Level of Community Engagement in Routine Immunization Service Delivery in Kiyawa Town Jigawa State

Level of Community Engagement in Routine Immunization Service Delivery in Kiyawa Town Jigawa State

Chapter One

General and Specific Objectives

General objective

To identify the level of community engagement in routine immunization service delivery in Kiyawa town, Jigawa State.

Specific objectives

To assess the levels of knowledge of mothers or care givers regarding RI in Kiyawa town
To assess the attitude of mothers or care giver regarding RI in Kiyawa town.
To determine coverage for the various RI antigens among children 12-23 months old in Kiyawa town.
To determine the socio–demographic factors that affects routine immunization coverage among children aged 12 -23 months in Kiyawa town.

CHAPTER TWO

LITERATURE REVIEW

National Programme on Immunization

The Expanded Programme on Immunization (EPI) which was launched by the world Health Organization (WHO) in 1974 globally focused on prevention of six childhood vaccine preventable diseases namely tuberculosis, poliomyelitis, measles, diphtheria, Pertussis (whooping cough) and tetanus. However, high prevalence of some vaccine preventable diseases such as hepatitis and yellow fever has necessitated their inclusion in the national immunization programme of some countries including Nigeria. The Federal government of Nigeria which has pursued an active immunization programme through the Federal Ministry of Health (FMOH) introduced the EPI in 1979. In view of the critical need to enhance the effectiveness of immunization which was fast declining and to meet the global challenges of immunization, the EPI was restructured in 1997 and renamed National programme on immunization (NPI).

Following the Health Sector Reform of 2007, the NPI was merged with the National Primary Health Care Development Agency (NPHCDA) which is charged with the responsibility of effectively controlling through provision of vaccines and immunization guidelines, the occurrence of the eight vaccines preventable diseases (VPDs) earlier mentioned. Currently, the country has introduced the Haemophilus Influenzae type b vaccine as Penta-valent vaccine into its EPI programme in order to reduce substantially child mortality from pneumonia and meningitis.

In Nigeria, the government provide vaccines and immunization services free to all eligible populations through the functional Primary Health Care (PHC) centres government and private health facilities. The Target Groups for Immunization in Nigeria are: Children 0 – 11 months, Children 0 – 59 months, Women of child bearing age 15 – 49 years, Other at – risk groups especially in outbreak situation and those travelling to endemic areas and International travellers. The traditional routine immunization vaccines that are administered in Nigeria are nine and they include Bacille-Calmette Guerin (BCG) for tuberculosis, oral polio vaccine (OPV) for poliomyelitis, Penta-valent vaccine for diphtheria, Pertussis, tetanus, hepatitis b and Haemophilus Influenzae type b, measles and yellow fever vaccines.

Nigeria routine immunization schedule is designed to include all children aged 0 – 1 year who are to receive one dose of BCG vaccine which is given at birth, 3 doses of Pentavalent vaccines given as Pentavalent 1 at 6 weeks of age, Pentavalent 2 at 10 weeks of age and Pentavalent 3 at 14 weeks of age, 4 doses of OPV given as OPV0 at birth, OPV1 at 6 weeks, OPV2 10 weeks and OPV3 14 weeks of age, 4 doses of Hepatitis B vaccines given as HepB0 birth while the remaining are given as Pentavalent vaccine at 6 weeks, 10 weeks and 14 weeks of age, one dose of Measles vaccine is given at 9 months of age and one dose of Yellow Fever vaccine also given at 9 months of age.^7,12

The funding of immunization is a collective responsibility of the Federal, State and Local Governments. However, external donors/development partners such as World Bank, European commission, USAID, WHO, DFID, UNICEF, GAVI are explored for financing immunization services on a sustainable basis.⁷

There are medical incident that take place within one month after an immunization and is believed to be caused by the immunization and they are referred to as adverse events following immunization (AEFIS). They include; hotness of the body, pains and swellings at the injection site, restlessness. Other serious or severe effects are all deaths that are thought by health workers to be related to immunization, that occur within one month of an immunization, all cases requiring hospitalization that are thought by health workers and/ or the public to be related to immunization, that occur within one month of an immunization and any severe or unusual medical incidents that are thought by health workers and/ or the public to be related to immunization.

Infant Immunization Coverage

In order to improve national immunization program and decrease the VPDs associated with morbidity and mortality, the WHO and United Nations Children’s Fund (UNICEF) in 2005 developed the global immunization vision and strategy (GIVS). The goal is to reach sustained national vaccination coverage of 90% in all countries and at least 80% coverage in every community. According to 2011 vaccination coverage, an estimated 106.8 million (representing 83%) of infants globally received at least 3 doses of DPT. This ranges from 71% in African Region to 96% in Western Pacific Region. The estimated global coverage for BCG, Polio 3, and MCV1 was 88%, 84% and 84% respectively.

Among the 194 WHO member states, about 130 (67%) achieved ≥90% national DPT3 coverage and 46 (24%) achieved GIVS goal of ≥80% DPT3 coverage in every community (administrative unit).

CHAPTER THREE

METHODOLOGY

Study Area

The study area is Kiyawa town in Jigawa state. Kiyawa is a town and Local Government Area in Jigawa State, Nigeria. It has an estimated population of 17,704. It is situated on the road running between kano and Azare with Dutse (30 km west), Jemma (35 km east), and Azare (65 km east).

