A Critical Examination of the Immunization Status of Children in a Rural Suburb Areas of Osun State
To identify the attitude women of children bearing age towards immunization among children aged 12- 23 months in Rural suburb.
- To assess the levels of knowledge of women of child bearing age regarding Immunization in The rural suburbs
- To assess the attitude of mothers or care giver regarding Immunization in The rural suburbs.
- To determine the rate of immunization among children 12-23 months old in The rural suburbs.
- To determine the socio–demographic factors that affects rate of immunization among children aged 12 -23 months in The rural suburbs.
National Programme on Immunization
The Expanded Programme on Immunization (EPI) which was launched by the world Health Organization (WHO) in 1974 globally focused on prevention of six childhood vaccine preventable diseases namely tuberculosis, poliomyelitis, measles, diphtheria, Pertussis (whooping cough) and tetanus. However, high prevalence of some vaccine preventable diseases such as hepatitis and yellow fever has necessitated their inclusion in the national immunization programme of some countries including Nigeria. The Federal government of Nigeria which has pursued an active immunization programme through the Federal Ministry of Health (FMOH) introduced the EPI in 1979. In view of the critical need to enhance the effectiveness of immunization which was fast declining and to meet the global challenges of immunization, the EPI was restructured in 1997 and renamed National programme on immunization (NPI).
Following the Health Sector Reform of 2007, the NPI was merged with the National Primary Health Care Development Agency (NPHCDA) which is charged with the responsibility of effectively controlling through provision of vaccines and immunization guidelines, the occurrence of the eight vaccines preventable diseases (VPDs) earlier mentioned. Currently, the country has introduced the Haemophilus Influenzae type b vaccine as Penta-valent vaccine into its EPI programme in order to reduce substantially child mortality from pneumonia and meningitis.
In Nigeria, the government provide vaccines and immunization services free to all eligible populations through the functional Primary Health Care (PHC) centres government and private health facilities. The Target Groups for Immunization in Nigeria are: Children 0 – 11 months, Children 0 – 59 months, Women of child bearing age 15 – 49 years, Other at – risk groups especially in outbreak situation and those travelling to endemic areas and International travellers. The traditional routine immunization vaccines that are administered in Nigeria are nine and they include Bacille-Calmette Guerin (BCG) for tuberculosis, oral polio vaccine (OPV) for poliomyelitis, Penta-valent vaccine for diphtheria, Pertussis, tetanus, hepatitis b and Haemophilus Influenzae type b, measles and yellow fever vaccines.
Nigeria routine immunization schedule is designed to include all children aged 0 – 1 year who are to receive one dose of BCG vaccine which is given at birth, 3 doses of Pentavalent vaccines given as Pentavalent 1 at 6 weeks of age, Pentavalent 2 at 10 weeks of age and Pentavalent 3 at 14 weeks of age, 4 doses of OPV given as OPV0 at birth, OPV1 at 6 weeks, OPV2 10 weeks and OPV3 14 weeks of age, 4 doses of Hepatitis B vaccines given as HepB0 birth while the remaining are given as Pentavalent vaccine at 6 weeks, 10 weeks and 14 weeks of age, one dose of Measles vaccine is given at 9 months of age and one dose of Yellow Fever vaccine also given at 9 months of age.7,12
The funding of immunization is a collective responsibility of the Federal, State and Local Governments. However, external donors/development partners such as World Bank, European commission, USAID, WHO, DFID, UNICEF, GAVI are explored for financing immunization services on a sustainable basis.7
There are medical incident that take place within one month after an immunization and is believed to be caused by the immunization and they are referred to as adverse events following immunization (AEFIS). They include; hotness of the body, pains and swellings at the injection site, restlessness. Other serious or severe effects are all deaths that are thought by health workers to be related to immunization, that occur within one month of an immunization, all cases requiring hospitalization that are thought by health workers and/ or the public to be related to immunization, that occur within one month of an immunization and any severe or unusual medical incidents that are thought by health workers and/ or the public to be related to immunization.
This was cross sectional study.
These are women of child bearing age of eligible children who are permanent resident in the community.
