CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
It is obvious that immunization is one of the most cost-effective public health interventions for reducing global child morbidity, mortality and life time disabilities (Lee, 2003) (Chen et al, 2004). Worldwide, immunization prevents more than 2.5 million child deaths each year (WHO/UNICEF and World Bank, 2009, WHO 2009). Global public health has greatly improved through the widespread use of vaccines, preventing millions of childhood hospitalizations and deaths each year rating immunization as a number one public health intervention (CDC, 2010 CDC 2009). Before the advent of immunization programs, infectious diseases such as measles, diphtheria, smallpox and pertussis were leading causes of child mortality (Stern et al., 2005). Tetanus toxoid vaccine is given to pregnant women to prevent against neonatal tetanus, which can be a major cause of infant deaths (KDHS 2014).
In the United States there has been a remarkable achievement in the control of vaccine preventable diseases resulting in decline in morbidity and mortality associated with vaccine preventable diseases (CDC 2010). In Africa, there has been tremendous improvement in the overall immunization coverage, though at a relatively slower rate (WHO 2004, WHO 2014). However, some African countries like Ghana, Morocco and Gambia have registered success in reaching coverage of over 90% (Ghana News Agency 2012, WHO 2014, UNICEF, 2014). The introduction of the immunization programme has led to continual reduction of vaccine preventable disease incidence.
Despite the remarkable achievements and improvements in immunization services, the agenda remains largely unfinished with large numbers of children (24 million) remaining unreached, unvaccinated or under-vaccinated (WHO, UNICEF & World Bank 2009). One-fifth of the world’s children which is about 22.4 million infants, are not immunized against VPD and 70 percent of these children come from 10 countries, Nigeria being one of them (WHO/UNICEF 2014), (UNICEF/WHO 2011), (UNICEF Australia 2013). One of the causes of high mortality rates in Nigeria are vaccine-preventable diseases. Previous studies have explored factors associated with implementation of childhood immunization programs, however most of these studies focused on the demand side factors. Some of the most cited demand-side factors that have been shown to influence functioning of immunization programs include parity, household income, ethnicity, place of delivery, mother’s level of education, distance to health facility, culture, religion, age and forgetfulness of guardian due to preoccupation with other activities, (Abdulraheem et al 2011.,Bbaale, 2013,Barman et al, 2009)(Bates, 1994)(Calhoun et al., 2014)(Kariuki, 2004) Mutua et al., 2011, Maina et al,. 2013, Ndiritu et al. 2007, Njeru, 2011, Ophori et al, 2014, Odusanya, et al 2003). There are relatively few studies examining supply-side factors influencing implementation of childhood immunization programs in the Nigerian context, particularly in predominantly rural areas. This study aims to fill this gap. The relatively poor health indices and large size of the county makes it a reasonable choice for understanding the factors influencing implementation of immunization programs in primary healthcare facilities in Nigeria.
1.2 Statement of the Problem
Immunization program is a key strategy for prevention of child and neonatal deaths and lifetime disabilities. Immunization prevents 2.5 million child deaths each year (WHO, 2009). Despite the global improvement in vaccine coverage that has seen 84% of children around the world receiving this life-saving intervention, 10 million children in low and middle level countries die before reaching age of five (Arevshatia et al, 2007) (WHO 2014). Full immunization potential has not yet been realized in many countries where 22.4 million Children around the globe are not fully immunized. Majority of not fully immunized children 70% are from 10 countries, Nigeria being one of them (WHO/UNICEF 2014). Low immunization coverage remains a challenge even in a committed country like Nigeria. This study sought to identify intervention targets for improving immunization coverage by investigating factors affecting the implementation of immunization in Jere Local Government Area of Borno State, Nigeria. The focus was to identify factors contributing to missed immunization and ways to reduce the number of missed opportunities for immunization at the health facilities. Much effort has been made to provide vaccines through the GAVI alliance, enabling states to acquire the recommended vaccines. In Nigeria for instance, vaccines are made freely available to the public, yet over 20 percent of Nigerian children are not immunized each year. There is a need to identify strategies for improving implementation of vaccination programs in the country, particularly at primary health care level in predominantly rural areas and this study aimed to fill this gap.
1.3 Research Objectives
The general objective or main objective of this study is to examine the factors affecting the implementation of immunization in Jere Local Government Area of Borno State, Nigeria. The specific objectives are:
i) To understand the factors affecting the implementation of immunization in Jere Local Government Area of Borno State.
ii) To identify the problem of immunization in Jere Local Government Area of Borno State.
iii) To understand the attitudes of parents toward immunizing their children in Jere Local Government Area of Borno State.
1.4 Research Questions
The following are some of the questions which this study intends to answer:
i) What are the factors affecting the implementation of immunization in Jere Local Government Area of Borno State?
ii) What are the problems of immunization in Jere Local Government Area of Borno State?
iii) What are the attitudes of parents toward immunizing their children in Jere Local Government Area of Borno State?
1.5 Significance of the study
The findings of this study are of great significance to immunization program managers and policy makers in geographical areas with large rural populations. It provides a basis for rational interventions to improve vaccine delivery in primary healthcare facilities, improve vaccination coverage indices and reduce the burden of childhood infectious diseases. The results are of benefit to the county health management team by providing actionable information relevant for planning and policy making to improve delivery of childhood vaccines in the county. This study contributes to the broader literature addressing how to improve implementation of childhood immunization programs in rural areas by providing an empirical analysis of challenges faced by program implementers. Specifically, this study seeks to contribute to the literature related to the identification of intervention targets for increasing the effectiveness of immunization programs in primary healthcare facilities in Jere Local Government Area of Borno State, Nigeria.
1.6 Assumptions of the Study
This study investigates the factors affecting the implementation of immunization in Jere Local Government Area of Borno State, Nigeria. It will therefore be carried out in the four regions (north, south, east and west) of the local government area.
1.7 Limitations of the Study
Health care institutions always have very busy schedules and work in shifts. This was seen as one of the limitations of identifying appropriate time periods to administer surveys. This was addressed by obtaining phone contacts of health facility managers and scheduling interview dates ahead of time. The study might have also been affected by the way respondents would answer questions in the data collection tool, they could have chosen answers that are socially desirable to be seen as performing well.
1.8 Definition of Terms
The following terms were used in the course of this study:
Immunization: is the process by which an individual's immune system is stimulated through exposure to an immunogenic agent known as vaccine (a substance that stimulates the immune system is said to be immunogenic)
Implementation: Is a specified set of activities designed to put a plan or strategy into practice. In this study, it refers to the set of activities put together in the immunization program to ensure that children are vaccinated and thereby increase immunization coverage.
Immunization programs: is a set of activities designed to ensure all eligible children and women. In a specific location receive timely vaccination and become immunized against specific vaccine-preventable diseases. The programs include childhood immunization and maternal immunization.