Effects of Socioeconomic and Geographical Factors in the Utilization of Immunization Services in Three Selected Local Government Areas of Anambra State, Nigeria
Chapter One
OBJECTIVES OF THE STUDY
General Objective
The general objective of this study is to identify socioeconomic and geographical factors which affect the utilisation of immunisation services in Anambra State.
Specific Objectives
The specific objectives of the study are to:
- Identify the social, economic and geographical pattern of people requiring immunisation services in Anambra
- Assess the effect of social, economic and geographical factors on immunisation uptake.
- Identify factors hindering or fostering immunisation in the State.
CHAPTER TWO
LITERATURE REVIEW
A REVIEW OF IMMUNISATION ACTIVITIES IN ANAMBRA
Immunisation remains one of the cheapest and most cost effective means of protecting the masses from vaccine preventable diseases.
It has been widely employed in the prevention and control of epidemic and endemic diseases in Nigeria since 1956.
National Programme on Immunisation is the parastatal saddled with the responsibility of immunisation in Nigeria.
Another parastatal, the National Primary Health Care Development Agency (NPHCDA), has responsibilities in immunisation. The Anambra State office of the NPI oversees immunisation activities in the state. Routine Immunisation (RI) is the major focus of the NPI.
It has a schedule in Nigeria for the full immunisation of every child before the age of one. Nigeria’s immunization schedule contains tetanus toxoid (TT), BCG, Hepatitis B vaccine (HBV), OPV, DPT, measles, cerebro-spinal meningitis vaccine (CSM) for types A and C, and yellow fever (YF).
CSM is administered in an annual campaign in susceptible areas in the north of Nigeria, to age groups which vary according to the quantity of vaccine supplied.
Apart from the RI, the NPI employs supplemental immunisation to enhance immunisation coverage. This is seen in the Polio Eradication Initiative (PEI). National activities for polio eradication started in 1996, and the global effort to eradicate polio has made PEI National Immunisation Days (NIDs) and Sub-NIDs the main focus of NPI’s attention since 1998.
“One of the problems with NIDs is that it tends to undermine the importance of the routine immunization. The publicity given to NIDs usually makes the routine look like it is non-existent. However, recently RI has received some attention in Nigeria through the series of trainings of health workers in RI by European Union Partnership to Reinforce Immunisation Efficiency (EU-PRIME) in 18 states of the federation including Anambra state. Cases of polio genetically linked to the wild polio virus is endemic in Nigeria. This has recently been discovered in Enugu State which is a close neighbour to Anambra state.
This WPV has been found not only in 13 African countries but also in Indonesia and Yemen.
In spite of the considerable efforts that have been put into immunisation programme in Nigeria, immunisation uptake remains generally low in the country, especially in the northern states. Each year, thousands of children die or are maimed for life as a result of diseases that are preventable through immunisation. Preliminary results from the 2003 Demographic and Health Survey (DHS) revealed a DPT3 coverage rate of 21% among children aged 12 – 23 months. Moreover, Nigeria remains one of the few reservoirs of polio around the world. Data for 2003 shows that with 347 cases, Nigeria has the highest number of children paralysed by the poliovirus.
FACTORS THAT AFFECT UTILISATION OF IMMUNISATION SERVICES.
In 2004 survey on the individual and community factors affecting the uptake of immunization in four northern and two southern states of Nigeria, a total of 7200 respondents, mostly women with under-5 children, were interviewed. One finding from the survey is that there is a strong correlation between household poverty level (measured in terms of the socio-economic status of the household) and the prevalence of full immunization.
The paper also explored the mediating role of mother’s decision-making power in this relationship. It was deduced that the stronger the mothers decision-making power, the higher the likelihood of full immunisation. The woman’s decision-making power was measured through a set of questions that assessed the woman’s contribution to specific household decisions.
This study by Babalola showed that poverty is likely to distract parents from placing high premium on disease prevention as is the case in immunisation. This must be due to the pressure on the family scarce resources hence giving the men and women no chance to think about essentials like immunisation. This study clearly showed that the lower the socio-economic class, the less likelihood for full immunisation. Furthermore, the study showed that spousal communication around child immunization significantly is a function of education, socio-economic status and exposure to immunization-related information on the media or through community sources. Specifically, spousal communication increases steadily with the woman’s education such that the women least likely to report discussion with their spouse are the illiterates. Exposure to immunization related information is associated with increased spousal communication, indicating that the information obtained served as a point for discussion about immunization among spouses.
