RESEARCH
An Evaluation of Immunization Coverage of Nigerian Army Depot: A Case Study of Zaria,
Northern Nigeria Dr R D Ebong Department of Physical and Health Education, University of Cross River State, Uyo Akwa Ibom State, Nigeria
INTRODUCTION AND LITERATURE REVIEW healthy child today is a nation’s pride and the leader of tomorrow. Nigeria of the oil boom that could afford to rear healthy children is different from the economically battered Nigeria of today in which healthy children are difficult to come by. Concurrently, the cost of basic medical services is unaffordable by the majority, thus the emphasfs on prevention rather than curative medical care; the former being better and cheaper than the latter considering the fact that the economic strength of a nation is not the main indicator of the level of development of a nation and even the economic wealth of any nation is not only measured in terms of currency but also by the health status and the number of surviving children; the importance of child health in Nigeria cannot be over-emphasised. Nigeria, like other developing countries, has a high infant mortality rate (IMR) of 100 deaths per 1000 live births (Henderson, 1986). The mortality of children less than 5 years in Nigeria is 185 deaths per 1000 live births, which is also high (Henderson, 1986). The 6 major diseases
A
that have been identified as the scourge of childhood and have been termed ’killer diseases’ are: measles, pertussis, tetanus, poliomyelitis, diptheria and tuberculosis. These diseases have been perpetuated by unhygienic conditions due to poor sanitation, and housing coupled with adverse cultural beliefs as well as ignorance and illiteracy. Concurrently, these diseases are closely related in that they are all virtually communicable, associated with ignorance and poverty usually occurring in epidemic proportions and are all preventable by immunization
(Philips, 1986). The high susceptibility of children to various killer diseases is explained by their low level of immunity. Therefore, boosting the immune of any individual is the basis for vaccinations, thanks to Edward Jenner who first discovered the role of vaccination as a cost effective means of preventing diseases (Philips, 1986). Immunization services have existed and developed throughout the years, but because of the rapid growth of the world’s population and the high cost of curative medicine, the World Health Organisation (WHO) launched the
Expanded Programme of Immunization (EPI) in 1974 with the aim of expanding the immunization services
geographically to ensure nationwide coverage, socially, and to make immunization free or at least readily affordable. EPI was launched in Zaria Local Government Area (LGA) 1985/86 along with 140 Local Government Areas out of the total 304 Local Government Areas in Nigeria (Yakubu, 1986) a decade after the original launching of EPI by World Health Organisation (WHO). The coverage in Zaria as well as throughout the whole country was not very impressive; therefore the National Immunization Days (NIDs) were launched as well by the Federal Ministry of Health in collaboration with the Rotary International Club of Nigeria in 1988, with the view of increasing the coverage reasonably in
towards 1990 (Odunsi, 1988). Immunization is a very important component of the Alma Ata declaration of Primary Health Care, and therefore it should be seen as progressing towards the achievement of the general objectives of Primary Health Care, and in particular the attainment of health for all by the year 2,000
(Akintola, 1988). It is worth noting that the positive effects of immunization on the incidence of infectious diseases is much appreciated in developed countries where immunization is routine and nearly universal, where serious childhood diseases such as measles, poliomyelitis, tuberculosis, diphtheria, tetanus and whooping cough are now rare. In developing countries, immunization saves the lives of about 1 million children yearly (Philips, 1986). The importance of immunization programs cannot be overemphasised considering its ability to greatly reduce the incidence of infectious diseases. For instance, in just 10 years, an intensive world-wide vaccination and surveillance campaign eradicated smallpox, which for centuries was one of the most feared human diseases. Furthermore, in some developing countries, extensive immunization programmes have shown dramatic results in a few years and disease rates are dropping. At the same time, however, about 40% of children in the developing world (excluding China) are protected against diphtheria, tetanus, pertussis and polio and only 20 -30% are protected against measles (McBeath and Kesster, 1981). Every year, these diseases which are easily preventable, kill or permanently handicap over 3 million children which form part of the 12 million (10%) children that die out of 125 million children born. Some of
3 Downloaded from rsh.sagepub.com at UNIV OF MONTANA on April 8, 2015
the remaining 9 million deaths occur due to gastroenteritis, respiratory diseases and malnutrition. 97 % of these deaths occur in developing countries, 25% can be prevented by vaccination. Today the coverage has gone up to 40% and the figure is rising rapidly (McBeath and Kesster, 1981).
