THE EFFECT OF  ROUTINE IMMUNIZATION DEFAULT AMONG WOMEN OF CHILD BEARING AGE

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Immunisation refers to the administration of a mixed vaccine designed to stimulate the immune system and induce the production of antibodies that provide permanent protection against specific infectious diseases. Vaccination has been shown to be a practical, cost-effective, risk-free, and uncomplicated health intervention that reduces morbidity and mortality among children (Gothefors, 2018). Significant reductions in the worldwide prevalence of vaccine-preventable illnesses have been observed since the inception of the expanded immunisation programme in 1974 (Feldstein et al. 2021). 

According to Gothefors (2018), immunisation is the most effective public health intervention for averting vaccine-preventable infectious diseases. Annually, it averts the transmission of measles, diphtheria, pertussis (commonly referred to as whooping cough), diphtheria, and influenza (Skehan et al. 2020). The worldwide prevalence of polio and neonatal tetanus has both decreased by 94%, and smallpox has been eradicated. Furthermore, the incidence of common childhood diseases associated with morbidity, disability, and mortality has been reduced by an additional 94% (WHO 2019). Vaccine preventable causes of death among children under the age of five account for approximately 29% of fatalities worldwide (Melaku et al. 2021). On the contrary, 19.9 million infants did not receive the recommended vaccination doses (Pagliusi et al. 2019). Furthermore, it is significant to highlight that there has been a chronic upward trend in the vaccination dropout rates observed in Asian and African countries (WHO, 2018). Ethiopia is one of ten countries where routine immunisation is not practiced for sixty percent of the 19.4 million neonates worldwide (WHO, 2019). 

(Mihigo et al., 2020) Variation has significantly contributed to the improvement of public health in Africa through its facilitation of the elimination, eradication, and management of dangerous diseases. Africa's Expanded Programme on Immunisation (EPI) has witnessed notable progress during the last four decades (Uwizihiwe et al. 2015). Notwithstanding advancements in the overall implementation of routine expanded immunisation in Africa, substantial barriers remain. 

It is recommended that all countries aim to achieve a minimum immunisation coverage of 90% for all vaccines (WHO, 2019). However, considerable proportions of minors do not obtain the vaccinations that are recommended by the WHO. The act of vaccinating a child against all ten vaccine-preventable diseases constitutes immunisation (AACSA, 2011 cited Gothefors (2018). It is mandatory for children to have received the following vaccines by this age: hepatitis B hemophilus influenza type b (DPT-Hep B-HIB), three doses of polio vaccine, and measles vaccine; and Bacillus Chalmette Guerine (BCG), three doses of pentavalent vaccine, two doses of Rota vaccine; (AACSA, 2011 cited in Gothefors (2018). 

On a global scale, approximately 5% (6.6 million) of children discontinue receiving the third dose of the DTP vaccine. The African Region had the highest dropout rate, at 11% (3.1 million), while the Western Pacific Region had the lowest dropout rate, at 0.4% (0.08 million) (Casey et al. 2022). In 2016, fourteen percent of children around the world failed to finish the prescribed course of three dosages of DTP. Nevertheless, 19.5 million children were not administered the DTP3 dose (dropped out). 11.8 million individuals (61 percent) of those who did not receive the third dose of DTP resided in ten countries (Casey et al. 2022). Ethiopia (4%), Nigeria (18%), India (16%), and Pakistan (7%), followed by Indonesia (6%), are the countries with the highest default rates (WHO, 2019). 

A persistent issue in all African regions, including Nigeria, is the failure to vaccinate children against potentially fatal illnesses. This places children at grave risk of contracting such diseases. EPI encountered challenges to its success due to demographic barriers, including populations residing in difficult-to-reach areas and parents with limited education or socioeconomic status. Furthermore, obstacles related to programming, such as shortages of vaccines and acts of violence, persistently impede the ability of certain children to avail themselves of comprehensive immunisation initiatives at the community or national scale. Further exacerbating the problems are programme expenditures and a dearth of political determination (Tadesse et al. 2019). 

