ABSTRACT
Immunization 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. This present study aimed to assess the mothers’ knowledge, attitude and practice regarding immunization of under five children attending antenatal clinic in Ahmadu Bello University Teaching Hospital (ABUTH) in Sokoto State, towards childhood immunization. This descriptive cross-sectional study involved 180 mothers attending antenatal clinics in ABUTH. The results showed that almost all (98.9%) the respondents were aware of immunization and that immunization could prevent childhood illness (97.2%). majority of the respondents believe immunization is important (98.9%). (89.4%) of respondents indicated that vaccines are not harmful. All the respondents had positive attitude towards immunizing their children of under 5years of age and almost all the respondents’ (99.4%) will advise others to immunize their children below 5 years of age. shows that (88.9%) had excellent practice on immunization. Although the percentage of mothers who completed immunization of their children was high, there’s still room for improvement as a strong policy will in addition to a general improvement of health care services could bring about a better result. I 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. The government should also work with health personnel to set up supplementary vaccination programmes 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.
TABLE OF CONTENTS
TITLE PAGE …………………………………………………….…………………………………..……i
CERTIFICATION ii
DECLARATION iii
DEDICATION iv
AKNOWLEDGEMENT v
ABSTRACT vi
CHAPTER ONE
1.0 INTRODUCTION 1
1.1 BACKGROUND OF STUDY 1
1.2 STATEMENT OF THE PROBLEM 4
1.3 SCOPE OF STUDY 5
1.4 RESEARCH QUESTIONS 5
1.5 RESEARCH OBJECTIVE 6
1.6 OPERATIONAL DEFINITION OF TERMS 6
CHAPTER TWO
LITERATURE REVIEW 7
2.1 OVERVIEW 7
2.1.1 BRIEF HISTORY OF IMMUNIZATION IN NIGERIA. 8
2.1.2 VACCINE AND VACCINATION 9
2.1.3 TYPES OF VACCINES 9
2.1.4 MECHANISM OF ACTION 10
2.1.5 VACCINE PREVENTABLE DISEASES. 10
2.1.6 NATIONAL IMMUNIZATION PROGRAMME. 11
2.1.7 ROUTINE IMMUNIZATION SCHEDULE 11
2.2 EMPIRICAL STUDIES 14
2.2.1 KNOWLEDGE OF IMMUNIZATION 14
2.2.2 ATTITUDE TOWARDS IMMUNIZATION 16
2.2.3 PRACTICE AND DETERMINANTS OF IMMUNIZATION UTILIZATION 17
2.3 THEORITICAL FRAMEWORK 18
CHAPTER THREE
METHODOLOGY
3.1 INTRODUCTION 21
3.2 RESEARCH DESIGN 21
3.3 RESEARCH SETTINGS 22
3.4 TARGET POPULATION 22
3.5 INCLUSION AND EXCLUSION CRITERIA 23
3.6 SAMPLE SIZE CALCULATION 23
3.7 SAMPLE AND SAMPLING TECHNIQUE 25
3.8 INSTRUMENT FOR DATA COLLECTION 25
3.9 VALIDITY OF THE INSTRUMENT 26
3.0 RELIABILITY OF THE INSTRUMENT 26
3.11 METHOD OF DATA COLLECTION 26
3.12 METHOD DATA ANALYSIS 26
3.1.3 ETHICAL CONSIDERATIONS 26
CHAPTER FOUR
RESULTS
4.0 INTRODUCTION 28
4.1 SOCIODEMOGRAPHY 28
CHAPTER FIVE
DISCUSSION
5.0 INTRODUCTION 35
5.1 DISCUSSION 35
5.1.1 KNOWLEDGE OF IMMUNIZATION 35
5.1.2 ATTITUDE TOWARDS IMMUNIZATION 36
5.2.3 UTILIZATION OF IMMUNIZATION AND ITS DETERMINANTS 37
5.3 IMPLICATION OF THE STUDY TO NURSING 38
5.4 LIMITATIONS 38
5.5 SUMMARY 39
5.6 CONCLUSION 40
5.7 RECOMMENDATIONS 40
5.8 SUGGESTION FOR FURTHER STUDIES 41
REFERENCES 42
Appendix I 47
LIST OF TABLES
Table 1: Immunization schedule…………………………………………………………..……..12
TABLE 4.1: Sociodemographic Data of the Respondents …………………..............................28
Table 4.2: Respondents’ General Knowledge on Immunization………………………………..29
TABLE 4.3: Respondents’ Score on Knowledge Regarding Vaccination……………………31
Table 4.4: Attitude of respondents towards immunization……………………………………...31
Table 4.5: Attitude of respondents’ family and friends towards immunization………………...32
Table 4.6:Respondents’ Overall Score on Attitude Regarding Immunization………………….33
Table 4.7: Respondents Practice Regarding Immunization…………………………………….33
Table 4.8: Respondents overall score on practice of immunization……………………………34
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF STUDY
Immunization is a modern miracle it has saved millions of lives worldwide and its origin dates back ancient Greece. In the 14th century the Chinese discovered and used a primitive form of vaccination called variolation. The aim was to prevent small pox by exposing healthy people to tissue from the scabs caused by the disease this is the first recorded attempt at vaccination (National Health Service NHS, 2016).