according to the geography of the barracks should be eastwards. iv) Children less than 2 years of age were identified in consecutive households in both the blocks till a total of 7 were obtained, but all the children within that age group in the last household were included. A total of 215 children were included in the study. Data for the study was collected by a questionnaire which sought information on personal data, parental knowledge on 6 killer diseases, EPI and NID programmes respectively. The questionnaire was administered to parents. The vaccination records of immunised children were obtained documenting the dates of vaccine and the number of doses obtained. Data was analysed using tabulations, statistical significant tests, bar diagrams and pie charts respectively.
Limitations be seen in any study of this nature, limitations be ruled out. It was not easy for a civilian to gain entrance into barracks to collect data. The procedure to secure permission to get in was both cumbersome and As
can
cannot
f’rustrating. Some parents had lost the immunization records of their
AIMS AND OBJECTIVES OF THE STUDY The major objectives of this study set out to evaluate the Expanded Programme on Immunization (EPI) in the Nigerian Army Depot, Zaria are as follows: i) To estimate the proportion (,7o) of children aged less than 2 years old who have been covered by the EPI in Zaria Depot. find out the parental knowledge of common ii) To childhood killer diseases and the benefits derived from immunization. iii) To find out the effects of good organisation and mobilisation on improving coverage of EPI. For instance, the effect of National Immunization Days (NIDs) on improving coverage or otherwise. iv) To make recommendations (based on the analysis) towards better coverage or emulation by a bigger set up if coverage is good. current
children due to postings and transfers and this made data collection difficult. There were problems associated with understanding and responding to the questionnaire properly with the result that the responses on some parts were not good enough for proper analysis. Some parents refused to answer questions associated with knowledge of Immunization Programmes stating that they were not supposed to know since they were not medical personnel.
RESULTS following analysed and
the results of the study statistically furthermore used for discussions with recommendations as the case may be. The study showed an immunization coverage of 88.9% which implies a good coverage for Nigeria by 1990. The
were
Research Method The EPI/WHO 30 cluster sampling method was employed for the study. Each cluster comprised of 7 children of the age group for the study. The procedure is as follows: i) 30 clusters were made up from the officers and senior non-commissioned officers’ residence block. For each cluster, the span of choice went across the ii) above areas. iii) The first cluster was randomly identified by locating the first house with the subject of study. By doing so, the 7 children less than 2 years were chosen and was decided that the progression of the next clusters
There was no relationship found between the ranks of soldiers and the immunization status of their children (X =
3.57; P>0.1)
so
statistically
4 Downloaded from rsh.sagepub.com at UNIV OF MONTANA on April 8, 2015
not
significant.
their children for immunization because of fear of reactions from the vaccine. It is worth noting that only 9.1 % of respondents were unaware of the EPI programme existence. Concurrently, only 20% of respondents agreed that they had never heard about National Immunization Day (NID) the intention of which was to improve immunization coverage in the nation.
Measles vaccination is the only one below the 1987 required national coverage of 60%. For the immunised, it is assumed that most children who have started immunization will complete the vaccine doses accordingly (Fig 1). The study also showed that the children of soldiers attached to the medical division of the depot and the children of engineers formed high number of immunized children. The others comprising of those on signals, guard, training etc, formed a small proportion of
uarter immunised. ~ose 2,
In Fig the result showed that most soldiers (46%) ordered to take their children for immunization but
were
few (19.4%) went willingly and an additional 7.8% had to take their children in for immunization to avoid punishment. As can be seen in Table 2A, there is no significant relationship between educational level of respondents and knowledge about vaccine preventable diseases. For example 25 illiterates knew that measles can
be
prevented by
same
compared with 20 participants Secondary education who had the
vaccine
each with Adult and
knowledge.
