Analysis on the Knowledge, Attitude and Practice Regarding Immunization of Under-five Children Among Mothers Attending Antenatal Clinic (ANC) at Madonna University Teaching Hospital in Elele, Rivers State
CHAPTER ONE
OBJECTIVES OF STUDY
GENERAL OBJECTIVES
The aim of this study was to determine the knowledge, attitude and practice regarding immunization of under-five children among mothers attending antenatal clinic (ANC) at Madonna University Teaching Hospital in Elele, Rivers State.
SPECIFIC OBJECTIVES
- To determine the knowledge regarding immunization among mothers of under-five children attending ANC at MUTH.
- To determine the attitude towards immunization among mothers of under five children attending ANC at MUTH.
- To assess the level of utilization of immunization by mothers of under five children attending ANC at MUTH.
- To determine factors /reasons affecting utilization of immunization by mothers of under five children attending ANC at MUTH.
CHAPTER TWO
LITERATURE REVIEW
OVERVIEW
Immunization is one of the most effective interventions to prevent major illnesses that contribute to child mortality in the country particularly in an environment where malnourished children, overcrowding, poverty and illiteracy reign.22
Immunization has made an enormous contribution to public health, including the eradication of one dreaded disease, small pox and elimination of poliomyelitis from all but a handful of countries.23 In addition to other child care services, it ensures that the new born child, grows with good health through infancy, preschool, school and adolescent period to a healthy adult with healthy children.24
Millions of childhood deaths are averted annually through vaccination against diphtheria, tetanus, pertussis and measles. However, vaccine-preventable diseases are still responsible for about 25% of the 10 million deaths occurring annually among children under five years of age.23
With the availability of new vaccines and further improvement in vaccination coverage, a much larger proportion of children can now be protected against a broader range of infectious diseases. Thus making vaccines one of the basic means of achieving the health related United Nations Millennium Development Goals (MDG), especially MDG425 that calls for reduction in the under-five mortality rate by 2015.26
The 58th World Health Assembly in 2005 recognised the role that immunization can play in reducing under five mortality, welcomed the Global Immunization Vision and Strategy (GIVS) 2006-2015 developed by WHO and UNICEF as a framework for strengthening national immunization programmes. The goals of GIVS is to reduce illnesses and deaths due to vaccine preventable diseases by at least two third by 2015 or earlier.27, 28
The task force on immunization in Africa (TFI), recognized from the onset the need for high vaccination coverage to counter the disproportionate burden from vaccine preventable diseases in African Region, and therefore set challenging goals for 2001-2005. These goals aimed to ensure that immunisation performance of the African Region’s caught up with other regions performance.29
BRIEF HISTORY OF IMMUNIZATION IN NIGERIA
Immunization started in Nigeria in 1956 prior to the small pox eradication campaign. The Expanded program on immunization (EPI) responsible for routine delivering of immunization started in 1970 (USAID). Since then, The Federal Government of Nigeria continued to place high priority on immunization and implementation with the aim of providing immunization services to all children below 24 months of age against the childhood killer diseases such as tuberculosis, whooping cough, poliomyelitis, diphtheria and measles 30.
Following her partnership to the World Health Assembly, Nigeria adopted the World Health Assembly Resolution (WHAR) and United Nation General Assembly Special Session goals for all countries to achieve by 2005 and this lead to the development of certain policies to be undertaken by the EPI as stated specifically by the Federal ministry of health. The policies included; strengthening of immunisation system, accelerated disease control(that is reduced incidence of measles and reduced cases of acute flaccid paralysis associated with poliovirus by 2004 ), innovations (which involves introduction of new vaccines like vitamin A and hepatitis B in the NPI and vaccination coverage not less than 80%). This policies has not recorded 100% success, though enormous progress has been made31.
CHAPTER THREE
METHODOLOGY
STUDY AREA
The study area was Madonna University Teaching Hospital (MUTH). MUTH is located in Elele town Ikwere local government area of Rivers state, Nigeria. It is a private tertiary health care facility located along the Owerri-Portharcourt express way with latitude of 6.20N and longitude of 700N. It is bounded by the catholic prayer ministry (CPM) and Madonna University, Elele campus.
The type of persons seen in MUTH include health workers (such as doctors, nurses, laboratory scientist, pharmacist) auxiliary nurses, hospital cleaners, lecturers, medical students and other student offering health related courses. Majority of these persons are Christians of different denominations.
