Impact of Immunization on Children Health 0-5yrs

Impact of Immunization on Children Health 0-5yrs

CHAPTER ONE

Objectives Of Study

General Objective

To determine main objective of this study is to examine the impact of immunization on children health 0-5years in Kaduna state  

Specific objectives

1. To assess the knowledge and perception of mothers/caregivers on vaccine preventable diseases in children aged 0-5 years in the Kaduna State
2. To determine the sources of information on routine immunization among mothers/caregivers of children aged 0-5 years in the study area
3. To determine the mothers/caregiver’s immunization practices based on available information on immunization
4. To assess factors that influence the uptake of routine immunization by mothers in Kaduna State

CHAPTER TWO

LITERATURE REVIEW

History of Immunization

The use of immunization to prevent disease predated the knowledge of both infection and immunology.  In about 600 BC, Chinese were accustomed to using smallpox material inoculated through the nostril to prevent the disease in a process, known as “variolation” which took a variety of forms.  Inoculation of healthy people with a tiny amount of material from smallpox sores was done in many Asian countries at that time. And the knowledge about disease was vague. However, Hippocrates, the father of Medicine was able to described mumps, diphtheria, epidemic jaundice, and other conditions, in 400 BC.²⁷

In 1798, Edward Jenner published his work on the development of a vaccination that would protect against smallpox. Two years earlier, in 1796, he had first speculated that protection from smallpox disease could be obtained through inoculation with a related virus, vaccinia or cowpox. He tested his theory by inoculating eight-year-old James Phipps with cowpox pustule liquid recovered from the hand of a milkmaid, Sarah Nelmes in a process known as―vaccinia‖.  The boy caught cowpox. However, when the boy was exposed to smallpox eight weeks later by Jenner, the child did not contract the disease.²⁸

During the nineteenth century, there were many theories of diseases, but Louis Pasteur was the first to propose ―The Germ Theory of Disease‖ in 1877. He went ahead to create the first live attenuated bacterial vaccine (chicken cholera) in 1879. Robert Koch in 1882 identified the tubercle bacillus as the cause of tuberculosis, subsequently called Koch’s bacillus. The diphtheria toxin was discovered by Emile Roux in 1888.²⁷ Passive serum therapies were developed through the scientific contributions of many, including Emil Von Behring who developed the first effective therapeutic serum against diphtheria and Paul Ehrlich who developed enrichment and standardization protocol, which allowed for an exact determination of quality of the diphtheria antitoxins. Tetanus toxoid was introduced in 1914 following the development of an effective therapeutic serum against tetanus by Emil Von Behring and Shibasaburo Kitasato.²⁷

In a related development, in 1927 Bacille Calmette-Guerin (BCG) vaccine was first used in newborns, having been developed by Albert Calmette and Camille Guéérin in 1921. BCG (live-attenuated Mycobacterium bovis) represented the only vaccine against tuberculosis.²²

Goodpasture’s demonstrated in 1931 how virus can grow in cell culture which was further developed and shown to be able to grow virus in the medium, thus paving the way for the subsequent production of viral vaccines.²² Oral polio vaccine types 1 and 2, developed by Albert Sabin and grown in monkey kidney cell culture were licensed for use in the U.S in 1961. In 1960, Sabin introduced the monovalent live oral poliovirus vaccine followed by its trivalent type in 1963²⁹. This is the most commonly used polio vaccine today. Live attenuated measles virus vaccine was also licensed in the U.S in 1965. The recommended age for routine administration was changed from 9 to 12 months of age.

