CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Immunization is one of the most successful and cost-effective public health interventions, saving the lives of 3 million children annually. One-third of the deaths among under-fives are preventable by vaccines.  Epidemiological study has shown that 2.5 million deaths occurred  yearly  as a result of vaccine‐preventable diseases, majorly in Africa and Asia among children less than 5 years old (GIVS, 2012). Immunization is the process of conferring increased resistance to an infectious disease by a means other than experiencing the natural infection. Typically, this includes exposure to an agent (antigen or immunogenic) designed to fortify the individual immune system against that agent or similar infectious agents (active immunization). Immunization also can include providing a person with protective antibodies developed by someone else or another organism (passive immunization).When the human immune system is exposed to a disease once, it can establish the ability to respond fast to a subsequent infection. Therefore, by exposing a person to an immunogenic in a controlled way, the person’s body will then be able to protect itself from infection later as life progresses (Blakemore & Jennett, 2014).Medical scientists have developed diverse immunizationprocesses for a large number of diseases, beginning on a large scale about 100 years ago. Immunization is one of the most important public health interventions and a cost effective strategy to reduce both the morbidity and death associated with infectious diseases. In line with the aforementioned, the report of World Health Organization and the  study of Breslow (2011) have shown that over two million deaths are delayed through vaccination each year worldwide.Immunization coverage has now reached a plateau in many developing countries like Nigeria , and even where good coverage has been attained; reaching children not yet vaccinated has proved challenging (EPI, 2015).The dynamics of vaccination uptake remain unclear; the critical questions that remain to be answered therefore include to what extent is immunization accepted by the public in response to recommendations and advice from health workers and community leaders? To what extent does an informed public actively demand it? What is the level of awareness of its benefits and importance? Previous studies have shown that uptake of vaccination services is dependent not only on provision of these services but also on other factors including knowledge and attitude of mothers (Matsumura et al., 2012; Torun & Bakirci, 2011), density of health workers (Anand & Barnighausen, 2017), accessibility to vaccination clinics, availability of safe needles and syringes and the opportunity costs (such as lost earnings or time) incurred by parents (mothers). A good attempt to address these factors may go a long way to improve vaccine utilization and subsequent protection of the children against childhood infectious diseases. Although, the low immunization coverage in Nigeria has been mostly attributed to poor knowledge, compliance, accessibility and inappropriate attitude among others factors; poor compliance with full immunization is believed to be the most significant reason for low immunization coverage in the country due to socio-cultural obstacles to acceptance of immunization.Reasons underlying poor immunization coverage has been studied by different researchers world-wide and beside other factors, parental knowledge and belief has been documented to influence immunization uptake (Siddiqi, 2010). Other factors that have been found to influence compliance with full immunization of children against VPDs include lack of services due to system weakness, low public awareness, fear and misconception (Jheeta M, Newell 2008). Although, most of the World Health Organization's (WHO's) regions reached more than 80% of their target populations with three doses of diphtheria, pertussis and tetanus (DPT) vaccine in 2013, coverage with these vaccines remained short of the 2020 goal of 90% national coverage for all vaccines, particularly in the African (75%) and South-East Asia (77%) regions (Restrepo-Mendez, 2016) In addition, a review of the trend of full immunization coverage in low- and middle-income countries showed conspicuous inequalities among and within countries, and Nigeria is among the eight low-income countries that have been identified as having the greatest within country disparity in vaccination coverage.Immunization program is more systemized in developed countries, but the situation is poor in most populous countries. In Nigeria, educational level of mothers is not up to the mark unlike in the developed countries. Unfortunately, despite a lot of effort by the governmentto eradicate childhood diseases like polio, measles, tetanus, whooping cough etc. the challenges still remains. However, Nigeria was recently declared polio free by the United Nations. The main reason behind these problems is lack of public awareness about the importance of immunization and lack of education. Due to these factors disease rate is high in developing countries. World Health Organization (WHO) initiated the Expanded Program on Immunization (EPI) in May1974 with the objective to vaccinate children throughout the world. A major goal for the World Health Organization is the global control of certain infectious diseases [WHO 1997]. The main strategies for the prevention of infection are to eliminate or diminish the amount of infecting microorganism from circulation, to enhance the host immune response and to treat the infected host. These strategies are achieved by two of immunization types (active and passive)(WHO 1997). Kapoor and Vyas (2010) had stated that although immunization is one of the most effective, safest and efficient Public Health Interventions, and that its impact on childhood morbidity and mortality has been great, its full potential was yet to be reached. Through proven strategies, immunization has been made accessible to even the most hard-to-reach and vulnerable populations since it involves clearly targeted groups (WHO, 2013). When immunization rates are high, it is much less likely a pathogen will be carried and transmitted from person to person. Declines in vaccination rates allow diseases to emerge in the population again. A case in point is the fact that Measles is now endemic in the United Kingdom, after vaccination rates dropped below 80% (Awosika, 2012). In Nigeria in 2014, unfounded fears of the polio vaccine led to a drop in vaccination rates and reemergence of infection, and the spread of polio to ten other countries (Awosika, 2012). Since mothers are the important health decision makers of their children, their Knowledge, Attitude and Practices regarding immunization in general have a great impact on immunization status of their child [Qidwai et al, 2017 & Angadi et al, 2013]. Several studies on immunization conducted in various countries have revealed that increasing mothers’ knowledge regarding vaccination improves immunization status and affects success of immunization program. Education status and other socioeconomic status of mothers have a great impact on their decision regarding vaccination. Therefore, our aim of this study was to assess mother’s attitude towards vaccination and to correlate these factors with vaccination status of their child in order to improve and increase vaccination coverage and completeness [Al-lelaomer et al, 2014].