Based on available reports, Nigerian children receive initial vaccination doses but fail to receive subsequent doses, resulting in a significant rate of vaccination non-compliance in the country. As a result, the high attrition rate caused the deaths of more than 1.5 million children annually (Gothefors, 2018). Therefore, this study aimed to investigate the effect of  routine immunization default among women of child bearing age.

1.2 Statement of the problem

The Nigerian EPI was formulated in accordance with the guidelines set forth by the WHO. A child is deemed to be fully immunised prior to their first birthday if they have received the following vaccinations: bacille Calmette-Guerin (BCG) for tuberculosis; three doses of vaccines against diphtheria, pertussis, and tetanus; a minimum of three doses of polio vaccines; one dose of measles vaccine; and yellow fever vaccine (NCPN & ICF Macro, 2014 cited in Skehan & Muller 2020). In comparison to the other five geopolitical regions of Nigeria, the vaccination coverage in the North West and south south region is the lowest, as indicated by the fact that only 52% of children in the South East and South West are entirely immunised, while the proportion is higher in the south south and north west. 

A persistent issue in all African regions, including Nigeria, is the failure to vaccinate children against potentially fatal illnesses. This places children at grave risk of contracting such diseases. EPI encountered challenges to its success due to demographic barriers, including populations residing in difficult-to-reach areas and parents with limited education or socioeconomic status. Furthermore, obstacles related to programming, such as shortages of vaccines and acts of violence, persistently impede the ability of certain children to avail themselves of comprehensive immunisation initiatives at the community or national scale. Further exacerbating the problems are programme expenditures and a dearth of political determination (Tadesse et al. 2019). A significant proportion of children in Nigeria fail to receive subsequent doses of vaccinations after receiving the initial doses, resulting in an elevated withdrawal rate. In view of the above, this study seek to examine the effect of  routine immunization default among women of child bearing age.

1.3 Objectives of the Study

The major objective of this study is to examine the effect of  routine immunization default among women of child bearing age using lkpoba Okha local government of Edo State as a case study. While other specific objectives are:

Determine the extent of immunization coverage in lkpoba Okha local government of Edo State.

Ascertain the level of immunization completion among women of child bearing age in lkpoba Okha local government of Edo State.

Investigate the factors associated with immunization default among women of child bearing age in lkpoba Okha local government of Edo State.

1.4 Research Questions

The following research questions will be answered in this study:

What is the extent of immunization coverage in lkpoba Okha local government of Edo State?

What is the level of completed childhood immunization among women in lkpoba Okha local government of Edo State?

What are the factors associated with immunization default among women of child bearing age in lkpoba Okha local government of Edo State?

1.5 Research Hypothesis

Ho: The level of childhood immunization series completion among mothers in Ofagbe Community is low

Ha: The level of childhood immunization series completion among mothers in Ofagbe Community is high.

1.6 Significance Of The Study

This study will be significant to the society as the findings of this study will show the importance of immunization to children is, its effects and the perception of mothers towards immunization and as such will know the shortcomings and determine  the factors affecting the immunization completion.

Additionally, healthcare providers will use it as a literature review. This means that healthcare providers who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. 

Invariably, the result of the study contributes immensely to the body of academic knowledge with regards to the factors affecting completion of childhood immunization series.

1.7 Scope Of The Study

The broad objective of this study borders on evaluation on the effect of  routine immunization default among women of child bearing age. Geographically, this study will be carried out in lkpoba Okha local government of Edo State.

1.8 Limitations Of The Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study. In this study we did not take into consideration the validity of vaccines as at when they were taken • Our data were collected on the premises of routine immunization, as such the study did not consider the immunization given during Supplementary Immunization Activities (SIA) • The study design is cross-sectional, so causal effect could not be established.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.

1.9 Definition Of Terms

Knowledge: awareness or familiarity gained by experience of a fact or situation.

Vaccine: A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins.

Vaccination: Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism.