CHAPTER ONE

INTRODUCTION

1.1       BACKGROUND INFORMATION

Immunization can be termed as the process of protecting a person from a specific disease. It is the stimulation of the body’s own immune response (by administration of a vaccine) is referred to as active immunization; while passive immunization is temporary immunity brought about by the transfer of pre-formed antibody, or specifically sensitized lymphocytes, from an immune individual to a non-immune individual – the latter thus becoming immune without necessarily having had contact with the corresponding antigen(s). Immunization is an important form of primary prevention which protects the individual and the wider population by impeding the spread of infectious disease (John et al., 2010) and is a cornerstone of public health. The World Health Organization (WHO) estimates, that in 2006, immunizations saved two to three million lives (WHO, 2006). Since the launch of the Expanded Program on Immunization (EPI) in 1974, vaccination programs have been seen as one of the world’s most cost-effective public health strategies in reducing the burden of infectious diseases globally and serve as a key building block for health systems in the developing world.

Immunization coverage is a health output the ultimate effect of which is a reduction in disease incidence. Disease surveillance systems currently lag behind coverage assessments, and reported cases of vaccine-preventable diseases in most countries are only a small, and unknown, fraction of the actual number of cases occurring. Disease surveillance systems are essential tools for effective health systems: they provide early warning of disease outbreaks and provide information essential to the management of immunization programs. Strengthening surveillance systems as part of improvement of immunization programs is therefore of vital importance. Achieving high levels of coverage is, by itself, not a sufficient indication of the effectiveness of a health care system, as deficiencies in other areas could be widespread. However, lack of progress in moving towards high levels of coverage is a strong indication of failure to provide essential services to protect the health of the most vulnerable segment of a population. For diphtheria, pertussis, tetanus (DPT), a minimal coverage goal of 80 percent (three doses) by 2005 has been proposed by the Global Alliance for Vaccines and Immunization (GAVI), to be achieved in all districts in all countries (Edward et al, 2014).

Countries across the world, at different levels of income, have shown that this is achievable with sustained efforts (Edward et al, 2014).

In Nigeria, the Expanded Program on Immunization (EPI) was launched in 1979 and provides routine vaccinations to all children aged <12 months and pregnant women (Federal Ministry Health, 2015). Core vaccines provided to infants as part of EPI include Bacille Calmette-Guérin vaccine (BCG), diphtheria-pertussis-tetanus vaccine (DPT), oral poliovirus vaccine (OPV), and measles vaccine. Though centrally managed by the National Primary Health Care Development Agency (NPHCDA) of the Federal Ministry of Health (FMOH), RI services are organized and implemented at subnational levels, including states and Local Government Areas (LGAs), which are equivalent to districts. Given the variation in sociodemographic characteristics of the population over a large number of states (36 plus the Federal Capital Territory, or FCT) and LGAs (774), RI service delivery must be tailored to suit local needs and assure high, uniform vaccination coverage.

During 2010–2014, national coverage with the third dose of DPT vaccine (DPT3), a key indicator of RI program performance, i.e., the percentage of children aged <12 months reported to have received the vaccine dose, ranged from 57%–74% by administrative reporting (WHO, 2016). Multiple coverage surveys suggest even lower vaccination coverage than reported by administrative data and demonstrate that national estimates can often mask subnational immunity gaps at state and LGA levels (Dunkle et al, 2014). Data from the 2013 National Demographic and Health Survey (DHS) show that while the national estimate for DPT3 coverage was 38%, state-level coverage ranged from 3%–76% across 20 states in the northern part of the country (NPC and ICF, 2014).

A lack of reliable vaccination coverage data at the operational-level (i.e., LGA), makes it challenging to monitor and remediate RI service delivery to achieve uniformly high vaccination coverage. To fill this information gap, we used a pre-existing infrastructure of polio technical field staff to conduct RI coverage surveys in 40 polio high-risk LGAs across eight states in northern Nigeria during 2014–2015. The overall survey objectives of providing LGA-level vaccine coverage estimates and RI service delivery information to LGA immunization staff for use in planning and program improvement were successfully achieved.

This study aimed at determining the immunization coverage and factors associated with immunization coverage in Kudan Town, Kudan L.G.A, and Kaduna State.

1.2       Statement of the Problem

Immunization has proved to be one of the most important and cost-effective ways of ensuring child survival. It is therefore necessary to ensure that children from all backgrounds have access to immunization (WHO, 2012). In the past two decades immunization prevented an estimated 20 million deaths from vaccine-preventable infections globally. Despite these successes, much remains to be done. In 2015, an estimated 19.4 million infants worldwide were not reached with routine immunization services such as DTP3 vaccine. Around 60% of these children live in 10 countries: Angola, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Iraq, Nigeria, Pakistan, the Philippines, and Ukraine.

Monitoring data at subnational levels is critical to helping countries prioritize and tailor vaccination strategies and operational plans to address immunization gaps and reach every person with lifesaving vaccines.

Slums are also affected by poor access to health facilities and therefore there is little or no information on the health status or health seeking behavior of slum dwellers. Kudan Town is an example where such a situation exists. There is very little information on the health seeking behavior, which includes immunization coverage of children, of people living within the area. 

1.3       Research Question

1.      What is the level of immunization status and coverage in Kudan Town

2.      What are the effects of socio-demographic factors of mothers living in Kudan Town on the immunization coverage in children in Kudan Town

3.      What is the level of immunization coverage in Kudan Town?

4.      What are the challenges facing immunization of children in kudan Town?

1.4       Aim and Objectives

The aim of this research is to examine immunization coverage of children at Kudan Town.

The Specific Objectives of this research are to:

1.      To assess the immunization status and coverage of children in Kudan Town

2.      To analyse the effect of socio-demographic factors of mothers living in Kudan Town on the immunization coverage in children in Kudan Town

3.      To examine the level of immunization coverage in Kudan Town.

4.      To assess the challenges facing immunization of children in Kudan Town.

1.5       Scope of the Study

The study covers Kudan Town in Kudan LGA. It is made up of different wards which are: Kofar Fada, Kofar Gabas, Kofar Arewa, Sabon Gari Kudan, Ungwan Takalma, Belbelu, Ungwan Gana, Ungwan Makera, Ungwan Zabe, Kuka, Bakin Juga, Bakin Kasuwa, and Ungwan Tsauni. And is located in Kaduna state, the Northern part of Nigeria, the local government is having an estimated population of approximately 8706 people according to the 2006 national population census. The scope of this study surrounds the whole of Kudan Town.

1.3       Justification for the Study

This study sought to determine the immunization coverage in Kudan Town by collecting information on immunization status and factors associated with immunization coverage. The resulting information will be used to answer questions related to immunization coverage in the area, reasons for non/delayed immunization, and factors associated with immunization uptake in undeveloped area of Kudan Town. The results will also provide baseline data for other research studies on immunization in Kudan Town. The findings from this study will be useful to Kudan Wards Hospitals, and clinics in deciding on the best approach to use to increase or maintain coverage of immunization in the area.

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