FACTORS INFLUENCING THE UTILISATION OF IMMUNISATION SERVICES IN AKINYELE LOCAL GOVERNMENT AREA, OYO STATE
ABSTRACT
Improving coverage of immunisation is a key component of programmes for reducing childhood morbidity and mortality. Despite several resources committed, Akinyele Local Government Area (LGA) had low immunisation coverage of 28% of OPV-3 as at October 2007 when the study was conducted. The factors contributing to these problems were yet to be fully explored. This study was therefore designed to assess the factors influencing utilisation of immunisation services in Akinyele LGA, Oyo State.This descriptive study involved random sampling of 500 mothers of children under 5 years from Primary Health Care (PHC) facilities in all of the 12 wards of the LGA. Data were collected using validated questionnaire. These services consisted of availability of vaccines, adequate manpower, maintenance of cold-chain, awareness and advocacy among others. Also, six Focus Group Discussions (FGDs) were conducted with the nursing mothers and caregivers. Descriptive statistics, Chi-square test was used to analyse the quantitative data at p≤0.5 while information obtained through FGDs data were subjected to content analysis.The respondents’ mean age was 29.6±7.6 years. About 43% of the respondents had secondary school education. Majority (95.4%) of the respondents had heard about childhood immunisation. The percentage of respondents whose children had completed their children’s immunisation, those that did not complete and those that did not receive immunisation at all were 28.0%, 64.0% and 8.0% respectively. Prominent sources of Vaccine Preventable Diseases (VPDs) immunisation information among those ever used respondents were Primary Health Centres (62.2%), State Hospital (27.4%), Mobile Clinic (24.1%) and tertiary health institutions (5.2%). Utilisation of immunisation services according to the respondents’ level of education was non-formal (54.3%), Arabic (60.0%), primary (57.7%), secondary (71.8%) and tertiary education (80.8%). The main sources of information on completion of immunisation schedule were immunisation card (75.5%), information from health workers (56.2%), mass media (29.2%) and neighbours/family members (23.3%). The major reasons adduced by the 64.0% of respondents for non-completion of immunisation schedules were report sickness of the children (45.7%) and forgetfulness of the mothers (26.8%). Fear of side effects and religious beliefs were responsible for non-acceptance of immunisation by the respondents who did not receive immunization at all. The respondents who took part in the FGD said the
major reasons for not receiving full immunisation were fear of side effects, lack of presence of health workers during immunisation.Despite the high percentage of children that received immunisation services, non- chalant attitude by mothers, fear of side effects, religious beliefs and level of education are the major factors that influenced the utilisation of immunisation services. Health education strategies such as public enlightenment, community mobilization and advocacy may be needed to address the problem.
TABLE OF CONTENTSPagesTitle Page - iDedication - iiAbstract - iiiAcknowledgement - vCertification - viiTable of Contents - viiiList of Tables - xiList of Figures - xiiList of Appendices - xiiiAccronyms used in the study - xivCHAPTER ONE: INTRODUCTIONBackground Information 1Statement of Problem - 2Justification of the Study - 3Research Questions - 4Broad Objective - 4Specific Objectives - 4Research Hypothesis - 5CHAPTER TWO: LITERATURE REVIEW - 6History of Immunization - 6Nature of Immunization and vaccination - 7Types of Immunization - 8Active Immunization - 8Passive Immunization - 9Naturally acquired passive immunity - 9Artificially acquired passive immunity - 10Childhood Immunization Programme - 10Vaccine preventable childhood diseases - 11Poliomyelitis - 11Diphtheria - 12Measles - 12Tetanus - 13Tuberculosis - 14Pertussis - 14Polio Eradication Campaign - 18Factors Influencing Eradication - 18Strategy - 18Immunization Activities in Nigeria - 19Immunization activities in Oyo State - 21Conceptual frame work - 24CHAPTER THREE: METHODOLOGY - 29Study Design and Scope - 29Description of study Area - 29Populations - 30Study Population - 30Target Population - 30Eligibility Criteria - 30Sample Size Calculation - 30Sample Selection Procedure - 31Instruments for Data Collection - 36Qualitative Method - 36Quantitative Method - 37Validity and Reliability - 37Training of research Assistants - 38Data collection - 38Data Analysis - 38Qualitative Data Analysis - 38Quantitative Data Analysis - 39Ethical considerations - 39Limitations of the study - 39CHAPTER FOUR : RESULTS - 41
