CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF THE STUDY

The World Health Organization (WHO, 2009) stated that immunization is one of the most important public health interventions and cost-effective strategies to reduce child mortality and morbidity associated with childhood infectious diseases. Immunization is also a good strategy to reach vulnerable populations (WHO, 2009). Immunization is reported to prevent an estimated 2 to 3 million deaths each year worldwide (WHO, 2009). The year 2014 marked the 40th anniversary of the WHO’s Expanded Program on Immunization (EPI), which was established to ensure equitable access to routine immunization (RI) services (CDC, 2015). The WHO (2009) has stated that “vaccines have the power not only to save, but also to transform lives – giving children a chance to grow up healthy, go to school, and improve their life prospects” (WHO, 2009).

Strong RI was among the strategies for the Global Polio Eradication Initiative, which further underscored the importance of childhood immunization in preventing infant and childhood morbidity, mortality, and disabilities (WHO, 2009). Children and infants in North West Nigeria are more likely to die than children in any other region of Nigeria, based on neonatal, postneonatal, infant, childhood and under 5 mortality rates (National Population Commission Nigeria [NPCN] & ICF Macro, 2013). Infant mortality is 43% higher in rural areas (86 deaths per 1,000 live births) than in urban areas (60 deaths per 1,000 live births), and the urban-rural difference is more prominent in the under-5 mortality category (NPCN & ICF Macro, 2013). Regional differences range from as low as 90 deaths per 1,000 live births in South West Nigeria to as high as 185 deaths per 1,000 live births in North West Nigeria. According to the NPCN and ICF Macro (2013), mortality rates are significantly higher among male children than female children for all categories of mortalities. Nigeria and four other countries (India, Democratic Republic of Congo, Pakistan, and China), which make up about one third of the world’s population, accounted for half of the overall number of under-5 deaths worldwide in 2010 (WHO, 2015).

In Nigeria, about 700,000 children died before their fifth birthday (Riedmann, 2010). Providing safe and effective vaccines reduces the high burden of communicable diseases in African countries and helps to meet the health-related millennium development goals (WHO, 2015). Vaccine-preventable diseases contribute significantly to morbidity and mortality; an estimated 4 million people die each year from diseases for which vaccines are available (WHO, 2015). Pneumonia and diarrhea disease account for approximately 34% of the global 10.4 million deaths among children less than 5 years of age (WHO, 2015). With effective immunization, many of these deaths could be prevented. Globally, invasive pneumococcal disease has recently been shown to cause the deaths of 826,000 children aged 1 to 59 months, while rotaviruses are the most common cause of severe diarrheal disease in young children (WHO, 2015). According to the WHO (2015), an estimated 527,000 children under 5 years, most of whom live in low-income countries, die each year from vaccine-preventable rotavirus infections

1.2 STATEMENT OF THE PROBLEM

In Nigeria, the EPI was developed based on the WHO’s guidelines. A child is considered fully vaccinated if he or she has received bacille Calmette-Guerin (BCG) vaccination against tuberculosis; three doses of vaccine to prevent diphtheria, pertussis, and tetanus; at least three doses of polio vaccines; a dose of measles vaccine; and a yellow fever vaccine before the first birthday (NCPN & ICF Macro, 2014). The North West region of Nigeria has the lowest vaccination coverage compared to the other five geopolitical regions of the country, as evidenced by 52% of children fully immunized in the South East and South West compared to only 10% in the North West. Despite the North West region being ranked second in terms of availability of public health resources such as health facilities and Primary Health Care workers (Health Reform Foundation of Nigeria, 2007), there is lower coverage of all antigens in the region compared to other regions in the country (NPCN & ICF MACRO, 2014). Several small-sample hospital-based studies have been conducted in Nigeria on coverage of routine antigens; however, there is a paucity of data from community-based studies with appropriate sampling technique and large sample size in the North West region (Gidado et al., 2014). There are also data gaps on the association between the parents’/caregivers’ cultural factors such as their ability to take decisions independently, religious affiliation, and tribe/ethnicity, and the completion or noncompletion of routine immunization schedules. The current study also addressed the association between the parents’/caregivers’ place of residence (rural/urban), distance from the immunization routine service point, the cost of transport, session plan, and cost of immunization services, and the completion or noncompletion of RI. Findings may provide a better understand of the factors that determine how parents make health decisions for and about their children in the context of diseases with high levels of morbidity and mortality.

1.3 AIM AND OBJECTIVES OF THE STUDY

The main aim of the research is to determine the role of immunization on prevention of disease among children 0-57 months of age in Jega L.G.A of Kebbi State. The objectives of the study are:

1. to determine the effect of immunization on the prevalence of diseases among children 0-57 months old in Kebbi State
2. to determine the relationship between immunization and mortality rate among children from 0-57 months of age in Jega L.G.A of Kebbi State
3. to examine whether children from 0-57 months old are given immunization
4. to investigate the factors affecting the immunization activities in Jega L.G.A of Kebbi State

1.4 RESEARCH QUESTIONS

The study came up with research questions so as to ascertain the above stated objectives of the study. The research questions for the study are:

1. What is the effect of immunization on the prevalence of diseases among children 0-57 months old in Kebbi State?
2. What is the relationship between immunization and mortality rate among children from 0-57 months of age in Jega L.G.A of Kebbi State?
3. Are children from 0-57 months old given immunization in Jega L.G.A of Kebbi State?
4. What are the factors affecting the immunization activities in Jega L.G.A of Kebbi State?

1.5 STATEMENT OF THE HYPOTHESIS

H0: immunization has no significant effect on the prevalence of diseases among children 0-57 months old in Kebbi State

H1: immunization has significant effect on the prevalence of diseases among children 0-57 months old in Kebbi State

1.6 SIGNIFICANCE OF THE STUDY

The study on the role of immunization on prevention of disease among children 0-57 months of age will be of immense benefit to nursing mothers and other health centers in Jega L.G.A of Kebbi State. The study will ascertain the effect of immunization on the prevalence of diseases among children 0-57 months old in Kebbi State. The findings of the study will establish a correlation between immunization and the well being of children from the ages of 0-57 months old. The study will help create awareness on the benefits of immunization to children from the ages of 0-57 months old. The study will also serve as a repository of information to other researchers and students on the role of immunization on prevention of disease among children 0-57 months of age. Finally the study will contribute to the body of the existing literature on the role of immunization on prevention of disease among children 0-57 months of age.

1.7 SCOPE OF THE STUDY

 The study on the role of immunization on prevention of disease among children 0-57 months of age will be limited to children in Jega L.G.A of Kebbi State.

1.8 LIMITATION OF THE STUDY

Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work

1.9 DEFINITION OF TERMS

IMMUNIZATION: is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine

INFANT MORTALITY: the death of children under the age of one year.