The routine immunization services are provided by two public health centres in the communities i.e. Kiyawa Basic Health Centre with staff strength of 14 but only two of them (a vaccinator and a recorder) provides the services on every Thursday of the week. the other is Abuchi Primary Health Care with staff strength of 5, and RI services are provided on every Tuesday of the week. There are also two private health facilities but do not provide RI due to inadequate staff. Outreaches are conducted from time to time to provide RI services in hard to reach areas.

Study Design

This was cross sectional study.

Study Population

These are mothers or care givers of eligible children who are permanent resident in the community.

CHAPTER FOUR

RESULTS

Three hundred and sixty (360) mothers or care givers participated in the study, the mean age of the respondents was 28.1 ± 7.032 years. 67% of mothers or care givers are aware of routine immunization but their levels knowledge was rated poor 30(8.3%) while their attitude towards the immunization was rated good 308 (85.6%).

CHAPTER FIVE

DISCUSSION

Researchers have identified the role of maternal knowledge as an important determinant of vaccination coverage.^20,24 In this study, maternal knowledge on routine immunization was rated poor as only 21(5.8%) consistent with the study conducted in Zamfara state, Nigeria.⁴³Similarly only (5.8%) of them knew the correct meaning of RI as the immunization given to children at health centres from birth and at various ages till they are nine months old, 30(8.3%) knew the vaccination schedule for BCG at birth and that

OPV, Pentavalent at 6, 10 and 14 weeks of age and measles vaccines at nine months. However, 162 (44.7%) of mothers knew the correct number of visits (5) to be made to health centre before a child can be fully immunize. while 211(58.6%) knew the age at which first visit should be made, 213(59.6%) knew the age at which the last visit is made this is consistent with other findings .^27,29 The low levels of mothers or care givers knowledge on routine immunization in this study contrast with the finding,²⁰ in spite of this poor maternal knowledge on routine immunization, high proportion of has positive attitude towards immunization, 86.6% of mothers believed immunization is beneficial and could advise others to take their children for immunization.

The proportion of fully immunized children (35.5%) though higher than the national coverage of 25%,¹¹the immunization coverage in the community is still very low when compared with acceptable national target of 90%. The finding is similar to a study conducted in northern Nigeria and India.^23,43The coverage for the various antigens shows; BCG has the highest coverage of 60.8% and the lowest is measles vaccine coverage of 34.2% while coverage for both OPV1 and Pentavalent1 was 58.9%

(Pentavalent 1 – Pentavalent 3 Drop – out rate was 14.2%). the low coverage for OPV and Measles vaccines has negative effects on the government efforts to eradicate polio and the fight against measles.

CHAPTER SIX

CONCLUSION AND RECOMMENDATIONS

Conclusion

The maternal knowledge on the routine immunization was poor (8.3%), however mother’s and attitudes towards immunization are good.

More so, and in spite of the successes recorded in the area of childhood Immunization services in Nigeria, the fully immunized children aged 12-23 months in Kiyawa town was still far below the recommended 80% at community level (35.5%).

Among the factors that were significantly associated with full immunization coverage of children in the community are maternal education, sources of maternal information on routine immunization, and place of child delivery.

While only sources of maternal information on routine immunization was found to be independently associated (predictor) with full immunization coverage of children in the community.

Recommendations

Based on the findings of the study, the following recommendations are proffered

The Jigawa state government through the ministry of health and state primary health care development agency should coordinate and disseminate information on the importance of routine immunization through radio and television messages and jingles.
Kiyawa town shouldcreate awareness on routine immunization in the community through the social mobilization.
In the light of the inconvenient time and busy schedule of the mothers or care giver in the community, the community should be involved in the planning and implementation of routine immunization activities.
Kiyawa town should strengthen the communication skills among the health care workers to be able to stress to the mothers and care givers the importance of routine immunization.
The Non-Governmental Organization and Community based Organizations should be involved in routine immunization activities.
Others scope of the study such as health system and operational barriers and demand barriers against RI should be explore for further research.
The Kiyawa town through the health department should advocate and sensitize both the community and religious leaders on the importance of routine immunization in their communities.

References

World Health Organization (WHO). Immunization Coverage – Fact Sheet http://www.who.int/mediacentre/factsheets/fs378/en/.Accessed 14^th 2014
Olesen OF, Lonnroth A, Mulligan B. “Human vaccine research in the European Union”. Vaccine. 2009; 27 (5): 640–5.
WHO Smallpox Eradication Programme. http://choo.fis.utoronto.ca/fis/courses/lis2102/ko.who.case.html accessed 22^nd June, 2014.

History and Epidemiology of Global Smallpox Eradication.https://emergency.cdc.gov/agent/smallpox/training/overview/pdf/eradicationhistory. pdf accessed 17th December, 2014.

Global Routine Immunization Coverage, 2011, Morbidity and Mortality Weekly Report (MMWR)/November. 2, 2012; 61(43):883.
WHO Expanded Programme on Immunization (EPI), 1987. http://www.who.int/immunization/programmes_systems/supply_chain/benefits_of_i mmunization/en/ accessed on 6^th August, 2013.
National Immunization Policy Revised 2009, National Primary Health Care Development Agency.
Paediatric Association of Nigeria (PAN), Recommended Routine Immunization Schedule for Nigeria Children, Nigeria Journal of Paediatrics, 2012; 39(4): 152158.
Vaccines and Immunization: the past, present and future in Nigeria, Nigeria Journal of Paediatrics, 2011; 38(4): 186-194.

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