Of the responses given on a question asked about why some soldiers did not take their children for immunization, it is worth noting that most of them (68.2% ) were settling down for the first time because of being posted from time to time to new places. Few of them (13.6%) refused to take
DISCUSSION As can be seen in Table 2, the military rank did not have any relationship with the immunization records of the participants. This notwithstanding, more encouragement should be given to the few who were not immunized. Fig 1 also shows a good coverage of immunization in Zaria Army Depot. The Pie Chart shows that majority of soldiers (46% ) were ordered to take their children for immunization while 19.4% went willingly. More soldiers should be made aware of the beneficial effects of vaccination so that they can take their children willingly for immunization.
5 Downloaded from rsh.sagepub.com at UNIV OF MONTANA on April 8, 2015
SUMMARY AND CONCLUSION A total of 215 children below 2 years of age were included in the study. The study was carried out in Zaria Army Depot in 1989. The major objective was to evaluate the coverage of Expanded Programme on Immunization (EPI) in Zaria Army Depot. The study also intended to find out whether National Immunization Days (NIDs) have improved the immunization coverage as expected. It was found that the rank of soldiers had no relationship with the immunization status of their children. The study also showed good immunization coverage of 88.9%. The study also showed that majority of soldiers (46%) were ordered to take their children for immunization when compared to 19.4% who took their children for immunization willingly. It was also found out that 80% of soldiers heard about NID programme and responded to it. This implies that NID will provide a good mobilization force as it will improve the immunization coverage of EPI.
RECOMMENDATIONS In order
goals of immunization, emphasis placed continuously on public health workers making people aware of the importance of and the need for immunization throughout the nation. Awareness can be obtained through radio and television programmes as well as newspaper publications. Another way of creating public awareness could be through advertisement of the programme on stamps stating the different immunizable diseases. Providing funds for constant availability of vaccine is also recommended for the Government. Establishing more NID programmes will go a long way in improving the immunization coverage. More EPI personnel should be to
achieve the
should be
trained who will be dedicated to such work. Nongovernmental organisations who would encourage and contribute their own quota in ensuring adequate supply of cold chain equipment and vaccines to supplement government efforts should be incorporated into this programme.
ACKNOWLEDGEMENT I wish
to acknowledge Mele Mansfield, a part 5 Medical Student at Ahmadu Bello University, Zaria who collected data that made this study possible. I also acknowledge with thanks Dr E S Essien, an Associate Professor in the Community Medicine Department, Ahmadu Bello University, Zaria who supplied input for the methods and analyses used in this study. My thanks also go to Mr B L Bateng of Physical and Health Education Department at Ahmadu Bello University, Zaria who proof read the
manuscript.
References AKINTOLA S (1988). Information on Nigerian Army, Information Bulletin Public Relations Office, Nigerian Army Depot, Zaria BLUM D and PHILIPS M (1984). An Assessment of the Expanded Programme on Immunization (EPI) in Nigeria. The State of the World’s Children; UNICEF GRANT J P (1985). Towards Universal Immunization. The State of the World’s Children; UNICEF pp 93-97 GRANT J P (1987). Expanded Programme on Immunization (EPI). The State of the World’s Children; UNICEF pp 45-55 HENDERSON R H (1986). Protecting the Nigerian Child. The Vaccine Cold Chain, UNICEF Publication KEJA K O and HENDERSON R H (1985). EPI; Continuing Role of the European Region, WHO Chronicle ,Vol 39, No 3; 92-94 McBEATH W and KESSTER S (1981). Immunization, Primary Health Care, 1-20 ODUNSI P Y (1988). A Rapid Assessment of National Immunization Days in Nigeria. Assignment Children No 53/54 UNICEF PHILIPS M P (1986). Immunizing the World’s Children, Population Reports; WHO Geneva REID R S and SMITH E A (1984). Going National with EPI in Nigeria: A Case Study, Going to Scale for Child Survival and Development. Assignment Children 65/68 UNICEF YAKUBU A M(1986). Expanded Programme on Immunization. Paediatrics Departmental Seminar at Ahmandu Bello University Teaching Hospital, Zaria unpublished report
6 Downloaded from rsh.sagepub.com at UNIV OF MONTANA on April 8, 2015
The
An Evaluation of Immunization Coverage of Nigerian Army Depot: A Case Study of Zaria,
Northern Nigeria Dr R D Ebong Department of Physical and Health Education, University of Cross River State, Uyo Akwa Ibom State, Nigeria