Following the tremendous success associated with vaccine development and especially the successful eradication of smallpox; in 1974 the Expanded Program on Immunization (EPI) was created by WHO, in a bid to provide vaccination to most of the world’s population before the first birthday.³⁰ The six diseases chosen to be tackled under this initiative were tuberculosis, diphtheria, tetanus, pertussis, polio and measles. It was not until 1988 that the WHO recommended that yellow fever vaccine be added to the national immunization programme of those countries where it is endemic. Later in 1992 the World Health Assembly recommended hepatitis B vaccination for all infants.³¹

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CHAPTER THREE

METHODOLOGY

Background of the Study Area

The study area is Kaduna State which was created in 1976 from the Northern Central State with its capital at Kaduna. It shares boundaries with Niger State to the West, Zamfara, Katsina and Kano States to the North, Bauchi and Plateau State to the East and the FCT and Nasarawa State to South.⁷⁵

Kaduna State, the third most populous state in Nigeria, is in the North West geographical zone. It is the twelfth largest State in Nigeria accounting for some 5 percent (48,473 square kilometers) of Nigeria’s total land mass. It is culturally diverse with a projected population of 7,589,699 people⁷⁶ (projection from 2006 Census) and a population density of 130 people per sq km and an annual rate of increase of around 3 percent. The State has 23 Local Government Areas (LGAs) and politically, it is further divided into 3 Senatorial zones: Kaduna South Senatorial zone, Kaduna North Senatorial zone, and Kaduna Central Senatorial zone with 255 wards and over 1000 health facilities. It has rural and semi- urban settlements in most of the LGAs.77

Health status

The leading cause of ill health and death in children within the State is communicable diseases: malaria, diarrheal diseases, respiratory tract infections and childhood vaccine preventable diseases topped the list. Mothers died frequently from complications of pregnancy and childbirth: anemia, obstetric hemorrhage, obstructed labor, sepsis and other reproductive health problems. Malaria was associated with 70 percent of illnesses in pregnancy and though the use of insecticide treated nets (ITNs) is known to be an effective preventive measure; their utilization is still low in the State.⁷⁷ Kaduna is situated in the epidemic belt of cerebro-spinal meningitis which has the highest fatality rate among the acute diseases. Kaduna’s HIV/AIDS prevalence rate is 6 percent of the population of the State.⁷⁷

CHAPTER FOUR

RESULTS 

Results

This section highlights results obtained from the quantitative analysis of respondents. A total of 379 questionnaires were administered based on the sample size determined and the response rate was 100%. The uni-variate analysis presents frequencies and percentages of their responses. The results are that of the socio-demographic characteristics of respondents, Socio-demographic characteristics of studied children, details of information received on routine immunization and knowledge, perception and practices of respondents on routine immunization. Bi-variate analysis results are presented to show the relationship between the socio-demographic characteristics, knowledge, perception and practices of respondents with the information received on routine immunization within the past 12 months.

CHAPTER FIVE

DISCUSSION

Immunization of children has remained an outstanding preventive measure against vaccine preventable diseases (VPDs) in modern medicine. However, information on routine immunization received by mothers and caregivers may make or mar its successes. Proper communication and dissemination of information on immunization to mother/caregiver cannot be overemphasized. Exclusion of well-planned communication on immunization issues will lead to inadequacy in meeting and sustaining coverage goals in hard-to-reach populations and to indemnify trust in vaccines used in routine immunization in some communities. Access to quality information on immunization by mothers or caregivers has a direct effect on awareness and vaccination rates in several countries where mass media is accessible and widely consumed,^{1, 2} and from other sources.^{13, 22}

The result of this study showed that most respondents are between the ages 30-34years (Mean= 28.6 SD= ±6.6), this was very similar to separate studies conducted in Ahmedabad in India and in southern part of Nigeria where the mean ages were found to be (28.6%) and (27.3%) respectively. ^80,81 Although there was no significant association between maternal age and getting information on RI (CI= 0.97-2.51), the study showed that women older than 28 years had higher chance (OR=1.84) of getting information on RI than the lower age, similar to findings from studies conducted in Sudan and Ibadan.⁸,⁹ respectively. This could be because older mothers have better experience, know the effects and the importance of immunization on children than younger women.

