PERCEPTION OF IMMUNIZATION INFORMATION BY MOTHERS OF UNDER FIVE CHILDREN IN GWANDA VILLAGE, SABON GARI LOCAL GOVERNMENT, KADUNA STATE
This research work focuses on theperception of immunization information by mothers of under-five children in Gwanda Village Sabon Gari Local Government Kaduna State. The research work stemed from challenges faced in administering immunization in rural villages. To achieve the objectives of this research,four, research questions were formulated: What is the perception of vaccine preventable diseases by mothers of under-five children?How do mothers of under-five children in Gwanda Village perceive immunization programme? What is the perception of mothers of under-five children on immunization information? And lastly how will Chatman’s Theory of Normative Behavior explain the perception of immunization information by mothers of under-five children in Gwanda Village?The Chatman’s Theoryof Normative Behaviorwas employed as the theoretical framework. Qualitative research method was used and case study design, purposive samplingtechnique was used to select the 5 respondents and semi-structured interview for data collection.The data collected was transcribed manually, which yielded (111) open codes, (14) sub-categories and (9) categories. The findings revealed thatparticipants perceived vaccine preventable diseases contacted by small children to be caused by Jinn and Witch Craftand with life time threats, it was also deduced that participants didn’t believe in immunization programsand child death or physical deformity, they only perceived it to be destiny.Hence, not even immunization can cure or avertit.They alsofind information on immunization asirrelevant. Community based health services and mass media were their sources of information on immunization. It was concluded that, participants perceive immunization information as bogus that would not help them possitively. This is due to the fact that the information comes from outsiders (whitemen), also the participants confirmed to the Chatman’s (2000) notions of small world context. This studyalso recommended that more measure shouldbe put in place in order to change the notion of the participants on the causes and cure of the vaccine preventable diseases.
1.1 Background to the Study
Over the years, Immunization hasbeena major effect on child‘s death and physical deformity reduction and is one of the most powerful and cost-effective of all health interventions. It prevents debilitating illness, disability and saves millions of lives every year. It is also a key to achieving the Millennium Development Goals (MDGs) designed and agreed by world leaders in 2000 to reduce poverty and improve human development. The contribution of immunization isespecially critical in achieving the goal to reduce deaths among children of underfive years old (MDG, 2014). Immunization have the power not only to save, but also to transformlives; giving children a chance to grow up healthy, go to school and improve their life prospects. When vaccines are combined withother health interventions such as vitamin A supplementation, provision of deworming medicine and bednets to prevent malaria, immunization becomes a major force for child survival.
However, despite the importance of Immunization inrecent years, millions of children are not immunized, exposing them to physical defects or premature death., (UNICEF, 2008).Many researches has been carried out in order to examine immunization coverage and acceptance,having discovererd Nigeria has high underfive (5) child mortality rate, with Northern Nigeria having lowimmunization coverage of 30.7% and highimmunization coverage of 45% in Southern Nigeria by National Demographic and Health Survey (NDHS 2003). In a study Abdulrahman, (2011)noted that pressing emphasis on Partial immunizationcoverage against vaccine preventable diseases which is a significant public health problem especially in rural areas of Nigeria, the reasons for partial immunization and factors responsible for missed opportunitiesare poorly understood and little data is available to explain the phenomenon that could help support thedecision making of mothers.
Abdulrahman et al are of the view that Parentsobjection, disagreement or concern about immunization safety, long distance walking,and long waiting time at the health facility, are the most common reasons for missed immunization. Oluwadere (2009) also noted, for the poor immunization coverage are the salient issues which include ignorance and social cost of access to the service, the quality of the immunization service, availability to the remote areas, health personnel commitment, and consistent availability.He futher stated that the extended Programme on immunisationintroduced in 1979 with the aim of providingroutine immunisation to children less than the age of two, recorded initial but intermittent successes; The optimum level was recorded yearly 1990s with the country achieving universalchildhood immunisation of 81.5 percent coverage,meanwhile since that period of success,Nigeria has witnessed gradual but consistentreduction in immunisation coverage.
By 1996, theNational Coverage Data showed less than 30% coverage for the entire vaccines (NDHS 1999) from 1999 this has reduced to 16.8% for all immunizations and by 2003, it was 12.9% (Babalola and Olabisi2004). This figure is consistent with the 2003National Immunisation Coverage Survey figure,it is the lowest in the world and explains the poor health status of children in the country and the worst in west Africa.In another claim by The MICS (2007) for Nigeria it shows that there are real disparities in coverage of all types or levels of vaccination along rural-urban and North-South partitions of the country and along levels of education and wealth status. The coverage is low in rural areas, in the North, among children with mothers with less education and among children in the poorest wealth.
However, studies revealed distance and long waiting at the facility, inadequate awareness, educational status, concerns on immunization safety, health facility, ignorace and social cost of access to immunization services, quality of immunization service, health personel commitments are the contributory factors of limiting coverage on immunization. This suggests that, mother‘s perceptionhas great influene on acceptance of immunization program as well as rejection. All these researches did not look at the socio-cultural factors influencing mothers perceptions on immunization program, hence the premise of this reseach. The perception of mothers on immunization information is the militating foctor to immunization acceptance, allowing children to suffer from vaccine preventable diseases, increasing the number of deaths and physically deformed children within the age of five.
With the billions of dollars spent every year by Nigerian Government and other development partners to provide vaccines and create awareness for Immunization,the increased risks of diseases in children population is inpart because of increasing rates of vaccine refusal, which can mean that immune-deficient children are at bigger risk of being exposed to vaccine-preventable disease. In most situations, they are worried about vaccine complications from vaccinated kids.To avoid vaccine-preventable diseases, they talk about creating "a 'protective cocoon' of immunized persons surrounding patients with primary immunodeficiency diseases.
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. Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investment with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change (WHO/Sergei Deshevoi, 2014).
When children are born, they inherit specific types of antibodies from their mothers. These antibodies help them fend off different diseases. The antibodies are also natural way of protecting children when they are most vulnerable. However, starting around six months of age, these antibodies start to diminish, and almost completely disappear by the time a child is one year old. In the ideal situation, children should start to make their own antibodies i.e. the beginning of their immune system, as they increasingly become exposed to the diseases that the maternal antibodies had previously protected them against. Immunization replace through Vaccines which are either parts of the viruses or bacteria (called antigens) or weakened live viruses and bacteria. immunization are given to children before the mother‘s antibodies completely disappear. Most children get upto 20 vaccines before one year.
Immunization is one of the most cost-effective public health measures available. But although it is possible to manufacture vaccines against a wide variety of viruses and bacteria, it is important to ensure that the introduction of a particular vaccine will always confer a major benefit to the population receiving it. Therefore certain broad principles are followed before a vaccine is recognized as being suitable for general use.
- They should be a major risk of contracting the infection against which, the vaccine is intended to protect;
- The vaccine should prevent an illness, complications and squealed which is regarded as serious, especially when it is fatal.
- The efficacy of the vaccines should be sufficiently high
- Any risk associated with the vaccine should be sufficiently low) the procedures and the number of dozes required for successful immunization should be acceptable to the public.
The Routine Immunization Schedule
- BCG ( Bacilli Calmette Guerin)—at birth or as soon as possible after birth
- OPV (Oral Polio Vaccine)—at birth and at 6, 10, and 14 weeks of age
- DPT (Diphtheria, pertusis, tetanus)—at 6, 10, and 14 weeks of age
- Hepatitis B—at birth, 6 and 14 weeks
- Measles—at 9 months of age
- Yellow Fever—at 9 months of age
- Vitamin A—at 9 months and 15 months of age
Immunization Information encompasses the study and use of communication strategies to inform and influence individual of all ages and community decisions, providing timely, accurate, and proven information about vaccines and the diseases they prevent (Immunization Action Coalition IAC 2013). Like prescription of drugs, vaccines are pharmaceutical products that carry two risks: a risk the product will not work and a risk the product will cause harm. It also provide ways to prevent vaccine injuries and deaths through public education advocates for informed consent in medical research and medical policies and public health laws, including flexible exemptions in vaccine policies and laws for health reasons and for religious and conscientiously held beliefs. It also supports adoption of the precautionary principle based on the Hippocratic ―first, do no harm‖ approach to public health policymaking and in shared medical decision-making by doctors with patients (National Vaccine Information, 2013).