1.2 STATEMENT OF THE PROBLEM

It was reported in the NDHS (2015) that widespread inequities persist in immunization coverage to the disadvantage of children of parents in the lowest socio- economic quintile, parents with no education, and parents residing in rural areas, especially in the Northern regions. Babalola and Aina (2013) also noted that inequitable access to routine immunization in Nigeria has also been attributed to fear and confusion. As reported by WHO (2014), 22.4 million children were incompletely vaccinated at 12 months of age and remained at risk for vaccine-preventable morbidity and mortality. The result was more disturbing when it revealed that more than half of all incompletely vaccinated children live in India (32%), Nigeria (14%), and Indonesia (7%). Vaccines are one of the best and most cost effective public health interventions known to man. Nigeria is an important country in the immunization world. Nigeria is a large country with high child mortality and low immunization coverage rates. Of the 6 million Nigerian children born every year, more than 1 million fail to get fully vaccinated by their first birthday (IVAC 2012). Current coverage rates for the various childhood vaccines in Nigeria are among the lowest in the world (Babalola&Aina, 2013). For instance, Measles was responsible for 5 percent of the child deaths in Africa (Bryce, Boschi-Pinto, Shibuya & Black, 2012), of an estimated 282 000 deaths in 2015 (Stein, Birmingham, Kurian, Duclos & Strebel, 2012; WHO, 2015); half of these occurred in Nigeria (Hersh, 2012). Lack of knowledge on immunization and financial challenges were among some of the factors that created a negative perception about immunization among mothers it is on the background that this study aims to assess mothers’ knowledge level, attitude and the barriers to childhood immunization in Obukpa Area, Nsukka L.G.A.

1.3AIMS OF THE STUDY

The major aim of the study is to examine the attitude of mothers towards immunization. Other specific objectives of the study include;

1.  To assess the attitude of mothers as regards vaccination in Obukpa Area in Nsukka L.G.A.

2.  To examine the role mothers play in the immunization of their children in Obukpa Area in Nsukka L.G.A.

3.  To examine the relationship between the attitude of mothers and mortality rate of infants in Obukpa Area in Nsukka L.G.A.

4.  To examine the impact of immunization on infant mortality rate in Obukpa Area in Nsukka L.G.A.

5.  To examine the challenges faced by mothers in the immunization of infants in Obukpa Area in Nsukka L.G.A.

6.  To suggest interventions or measures to improve the knowledge and attitude of mothers towards immunization in Obukpa Area in Nsukka L.G.A

1.4 RESEARCH QUESTIONS

1.  What is the attitude of mothers as regards immunization in Obukpa Area in Nsukka L.G.A?

2.  What is the role mothers play in the immunization of their children in Obukpa Area in Nsukka L.G.A?

3.  What is the relationship between the attitude of mothers and mortality rate of infants in Obukpa Area in Nsukka L.G.A?

4.  What is the impact of immunization on infant mortality rate in Obukpa Area in Nsukka L.G.A?

5.  To examine the challenges faced by mothers in the immunization of infants in Obukpa Area in Nsukka L.G.A?

6.  What are the interventions or measures to improve the knowledge and attitude of mothers towards immunization in Obukpa Area in Nsukka L.G.A?

1.5 RESEARCH HYPOTHESES

HYPOTHESIS QUESTION 1

H0: The knowledge of mothers towards immunization has no significant impact on infant mortality rate in Obukpa Area in Nsukka L.G.A

H1: The knowledge of mothers towards immunization has a significant impact on infant mortality rate in Obukpa Area in Nsukka L.G.A

HYPOTHESIS QUESTION 2

HO: There is no significant relationship between attitude of mothers and mortality rate of infants in Obukpa Area in Nsukka L.G.A.

H1: There is a significant relationship between attitude of mothers and mortality rate of infants in Obukpa Area in Nsukka L.G.A.

1.6      Significance of the study

The study would have contribution to enlighten the society on the   attitude and knowledge of mothers towards immunization -in Nigeria. It would also prepare ground for interested researcher who might wish to conduct further research in related areas and could contribute to the existing literature.

1.7      SCOPE AND LIMITATION OF THE STUDY

The study is restricted to the attitude of mothers towards immunization in Obukpa community in Nsukka local government of Enugu state.

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.

1.8      DEFINITION OF TERMS

Immunization: Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body's own immune system to protect the person against subsequent infection or disease.

Mother: The definition of a mother is a woman who gives birth or who has the responsibility of physical and emotional care for specific children. An example of a mother is a woman who has just given birth to twins.

Attitude: The definition of an attitude is a way of feeling or acting toward a person thing or situation.

Positive Attitude: Those mothers who answer correctly the attitude questions and if they score the median value and above

Negative Attitude: Those mothers who answer correctly the attitude questions and if they score below the median value

Benefits of Immunization: the usefulness, values or gains of child immunization.