SOURCES OF INFORMATION AND IMMUNIZATION COVERAGE IN BIDA EMIRATE AREA: A RURAL-URBAN COMPARATIVE ANALYSIS

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The WHO projected that complete vaccination coverage should reach at least 90% of children at the country level and 80% in sub-areas by the year 2010. In 2013 a national survey reported that the full immunization coverage for Nigerian children was
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  Obasohan  et al  . European Journal of Pharmaceutical and Medical Research www.ejpmr.com 596   SOURCES OF INFORMATION AND IMMUNIZATION COVERAGE IN BIDA EMIRATE AREA: A RURAL-URBAN COMPARATIVE ANALYSIS 1 * Obasohan Phillips Edomwonyi, 2 Anosike Bernard Ubannache and 3  Etsunyakpa Mohammed Busu 1,2 Department of Liberal Studies, College of Administrative and Business Studies, Niger State Polytechnic, Bida Campus, Bida, Niger State.  3 Department of Social Welfare Administration, College of Administrative and Business Studies, Niger State Polytechnic, Bida Campus, Bida, Niger State. Article Received on 18/03/2016 Article Revised on 09/04/2016 Article Accepted on 30/04/2016 1.0 INTRODUCTION Vaccine Preventable Diseases (VPDs) have remained the major Childhood killer worldwide with over 3 million deaths annually. [1,2,3,4]  A greater proportion of these numbers occur in Nigeria, putting her as one of the highest in the world accounting for more than a quarter. [4,5]  In 1974 the Expanded Program on Immunization (EPI) was launched by World Health Organization (WHO) and became nationalized in  Nigeria ’s  National Program on Immunization (NPI) in 1996. [4,5]  These programs were directed to expand the coverage and increase the number of antigens, [6]  thereby  promoting the expansion of immunization so as to reduce the incidence and mortality due to VPDs. [7]  Over the years, several other programs have been initiated to complement the routine immunization processes, such as Reaching Every Ward (REW), Accelerated Measles Campaign (AMC) and Immunization Plus Days (IPDs) to ensure that vaccination reached all the target children. [5]  These strategies and programs have gulped very huge resources placing Nigeria as the most expensive among developing countries to have a child fully immunized. [8]  Until recently under the NPI schedule, a child is said to  be fully immunized if he/she has taken 4 doses of OPV (Oral Polio Vaccines), 3 doses of DPT (Diphthera, Pertussis and Tetanus), 3 doses of HB (Heapatheitis B) 1 dose each of BCG (Bacille Calmette Guerin), Measles and Yellow Fever vaccines. In a related development, recent immunization schedule by World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and NPI, was adopted for Nigeria and began in Niger State in February, 2013. It stipulates that children take BCG, OPV0 and HEPB0 at birth, and are immunized with OPV1, Pentavalent 1(a combination of five vaccines-in-one that prevents diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza) at 6weeks. These are repeated at 10weeks and at 14weeks of baby age, and at 9months, MCV (Measles Containing Vaccine) and Yellow Fever (or at 12months) are given. [3,9,10] Recent study indicated that full immunization coverage in Bida Emirate Area is about 30% (Obasohan et al. 2015a), One of the most current national surveys conducted in Nigeria in 2013 by National Population SJIF Impact Factor 3.628   Research Article ISSN 2394-3211 EJPMR    EUROPEAN JOURNAL OF PHARMACEUTICAL  AND MEDICAL RESEARCH www.ejpmr.com    ejpmr, 2016,3(5), 596-601 *Corresponding Author: Phillips Edomwonyi Obasohan  Department of Liberal Studies, College of Administrative and Business Studies, Niger State Polytechnic, Bida Campus, Bida, Niger State.   ABSTRACT The WHO projected that complete vaccination coverage should reach at least 90% of children at the country level and 80% in sub-areas by the year 2010. In 2013 a national survey reported that the full immunization coverage for  Nigerian children was 25%. This is quite low considering the huge financial resources committed into it and as such raises concerns to identify the factors that may be responsible. The aim of this study therefore is to identify the role of sources of information in the determination of immunization status/coverage of children aged 12  –   24 months in Bida Emirate Area (BEA) of Niger state. We used Chi Square to establish the effects of sources of information and Multiple Logistic analyses was used to determine the likelihood effects of these factors on full immunization status of children in Urban/Rural communities of BEA. The analysis revealed that household visits  by officials of immunization, getting information on immunization before delivery, attendance to health education, attendance to village meetings and receiving information on immunization from mass media were all significantly associated with immunization status of the child both in rural and urban BEA. The study recommended more advocacies through the mass media, village meetings and religious centers. Also the use of Short Messaging Services (SMS) to remind mothers/care givers on immunization schedules especially those who delivered in the health facilities should be exploited. KEYWORDS: information, Vaccination, Immunization, Coverage, Bida Emirate Area, Rural, Urban.  