Project Topic – IMMUNIZATION ATTITUDE AND PRACTICE OF MOTHERS IN NIGERIA

Project Topic – IMMUNIZATION ATTITUDE AND PRACTICE OF MOTHERS IN NIGERIA

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CHAPTER ONE

Introduction

Background to the Study

UNICEF (1992) revealed that Nigeria and UNICEF have been working together since 1951 on the programme to improve the well-being of children and women in the country. The early thrust of UNICEF cooperation centered on cash grants and technical support to primary education, health and social development. According to UNICEF, special allocation of US $100 million was made in 1980 for a phase restructuring of Primary Health Care(PHC) to reflect the new national policy of decentralization of health care services. The emphasis then was more on the Expanded Programme on Immunization (EPI) at the grassroots. The EPI in Nigeria is currently referred to as National Programme on Immunization (NPI).

Bland and Clement (1998) traced the idea of immunization to Edward Jenner who in 1796 demonstrated that scratching cowpox virus on the skin produced immunity. Based on this discovery immunization programme was developed andtoday it is accepted worldwide. World Health Organization – WHO (1980) attested that following the discovery of this vaccine by Edward Jenner, mankind was saved from dreaded diseases.

Jenner’s effort was a challenge to other scientist to produce vaccines which led to the eradication of small pox globally, elimination of polio from western hemisphere and major reduction in the incidence of other preventable diseases in the United States (Bland & Clement, 1998). Based on this, WHO developed its plans for world-wide immunization programme which include the eradication of poliomyelitis (paralysis of one or more of the limbs by the polio virus) from the world by the year 2000. In order to attain the desired result, the Federal Ministry of Health – FMOH (2000) adopted EPI in 1978 and launched it in 1979, with the target of achieving 60 per cent immunization coverage by the year 1984. A national survey to determine the achievement was conducted by the FMOH at the end of 1984, but the results showed a very low coverage ranging from 20-29 per cent at the end of the period. The low coverage was attributed to poor management and implementation strategies.

Following the low coverage, the programme was revised in 1984, with the target of achieving 80 per cent by 1990, but the coverage remained low (FMOH, 2000). In 1988, the FMOH supported by the WHO, UNICEF, Polioplus and Non-Governmental Organizations (NGOs) introduced the idea of mass campaign as a means of boosting and sustaining EPI coverage nationwide. The strategy, according to FMOH (2000), accelerated the immunization coverage to about 60 per cent by 1989, and this became the spring board for the attainment of Universal Child Immunization (UCI) target coverage of 80 per cent by 1996.

Tarfa (1992) indicated that the findings of national survey to assess the coverage of EPI carried out in February 1991 indicated that 96 per cent of Nigerian children had received national immunization services at least once. In attempt to extend and improve health care services to the grassroots, the Federal Government transferred Primary Health Care (PHC) programme to the Local Government Authorities in 1990 (Tarfa, 1992). In the same year the nomenclature, EPI,was changed to NPI which implied the adoption and owning of the programme by the Federal Government thus making it a national programme. To implement the programme, the FMOH (2002) set up the following objectives to be achieved by the year 2003: eradicate polio, control measles, eliminate neonatal tetanus (NNT), and sustain routine immunization of at least 80 per cent of children under two years and women of child-bearing age.

Odusanya, Alufoha, Meurice and Ahonkhai (2008), stressed that immunization remains one of the most important public health interventions and a cost effective strategy to reduce both the morbidity and mortality associated with infections diseases. They asserted that over two million deaths are delayed through immunization each year world wide. The researchers further explained that despite the above assertion, vaccine preventable diseases remain the worst common cause of childhood mortality within an estimated three million deaths each year. They reiterated that the uptake of vaccination services is dependent not only on provision of these services but also of mothers, density of health workers accessibility to vaccination clinics and availability of safe needles and syringes.

The Nigerian National Programme on Immunization (NPI) schedule is Bacillus Calmette Guerin (BCG), Oral Polio Vaccine (OPV0), Hepatitis B1 (HB1) (first dose) at 6 weeks, Diphteria Pertussis and Tetanus (DPT2), OPV2 at 10 weeks; DPT3, OPV3, HB3 (third dose) at 14  weeks; measles and yellow fever at 9 months.

Following from the above, the question arises as to what immunization is and what it is intended for. John, Sutton and Webster (1986) described immunization as the most effective measure for protecting the susceptible host against a particular disease. Osakwe (1988) viewed immunization as one of the major ways employed in preventing diseases. He further indicated that high survival rate of children these days is largely attributed to immunization. Onuzulike (1998) sees immunization as a deliberate stimulation of the body’s defence against specific harmful germs. Furthermore, Akubue (2000) perceived immunization as a process which confers immunity against a specific disease.

The process of administering special medicine into a person’s body in order to make the person’s body resistant to diseases stronger so that he/she may not become sick or die from disease is known as immunization (WHO, 2001). UNICEF (1989) warned that without immunization, an average of three out of every hundred children born will die from measles, two will die from whooping cough, one or more will die from tetanus. UNICEF further warned that out of every two hundred children not immunized one will be disabled by polio.

