IMMUNIZATION ATTITUDE AND PRACTICE OF MOTHERS IN LAPAI LOCAL GOVERNMENT AREA OF NIGER STATE

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CHAPTER ONE

Introduction

Background to the Study

          Care about the optimal well-being of children and women are global. Wright (1992) stressed that United Nations Children’s Emergency Fund (UNICEF) initiated the programme on child survival and protection in 1947. This was because of the suffering of children as a result of the World War II in 1939. Wright pointed out that the programme was restricted to the developed countries and further emphasized that in recognition of the relevance this organization has to the survival and protection of children, the United Nation’s (UN) General Assembly in an interim decision in 1950 extended UNICEF mandate to concentrate on the needs of children in the developing countries.

          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.

UNICEF/WHO (2001) reported immunization coverage in some developed countries as follows: in UK 88.1 per cent for measles; in USA 91 per cent coverage for measles; and in Sweden, 95.4 per cent coverage for measles. The report further indicated that poliomyelitis had been eradicated and tetanus eliminated in these countries.

Antai (2009) stressed that immunization coverage in many parts of Nigeria is far from optimal, and far from equitable. According to the author, current coverage rates for the various childhood vaccines in Nigeria are among the lowest in the world. For instance, measles was responsible for 5 per cent of the child death in Africa, of an estimated 282,000 deaths in 2003, half of these occurred in Nigeria. Nigeria is among the ten countries in the world with vaccine coverage rate below 50 per cent, having been persistently below 40 per cent since 1997. The country also has the highest prevalence of circulating wild poliovirus in the world.

Certain factors influence immunization uptake at general practice level. These include the mothers’ age, gender, education level, occupation, location, media exposure, and economic status (Bhuiya, Bhuiya & Chowdhury, 1995).  They explained that the age of mothers refer to age at the time of birth of the child. According to the authors, acceptance of immunization among children also varies with mother’s age. Children of younger mothers were more likely to be immunized than those of older mothers. They stressed that the acceptance of immunization programme is predicated on the mothers’ level of education. The more mothers are educated, the more likely they are to accept the immunization programme than the lower primary level of school. The authors also stated that the sex differentials in immunization were found to be statistically significant. Male children were 20% more like to be immunized than female children. They further asserted that the economic condition of the household, as measured by ownership of chair, bed, and wardrobe, showed a positive relationship with immunization of children. Children from households with all of the above items were nearly twice as likely to be immunized as those from households with none of these items.

Location is another independent variable which was found to have a positive impact on immunization of children. Children in remote areas were more likely not immunized because of the distance and their areas of settlement (Bhuiya et al., 1995). The authors emphasized that children of mothers in areas where health facilities could easily be accessed were found to be more immunized than those in remote places. Media exposure of the mothers to radio was also found to have a positive impact on children’s immunization. Children from households with a working radio had a 47% higher chance of being immunized than those from households with no working radio Media exposure. Media exposure of the parent to radio was also found to have a positive impact on children’s immunization. Children from households with a working radio had a 47% higher chance of being immunized than those from households with no working radio (Bhuiya et al., 1995). These factors enumerated in the above literature could also be found in Lapai Local Government Area (LGA). Mothers in local government are therefore expected to have a working radio media exposure to enhance the chances of their children being immunized against the killer disease.

Since immunization exercise is a worldwide phenomenon, it seems necessary that attitude and practice of mothers towards immunization exercise be carried out in Lapai LGA of Niger state.In the previous years to date, such study has not been conducted, to the best of this researcher’s knowledge. The present study will go a long way to proffer solution to the problem of the killer diseases in the area.

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.

IMMUNIZATION ATTITUDE AND PRACTICE OF MOTHERS IN LAPAI LOCAL GOVERNMENT AREA OF NIGER STATE