CHAPTER ONE

INTRODUCTION

1.1     Background to the Study

Immunization is one of the safest and most effective interventions to prevent disease and early child death. Although, about three quarters of the world‘s child population is reached with the required vaccines, only half of the children in Sub-Sahara Africa (WHO/IVB, 2009) get access to basic immunization. In recent years, many countries have employed a growing range of strategies to increase both the provision and utilization of immunization services. These experiences are in consonant with the Global Immunization Vision and Strategy (GIVS) of ―using a combination of approaches to reach everyone targeted for immunization (WHO/IVB, 2009).

A substantial number of children worldwide do not complete immunization schedules because neither health services nor conventional communication mechanisms regularly reach their communities (Waisbord, S. et al, 2015). In some communities, low immunization rates are associated with families living a long distance from health services, having little access or exposure to large-scale or local media, and low doctor- and nurse-patient ratios (e.g. slum-dwellers in the Philippines and South Africa, nomadic populations in Sub-Saharan Africa, and internal migrants in Brazil, Cameroon, and Mozambique) (Waisbord, S. et al, 2015). Anti-vaccination information and/or refusal to get children immunized is not new in the world. Historically, populations have rejected immunization due to concerns about vaccine safety as well as political, cultural, and religious reasons (Greenough, P., 2005). Today, trust and acceptance of immunization faces two new formidable challenges. Firstly, a global, fast-paced communication environment makes it possible for negative publicity and anti-immunization positions to be disseminated quickly worldwide. Localized opposition (e.g., polio campaigns in India and Nigeria), negative publicity surrounding vaccine safety (e.g., MMR vaccination in the UK), and suspected or real adverse events following immunization are more likely to attract wide media coverage, and spread through the Internet (Offit P.A., 2013; Clement, C.J., 2013). Secondly, increased democratization promotes debates about individual and community rights and choice. Today, democratization offers an environment more conducive to the emergence of challenges to government-mandated programs such as immunization (Waisbord, S., 2015).

More vaccines have become available, but most developing countries cannot afford the newer vaccines, lack well-functioning systems to deliver them, and have inadequate surveillance systems or study data to determine the burden of disease to motivate decision-makers to adequately fund them. A number of vaccines such as hepatitis B, yellow fever, and haemophilus influenza type B (Hib) are under-utilized due to inadequate funding from Ministries of Health, overstretched health systems, and weak demand from health providers and caregivers (Waisbord, S., 2015) (who lack sufficient knowledge about the efficacy of specific vaccines and are unaware of the burden of vaccine-preventable diseases or the availability of vaccines).

The induction of immunity by applying vaccine in children is among the most cost-effective health interventions and awareness creation programs to reduce child mortality, morbidity, and disability in the world (WHO/AFRO, 2009-2012). This is achieved through a routine vaccination schedule for children in Nigeria which are given starting from birth, and are being completed before one year of life by all children as it obtained elsewhere (WHO, 2012). Nigerian government introduced pentavalent vaccine into her immunization schedule recently (2012).

Nigeria like many countries in Africa is making efforts to strengthen its health system especially immunization so as to reduce disease burden from vaccine preventable diseases (VPDs). Such efforts include creating awareness of the importance of health education, provision of the vaccines and personnel through the NPHCDA, private or NGO providers‘, community based participation and the media.

 

1.2     Statement of Problem

Despite the numerous campaigns on immunization, infant mortality has been a prevalent issue affecting the health sector..This could be associated with educational, social and cultural practices that restrict most women from practicing taught information on immunization.. The low routine immunization coverage has favored the transmission of certain communicable diseases such as the recent  polio virus out brake in the north.

According to the WHO, the persistence of vaccine-preventable diseases in Nigeria can largely be attributed to the under-utilization of available vaccines (National Population Commission (NPC), 2013), and health education knowledge gaps by the mothers/caregivers which underscores low compliance with vaccination schedules; [many parents are not fully aware of the benefits of vaccination and as a result do not immunize their children against vaccine preventable diseases] (WHO, 2012).

1.3     Research Objectives

The general objective of this research study is to assess the impact of health education towards compliance of immunization among children 0-5 years in Ahoada General Hospital, Rivers State. The specific objectives are stated below;

1. To determine the sources of information on immunization among mothers/caregivers that aid compliance with immunization of children aged 0-5 years in Ahoada General Hospital, Rivers State
2. To assess the knowledge and perception of mothers/caregivers on vaccine preventable diseases in children aged 0-5 years in Ahoada General Hospital, Rivers State .
3. To determine the mothers/caregivers immunization practices based on available health information on immunization
4. To assess factors that influence the compliance with immunization by mothers of children0-5 years in Ahoada General Hospital, Rivers State.

1.4     Significance of Study

Different studies have shown that knowledge gaps underlie low compliance with vaccination schedules (Bond L., et al, 2008). Mothers/Caregivers are less likely to complete immunization schedules if they are poorly informed about the health implication and need for immunization, logistics (time, date, and place of vaccination), and the appropriate series of vaccines to be followed. Although knowledge in itself is insufficient to create demand, poor knowledge about the need for vaccination and when the next vaccination is due is a good indicator of poor compliance (Waisbord, S., 2015).

Tracking, evaluating and assessing the type and quality of information received by mothers would provide a vital tool for understanding routine immunization gaps in the study area.

Thus, it is important to conduct this study to examine the impact of health education towards compliance of immunization among children 0-5 years aside their socio-demographic factors because when up-to-date, complete, and scientifically valid health information about vaccines is available, parents can make informed decisions. For example, they need to have access to accurate evidence-based information so that they understand the risks of non vaccination, the importance of community immunity, and the actual risks of complications (USAID, 2009). Without this information, many mothers may develop a false sense of security and regard immunizations as unimportant.

1.5     Research Questions

The following research questions were formulated from the research objectives for the study;

1. What are the sources of health information on immunization in Ahoada General Hospital, Rivers State?
2. What is the impact of health education on level of immunization coverage in the study area?
3. What are the factors that influence the compliance of immunization activities by mothers/caregivers of children 0-5 years?
4. How can the educational, social and cultural practices be tackled in order to meet the compliance of immunization activities by mothers/caregivers?

1.6     Scope of the Study

This study was set out to find the impact of health education towards compliance of immunization among children 0-5 years. The research was focused in Ahoada General Hospital, Rivers State.

1.7     Definition of Terms

Health Education: this is any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes.

Immunization: A process whereby a vaccine is injected or introduced into a child to confer immunity to the child against a specific disease.

Access: the opportunity or right to experience or make use of something.

Information: It is definite knowledge acquired or supplied about something or somebody or the collected facts and data about a specific subject.

Knowledge: A familiarity, awareness or understanding of someone or something, such as facts, information, description or skills which is acquired through experience, education or learning.