The teaching hospital is made up of ten departments which includes the obstetrics and gynaecology, ophthalmology, dental, psychiatric, radiology, surgical, medical, paediatric, and physiotherapy departments; it has 26 wards – obstetrics and gynaecology wards, medical ward, surgical ward, private ward, psychiatric ward, paediatrics ward. It also has the GOPD, SOPD, MOPD, a pharmacy, a provision store, immunization unit, a medical laboratory and 2 restaurants.
STUDY POPULATION
The study population comprised of all mothers who had children under five years of age irrespective of their status who are attending antenatal clinic of MUTH. The population of women who attended clinic from 2014 to the month of August 2016 was obtained and it was discovered that on average about 210 women usually come for antenatal visit within 3 months.
CHAPTER FOUR
RESULTS
COMPLETION OF IMMUNIZATION OF LAST CHILD
Table 29 shows the association between knowledge score of respondents and completion of immunization of their last child. The p value is 0.199 which is not statistically significant.
KNOWLEDGE OF IMMUNIZATION
The study showed that 98.9% of mothers attending antenatal care had heard about immunization, most of their knowledge source was from health workers, antenatal clinic and doctors (48.3%,36.1% and 26.7%) respectively, this is similar to a study conducted by Adeyinka45 where most of the mothers source of knowledge was from the antenatal clinic (65.7%) and health workers(19.2%). Generally this indicates that mothers of under five children get informed about immunization mostly from or around the hospital environment. Other sources of immunization are quite low with information from friends, parents and radio taking 8.9% each and television 13.9%.
In our study, knowledge about vaccine preventable diseases was encouraging because a large number of mothers knew that vaccines could prevent measles (83.3%), polio (80.5%), chickenpox (65.0%), tuberculosis (60%), yellow fever (57.8%), hepatitis B (44.4%), pertussis (31.7%) and diphtheria (27.2%). In comparism to a study done by Abidoye et al46 where mothers knowledge of the vaccine preventable diseases was for measles(73.5%), polio(85.5%), tuberculosis(89.5%), yellow fever(71.0%), hepatitis B (42.0%) pertussis and diphtheria(78.5%). This showed that the respondents had a good knowledge about the vaccine preventable diseases.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
CONCLUSION
Immunization of under five children is mainly dependent on their mothers. In our study, we did not just focus on assessing the knowledge, attitude and practice of immunization of under five children among the mothers but also the determinants of their practice.
The knowledge, attitude and practice of immunization of under five children in these women was relatively high. High maternal education as well as a good knowledge and attitude towards immunization of children was found to be great contributors to the adequate utilisation of immunization services. The negative contributors in the study include negligence, ignorance and distance to immunization centres.
Although the percentage of mothers who completed immunization of their children was high, there’s still room for improvement as a stronger political will in addition to a general improvement of health care services could bring about a better result.
RECOMMENDATIONS
We recommend there should be an increase in amount of materials on immunization posted on social media, radio and television shows held to further enlighten the general public about the importance of immunization.
The government should also work with health personnel to set up supplementary vaccination programmes and campaign and also train more health personnel so the rural communities can be reached.
Initiation of a well-financed mobile health care service which will include immunization in hospitals to serve as a means to help remind mothers via calls and text messages when it’s time for immunization of their children.
The government should also organise talks on immunization at the community level to help educate mothers the communities who have refuse to immunise their children.
REFERENCES
- National Health Service (NHS). “The history of vaccination 2016”. Available from nhs.uk/conditions/vaccinations/pages/the-history-of-vaccination.aspx. Accessed August 2016.
- The University of Auckland. “The history of vaccines 2015”. Available from immune.org.nz/vaccines/vaccine-development. Accessed August 2016.
- Bruce Gellin. “Vaccine and infectious diseases, putting risk into perspective”. American Medical association briefing on microbial threat. National press club Washington DC 2000. Available from iaomt.org/testfoundaton/lifesaver.htm. Accessed August 2016.
- World health organization (WHO). “Global vaccine action plan 2011-2020 (Geneva 2012)”. Available from who.int/immunization/global_vaccine_action_plan/en. Assessed August 2016.
- “Immunization”. Wikipedia the free encyclopaedia (2016). Available from https://en.m.wikipedia.org/wiki/Immunization. Accessed august 2016.
- Edina Iroha. “Vaccines and Immunization” In: Azubike J.C, Nkanginieme K.E (eds.). Paediatrics and Child Health in a Tropical region. 2nd Owerri, Nigeria: Africa educational service; 2007. p.28.
