SUMMARY

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

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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.

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CHAPTER ONE: INTRODUCTION

1.1 Background

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.