A critical analysis of the different attitudes of mothers towards the immunization of their children in rural and urban area in Nigeria
1.0 Introduction
1.1 Background information and justification for the study
Child survival beyond the age of five in Nigeria is a great concern in both academic and professional circles with statistics indicating that only 194 out every 1000 children live beyond the age of five. A United Nations study revealed that the Nigeria ranked 15th among the nations with the highest under five mortality rates. High infant mortality rates in Nigeria are attributed to immunizable diseases such diphtheria, tuberculosis and poliomyelitis tetanus and measles. Deaths as result o f these disease accounts for about one third of infant deaths in Nigeria. Death as result of these vaccine preventable diseases, stands at 112 per 1000 in Nigeria; a figure that is much higher than in most African nations. New strains of measles have also been identified in Lagos and Ibadan and have since been deposited into world database of viruses for incorporation into future vaccines. Polio outbreaks in different parts of the country raise questions about the uptake of vaccines in the country.
These grim statistics have led to tireless efforts by the stakeholders to increase the number of children who are fully immunized in Nigeria. As early as 1979, the federal government has had initiatives such as the Expanded Program on Immunization which was later renamed the National Program on Immunization in 1997 geared towards getting vaccines to as more infants in Nigeria. More than 50% of children aged between 12-23 months in Nigeria have never received any form of vaccination. The low uptake of vaccines in Nigeria is not only dependent on the availability of the vaccines but also the education level of the mothers and traditional and cultural beliefs regarding vaccines. For instance, among the Yoruba, measles is considered a punishment from the gods following the breaking of taboos. Past studies have focused on the issues surrounding the availability such as finances, storage and availability of syringes. Social and cultural attitudes particularly those of the mothers remain understudied hence the need for insight into the subject. The attitudes of the mothers are a key determinant in the acceptance or non acceptance of vaccines in Nigeria.
1.2 Objectives of the study
The researcher shall undertake a survey geared towards documenting the attitudes of the mothers towards immunizations. The following aims shall be explored during the study:
2.0 Literature review
- Studies on the incidences of vaccine preventable disease in Nigeria
- Studies on the immunization status of children in Nigeria
- Studies on the attitudes of mothers towards immunization in Nigeria
2.1 Incidences of vaccine preventable diseases in Nigeria
22% of the incidences of infant mortality in Nigeria are caused by vaccine preventable diseases. The World Health organization reports that around 868,000 children die in Nigeria every year as a result of vaccine preventable diseases. The high child mortality rates in Nigeria place it as the second country with the highest infant mortality rates in the world after India. The Nigeria Demographic and health survey which was carried out in 2003 indicates only 13% of children between the ages of 12 and 23 months in Nigeria can be considered fully immunized. In the same year, only 5% of the infant deaths were caused by vaccine preventable diseases. Half of these deaths occurred in Nigeria.
2.2 Immunization status of children in Nigeria
The vaccine coverage in Nigeria is below 50% which makes Nigeria one of the ten countries with the lowest vaccine rates in the world. The Nigerian demographic and health survey which was carried out in 2003 paints a very grim picture of the disparities that exist between the northern and southern states. While 44.6% and 32.5% of the children in south east and south west Nigeria had completed their immunization schedule, only 6% and 3.7% in north east and northwest had completed their schedule as at the time of the survey. Statistics from the World Health Organization reveal that an increase in vaccine uptake from 29% to 69% in the period between 2000 and 2010. While these rates are below the recommended rates, research indicates that if the trend continues, then the infant mortality rates could significantly reduce. In addition to this, the economy of Nigeria would have a major impact on the country’s economy. Researchers has revealed that attainment of 90% vaccine coverage against five diseases would save 600,000 lives annually resulting in aversion of economic losses worth US $17 billion annually.
2.3 Studies on the attitudes of mothers towards immunization
The mother’s knowledge and attitudes towards immunization has been found to a significant predictor in the uptake of immunization in Nigeria. In a cross sectional study carried out by the Paediatric Association of Nigeria which involved interviewing 40 adults from Ile Ife, it emerged that 63.7% of respondents were educated; a factor that contributed to acceptance of vaccination. Mothers who had misconceptions about the timing of polio vaccines and contraindications of vaccines were skeptical about having their children vaccinated. About a third of mothers who participated in the study indicated that they would not be willing to take their children for another round of vaccination if the children developed side effects to the vaccination such soreness at the injection site and high fever. Several participants in the study revealed that they would not take their children for immunization due to the following reasons: history of convulsion in the family, mental challenges and use of antibiotics to treat other conditions prior to the vaccination dates.
A survey of 1500 mothers in Northern Nigeria revealed the deep seated myths held by most of the respondents. Only 1 out of 500 of the mothers who were interviewed believed that measles could be prevented by immunization. 16% of them believed that measles is contagious, 26% believed that it was as a result of heat, evil spirits and witchcraft. 27% of the respondents in the study were of the opinion that immunization against measles was not effective while 25% had never heard of immunization against measles. 4% of the women who were surveyed did not take their children for immunization since they were prevented from doing so by their husbands.
Whilst a clear cut relationship between the mother’s education and immunization has been demonstrated in the studies done in Nigeria, studies else suggest otherwise. Variables such as paternal education, mother’s place of residence and paternal education have been found to result in a different correlation between mothers’ attitudes and the immunization of their children.
3.0 Methodology
The study population will be made up of women drawn from Ile Ife in Nigeria. The respondents will all be native Yoruba speakers of varying educational levels and economic capabilities. With the help of local administration, the researcher will identify women with children between the ages of 12 and 18 months. The total number of respondents during the study will be 40. The sample size was determined using multi stage sampling method in order to minimize the data collection costs and ensure that the process was carried out in a precise manner. Using systematic sampling, the researcher will determine the households that will participate in the study. The researcher will first obtain informed consent from all the participants prior to the commencement of the research. The mother will be interviewed as the main respondent. Mothers of children between the ages of 12 and 18 months would be best placed to give information of their attitudes towards immunization and their experiences as they took their children for immunization in the one year period after birth. Respondents who do not have children between the ages of 12 and 18 months will be excluded from the study since they could give incorrect data.
The interview questions will first be pilot tested among 25 households which will not be participating in the study. After this, they will be reviewed and refined accordingly. The researcher will then administer the interview questions to the respondents. The questionnaires will be administered by the researcher since the respondents are of different education levels hence they may not all be capable of writing their responses.
4.0 Data analysis
The analysis of the data that will be collected by the researcher will be carried out using social scientists package version 13.0. Two forms of analysis will be carried out: univariate and bivariate analysis. Univariate analysis was done in order to represent the background traits of the respondents. Some of these traits include: sex, educational background and religion.
The bivariate analysis will entail performing a Pearson’s Chi square test. The statistical significance of the association between the dependent variable (immunization coverage) and the independent variable (attitudes of the mothers) will be interpreted using the Pearson chi square test with the significant level at 95%.
5.0 Ethical and legal considerations
The researcher will obtain the relevant legal documents from the Ministry of Health in Nigeria. These letters will be availed to the local administration in Ile Ife prior to the commencement of the study. Informed consent will be obtained from the respondents. The researcher will use codes in place of personal identifiers.
6.0 Expected outcomes
The insights obtained from this study will contribute significantly to the knowledge that is currently available. It will provide the much needed knowledge on the impact of the attitudes of mothers towards immunization on immunization coverage. It will enable the professionals to tailor make the sensitization programs to address the attitudes that hinder the mothers from fully embracing immunization.
Schedule
References
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