- Mothers of children aged 12-23 months will be eligible for the study.
- Women of child bearing age who are not permanent resident in the community.
Sample Size Determination
The minimum sample size was determined using the formula:
n = [z²xpq/d²] x DEFF20 Where:
n = minimum sample size
z = standard normal deviate at 1.96
p = proportion of children aged 12 -23 months with full immunization coverage in OsunState (12.3%).11 = 0.123
q = 1 – p (87.7%) = 0.877
d = precision 5%
DEFF = Design effect = 2
n = (1.96² x 0.123 x 0.877 / 0.05²) x 2
n = (3.8416 x 0.123 x 0.877/0.0025) x 2 = 331.51 ≈ 332
n = 332
DATA ANALYSIS AND RESULT PRESENTATION
One hundred (100) women of child bearing age participated in the study, the mean age of the respondents was 28.1 ± 7.032 years. 67% of women of child bearing age are aware of routine immunization but their levels knowledge was rated poor 6(8.3%) while their attitude towards the immunization was rated good 82 (85.6%).
CONCLUSION AND RECOMMENDATIONS
The maternal knowledge on the routine immunization was poor (8.3%), however mother‟s and attitudes towards immunization are good.
More so, and in spite of the successes recorded in the area of childhood Immunization services in Nigeria, the fully immunized children aged 12-23 months in The rural suburbs was still far below the recommended 80% at community level (35.5%).
Among the factors that were significantly associated with full immunization coverage of children in the community are maternal education, sources of maternal information on routine immunization, and place of child delivery.
While only sources of maternal information on routine immunization was found to be independently associated (predictor) with full immunization coverage of children in the community.
Based on the findings of the study, the following recommendations are proffered
- The Osun state government through the ministry of health and state primary health care development agency should coordinate and disseminate information on the importance of routine immunization through radio and television messages and
- Ikpoba Okha Local Government Area should create awareness on routine immunization in the community through the social mobilization.
- In the light of the inconvenient time and busy schedule of the mothers or care giver in the community, the community should be involved in the planning and implementation of routine immunization activities.
- Ikpoba okha Local Government Area should strengthen the communication skills among the health care workers to be able to stress to the mothers and care givers the importance of routine
- The Non-Governmental Organization and Community based Organizations should be involved in routine immunization activities.
- Others scope of the study such as health system and operational barriers and demand barriers against immunization should be explore for further
- The Ikpoba okha Local Government Area through the health department should advocate and sensitize both the community and religious leaders on the importance of routine immunization in their
- World Health Organization (WHO). Immunization Coverage – Fact Sheet http://www.who.int/mediacentre/factsheets/fs378/en/. Accessed 14th 2014
- Olesen OF, Lonnroth A, Mulligan B. “Human vaccine research in the European Union”. Vaccine. 2009; 27 (5): 640–5.
- WHO Smallpox Eradication http://choo.fis.utoronto.ca/fis/courses/lis2102/ko.who.case.html accessed 22nd June, 2014.
- History and Epidemiology of Global Smallpox Eradication. https://emergency.cdc.gov/agent/smallpox/training/overview/pdf/eradicationhistory. pdf accessed 17th December, 2014.
- Global Rate of immunization, 2011, Morbidity and Mortality Weekly Report (MMWR)/November. 2, 2012; 61(43):883.
- WHO Expanded Programme on Immunization (EPI), 1987. http://www.who.int/immunization/programmes_systems/supply_chain/benefits_of_i mmunization/en/ accessed on 6th August, 2013.
- National Immunization Policy Revised 2009, National Primary Health Care Development
- Paediatric Association of Nigeria (PAN), Recommended Routine Immunization Schedule for Nigeria Children, Nigeria Journal of Paediatrics, 2012; 39(4): 152-
- Vaccines and Immunization: the past, present and future in Nigeria, Nigeria Journal of Paediatrics, 2011; 38(4): 186-194.
- FBA Health System Analysts, Revised Version, June, 2005, The State of Routine Immunization Services in Nigeria and Reasons for Current Problems.
- Nigeria Demographic and Health Survey (NDHS), 2013, National Population