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Routine Immunization coverage is generally low in several parts of Nigeria especially
the northern region. It is even lower among people who live in hard to reach areas
including nomads. Although the exact figures of RI coverage amongst the nomads are not
available. There are many cultural/religious beliefs and also physical barriers such as
distance to the health facility and migration which negatively affect immunization
services. This study was carried out to assess the knowledge, attitude and practice of
routine immunization among mothers of children 12-23 months in nomadic population of
Akwanga, Nasarawa state, Nigeria.
A cross-sectional descriptive study was conducted in April 2014. A sample of mothers of
501 children of nomads, 12-23 months of age, was selected using the WHO/EPI 30 by 7
cluster sampling technique and data were obtained through a structured interviewer
administered questionnaire containing both open and close ended questions.
Majority (89.0%) of the caregivers were aware of at least one vaccine preventable disease
(polio) in the LGA. More than a fifth (21.8%) believed immunization is for preventive
services and 70.1% believed immunization is safe and can be accepted for their children.
Despite this, only 6.0% of the children were fully immunized, with 28.1% partially
immunized and 65.9% not immunized at all. The BCG coverage was 23.2%, DPT3
24.0%), OPV3 24.2%, Measles 29.7%, HBV3 12.0% and Yellow fever 27.3%. The DPT
drop-out rate was 15%. Factors associated with failure to immunize children include
caregivers‟ family movement (nomadic) from one place to another (48.5%), distance to
health facility (38.2%), lack of knowledge on routine immunization (23.6%),
discouragement against immunization mainly by the husbands/child‟s father (6.7%) and
personal disapproval by the caregivers (4.8%). The factors affecting routine
immunization uptake among the study population are caregivers‟ age (OR=97.47,
C.I=13.12-723.87), the sex of the child (OR=0.05,C.I=0.01-0.19), place of delivery
(OR=0.03, C.I=0.01-0.09), distance to the nearest HF (OR=0.002, C.I=0.0003-0.015),
and the duration of stay in the current location (OR=21.22, C.I=2.87-157.01).The
significant predictors for the routine immunization uptake were caregivers‟ age
(AOR=14.8,p-Value=0.02), the sex of the child (AOR=0.035,p-Value=0.002), and
mother‟s utilization of ANC services during the index pregnancy (AOR=5.2, p-
Value=0.005). Others were the place of delivery (AOR=0.14,p-Value=0.001), the
duration of stay in the current location (AOR=20.06,p-Value=0.01), distance to the
nearest HF (AOR=0.0006, p-Value=0.0000), and the awareness of the number of visits to
HF to complete the RI (AOR=4.77, p-Value=0.004).
There is urgent need for sustained awareness campaigns of the importance of
immunization and the use of mobile and outreach strategies on migration routes.
CHAPTER ONE: INTRODUCTION
Immunization is one aspect of preventive medicine which gives protection to susceptible
individuals from vaccine preventable infectious disease by administration of a modified
infectious agent. The modified infectious agent can either be a suspension of a killed
organism or an inactive product of the agent, which shall lead to development of
immunity against the disease immunized against and which in turn result in reduction of
morbidity and mortality due to this disease. Immunization is one of the most successful
and cost-effective public health interventions.1
In 1796, Edward Jenner a Briton developed smallpox vaccine and this marked the
beginning of vaccine era for prevention of diseases. The early part of 19th century saw
widespread but not organized use of Jenner‟s vaccine and the first attempt to use it on a
global scale began in 1956 when the WHO and others selected smallpox for eradication
in the world.2,3 The eradication of smallpox in 1980 through smallpox vaccination is the
greatest success in preventive medicine. The successes or triumphs motivated the World
Health Organization (WHO) to adopt the Expanded Program on Immunization (EPI)
which is aimed at reduction, elimination, or total eradication of EPI targeted childhood
killer diseases by the year 2000 and beyond.
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