Obasohan  et al  . European Journal of Pharmaceutical and Medical Research www.ejpmr.com 597 Commission to assess the immunization coverage for children born within five years before that survey reported that the full immunization coverage for Nigerian children is 25%. [11]  Past studies that have attempted to advance reasons for many children remain unvaccinated have focused on individual, systematic and community factors. [12]  Others on the demographic factors of children and their families, [1,3,7,13,14]  m aternal/care givers’ knowledge, attitude and practice of immunization exercises. [1,4,14,15]  However, the power that propels one to do a thing is a function of the amount of Knowledge you have (Knowledge they say is Power). Information is the source of knowledge, but the quality of your information is principally determined by its source(s). As it relates to immunization coverage in Bida Emirate Area (BEA), the researchers are not aware of any study already done and not on the new immunization schedule to exploit the effects of this virtue. This study therefore is designed as a comparative study of the effects of sources of information on immunization coverage for children aged 12  –   24 months in urban and rural communities of BEA,  Niger State, Nigeria by a field study. 2.0 MATERIALS AND METHODS 2.1 Survey Design The sample areas were selected using a systematic and stratified cluster sampling design on the basis of 74.5% and 25.5% of population size by rural-urban strata. Bida Emirate Area has six Local Government Areas (Bida, Gbako, Katcha, Lavun, Edati and Mokwa). Bida Local Government is purely an urban community having 4 districts: Usman Zaki, Umaru Majigi, Malik and Masaba. [3]  Other districts from the other five Local Government Areas (after excluding the district hosting the administrative headquarters) were considered as the rural area. The data used in this study was a community- based cross-sectional which had been described fully in a  previous descriptive surveys. [3,4] . 2.2 Sample Size Determination We used the sample size computation as contained in the WHO immunization cluster survey manual (World Health Organization, 2014). Our expected coverage for the area was 25% obtained in a national survey 2013, [11]  a precision of ±4.7, a 5% level of significance and a design effect of 2 as recommended by WHO methods. [16]  This gave a minimum sample size of 652. However, 682 respondents were captured with 29 rejected leaving a total of 663 actually analyzed and distributed on the basis of 489 from rural and 174 from urban. 2.3 Ethical Approval  The researcher obtained informed consent from the Administrative Heads of the localities where data were collected and from the respondents who participated in the survey. Furthermore, approval was also given by the Research and Development Committee of Niger State Polytechnic, Zungeru. 2.4 Analytical Methods Data analysis was by appropriate statistical tests of Pearson’s  chi square for the relationship effects, univariate and multivariate logistic techniques for likelihood effect using Stata version 14 for academic users. [17]   3.0 RESULTS AND DISCUSSION 3.1 Background Variables The average ages of the participants in both rural and urban communities of BEA were almost the same with 29 years for the mothers and 17months for the children. In table 1, the proportion of the respondents in terms of their educational status has an inverse trend as by their  place of residence. For instance, in the rural area, the  proportion of respondents decreased by increasing educational status and only about 16% had primary education and above. The converse was the case for urban area where the proportion increased by increase in educational status. The result of this finding agrees with what Onyeika and Oguijawa [18]  noted in a study with girl-child enrolment (12%) in schools in rural Niger as against 83% enrolment in urban areas. This finding did not come