Introduction
Background Of The Study
Immunization remains one of the most important public health interventions and a cost effective strategy to reduce both the morbidity and mortality associated with communicable diseases. Over two million deaths are prevented through immunization each year worldwide1. Despite this, vaccine preventable diseases remain the most common cause of childhood mortality with an estimated 3 million deaths each year2. Uptake of vaccination services depends
not only on provision of the services but also on other factors including knowledge and attitude of mothers3,4, density of health workers5, accessibility of vaccination centres and availability of safe needles and syringes.
Nigeria like many countries in Africa is making efforts to strengthen its health system especially routine immunization so as to reduce disease burden from vaccine preventable diseases (VPDs).
In 1979, Nigeria’s Expanded Programme on Immunization (EPI) was initiated6 (though created in 1974 by WHO, UNICEF and Rotary International as partners). It was relaunched in 1984 due to poor coverage7. In 1996 it became the National Programme on Immunization (NPI). Following a review of EPI Decree 12 of 1997, NPI was made a parastatal.
- NPI has a sole responsibility of supervising and enhancing routine and supplemental immunization activities in Nigeria.
- Routine immunization (RI) is provided largely through the public health system, with significant variation between the 36 states and Federal Capital Territory (FCT). In Anambra State, private or NGO providers are the source of up to one third of RI in Anambra State8.
Public sector provision is by health staff based at facilities run by the 21 Local Government areas (LGAs), the General hospitals run by the state government and the tertiary institution run by the federal government.
There is also supplemental immunizations done periodically in the state in the form of National Immunization days (NIDs), local immunization days (LIDs), immunization plus days (IPDs) and child health week all aimed at boosting immunization coverage and mopping up and reaching every child (including those not already reached) irrespective of their immunization status.
Statement Of The Problem
Globally, 2.5million children die every year from easily preventable infectious diseases. In the year 2000, measles resulted in 777,000 deaths and 2 million disabilities9. The expanded programme on immunization (EPI) when introduced experienced some initial success. However a few years after its inception, it became obvious that it was no longer achieving its stated objectives and had to be relaunched in 1984.
Nigeria attained universal childhood immunization (UCI) with 81.5 percent coverage for all antigens in 1990, but the success was not to last long and by 1996, immunization coverage had declined substantially to less than 30 percent for DPT-3 and 21 percent for the doses of oral polio virus (OPV).
The situation had continued worsening, that presently the coverage rates of the various childhood vaccines in Nigeria are among the lowest in the world.
The above scenario has been playing itself out in Anambra State. Anambra State has continued to witness fluctuation in immunization coverage for all vaccine preventable diseases with its attendant increase in the incidence of the diseases.
Data from the 2008 National Immunization Coverage Survey shows that only about 23 percent of children aged 12-23 months received full immunization nationally, though this is almost double the value of 13% from the 2003 figure.
Justification Of The Study
Assessing immunization coverage helps to evaluate progress in achieving programme objectives and in improving service delivery10. In addition, evaluation of immunization coverage provides evidence whether substantial progress towards achieving vaccination targets is being made. Such positive evidence is required for continuing support from donor-supported initiative like Global alliance for vaccines and immunization (GAVI)11. It is also expected that findings from the study will help further research work on this topic thereby bridging the gap in knowledge, attitude and practice of the people on immunization.
It is in addition believed that findings will equip policy makers in the planning and policy making on immunization and averting the menace of vaccine preventable diseases in the LGA as there have been recorded outbreaks of measles and a confirmed case of Wild Polio Virus (WPV). It is equally noted that not much work has been done in this field in this locality.
Objectives
General: To determine the Immunization coverage of children aged 12-23 months living in a rural locality (Anambra East Local Government area).
Specific Objectives
- To assess immunization coverage levels of children aged 12- 23 months in a rural area of Anambra State.
- To assess mother’s knowledge, attitude and practice on childhood immunization.
- To identify any missed opportunities among the children.
- To identify the factors that are associated with inadequate coverage among the children.
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