Majority of the respondents practiced Islamic religion (64.64%) and were housewives (64.91%) which contrasted slightly with a study where Muslims were found to be (61.8 %) and housewives (65.6%)²¹. Furthermore, respondents that completed secondary school in this study were (41.95%), married (92.25%) while 52.82% of the respondents reside in rural settlements.

The socio-demographic characteristics of the children indicated that majority of children whose mothers were interviewed were between age 16-19months old (43.01%), females (53.30%) with birth order between 2-5 (62.8%).The sex of the child did not significantly affect the uptake of immunization in this present study and this is similar to other studies.^7,13,14 Sex can predict immunization status only if the child is from a society where gender inequality is prevalent. Birth order could have a close relationship with immunization status but such relationship was not explored in this study.

The educational status of the mothers in the study shows that 66.2 % having no formal education explained the low literacy level of women in the North West.⁴ It is believed that low educational level of women tend to put their children at risk of health hazards.³ Those educated were found to be more likely to have had information on RI than those without education (OR= 2.7) and hence likely to have had their children immunized. This finding was consistent with different other studies, where maternal education was a significant predictor of completeness of immunization because highly educated mothers were found to be more aware of the importance of immunization.^5,6 This study however was in contrast with a study which found no significant relationship between immunization status and mothers‘ educational level. ⁷

The result of this study indicated that majority of the respondents (70.5%) did not get any information on routine immunization. The organization saddled with the responsibility is the National Orientation Agency (NOA) in collaboration with National Primary Health Care Development Agency (NPHCDA) and the Ministry of information. One of its main responsibilities is to provide adequate support to the states and local governments for them to run continuous awareness-building initiatives, as an important aspect of community mobilization.²⁵ Of the few (29.5%) respondents who received information on RI within 12 months prior to this study, only 13.4% of respondents received information on the Schedule of routine immunization in their community. This could have increased the tendency for missed immunization or high dropout rate which might have caused the poor information access and poor immunization coverage. Majority of them (74.1%) got information on the benefits of routine immunization in their communities. This information could have influenced mothers that completed their children’s immunization schedule to do so (OR=6, CI=3.60-11.50). The finding is similar to a study carried out in Turkey.⁸² However, the information on the benefits of immunization alone may not be sufficient to achieve the desired coverage needed in the state. Poor impact of grassroots awareness-creating interventions in the studied communities is reflected in the limited knowledge and understanding of immunization amongst parents.²⁵

On the sources of information 12 months prior to this study, majority (61.61%) got information from radio. This could be explained based on the fact that a significant proportion (52.8%) of respondents are rural dwellers who most often than not rely on radio as a means of getting information concerning the outside world. This influenced their likely hood of higher participation in getting RI information (OR= 1.76, CI= 1.1-2.8) than the semiurban respondent. Awareness through the radio and television have increased vaccination rate in several countries where mass media is accessible and widely accessed as seen in two separate studies.^{83, 84} This result is however not consistent with the finding in a research which showed that about 65% of women got their information on routine immunization at the antenatal clinics.⁴⁷ Our result did not reflect the role of health facility/health care workers in the provision of quality information on RI when compared with a study where it was observed that awareness of RI may be attributable to the quality of information provided to mothers at the health facilities.⁶⁵

Utilization of available information on immunization was better achieved by the currently married women (29.6%) from this study. There was a statistical association (p= 0.38) between women currently married and living with their husbands than those that are not. It could possibly be explained by the fact that majority of those interviewed were housewives (64.9%) and their husbands gives them moral support and possibly provide the means of getting information on routine immunization like the radio, television or even transportation fare to the health facilities.⁸³

Mother’s knowledge about immunization was found to be a predictor of full immunization in urban and rural areas of Nigeria^47,.⁶⁴ The results of this study showed that over all, only 35.6% of respondents have knowledge on routine immunization. This is similar to a study where maternal knowledge on immunization was also low (34%).²⁵

Conclusion

Access to quality information on immunization by mothers or caregivers has a direct effect on awareness and vaccination rates. This study found majority of children whose mothers were interviewed were between age 16-19months old (43.01%), females (53.30%) with birth order 2-5 (62.80%).