as a surprise as there is the tendency that the more educated one is, the more likelihood he is going to leave in urban centers. This trend was not exactly observed for the partners’ educational status. But, as expected there were more proportion in higher educational status in urban than in rural area. Table 1; Showing the Percentage Frequency Distribution of Some Background Variables of Participants by Place of Residence Urban Rural Variables N(174) % N(489) % Age of Respondents 15  –   24 years 27 15.5 87 18.2 25  –   34 years 119 68.4 300 63.8 34+ years 28 16.1 91 19.0 Religious Status Christianity 24 13.8 4 0.80 Islam 150 56.2 491 99.2 Educational Status  No Education 34 19.5 41.4 83.6 Primary Education 36 20.7 51 10.3 Secondary Education 50 28.7 28 5.7  Obasohan  et al  . European Journal of Pharmaceutical and Medical Research www.ejpmr.com 598 Higher Education 54 31.0 2 0.40 Occupational Status Others 51 29.3 17 3.40 Civil Servant 37 21.3 7 1.40 Farming 63 36.2 421 85.1  Not Working 23 13.2 50 10.1 Birth Order of Child Fourth and Above 61 35.1 204 41.2 First 62 35.6 98 19.8 Second 28 16.1 112 22.6 Third 23 13.2 81 16.4 Indigenous Status  Non-Indigene 25 14.4 6 1.2 Indigene 149 85.6 489 98.8 Partner’s Educational Status   No Education 11 6.32 208 42.6 Primary Education 8 4.60 64 13.1 Secondary Education 48 27.6 135 27.6 Higher Education 107 61.5 83 16.9 Place of Delivery Home 40 23.0 263 53.1 Health Facility 134 77.0 232 46.9 Attended Ante-Natal Care  No 21 12.1 116 23.4 Yes 154 87.9 379 76.6 Also in the urban area, the proportion of those who delivered in the health facility were more than those who delivered at home, while the opposite is the case in rural area where more mothers delivered at home than those who delivered at a health facility. The reason for this may be that because more healthcare workers and facilities are in urban areas than are in the rural areas. This agrees with the position of a study elsewhere. [19] The use of ante-natal care services were both high for the two areas. 3.2 Urban-Rural BEA Immunization Coverage The full immunization coverage for children in urban area of BEA was found to be higher (35.6%) than in the rural area (27.8%). More children in the rural area were never immunized at all compared with their urban counterparts. Also more children in urban area (74.6%)  possessed immunization card than in rural area (66.5%). The full immunization coverage observed for urban and rural BEA in this study were almost 3 times higher than what was found in a study for urban (11.85%) and rural (10%) Bayelsa state. [5]   Fig: 1 Percentage Multiple Bar Chart of Immunization Coverage (Urban/Rural) The proportions of children immunized with the various antigens were generally higher in the urban area of BEA than in the rural area. This was contrary to the findings in another study. [5]  It was also observed in this study that the dropout rate of BCG to MCV or to Yellow Fever vaccination was relatively higher in urban area (33.4%)  Obasohan  et al  . European Journal of Pharmaceutical and Medical Research www.ejpmr.com 599 than in rural area (26.5%). But for individual vaccination type, for instance, the dropout rate from OPV 1 to OPV 3 was higher for urban area (16.7%) than for rural area (10%) and from Pentas 1 to Pentas 3 it was more in urban area (15.3%) than in rural area (11%). This is contrary to the findings elsewhere, [5]  where individual antigen’s dropout rate was more in rural than in urban.   Fig 2: Percentage Multiple Bar Chart of Vaccine Coverage (Urban/Rural). The dropouts we observed in urban were clearly above the allowable benchmark of 10%. [8] The possible reasons for these high dropouts in urban areas may not be unconnected with the fact that most mothers in urban areas are civil servants and may be too busy. This agrees with the earlier report of findings in BEA. [3]   Table 2: Relationship between Sources of Information and Immunization Status Urban Rural Variables CI (%) ICI (%) Chi-Sq CI (%) ICI (%) Chi-Sq Encouraged to immunize Child 19.12 **  33.8 **  None 3.2 29.7 5.1 27.1 Village Head 0.00 0.90 23.5 25.7 Hospital Staff 72.6 46.9 42.7 23.6 Friends and Relatives 24.2 22.5 27.9 23.6 Household Visit by Officials 12.1 **  25.9**  No 16.1 42.0 13.2 36.8 Yes 83.9 58.0 86.8 63.2 Information before delivery 15.5 **  28.8 **   No 4.8 30.4 22.1 48.7 Yes 95.2 69.6 77.9 51.3 Attended Health Education in last 1yr 19.7 **  30.9**  No 40.3 75.9 40.6 68.3 Yes 59.7 24.1 59.4 31.7 Attended Village Meeting in last 1yr 21.36 ** 30.5**  No 56.6 87.5 40.3 47.8 Yes 43.4 12.5 59.7 32.2 Immunization info on Mass Media 16.31 ** 16.28 **  