CHAPTER ONE

INTRODUCTION

Immunization remains one of the most important public health interventions and a cost effective strategy to reduce both the morbidity and mortality associated with infectious diseases. An estimated three million deaths are prevented through immunization each year worldwide.1 . In spite of this measures, vaccine preventable diseases remain the most common cause of childhood mortality in an estimated three million deaths each year.

Uptake of vaccination services is dependent not only on provision of these services but also on other factors including knowledge and attitude of mothers,3,4 density of health workers,5 accessibility to vaccination clinics and availability of safe needles and syringes.

Assessing immunization practice and coverage help to evaluate progress in achieving programme objectives and in improving service delivery.7 Such positive evidence is required for continuing support from donor-supported initiatives like global alliance for vaccine and immunization GAVI.7

National programme on immunization aims at delivering the primary immunization series to at least 90% of infants.8However, inadequate levels of immunization against childhood diseases remain a significant public health problem and reasons for non-uptake of immunization services are poorly understood.  Immunization coverage is non uniform throughout the country with rural area presenting significantly lower coverage9 and thus contributing to the circulation of wild measles and other immunization preventable disease10. The effectiveness of immunization programme in resource-poor setting can be influenced by factors such as coverage of health workers, the existence and quality of outreach services, the quality of the cold chain, the liaison of communities with health services, the existence of population movements and several other factors that are related to the vaccines in use, to health services or to communities.  The relative effect of each

factor may vary according to geographical area.8,11-13 In the immunization programme exercise, the understanding of the local customs, believe and tradition  is crucial to develop and implement appropriate solutions. 

The growing slum population in the developing world is an increasing challenge.  Reports show that 60% of individual who reside in most cities in the developing countries live in the urban slum.10 Most slum lack good access roads and are denied adequate health care due to unavailability of proper health care services. 

New estimates in “Levels and trends in child mortality report 2015 UNICEF DATA,” that although the global progress has been substantial, 16 000 children under 5 still die every day. It equally shows that under-five deaths have dropped from 12.7 million per year in 1990 to 5.9 million in 2015. This is the first year the figure has gone below the

6 million mark.16

Vaccine preventable disease have caused more than 20 percent of death for children under the age of five years. From international comparative data Nigeria’s immunization

coverage rates are among the worst in the world .17

A report revealed that in 2013, only 76% of Nigeria < 24 months receive all recommended vaccines while 24% of children in Nigeria were not vaccinated at all.  This lead to a lot of children in Nigeria at risk of dying from vaccine preventable diseases.18

In 2009 Nigeria was listed among countries with the highest incidence of poliovirus cases in the world.

  STATEMENT O PROBLEM

One of the important ways to reduce child morbidity and mortality from common vaccine presentable diseases is through immunization. Despite the immunization programme, vaccine preventable disease remain the most common cause of childhood mortality with estimated three million deaths each year..2

According to the centre for disease control and prevention, immunity to disease is achieved through the presence of antibodies to that disease in a person’s system.   This in fact is the main justification for using vaccines to boost immunity and a primary focus of vaccine research and development.2

JUSTIFICATION 

Child mortality rates plunge by more than half since 1990 but global MDG target was missed by wide margin asthe 53% drop in under-five mortality is not enough to meet the Millennium Development Goal of a two-thirds reduction between 1990 and 2015.16

Evaluating the determinants of immunization coverage provides evidence whether substantial progress towards achieving vaccination targets is being made.  Such positive evidence is required for continuous support from donor-support initiative like global

alliance for vaccine and immunization (GAVI).7

The routine immunization coverage against vaccine preventable disease are below targets of national level.  It is important to identify the factors influencing full childhood immunization among children less than 5 years in Nigeria in order to reduce child mortality and morbidity.19Equally findings from this study will help policy makers in the planning and policy making on immunization and averting the menace of vaccine preventable disease in the state. Several   reports have also shown that immunization rates in urban slums rural areas and inner cities are lower than urban cities.14, 15  The serious implication of low and unstable immunization coverage in Africa necessitate a closer look at immunization programmes among rural dwellers in our environment since their peculiar problems might contribute strongly to this low coverage.14 More so immunization as an important component of child care, yet children around the world are commonly not fully immunized.  The goal of this research was to assess current immunization practices, perceived factors influencing immunization practice and identify strategies that might improve immunization rates.

1.4.1 General Objective

To ascertain the determinants of childhood immunization in Idoha

1.4.2 Specific Objective

(1)              To find out immunization status of children 0-5years in Idoha

(2)              To determine mothers reasons for uptake and non uptake of immunizationin

Idoha

(3)              To identify factors  influencing uptake of immunization in Idoha

(4)              To ascertain mothers knowledge of  immunization in Idoha and its effect on immunization status

(5)              To deduce the perception of mother on immunization in Idoha and its effect on

status.

(6)              To describe mothers suggestions on how to improve uptake of immunization in the community