In spite of the obvious political will, government efforts, the contribution of local, international NGOs and donor agencies, the immunization programme in Nigeria is essential (Babalola & Adewuyi, 2005). They asserted that each year thousands of children die or are maimed for life as a result of diseases that are preventable through immunization. They furthermore observed that the factors affecting immunization practices in Nigeria are multiple and include supply and demand elements. On the demand side, there is lack of community ownership of immunization programmes fostered by a poor understanding of immunization, suspicion, myths, and rumours. On the supply side, immunization programmes are fraught with poor infrastructure, inadequacies in vaccine supply and distribution, poor provider skills and inadequate funding. These problems suggest the need to study immunization attitude and practice of mothers with a view to see how far they transcend the possible existing problems. Parent therefore means one that begets or brings forth offspring. It is however a source from which children are derived (Merriam Webster, 2012)

Mukherjee (1978) defined attitude as one’s feelings, thoughts, and predisposition to behave in some particular manner towards some aspect of one’s environment. According to him, attitudes are best expressed when individuals make statements about their feelings or opinions about certain objects, issues, or things. Park (2007) explained that attitude is a relatively enduring organization of beliefs around an object, subject or concept, which predispose one to respond in some preferential manner. Attitude in the context of this present study refers to the way and manner mothers feel, think and behave toward the immunization of their children.

Some of the dimensions of the attitude could be acceptance or rejection of immunization programme by mothers. Some mothers often preach to other mothers to reject immunization because of predetermined belief that such programme is meant to reduce/control the population of the society by tactical poisoning of children. Some mothers often take their children for immunization reluctantly because they are not fully convinced that the programme is meant to be a preventive measure for safeguarding and protecting the health of their children. Moreover, some mothers use religion as an excuse for the rejection of immunization because of certain negative pronouncement by some religious leaders against immunization programme (Felden Battersby Analyst [FBA], 2005).

Prior to recent period when orthodox form of medication came in to being, immunization was not being practiced and therefore some cultures do not believe in it and did not see the need to accept it even in this modern age of technological advancement. Similarly, this present study will like to identify the highlighted attitude and practice of mothers toward immunization programme in Lapai LGA.

Practice simply means action.Brown (1993) conceived the term practice as performing an act habitually or constantly. Ademuwagun, Ajala, Oke, Moronkola and Jegede (2002) stated that the ultimate goal of health education is practice or action. To buttress the above statement, they further stated that the goal of health education is positive health practice and not mere health knowledge.Funks and Wagnalls (2003) defined practice as any customary action or proceeding regarded as individual’s habit.

Practice in the context of this present study is the act of immunizing children against the six endemic killer diseases. The practice of immunization refers to the act of embarking on the immunization of children to safeguard them from the six killer diseases. The immunization officer in this circumstance, move from their health care offices to various homes where mothers reside for the purpose of immunizing their children. The mothers especially mothers also move to health centres to get their children immunized. This brings to focus the extent to which immunization vaccines are utilized for the prevention of children getting infected by the six filler diseases. Utilization according to Hornby (2000) means the ability to make use of a thing. Utilization of immunization service then meanshow far make use of immunization services provided for them. Such services as vaccine for BCG, poliomyelitis, DPT, measles, hepatitis, yellow fever, and tetanus toxoid.

 

 

Statement of the Problem

Survival is an enormous challenge for children under five years old, especially for those under one year. Immunization is perhaps one of the most effective and efficient ways of protecting the health of children and women worldwide against some of the most lethal and debilitating diseases in modern times. Vaccine preventable diseases are responsible for severe rates of morbidity and mortality in Africa (Babalola et al., 2005). Despite their use on infants, vaccine preventable diseases are highly endemic throughout sub-Saharan Africa. Antai (2010) reported that disparities in the coverage of immunization programmes persist between and within rural and urban areas, regions and communities in Nigeria.

Ransome-Kuti, Sorungbe, Oyegbite and Bamisanye (1991) identified diseases which claim the lives of mothers and children as follows: tuberculosis, polio, measles, tetanus, diphtheria, pertussis (whooping cough) and hepatitis B. It has been documented that the above vaccine preventable diseasesclaim lives of mothers and children worldwide including Nigeria. Lapai LGA may not be an exception. In an effort to avert this problem, UNICEP and all governments have been embarking on mass immunization of children and women including those of Lapai LGA.

Fathers of partially immunized children in Muslim rural communities see hidden motives, linked with attempt by NGOs sponsored by unknown enemies in developed countries, to reduce the local population and increase mortality rates among Nigerians. Belief in a secret immunization agenda is resonant in some of the Northern states where many believe activities are fuelled by western countries determined to impose population control on local Muslim communities (FBA, 2005).

The fear seems to translate in immunization attitude and practice with cloud be negative or positive. The situation is worrisome and could even be worsened by some recipient characteristics such as age, gender, level of education, location, occupation, economic status and religion. The above situation requires determination.