INTRODUCTION AND LITERATURE REVIEW healthy child today is a nation’s pride and the leader of tomorrow. Nigeria of the oil boom that could afford to rear healthy children is different from the economically battered Nigeria of today in which healthy children are difficult to come by. Concurrently, the cost of basic medical services is unaffordable by the majority, thus the emphasfs on prevention rather than curative medical care; the former being better and cheaper than the latter considering the fact that the economic strength of a nation is not the main indicator of the level of development of a nation and even the economic wealth of any nation is not only measured in terms of currency but also by the health status and the number of surviving children; the importance of child health in Nigeria cannot be over-emphasised. Nigeria, like other developing countries, has a high infant mortality rate (IMR) of 100 deaths per 1000 live births (Henderson, 1986). The mortality of children less than 5 years in Nigeria is 185 deaths per 1000 live births, which is also high (Henderson, 1986). The 6 major diseases
A
that have been identified as the scourge of childhood and have been termed ’killer diseases’ are: measles, pertussis, tetanus, poliomyelitis, diptheria and tuberculosis. These diseases have been perpetuated by unhygienic conditions due to poor sanitation, and housing coupled with adverse cultural beliefs as well as ignorance and illiteracy. Concurrently, these diseases are closely related in that they are all virtually communicable, associated with ignorance and poverty usually occurring in epidemic proportions and are all preventable by immunization
(Philips, 1986). The high susceptibility of children to various killer diseases is explained by their low level of immunity. Therefore, boosting the immune of any individual is the basis for vaccinations, thanks to Edward Jenner who first discovered the role of vaccination as a cost effective means of preventing diseases (Philips, 1986). Immunization services have existed and developed throughout the years, but because of the rapid growth of the world’s population and the high cost of curative medicine, the World Health Organisation (WHO) launched the
Expanded Programme of Immunization (EPI) in 1974 with the aim of expanding the immunization services
geographically to ensure nationwide coverage, socially, and to make immunization free or at least readily affordable. EPI was launched in Zaria Local Government Area (LGA) 1985/86 along with 140 Local Government Areas out of the total 304 Local Government Areas in Nigeria (Yakubu, 1986) a decade after the original launching of EPI by World Health Organisation (WHO). The coverage in Zaria as well as throughout the whole country was not very impressive; therefore the National Immunization Days (NIDs) were launched as well by the Federal Ministry of Health in collaboration with the Rotary International Club of Nigeria in 1988, with the view of increasing the coverage reasonably in
towards 1990 (Odunsi, 1988). Immunization is a very important component of the Alma Ata declaration of Primary Health Care, and therefore it should be seen as progressing towards the achievement of the general objectives of Primary Health Care, and in particular the attainment of health for all by the year 2,000
(Akintola, 1988). It is worth noting that the positive effects of immunization on the incidence of infectious diseases is much appreciated in developed countries where immunization is routine and nearly universal, where serious childhood diseases such as measles, poliomyelitis, tuberculosis, diphtheria, tetanus and whooping cough are now rare. In developing countries, immunization saves the lives of about 1 million children yearly (Philips, 1986). The importance of immunization programs cannot be overemphasised considering its ability to greatly reduce the incidence of infectious diseases. For instance, in just 10 years, an intensive world-wide vaccination and surveillance campaign eradicated smallpox, which for centuries was one of the most feared human diseases. Furthermore, in some developing countries, extensive immunization programmes have shown dramatic results in a few years and disease rates are dropping. At the same time, however, about 40% of children in the developing world (excluding China) are protected against diphtheria, tetanus, pertussis and polio and only 20 -30% are protected against measles (McBeath and Kesster, 1981). Every year, these diseases which are easily preventable, kill or permanently handicap over 3 million children which form part of the 12 million (10%) children that die out of 125 million children born. Some of
3 Downloaded from rsh.sagepub.com at UNIV OF MONTANA on April 8, 2015
the remaining 9 million deaths occur due to gastroenteritis, respiratory diseases and malnutrition. 97 % of these deaths occur in developing countries, 25% can be prevented by vaccination. Today the coverage has gone up to 40% and the figure is rising rapidly (McBeath and Kesster, 1981).
