Knowledge and Understanding of the Effects of Immunization of Children Under the Age of 5 Years
Abstract
This study was on knowledge and understanding of the effects of immunization of children under the age of 5years. Three objectives were raised which included:Â To find the effect of knowledge of mother on immunization of children under the age of 5years, to find out the effect of education of mother on immunization of children under the age of 5 years and to find out the effect of religion of mother on the immunization of children under the age of 5 years. A total of 77 responses were received and validated from the enrolled participants where all respondents were drawn from selected nursing mothers in Ibadan. Hypothesis was tested using Chi-Square statistical tool (SPSS).
CHAPTER TWO
LITERATURE REVIEW
2.1 Â Theoretical Framework
According to Trochim (2006), Theory is what goes on in the head of the researcher or what the researcher is thinking in his head, while observation is what goes on in the real world where data are collected. Theories help in guiding researchers to come up with research questions and problem statements through the findings of analysis of data and conclusions, while theoretical frameworks provide the rationale for the study and also enable the readers to understand the perspective of the researcher and support the fact that the study is backed by established theories and empirical facts from credible studies (Trochim, 2006). I used Andersen’s behavioral model to frame this study. Andersen’s behavioral model was created to empirically test hypotheses about inequality of access to health services in the United States (Willis, 1998). The Andersen model addresses the concern that some populations, specifically people from ethnic minority groups, people who live in inner cities, and people who live in rural areas, who receive less health care provision than the rest of the population (Phillips et al., 1998). Andersen’s model views access to services as a result of decisions made by individuals, which are constrained by their position in society and the availability of health care 13 services (Phillips et al., 1998). The Andersen model is useful because of its flexibility in allowing researchers to choose independent variables related to their specific hypotheses, such as hypotheses regarding social inequalities. According to Phillips et al. (1998) the Andersen model (see Figure 1) has become one of the most widely used frameworks to predict health care use since its inception more than 40 years ago.
Health Care SystemÂ
The responsibility for the management of health systems is shared among the federal, state, and local governments of Nigeria. The federal government is charged with the responsibility of providing policy guidelines and overall technical guidance to the states and the LGAs, in addition to running the tertiary health institutions which comprise teaching hospitals, federal medical centers in states without teaching hospitals, and other national specialized hospitals (i.e. national orthopedics hospitals, psychiatric hospitals, eye centers, ear centers, and laboratories). 28 The states are responsible for monitoring and supervision, as well as providing technical and policy guidance to the LGAs, in addition to the running of the secondary health facilities to provide health care services through the general and specialist hospitals (Health Reform Foundation of Nigeria, 2007). The LGAs are in control of primary health care (PHC) centers and provide services at this level of care, including maternal and child health care. At this level, there are various services being provided ranging from curative care, to routine immunization (preventive) and health promotion activities, depending on the facility and its available healthcare staff. Despite the strategic position of Nigeria in the African continent for its economic strength, and sophistication of its government oversight structure, its health care system has suffered major setbacks and the nation is seriously underserved in the healthcare sphere. There are inadequacies in all aspects of the system including trained personnel, health facilities, and medical equipment, especially in rural areas. Health care services are still fragmented, poorly coordinated, and lack resources such as drugs and supplies Inadequate and decaying infrastructure, unequal distribution of scarce resources and access to care, and unacceptable quality of care (despite the various reforms that have been put forward by the Nigerian government) are significant issues in the health care system. However, most of the federal reform measures are yet to be implemented at the LGA and State levels where the impacts are expected to be felt. This lack of implementation could partly be due to lack of clarity in the responsibilities among the three tiers of government (Osain, 2011).
Expanded Program on Immunization
The World Health Organization (WHO) started the global effort to use vaccination as a public health intervention in 1974 when it launched the EPI. Since then, immunization has remained one of the most cost-effective public health interventions for reducing global child morbidity and mortality (Machingaidze, Wiysonge, & Hussey, 2015). The EPI program is a blueprint of how to manage the technical and managerial functions required to routinely vaccinate children with a limited number of vaccines, providing protection against diphtheria, tetanus, whooping cough, measles, polio, and tuberculosis, and to prevent maternal and neonatal tetanus by vaccinating women of childbearing age with tetanus toxoid (Shen, Fields, & McQuestion, 2014). The original intent of EPI was to deliver multiple vaccines to all children through a simple schedule of child health visits (Shen, Fields, & McQuestion, 2014). This was challenging because at that time the health systems in most poor and developing countries were frail and in some cases nonexistent (Shen, Fields, & McQuestion, 2014). Vaccine coverage levels were less than 5%, until around 1990 when most of the poor countries had institutionalized immunization programs based on the EPI blueprint, and by 1991, the global target of vaccinating 80% of the world’s children was declared to have been met, likely saving millions of lives (Shen, Fields, & McQuestion, 2014). These successes were attributed to the building of the capacities and capabilities of these countries through the EPI blueprint that was developed at the inception of the program (Shen et al., 2014).
The cost of vaccination in the developing world has grown from less than one United States Dollar (USD) in 2001 to about $21 for boys and $35 for girls in 2014, as increasingly expensive vaccines are being introduced into national immunization programs, and vaccines for girls, such human papillomavirus vaccines, are being introduced more widely (Shen, Fields, & McQuestion, 2014).To address these and other challenges, additional efforts are needed to strengthen 8 critical components of RI: policy, standards, and guidelines; governance, organization, and management; human resources; vaccine, cold chain, and logistics management; service delivery; communication and community partnerships; data generation and use; and sustainable financing, though these may not affect the rates of vaccination among boys and girls (Shen et al., 2014). Countries are expected to ad0apt the available WHO global-level policies, standards, and guidelines to develop their own structures to provide overall guidance to their countries’ immunization activities. In the majority of nations, the national program of immunization provides leadership and a wide range of other functions as part of its role in building strong governance, organization, and management (Shen et al., 2014). There is a growing need for a highly trained health workforce as a result of the increasing complexity of immunization services caused in part by the rising number of vaccines given to a child and the growing populations of children who require these services. The quality of the health workforce has become more critical in the face of the increasing cost of vaccines, making competent handling and oversight of limited and expensive stocks a key issue. Despite the growing demand for skills in the health 31 workforce, the same basic method of vaccination training is still in use that was in place 30 years ago (Shen et al., 2014). Vaccines, cold chain, and logistics management have become increasingly important with the growing number of new vaccines for disease prevention, eradication of existing outbreaks, and frequent mass campaigns that require additional storage equipment, finance, and expertise in the management of the entire system. Communication and community partnerships are central to the EPI activities and the use of immunization services, especially to enlighten and mobilize the community to support immunization (Shen, Fields, & McQuestion, 2014). In practice, this requires the support of the health workforce and other trustworthy persons to ensure that parents or caregivers are kept informed of where and when, as well as how many times, they are required to bring children for vaccination. Health personnel remains the most cited source of health information including key details about immunization. (Shen, Fields, & McQuestion, 2014). The role of quality data in guiding policymakers to make informed programmatic decisions cannot be overemphasized. Data are usually obtained from vaccine coverage reports, either by periodic population-based surveys such as NDHS and Mixed Indicator Cluster Surveys, or by routine administrative reports (Shen et al., 2014).
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