Majority of respondents have unsatisfactory knowledge (64.4%) and perception (55.4%) towards routine immunization and analysis proved that mother’s educational status, family setting, knowledge, perception and practices about immunization are important factors that influence access to RI information which are ultimately predictors of full child immunization. This study found the main source of information within 12 months prior to study to be via radio.

Accepting polio vaccine during campaigns and not routine immunization, taking concoctions and praying in place of vaccine, delivering outside the hospital setting and not completing immunization schedule were some of the bad practices of majority (54%) of mothers/caregivers in Kaduna State. This also was found to be associated with poor access to information on immunization.

Recommendation

The following recommendations were made based on the findings from this study.

General recommendations NPHCDA government should: Re-strategize methods of creating awareness to change bad perceptions and practices on RI among people of the state.

Specific recommendation

1. The Kaduna State Ministry of Education and Agency for Mass Education should collaborate to improve the literacy level of the people
2. State Ministry of Education should create convenient adult education classes to improve educational status of mothers
3. Kaduna State government should divert resources specially for girl-child education in the state
4. It is recommended that all Health Centers and Health Personnel should encourage and educate the parents about the values and benefits of the vaccination and vaccine preventable diseases and its consequences to children’s health
5. Kaduna state government, through the Ministry of Information should intensify sensitization of mothers/caregivers to improve their knowledge on Routine Immunization through Radio and Television jingles
6. Local government authority should provide the parents with some health information by distributing printed materials such as brochures, pamphlets and leaflets in local languages.

REFERENCES

1. WHO/IVB. Periodic Intensification of routine immunization: Lessons Learned and Implications for Action 2009: 3-12. who.int/vaccines-documents accessed 16/7/14.
2. Bond L., Nolan T., Pattison P., and Carlin J. Vaccine preventable diseases and immunizations: A qualitative study of mothers‘ perceptions of severity, susceptibility, benefits and barriers. Australian/New Zealand Journal of Public Health 1998; 22 (4): 441-6.
3. Bukenya, G .B. & Freeman, P. A. Possible reasons for non-completion of immunization in an urban settlement of Papua New Guinea. Papua New Guinea Medical Journal 1991; 34(1): 22-5.
4. Eng E., Naimoli J., Naimoli G., Parker K.A., and Lowenthal N. The acceptability of childhood immunization to Togolese mothers: A sociobehavioral perspective. Health Education Quarterly 1991; 18 (1): 97-110.
5. Khanom, K. and Salahuddin, A. K. A study of an educational programme on immunization behavior of parents. Bangladesh Medical Research Council Bulletin 1983; 9:18-24.
6. Waisbord, S. & Larson, H. Why Invest in Communication for Immunization: Evidence and Lessons Learned. A joint publication of the Health Communication Partnership based at Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (Baltimore) and the United Nations Children’s Fund (New York), June, 2005.
7. Greenough, P. Global immunization and culture: Compliance and resistance in largescale public health campaigns. Social Science & Medicine 1995; 41 (5): 605-607.
8. Offit P.A. & Coffin S.E. Communicating science to the public: MMR vaccine and austim. Vaccine 2003; 22(1):1-6.
9. Clements C.J. & Ratzan S. Misled and confused? Telling the public about MMR vaccine safety; Measles, mumps, and rubella. Journal of Medical Ethics 2003; 29(1):22-6.
10. WHO/AFRO. Immunization Systems Support, 2009-2012 http://www.afro.who.int/en/clusters-a-programmes/iss.html accessed 15/06/14.
11. WHO Recommendations for Routine Immunization: A User’s Guide to the Summary Tables, Updated 4th October 2012.
12. National Population Commission (Nigeria) and ORC Macro. Nigeria Demographic and Health Survey 2008. Calverton, Maryland: USAID; 2009: 20-22.

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