No 4.8 31.3 27.5 48.1 Yes 95.2 68.7 72.5 51.9 Note: CI = Complete Immunization, ICI=Incomplete Immunization, ** p<0.05. From table 2, we observed that among the children who were fully immunized, hospital staff played more significant role to encourage mothers to take their children for immunization both in the rural (42.7%) and in the urban (72.6%) areas. Of those who reported that they were encouraged by the village head in urban area, none of them had their child immunized, but 23.5% in rural area were immunized. This may be so because the influence of village head is not quite visible in urban areas particularly on personal issues such as health than it is in rural areas. The proportion of those with household visitation by officials, having information on immunization before delivery, attendant to health education in the last 1 year before this survey was  Obasohan  et al  . European Journal of Pharmaceutical and Medical Research www.ejpmr.com 600 conducted were significantly higher among those who were fully immunized in both areas. This agrees with the study in Lao PDR which revealed that direct household visitation contributed to higher rate of immunization. [14,20,21]   3.3 Source of Information and Immunization Status. Logistic Analysis Table 3 displayed the results of logistic analysis of the independent effects of various sources of information on immunization status. Among those who encouraged mother to take child for immunization, the odds of immunization status were 14 times more for hospital staff than the reference group (nobody did) in the urban area and 8 times more in the rural area. Table 3: Logistic Analysis of Source of Information on Immunization Status Urban Rural Variables Encouraged to immunize Child  None 1.00 1.00 Village Head Empty 4.23(1.8  –   9.1) Hospital Staff 14.3 (3.2  –   62.8) **  8.33 (3.76  –   18.5)** Friends and Relatives 9.90 (2.1  –   47.3) **  5.46 (2.41  –   12.4) **  Household Visit by Officials  No 1.00 1.00 Yes 3.75 (1.73 -8.15) 3.82 (2.22  –   6.56) Obtained Information before delivery  No 1.00 1.00 Yes 8.57 (2.51  –   29.3) **  3.36 (2.13  –   5.30) **  Attended Health Education in last 1yr  No 1.00 1.00 Yes 4.66 (2.40  –   9.08) 3.15 (2.08  –   4.77)   Attended Village Meeting in last 1yr  No 1.00 1.00 Yes 5.40 (2.55  –   11.5) **  3.12 (2.07 4.72) **  Immunization info on Mass Media    No 1.00 1.00 Yes 8.94 (2.62  –   30.5) 2.44 (1.57  –   3.78) Respondent has access to GSM  No 1.00 1.00 Yes 6.12 (1.38  –   27.3) **  2.55 (1.66  –   3.93) **  Those who obtained information on immunization before delivery, the odds of immunization was more than double in urban and rural areas than observed in their respective reference groups (those who did not obtain any information). This finding agrees with previous studies that showed why direct communication through household visits were clearly given a boost in improving immunization. [20,21,22]   4.0 CONCLUSION AND RECOMMENDATIONS This study has clearly demonstrated the significant role sources of information through community mobilization  play in full immunization coverage in BEA. Home visitation by health workers to encourage mothers to take their children for immunization is a very strong factor in attaining full immunization status especially in the rural areas. We recommend therefore that more advocacies should be carried out through the mass media, village meetings and religious centers. In view of this, community mobilization and participation efforts should  be highly encouraged. ‘Know your clients to follow  up ’ should be the focus for health workers in a community. Greater percentage of qualified community health workers living in such communities should be trained and subsequently recruited to work in those communities. The use of Global System for Mobile Communication (GSM) as a source of reminder to mothers should be exploited especially in the urban areas. This can be an area for further research to experiment and ascertain how effective the use of GSM could be to increase the status of immunization coverage However, the interpretation of the results reached in this study is subject to the limitations of not taken into consideration the validity of vaccines as at when they were administered to the children. Also only information on routine immunization was considered. 5.0 ACKNOWLEDGEMENT The authors would like to thank the local communities and those that participated in the study. We recognize the contributions of all those that participated in the field word and data entry. We also like to appreciate the
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