Immunization Information enables individual to seek medical care, reaching the health facility, and receiving appropriate case management by health workers such as provision of accurate, comprehensive and up-to-date information about childhood vaccines, and the diseases they prevent, when to have the vaccines to parent and healthcare professionalsand Uptake of reproductive health services. Immunization information aims to advocate vaccine risk awareness and the right to exercise voluntary, informed consent to immunization. Immunization Information works to increase immunization rates and prevent disease by creating and distributing educational materials for health professionals and the public that enhance the delivery of safe and effective immunization services. It also facilitates communication about the safety, efficacy, and use of vaccines within the broad immunization community of patients, healthcare organizations, and government health agencies.
Immunization and Perception
An ideal vaccine should confer long lasting preferably lifelong protection against disease; it should be inexpensive enough for large scale use, stable enough to remain potent during transportation and storage, and have no adverse effect on recipient. Routine immunization are acceptable practices for residents in Northern Nigeria especially, the Muslim parents. For them, the main obstacle has been the lack of available vaccines (FBA 2005). For others, they are willing to take their children for immunization at local clinics and hospitals when diseases such as measles or meningitis threaten (Ejembi et al 1998). At such times, the fear of disease overshadow the perceived risk of immunization however, for some, immunization is unnecessary or even possibly dangerous undertaking for infants and children. For one parents fears is not only sufficient, but is the only real protection against disease which ultimately comes from God. Islamic children believe that for every disease there is a cure created by God which may consist of prayer alone or may be combined with specific medicinal substances, including western medicine (maganin boko) among others. Thus, as will be seen, Islamic scholars are Muslims in Northern Nigeria more generally, are not categorically opposed to western medicine.
In the first place, some people attributed the fear of injection and their association didn‘t know how to properly administer injections, leading to infections and possible nerve damage at the site of the injection (Fry 1965, Wall 1988). However, immunization which requires the injection or attenuated viruses) may be seen as unclean or harmful practice which threatens children health. In trying to follow Islamic precepts not to harm ones children, parents need to assess the risks and benefits of immunization, as interviews and archival documents suggest that present day resistance by Muslim teachers to the distribution vaccine, is due to fears that, it may cause more harm than good.
Fears regarding routine immunization are expressed in many parts of Nigeria. Fathers of partially immunised children in Muslim rural communities in Lagos State see hidden motives linked with attempts by non-governmental organisations (NGOs) sponsored by unknown enemies in developed countries to reduce the local population and increase mortality rates among Nigerians. Belief in a secret immunization agenda is prevalent in Jigawa, Kano and Yobe States, where many believe activities are fuelled by Western countries determined to impose population control on local Muslim communities.Lack of confidence and trust in routine immunization as an effective health interventions appears to be relatively common in many parts of Nigeria. For many, immunization is seen to provide at best only partial immunity. The widespread misconception that immunization can prevent all childhood illnesses reduces trust because when, as it must, immunization fails to give such protection, faith is lost in immunization as an intervention, for any and all diseases.
1.2 Statement of the Problem
Immunization is among the most efficient tool for promoting individual and public health and it is one of the most powerful and cost-effective of all health interventions. It eradicates diseases completely, control mortality, morbidity and complications. Immunization programmes are estimated to prevent almost 6million deaths annually worldwide and greatly reduce the burden of infectious diseases (Andre, 2015). Immunization is one of the most cost-effective health investmentswith proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities and does not require any major lifestyle change(WHO/Sergei Deshevoi 2013).Immunization it is also a way of protecting individuals against serious diseases. Once we have been immunised, our bodies are better able to fight these diseases if we come into contact with them.
