1.1 BACKGROUND OF STUDY
Immunization is a modern miracle, it has saved millions of lives worldwide and its origin dates back ancient Greece. In the 14th century the Chinese discovered and used a primitive form of vaccination called variolation. The aim was to prevent small pox by exposing healthy people to tissue from the scabs caused by the disease this is the first recorded attempt at vaccination1.
The British physician Dr. Edward Jenner in 1796 discovered vaccination in its modern form and proved to the scientific community that it worked. He was considered the founder of vaccinology in the west after he inoculated a 13year old boy with vaccine of a virus (cow pox) and demonstrated immunity to small pox. By 1798, the first small pox vaccine was developed2
Immunization is the most effective method of preventing infectious diseases3. Widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the restrictions of disease such as polio, measles and tetanus4.
Generally immunization involves stimulating immune responses with infectious agents, i.e. priming the immune system with an immunogen with the intention of creating specific resistance to an infectious disease. Simply put, a process by which an individual’s immune system becomes fortified against an agent.
Immunization is done through various techniques, most commonly vaccination and is definitely less risky and an easier way of being immune to a particular disease than risking a milder form of the disease itself. They are important for both adult and children because of the protection it confers. Immunization not only confers immunity but helps in developing child’s immune system. Immunization could be passive or active.
Active immunization can occur naturally or artificially. Naturally occurring active immunization is when a person comes in contact with an organism. The immune system essentially creates antibodies against the microbe, making it more efficient in the next exposure. Artificially active immunization is where the microbe or part of it are injected into the person before they are able to take it naturally.
Passive immunization is where pre synthesized elements of the immune system are transferred to a person so that the body does not need these elements itself. It can occur physiologically, transferred from mother to foetus during pregnancy. Passive immunity can also be artificial and it’s administered by injection especially if a recent outbreak of a disease has occurred5.
Immunization can prevent infectious diseases in an individual, restrict the spread of diseases and may ultimately eradicate the disease in the community. It represents the remarkably successful and cost effective means of reducing infectious diseases and thereby decreasing the morbidity and mortality in infants and children6.
According to an estimation made by WHO, vaccination annually prevents 2-3 million deaths of children from diphtheria, tetanus, pertussis and measles, a million alone due to measles vaccination in particular. It is believed that an additional 1.5 million deaths will be avoided if global vaccination coverage improves6.
1.2 STATEMENT OF THE PROBLEM
The global burden constituted by vaccine preventable disease is immense. Worldwide about 2.5 million children die every year from vaccine preventable infectious disease mainly in Africa and Asia among children less than 5 years old. In the year 2000, measles alone resulted in 777,000 deaths and 2 million disabilities7-8. Financial commitment towards immunization would amount to an estimate of 3 billion dollars per year in the next 10years with UNICEF investing 56% of its health funds7.
According to WHO 1.5 million children under the age of 5 died from vaccine preventable diseases in 2008 reported globally9. Every year more than 10 million children in low and middle income countries die before they reach their fifth birthdays. Most die because they do not access effective interventions that would combat common and preventable childhood illnesses10. Vaccine preventable diseases remain the most common cause of childhood mortality with an estimated three million deaths each year11.
Four countries in the world were reported to have endemic poliomyelitis with Nigeria being one of them. Others include India, Pakistan and Afghanistan. Presently Polio remains endemic in only two countries- Pakistan and Afghanistan. The deaths and disabilities resulting from this vaccine preventable disease is quite high is these countries12.
Vaccine preventable diseases remain one of the major causes of illnesses and deaths among children in Nigeria and this country is one of the few remaining countries in the world where polio is still endemic. The WHO Global Polio Eradication initiative 2005 Annual Report cited uncontrolled transmission of poliovirus in northern Nigeria and identified the states of Bauchi, Kaduna, Jigawa, Kano and Kastina as the greatest threat to the global eradication of Polio. Nigeria accounts for half of the deaths from Measles in Africa, the highest prevalence of circulating wild poliovirus in the world and the country is among the ten countries in the world with vaccine coverage rates below 50 percent, having been persistently below 40 percent since 199713. In Nigeria, one child in five dies before its fifth birthday and vaccine preventable disease account for 22 percent of deaths14.
Immunization coverage in Nigeria as well as other developing countries is low. As part of the Child Survival Programme, the EPI (Expanded Programme on Immunization) was created in 1974 by WHO and UNICEF and the Rotary International as partners. Since it’s launching over sixty countries have adopted the programme and others are being constantly added to the list. All of whom are laying emphasis on EPI as a building block for Primary Health Care. Its aim is assisting all nations to carry out immunization of their 0-2 year child population against vaccine preventable communicable and dangerous diseases of childhood. The attempt by the Nigerian government to make the program come alive by renaming it as NPI has been met with certain challenges due to lack of community participation, lack of motivation by mother and vaccine availability.15
There is dearth of data on the Knowledge, attitude and practice (KAP) of immunization among mothers of under 5 children in Nigeria. This can be attributed to the many barriers against immunization, including misinformation about vaccines, their adverse effect, vaccine preventable diseases and disease development after administration of vaccines.16-18Inadequate or complete lack of knowledge about the contraindications of vaccines also leads to many immunization errors.19
Certain mothers are of the opinion that ill-health is associated with vaccine administration. As a result, the slightest illness however mild is considered a reason for not giving their children up to date vaccination.19-21
Proper information and appropriate awareness regarding immunization will improve mothers’ perception about the benefits of vaccines and help enhance their attitude towards immunizing their children as well as ensure that they are up to date with the immunization schedule21. Hence, there will be reduction in the incidence of infectious diseases especially the vaccine preventable ones, giving children the chance for good health, ability to grow well, go to school and improvement in their life prospect.
This study has not been done in MUTH, Elele. If for any reason the knowledge and attitude is deficient in this area following this study, then substantial measures can be recommended to ensure that mothers of under five children are appropriately enlightened about immunization and where there are difficulties in uptake of the vaccines, proper investigations can be carried out to ascertain the reasons, so appropriate interventions can be put in place.
1.4 SCOPE OF STUDY
The study was not limited to assessing the knowledge, attitude and practice regarding immunization of under five children among mothers attending antenatal clinic in MUTH, but also to determine the factors and reasons why these children are not being immunized with the available vaccines and assessment of the children who are up to date with their immunization schedule. The research was done within the confinements of the hospital with the mothers being the direct point of contact.
1.5.1 GENERAL OBJECTIVES
The aim of this study was to determine the knowledge, attitude and practice regarding immunization of under-five children among mothers attending antenatal clinic (ANC) at Madonna University Teaching Hospital in Elele, Rivers State.
1.5.2 SPECIFIC OBJECTIVES
- To determine the knowledge regarding immunization among mothers of under-five children attending ANC at MUTH.
- To determine the attitude towards immunization among mothers of under five children attending ANC at MUTH.
- To assess the level of utilization of immunization by mothers of under five children attending ANC at MUTH.
- To determine factors /reasons affecting utilization of immunization by mothers of under five children attending ANC at MUTH.