The extent Nigerian mothers exhibit their attitude toward immunization appears to have received research attention. This can not be less true about the mothers in Lapai LGA of Niger state. Finding out these, certainly, will represent a positive step forward in the effort to enhance positive immunization attitude and practice of Nigerian mothers. Following from this, one is inclined to ask what is the parent’s attitude toward immunization? What is the parent’s practice of immunization? The above, in essence, represent the problem of this study.

 

Purpose of the Study

The purpose of the present study was to investigate the immunization attitude and practice among Mothers in Lapai LGA of Niger State. Specifically, the study was designed to find out the:

1. the attitude of mothers towards immunization against childhood killer diseases.
2. the immunization practice of mothers against childhood killer diseases.
3. the extent to which the mothers’ age influence their attitudes towards immunization of their children against childhood killer diseases.
4. the extent to which the mothers’ educational levels influence their attitudes towards immunization of their children against childhood killer diseases.
5. the extent to which the mothers’ age influence the practices of immunization against childhood killer diseases.
6. the extent to which the mothers’ educational level influence the practices of immunization against childhood killer diseases.

Research Questions

The following research questions were formulated to guide the study:

1. What are the attitudes of mothers towards immunization against childhood killer diseases?
2. What are the immunization practices of the mothers against childhood killer diseases?
3. To what extent does the mothers’ age influence their attitudes towards immunizations of their children against childhood killer diseases?
4. To what extent do the mothers’ educational level influences their attitudes towards immunization of their children against childhood killer diseases?
5. To what extent does the mother’s age influence the practice of immunization against childhood killer diseases?
6. To what extent do the mothers’ educational levels influence the practices of immunization against childhood killer diseases?

Hypotheses

The following null hypotheses were tested at 0.05 level of significance.

1. There is no significant difference in the attitude of the young and older mothers towards immunization in Lapai LGA.
2. There is no significant difference in the attitude of educated and uneducated mothers towards immunization in Lapai LGA.
3. There is no significant difference in the immunization practice of the young and old mothers in Lapai LGA.
4. There is no significant difference in the practice of immunization among educated and uneducated mothers towards immunization in Lapai LGA.

 Significance of the Study

The finding from this study will be of great benefit to mothers, health workers FMOH and the government. Specifically, data generated by determining the attitude and practice possessed regarding immunization programme will help in exposing the attitude and practice which the mothers posses in this area of immunization. The data generated regarding their attitude towards the reduction of measles morbidity and mortality will be beneficial to the mothers in Lapai LGA. The generated data will help the mothers to know the proper attitude to exhibit toward reduction of measles mortality and morbidity. Data generated on the attitudes of the mothers towards immunization of their children against poliomyelitis will be beneficial to the health workers because knowing how the mothers feel about the polio vaccine and the side effect of the polio injection will motivate the health workers to take proper step to correcting or preventing such reaction.

The data will help the public health care (PHC) providers determine the need and ways for positively enhancing the mothers’ attitude toward immunization of their children against poliomyelitis. Data generated on attitude of the mothers toward immunization of mothers and neonatal against tetanus will help to inform the mothers on the need to be immunized especially when she is pregnant. It will help the mothers to exhibit positive attitudes by attending antenatal care regularly. It will also help the health care providers to know the kind of attitude that is associated with mother thereby devising a means of encouraging mother and neonatal to get immunized against tetanus.

The data generated on the attitude of the mothers towards other immunization programmes in the FMOH’s10 years strategic plan will be of great help to the FMOH because the data will help the ministry to know the kind of attitude that is exhibited by the mothers toward immunization programmes and schedules respectively. This will equally help the FMOH to know how to plan and schedule desired immunization programmes.

The data generated will be of immense benefit to the mothers especially mothers. It will guide the mother on proper utilization of measles vaccine for their children. It will assist the mother to know the number of times upon which a child is expected to receive the vaccine by encouraging the mother to take the child to receive the vaccine at the appropriate periods. It will also inform the mothers on when the child is due for the vaccination. Same is also applicable to the utilization of tetanus vaccine and control of tetanus prevalence among mothers and babies. This research work will help the mothers, health care providers and the government to ascertain the extent to which education and age of mothers affect their attitude and practice towards immunization.

By implication, the younger mothers within the age bracket of (15-45 years) will find the result of the study more beneficial because these categories of mothers by their age will utilize the results of the study better than older mothers within the age bracket of 45 and above. When the mohters are educated at least from primary education to tertiary level it will enhance the attitude, understanding and practice forward immunization.

The study will be beneficial to curriculum planners when planning curriculum for certificate programmes offered in Schools of Health Technology enriching the curriculum with skills needed for proper immunization of children.

Scope of the Study

This study was delimited to Lapai LGA of Niger state. It was also delimited to the attitude and practice of the mothers towards immunization of the NIP target disease, namely: measles, poliomyelitis, tetanus, tuberculosis, pertussis, hepatitis B, diphtheria. Furthermore, this study was delimited to the age and level of education of the mothers in relation to immunization attitude and practice.

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Project Topic – IMMUNIZATION ATTITUDE AND PRACTICE OF MOTHERS IN NIGERIA