However, the researcher as an auxilliary nurse observed that from 1999 to date, the rate at which under-five children in Gwanda Village, Sabon Gari Local Government, Kaduna State are dying is at an increase. This is evident by the Department of Health of the said Local Government in the year 2015, whichdocumented that the rate of children‘s death in the village is worrisome. Similarly Kabir (2012) and Sani (2013) indicated that the children death ranging from 1-5yrs of age in villages around Zaria are increasing, Gwanda Village is one of such villages and many of the children in the village suffer physical deformities such as deafness and dumbness, loss of limbs, brain damage among others.
Researchers such as Sunday (2009), Anas (2011) and Ghali (2012), conducted researches about child death and physical deformities from the perspective of access to good food, portable drinking water, environmental hygine respectively. To the best of the researcher‘s knowledge none of the previous studies looked at the above problem from the perspective of compliance to Health Care Information, particularly Immunization Information.
This study investigated the perceptions of mothers on immunization informationwith the aid ofChatman‘s Theory of Normative Behavior as a theoritical frameworkto explore the socio-cultural factors influencing mothers perceptions leading to immunization rejection.
1.3 Research Question
The following research questions guided this study:
- What is the perception of vaccinne preventable diseases by mothers of under-five childrenin Gwanda Village,Sabon Gari Local Government, Kaduna State?
- How do mothers of under five children in Gwanda Village, Sabon Gari Local Government perceive immunization programme as a preventive and control meassure to vaccine preventable diseases?
- What is the perception of mothers of under-five children on immunization information and sources in Gwanda Village?
- How will the Chatman‘s Theory of Normative Behaviour explain the perception of immunization Information by mothers of under-five children in Gwanda Village Sabon Gari Local Government?
1.4 Objectives Of The Study
The following are the objectives of this study:
- To examine the perception of vaccine preventable diseases by mothers nof under-five childrenin Gwanda Village of Sabon Gari Local Government.
- To explore mothers of under-five children perception on immunization programme as a preventive meassure to vaccine preventable diseases in Gwanda Village of Sabon Gari Local Government.
- To identify how mothers of underfive children perceive immunization information and sources in Gwanda Village of Sabon Gari Local Government.
- To examine how Chatman‘s Theory of Normative Behaviorexplain the perception of mothers of under-five children on immunization Information in Gwanda Village of Sabon Gari Local Government.
1.5 Significance of the Study
This study will help check mate the increase in under five children‘s deaths and physical defects rate due to perception of Immunization Information based on socio-cultural practicesin Gwanda Village of Sabon Gari Local Government Kaduna State, using Chatman‘s Theory of Normative Behavior to better understandthe Perception on Immunization Information among mothers.
The study will serve as a body of knowledge that can also be used by stakeholders such as; Government officials, information professionals, policy makers, international organization such as world Health Organization and UNICEF to design immunization programmes, strategies and plan of actions, thereby increasing acceptance of immunization which will in turn promote children‘s health.
Similarly, the work will also serve as a reference material or literature to those that embark on a similar research work to prevent child death because they are the leaders of tomorrow.
1.6 Scope and Delimitation
This study specifically investigated the efficacy of Chatman‘s theory of Normative Behavior in accounting for perception of immunization information behavior among illitrates mothers of under-five children and never allow them to be immunize in Gwanda Village a rural community of Sabon Gari Local Government, Kaduna state.
1.7 Operational Defination of Terms
- Immunization: Is the process by which a child is made immune or resistance to any of the vaccine preventable diseases known to be deadly or cause physical defects to the child (infectious diseases).
- Immunization information: Refers to information that are produce to explain both the benefits, and risks how and where to get the services to the recipients, that is to the mothers.
- Perception: This are the ways mothers in gwanda village regards, understands and interpretes immunization information.
- Vaccine preventable diseases: They are diseases that can be controlled and prevented by vaccines ( tablets, injectables, drops etc) through immunization.
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PERCEPTION OF IMMUNIZATION INFORMATION BY MOTHERS OF UNDER FIVE CHILDREN IN GWANDA VILLAGE, SABON GARI LOCAL GOVERNMENT, KADUNA STATE