CHAPTER THREE
MATERIALS AND METHODS
STUDY AREA
The area for this study is three Local Governments in Anambra State; Njikoka, Aguata and Ogbaru. Anambra State is in the south-eastern zone of Nigeria. Anambra people are predominantly of the Igbo tribe. It is in the rain forest region. The state has total population estimated at 5 million. There are 21 local governments in the state with Awka as the state capital. There are urban, semi-urban and rural LGAs in the state. For the purpose of this study, three LGAs have been selected.
NJIKOKA LGA
Njikoka Local Government Area was created in 1976 and it is one of the twenty one LGAs in Anambra state with headquarters at Abagana. It is bound in the North by Awka North LGA and Awka South LGA and in the South by Dunukofia LGA. It has a target population for routine immunization for children under the age of one and pregnant women as 6,276 and 7,845 respectively and a total population of 156,895 from the 2006 census. It is classified as semi urban LGA of the state and is occupied by mostly Igbos. They are predominantly traders. The indigenes are mainly Christians with Roman Catholic and Anglican adherents dominating others. Njikoka Local Government Area is made up of 7 districts, 18 political wards and 93 settlements.
There are 22 health facilities that provide routine immunization in Njikoka LGA.
CHAPTER FOUR
RESULTS
300 questionnaires were distributed but 285 were appropriately filled and returned from the field, therefore the response rate was (285/300 X 100%) = 95%
Table 1: Socio-demographic characteristics of respondents
CHAPTER FIVE
DISCUSSION
The study was conducted on the socio-economic and geographical differentials in the utilization of immunization services in Anambra State of Nigeria. A total of three local government areas were studied under the following socio-demographic parameters; age group, educational level, marital status, occupation and husband’s occupation.
Findings from this study showed that the husbands’ decision (40.4%) was the factor that most often prevented a child’s immunisation. This showed the role of the husband in the Igbo family system. Critical decisions in a family are usually the sole responsibility of the husband. There are, however, some variations in cases where the woman is well educated or the bread winner of the family. In 2004 survey on the individual and community factors affecting the uptake of immunization in four northern and two southern states of Nigeria, a total of 7200 respondents, mostly women with under-5 children, were interviewed. The paper explored the mediating role of mother’s decision-making power in this relationship. It was deduced that the stronger the mothers decision-making power, the higher the likelihood of full immunisation. The woman’s decision-making power was measured through a set of questions that assessed the woman’s contribution to specific household decisions.
CHAPTER SIX
CONCLUSION AND RECOMMENDATIONS
CONCLUSIONS
- Husband’s decision is the most important factor that prevents a child’s immunisation.
- Health workers’ attitude is the biggest factor that deters mothers from going back for further immunisation after an initial immunisation
- Educational level has no association with adherence to immunisation schedule in Anambra State unlike
- Mother’s occupation has a direct association with adherence to immunisation schedule
- Geographical location has direct association with adherence to immunisation schedule. People in urban areas are more likely to be fully immunised than people in rural areas.
RECOMMENDATIONS
- A more detailed study should be done to analyse the husband decision factor as it affects immunisation of a
- Further study should be carried out on the effect of educational level on immunisation in Anambra
REFERENCES
- National Programme on Immunisation (NPI). Basic Guide for Routine Immunizationservice providers, 2nd edition, Abuja, Amana publishers,
- Awosika A. Boosting Routine Immunization in Nigeria: issues and proposed action points, power point presentation developed by NPI and BASICS, Abuja, September
- National Programme on Immunisation (NPI). National Immunisation coverage survey, Abuja,
- World Health Organisation (WHO). Global Summary on immunization,who.int/vaccines/globalsummary/immunization/countryprofileresult.cfm(accessed 20th March 2009)
- Babalola S O. Poverty and immunization coverage in Nigeria: the mediating role of mothers’ decision making power, a presentation at the 133rdannual meeting and exposition of American Public Health Association10th – 14th December 2005, Philadelphia, PA,
- Jegede A S, Idemudia E, Madu S Factors affecting access to health information among Nigerian nursing mothers. Research for Development, 2004 vol 6 pg15.
- Oluwadare C. The social determinants of routine immunization in Ekiti State Nigeria, department of sociology, University of Ado Ekiti, Ado Ekiti, Nigeria. 2005, vol 3 pg
- National population commission (NPC). Nigeria demographic and health survey 2003, Abuja,