to examine the knowledge, attitudes, and practices of mothers/caregivers towards immunization of children under 5 years at Abia State teaching hospital Aba, Abia state.
1.3 Research Questions
1) What is the knowledge level of mothers/caregivers, regarding immunization of children under 5 years in Abia State teaching hospital Aba Abia state?
2) What are the mothers’/caregivers’ attitudes towards vaccination of children under 5 years of age in Abia State teaching hospital center IV, Abia state?
3) What are the practices of mothers/caregivers towards immunization of children under 5 years of age in Abia State teaching hospital Aba, Abia state?
4) What is the association of sociodemographics and mothers/caregivers’ knowledge, attitudes and practices towards immunization of children under 5 years in Abia State teaching hospital Aba, Abia state?
1.4 Objectives of the study
1.4.1 General Objective
To examine the Demographic correlates of practice of immunisation of under five children among mothers attending child welfare clinic at Abia State teaching hospital Aba, Abia state.
1.4.2 Specific Objectives
1) To examine the knowledge level of mothers/caregivers of children under 5 years of age regarding immunization in Abia State teaching hospital Aba, Abia state.
2) To examine the attitudes of mothers/caregivers towards immunization of children under 5 years of age in Abia State teaching hospital Aba, Abia state.
3) To identify the practices of mothers/caregivers towards immunization of children under 5 years of age in Abia State teaching hospital Aba, Abia state.
4) To determine the association between sociodemographics and the mothers’/caretakers knowledge, attitudes and practices towards immunization of children under 5 years of age in Abia State teaching hospital Aba, Abia state.
1.5 Significance of the study
Findings from this study will provide numerous implications to both the public, the government, and other stakeholders. Stakeholders can base on the gaps identified and develop proper interventions to eliminate these gaps. Health care centers can design user-friendly solutions like outreaches and teaching programs, targeting these women.
Improved knowledge, attitudes, and practices towards immunization would then improve initiation and completion of immunization for children aged between 0 to 5 years. This will help reduce the proportion of immunizable childhood illnesses, which contribute to a big health problem and delay the achievement of the standard Development goals.
The study also intends to assist policy makers and planners as well as the Ministry of Health by identifying potential areas, which still require more funding and support for immunization outreaches in government facilities. Results from this study will contribute to the available research material about the knowledge, attitude, and practice gaps of mothers towards immunization of children under 5 years of age and therefore provide a valuable reference point for future studies on this issue.
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