according to the geography of the barracks should be eastwards. iv) Children less than 2 years of age were identified in consecutive households in both the blocks till a total of 7 were obtained, but all the children within that age group in the last household were included. A total of 215 children were included in the study. Data for the study was collected by a questionnaire which sought information on personal data, parental knowledge on 6 killer diseases, EPI and NID programmes respectively. The questionnaire was administered to parents. The vaccination records of immunised children were obtained documenting the dates of vaccine and the number of doses obtained. Data was analysed using tabulations, statistical significant tests, bar diagrams and pie charts respectively.
Limitations be seen in any study of this nature, limitations be ruled out. It was not easy for a civilian to gain entrance into barracks to collect data. The procedure to secure permission to get in was both cumbersome and As
can
cannot
f’rustrating. Some parents had lost the immunization records of their
AIMS AND OBJECTIVES OF THE STUDY The major objectives of this study set out to evaluate the Expanded Programme on Immunization (EPI) in the Nigerian Army Depot, Zaria are as follows: i) To estimate the proportion (,7o) of children aged less than 2 years old who have been covered by the EPI in Zaria Depot. find out the parental knowledge of common ii) To childhood killer diseases and the benefits derived from immunization. iii) To find out the effects of good organisation and mobilisation on improving coverage of EPI. For instance, the effect of National Immunization Days (NIDs) on improving coverage or otherwise. iv) To make recommendations (based on the analysis) towards better coverage or emulation by a bigger set up if coverage is good. current
children due to postings and transfers and this made data collection difficult. There were problems associated with understanding and responding to the questionnaire properly with the result that the responses on some parts were not good enough for proper analysis. Some parents refused to answer questions associated with knowledge of Immunization Programmes stating that they were not supposed to know since they were not medical personnel.
RESULTS following analysed and
the results of the study statistically furthermore used for discussions with recommendations as the case may be. The study showed an immunization coverage of 88.9% which implies a good coverage for Nigeria by 1990. The
were
Research Method The EPI/WHO 30 cluster sampling method was employed for the study. Each cluster comprised of 7 children of the age group for the study. The procedure is as follows: i) 30 clusters were made up from the officers and senior non-commissioned officers’ residence block. For each cluster, the span of choice went across the ii) above areas. iii) The first cluster was randomly identified by locating the first house with the subject of study. By doing so, the 7 children less than 2 years were chosen and was decided that the progression of the next clusters
There was no relationship found between the ranks of soldiers and the immunization status of their children (X =
3.57; P>0.1)
so
statistically
4 Downloaded from rsh.sagepub.com at UNIV OF MONTANA on April 8, 2015
not
significant.
their children for immunization because of fear of reactions from the vaccine. It is worth noting that only 9.1 % of respondents were unaware of the EPI programme existence. Concurrently, only 20% of respondents agreed that they had never heard about National Immunization Day (NID) the intention of which was to improve immunization coverage in the nation.
Measles vaccination is the only one below the 1987 required national coverage of 60%. For the immunised, it is assumed that most children who have started immunization will complete the vaccine doses accordingly (Fig 1). The study also showed that the children of soldiers attached to the medical division of the depot and the children of engineers formed high number of immunized children. The others comprising of those on signals, guard, training etc, formed a small proportion of
uarter immunised. ~ose 2,
In Fig the result showed that most soldiers (46%) ordered to take their children for immunization but
were
few (19.4%) went willingly and an additional 7.8% had to take their children in for immunization to avoid punishment. As can be seen in Table 2A, there is no significant relationship between educational level of respondents and knowledge about vaccine preventable diseases. For example 25 illiterates knew that measles can
be
prevented by
same
compared with 20 participants Secondary education who had the
vaccine
each with Adult and
knowledge.