The British physician Dr Edward Jenner in 1796 discovered vaccination in its modern form and proved to the scientific community that it worked. He was considered the founder of vaccinology in the west after he inoculated a 13year old boy with vaccine of a virus (cow pox) and demonstrated immunity to small pox. By 1798, the first small pox vaccine was developed(The University of Auckland, 2015).
Immunization is the most effective method of preventing infectious diseases(Bruce Gellin, 2000) Widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the restrictions of disease such as polio, measles and tetanus (World health organization WHO, 2016).
Generally immunization involves stimulating immune responses with infectious agents, i.e. priming the immune system with an immunogen with the intention of creating specific resistance to an infectious disease. Simply put, a process by which an individual’s immune system becomes fortified against an agent (WHO, 2016).
Immunization is done through various techniques, most commonly vaccination and is definitely less risky and an easier way of being immune to a particular disease than risking a milder form of the disease itself. They are important for both adult and children because of the protection it confers. Immunization not only confers immunity but helps in developing child’s immune system. Immunization could be passive or active.
Active immunization can occur naturally or artificially. Naturally occurring active immunization is when a person comes in contact with an organism. The immune system essentially creates antibodies against the microbe, making it more efficient in the next exposure. Artificially active immunization is where the microbe or part of it are injected into the person before they are able to take it natural (Elizabeth, 2015).
Passive immunization is where pre synthesized elements of the immune system are transferred to a person so that the body does not need these elements itself. It can occur physiologically, transferred from mother to foetus during pregnancy. Passive immunity can also be artificial and it’s administered by injection especially if a recent outbreak of a disease has occurred(Yobot, 2016).
Immunization can prevent infectious diseases in an individual, restrict the spread of diseases and may ultimately eradicate the disease in the community. It represents the remarkably successful and cost-effective means of reducing infectious diseases and thereby decreasing the morbidity and mortality in infants and children(Iroha, Azubike&Nkanginieme, 2007).
According to an estimation made by WHO, vaccination annually prevents 2-3 million deaths of children from diphtheria, tetanus, pertussis and measles, a million alone due to measles vaccination in particular. It is believed that an additional 1.5 million deaths will be avoided if global vaccination coverage improves. (Iroha, Azubike&Nkanginieme, 2007).
Siddiqi et al., (2010) concluded that mothers’ knowledge about Expanded Program on immunization (EPI) vaccination in Nigeria was quite low and not associated with their children’s EPI coverage. Mothers’ educational status, however, was significantly associated with child’s coverage. This finding depicted a better health seeking behaviour of a more educated mother. According to Angelilioet al., (2010), several studies on the immunization status of children have been published in various countries at different times, and comparisons with these studies are interesting but must be made cautiously. They also stated that since many factors may influence vaccination coverage, important differences should be taken into account, such as prevalence of vaccine-preventable diseases, availability of vaccination centre’s, level of knowledge and information about vaccination, and different methods used to measure immunization status.
The attitude of most mothers towards immunization services in Nigeria is positive and relies on the efficacy of the vaccine to protect against disease there was a poor attitude towards polio immunization among respondents who believe that it contains anti-fertility agents. Decision-making on immunization of a child lies predominantly on the father and, if vaccination was rejected because of rumors and the priority accorded to parent's preference to more severe diseases (Falade&Bankole, 2014).