Socio demographic Characteristics - 41Awareness/Knowledge about Immunization - 44Respondents’ perceptions about immunization and immunization schedules - 47Timeliness/Status of Immunization - 49Experience of side effects of immunization - 57Factors that hinder acceptance of immunization - 60Findings from focus group discussions - 63Findings from Key Informant Interviews - 67CHAPTER FIVE: DISCUSSION - 69Socio Demographic Characteristics - 69Knowledge and Awareness about Immunization - 70Perceptions about Immunization services and Status of Immunization 71Factors that encourage/discourage mothers to get their children Immunized 71
Implications for Health Education - 73Conclusion - 75Recommendations - 75References - 77Appendices - 84
CHAPTER ONE INTRODUCTION1 Background InformationImmunization remains one of the most important public health interventions and a cost effective strategy to reduce both the morbidity and mortality associated with infectious diseases. Over two million deaths are delayed through immunization each year worldwide. Despite this, Vaccine Preventable Diseases (VPDs) remain the most common cause of childhood mortality with an estimated three million deaths each year (Atkinson, Hamborsky, McIntyre and Wolfe, 2009). Uptake of vaccination services is dependent not only on provision of these services but also on other factors including knowledge and attitude of mothers (Mastsumura, Nakayama, Okamoto and Ito, 2005) density of workers, accessibility to vaccination posts/clinics and availability of safe needles and syringes.Research has shown that children who are not immunized on time are likely to be poor, live in rural areas, and be members of racial and ethnic minority groups (Wood and Halfon, 1996). Other identified risk factors associated with immunization rates below National averages includes low parental educational levels, inability to access appropriate transportation, single-parent family, lack of parental care and a late start on the vaccination series (Pruitt, Kline and Kovaz, 1995).Several reasons are cited in the literature for parental refusal of child vaccinations, including erroneous beliefs about contra-indications, not wanting to expose children to perceived dangers of vaccines, and not wanting to deliberately expose healthy children to diseases (Bedford 2000-cited in Frederickson et al 2004). In addition, studies focusing on vaccine decision making have found that parents may prefer to make errors of omission (bad outcomes due to lack of action) rather than error of commission (bad outcomes due to action) and that they may find it easier to accept “natural” risk rather than “man-made” risks (Meszaros et al., 1996).Parents cognitive processes, specifically their perceived ability to control their child’s susceptibility to the disease and the outcome of the disease, as well as doubts about the reliability of vaccine information, have also been noted as reason some parents forgo some childhood vaccines (Meszaros et al., 1996). Other studies note some mothers disagreed with
the practices of conventional medicine. Out of this group, some believed in “natural healing” and thought it is better for children to be exposed to the diseases and get over them naturally (Stein and Martin, 2001). Others refused based on religion convictions (Bonnie et al., 2009). Some parents and groups view compulsory vaccination as unnecessary infringements on individual rights (Fredrickson et al. 2004). Providers need to be aware of these concerns and develop strategies to effectively respond to each group of parents.