Of the responses given on a question asked about why some soldiers did not take their children for immunization, it is worth noting that most of them (68.2% ) were settling down for the first time because of being posted from time to time to new places. Few of them (13.6%) refused to take
DISCUSSION As can be seen in Table 2, the military rank did not have any relationship with the immunization records of the participants. This notwithstanding, more encouragement should be given to the few who were not immunized. Fig 1 also shows a good coverage of immunization in Zaria Army Depot. The Pie Chart shows that majority of soldiers (46% ) were ordered to take their children for immunization while 19.4% went willingly. More soldiers should be made aware of the beneficial effects of vaccination so that they can take their children willingly for immunization.
5 Downloaded from rsh.sagepub.com at UNIV OF MONTANA on April 8, 2015
SUMMARY AND CONCLUSION A total of 215 children below 2 years of age were included in the study. The study was carried out in Zaria Army Depot in 1989. The major objective was to evaluate the coverage of Expanded Programme on Immunization (EPI) in Zaria Army Depot. The study also intended to find out whether National Immunization Days (NIDs) have improved the immunization coverage as expected. It was found that the rank of soldiers had no relationship with the immunization status of their children. The study also showed good immunization coverage of 88.9%. The study also showed that majority of soldiers (46%) were ordered to take their children for immunization when compared to 19.4% who took their children for immunization willingly. It was also found out that 80% of soldiers heard about NID programme and responded to it. This implies that NID will provide a good mobilization force as it will improve the immunization coverage of EPI.
RECOMMENDATIONS In order
goals of immunization, emphasis placed continuously on public health workers making people aware of the importance of and the need for immunization throughout the nation. Awareness can be obtained through radio and television programmes as well as newspaper publications. Another way of creating public awareness could be through advertisement of the programme on stamps stating the different immunizable diseases. Providing funds for constant availability of vaccine is also recommended for the Government. Establishing more NID programmes will go a long way in improving the immunization coverage. More EPI personnel should be to
achieve the
should be
trained who will be dedicated to such work. Nongovernmental organisations who would encourage and contribute their own quota in ensuring adequate supply of cold chain equipment and vaccines to supplement government efforts should be incorporated into this programme.
ACKNOWLEDGEMENT I wish
to acknowledge Mele Mansfield, a part 5 Medical Student at Ahmadu Bello University, Zaria who collected data that made this study possible. I also acknowledge with thanks Dr E S Essien, an Associate Professor in the Community Medicine Department, Ahmadu Bello University, Zaria who supplied input for the methods and analyses used in this study. My thanks also go to Mr B L Bateng of Physical and Health Education Department at Ahmadu Bello University, Zaria who proof read the
manuscript.
References AKINTOLA S (1988). Information on Nigerian Army, Information Bulletin Public Relations Office, Nigerian Army Depot, Zaria BLUM D and PHILIPS M (1984). An Assessment of the Expanded Programme on Immunization (EPI) in Nigeria. The State of the World’s Children; UNICEF GRANT J P (1985). Towards Universal Immunization. The State of the World’s Children; UNICEF pp 93-97 GRANT J P (1987). Expanded Programme on Immunization (EPI). The State of the World’s Children; UNICEF pp 45-55 HENDERSON R H (1986). Protecting the Nigerian Child. The Vaccine Cold Chain, UNICEF Publication KEJA K O and HENDERSON R H (1985). EPI; Continuing Role of the European Region, WHO Chronicle ,Vol 39, No 3; 92-94 McBEATH W and KESSTER S (1981). Immunization, Primary Health Care, 1-20 ODUNSI P Y (1988). A Rapid Assessment of National Immunization Days in Nigeria. Assignment Children No 53/54 UNICEF PHILIPS M P (1986). Immunizing the World’s Children, Population Reports; WHO Geneva REID R S and SMITH E A (1984). Going National with EPI in Nigeria: A Case Study, Going to Scale for Child Survival and Development. Assignment Children 65/68 UNICEF YAKUBU A M(1986). Expanded Programme on Immunization. Paediatrics Departmental Seminar at Ahmandu Bello University Teaching Hospital, Zaria unpublished report
6 Downloaded from rsh.sagepub.com at UNIV OF MONTANA on April 8, 2015
The
Recommend Documents
Determinants of routine immunization coverage in Bungudu, Zamfara State, Northern Nigeria, May 2010.
An epidemic of meningococcal infection at Zaria, Northern Nigeria. 2. The changing clinical pattern.