Mothers' knowledge, attitude and practice play an important role in achieving complete immunization before first birthday of the child, the previous parent factors are also contributing to success or failure of immunization program,knowledge attitude, and practice studies provide information about the people’s awareness of certain topics, their feelings and their practices (Qutaiba, et al, 2014).
1.2 STATEMENT OF THE PROBLEM
The global burden constituted by vaccine preventable disease is immense. Worldwide about 2.5 million children die every year from vaccine preventable infectious disease mainly in Africa and Asia among children less than 5 years old. In the year 2000, measles alone resulted in 777,000 deaths and 2 million disabilities(United Nations Children Fund UNICEF, 2016; WHO, 2016). Financial commitment towards immunization would amount to an estimate of 3 billion dollars per year in the next 10years with UNICEF investing 56% of its health funds(UNICEF, 2016).
According to WHO 1.5 million children under the age of 5 died from vaccine preventable diseases in 2008 reported globally (WHO, 2014). Every year more than 10 million children in low and middle income countries die before they reach their fifth birthdays. Most die because they do not access effective interventions that would combat common and preventable childhood illnesses(Lee, 2003). Vaccine preventable diseases remain the most common cause of childhood mortality with an estimated three million deaths each year (Odusanya, Alufohai, Meurice&Ahonkha, 2008).
Vaccine preventable diseases remain one of the major causes of illnesses and deaths among children in Nigeria and this country is one of the few remaining countries in the world where polio is still endemic. The WHO Global Polio Eradication initiative 2005 Annual Report cited uncontrolled transmission of poliovirus in northern Nigeria and identified the states of Bauchi, Kaduna, Jigawa, Kano and Katsina as the greatest threat to the global eradication of Polio. Nigeria accounts for half of the deaths from Measles in Africa, the highest prevalence of circulating wild poliovirus in the world and the country is among the ten countries in the world with vaccine coverage rates below 50 percent, having been persistently below 40 percent since 1997(Schimmer, Ihekweazu, 2006). In Nigeria, one child in five dies before its fifth birthday and vaccine preventable disease account for 22 percent of deaths(Batters, 2005).
Immunization coverage in ABUTH is relatively low as in many other places. As part of the Child Survival Programme, the EPI (Expanded Programme on Immunization) was created in 1974 by WHO and UNICEF and the Rotary International as partners. Since it’s launching over sixty countries have adopted the programme and others are being constantly added to the list. All of whom are laying emphasis on EPI as a building block for Primary Health Care. Its aim is assisting all nations to carry out immunization of their 0-2 year child population against vaccine preventable communicable and dangerous diseases of childhood. The attempt by the Nigerian government to make the program come alive by renaming it as NPI has been met with certain challenges due to lack of community participation, lack of motivation by mother and vaccine availability (Tagbo, Onwuasigwe, 2005).
1.3 SCOPE OF STUDY
The study was not limited to assessing the knowledge, attitude and practice regarding immunization of under five children among mothers attending antenatal clinic in ABUTH, but also to determine the factors and reasons why these children are not being immunized with the available vaccines and assessment of the children who are up to date with their immunization schedule. The research was done within the confinements of the hospital with the mothers being the direct point of contact.
1.4 RESEARCH QUESTIONS
1. What is the level of knowledge regarding immunization among mothers of under-five children attending ANC at ABUTH?
2. What is the perceived attitude towards immunization among mothers of under five children attending ANC at ABUTH?
3. What is the level of utilization of immunization by mothers of under five children attending ANC at ABUTH?
4. What are the factors /reasons affecting utilization of immunization by mothers of under five children attending ANC at ABUTH?
1.5 RESEARCH OBJECTIVE
1. To determine the level of knowledge regarding immunization among mothers of under-five children attending ANC at ABUTH.
2. To determine the perceived attitude towards immunization among mothers of under five children attending ANC at ABUTH.
3. To assess the level of utilization of immunization by mothers of under five children attending ANC at ABUTH.
4. To determine factors /reasons affecting utilization of immunization by mothers of under five children attending ANC at ABUTH.
1.6 OPERATIONAL DEFINITION OF TERMS
Attitude: thinking or feeling about immunization by mothers.
Knowledge: facts, information, and skills of immunization acquired through experience or education by mothers.
Perception: the ability of mothers to see, hear, or become aware of immunization.
Immunization: is the act of protecting under five children from infection by administration of vaccine.
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