1 Statement of problemIn Nigeria, the National Programme on Immunization (NPI) formerly called the Expanded Programme on Immunization (EPI) was launched in 1979. The Nigerian National Programme on Immunization (NPI) schedules are BCG, OPV0 and HBV1 given at birth (also called first dose); DPT1, OPV1 and HBV2 given at 6 weeks (second dose); DPT2 and OPV2 given at 10 weeks (third dose); DPT3, OPV3 and HBV3 given at 14 weeks (fourth dose) and Measles and Yellow fever at 9 months (Odusanya et al., 2008,). Several resources have been committed to the implementation of the NPI that consist of two strategies namely the Routine Immunization which is the vaccination given at service centers (fixed post) and Supplemental Immunization Activities (SIAs) which are vaccination activities done at mobile / outreaches and house – to – house. These activities are sponsored by both the Nigerian Government and International donor agencies which include World Health Organization (WHO), United Nations Children Education Fund (UNICEF), USAID, and Rotary International just to mention but few.However, despite these efforts, 4.7 millions Nigerian children still die from Vaccine Preventable Diseases (VPDs) as a result of low immunization coverage (WHO Bulletin 2003). Oyo State, located in the South Western region of the country, has never attained the national average target of 75% in the last three years (Awosika, 2003). In 2007, the State was reported to attain a coverage rate of 32% due to a number of factors including poor outreaches, poor documentations and inadequate sessions to cater for the population of children less than one year of age (WHO Data report 2007, unpublished).Moreover, resurgences of vaccine preventable diseases in Oyo State was becoming a thing of the past until a case of Wild Polio Virus type 1 was reported in Akinyele Local Government Area of Oyo State in 2007. Despite the concern raised about the challenge, no
study has been conducted to identify factors that may be responsible for not complying with recommended immunization schedules in the affected LGA. Hence, this study was conducted to fill this gap.However, much data are available on the phenomenon of under utilization of immunization services by children in Nigeria. Many studies have been conducted in different population using various methods to assess immunization levels and to examine barriers to immunizations. These studies were conducted using diverse population ranging from urban to rural. Though these studies were conducted outside Oyo State and focus more on the perspective of the consumers, the providers and program planners in Akinyele Local Government Area of Oyo State.
1.3. Justification of the studyImproving immunization coverage is a key strategy in reducing infant and under-five mortality rates. Therefore, providers and policy-makers need to be aware of factors influencing immunization coverage at the individual and programmatic levels, which this study aims at identifying in Akinyele Local Government, where 6 years ago case of Polio was reported. It is by looking at the programmatic and non-programmatic factors influencing immunization for children that appropriate interventions may be developed to address the problem.Assessing immunization coverage helps to evaluate progress in achieving program objectives and in improving service delivery (Stock, 1983). In addition, evaluation of immunization coverage provides evidence whether substantial progress towards achieving vaccination targets is being made. Such positive evidence is required as feedback and for continuing support from donor-supported initiatives like the Global Alliance for Vaccine and Immunizations (GAVI).Moreover, available data from the Federal and State Ministry of Health only give information about coverage without detailed information about factors responsible for the coverage. Thus, it was decided to assess the immunization coverage of children aged 12-23 months in the LGA and to identify the determinants of full immunization status. This is likely to help in identifying maternal characteristics that could be predictive of immunization coverage and lead to improvement in services.
An educational diagnosis of factors influencing immunization for children would help to identify areas that communications messages should address as well as choice evidence- based strategies for improving coverage and appropriate remedial steps for maintaining public confidence in immunization programme.Thus, this study is significant in that the findings may help to effect necessary changes in order to boost the routine immunization services by nursing mothers. It is also hoped that through this study, growth of health care delivery system at the various LGA Health centers will be achievement of health for all and reduced infant and maternal morbidity and mortality rates. Furthermore, it is hoped that this study will increase the awareness of nursing mothers on utilization and administration of the immunization programme.
1.4 Research questionsThis study will provide answers to the following research questions:1. What knowledge do mothers and caregivers have about childhood immunization services in Akinyele LGA of Oyo State?2. What is the status of immunization services for children between the ages of 12-23 months within the selected populations?3. What factors contribute to compliance and non-compliance with recommended immunization schedules for children?4. How can the coverage of immunization services for children within the LGA be improved?
1.5 Broad objectiveThe aim of the study is to identify factors contributing to the poor coverage of childhood immunization services in Akinyele Local Government Area of Oyo state.1.5.1 Specific objectivesThe specific objectives of the study are to:1. Assess mothers’ and caregivers’ knowledge and perceptions of immunizations and childhood killer diseases in Akinyele LGA of Oyo State.2. Assess immunization status of children 12-23 months in the selected populations.
3. Identify factors influencing compliance with recommended immunization schedules for children.4. Make recommendations for improving coverage of immunizations for children based on the findings of the study.
1.6 Research hypotheses1. There is no significant difference between demographic characteristics of mothers and knowledge about immunization.2. There is no significant difference between mother’s knowledge of immunization and coverage of immunization.3. There is no significant difference between demographic characteristics of parents and immunization status of children in the study area.
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