CHAPTER ONE
Introduction
Background to the Study
For more than two hundred years now, after the discovery of vaccines by English Physician Edward Jenner, immunization has been credited with saving millions of lives every year worldwide by means of conferring immunity on them. Obionu (1999) affirmed that immunity is the ability of the body of an immunized person to resist certain diseases. He also posited that one who is immune to a disease is protected against that particular disease by means of antibodies. Immunity according to Bradley (1997) is the ability of the body to resist infection or disease, especially germs or other poisonous products (toxins) and that immunity can be actively or passively acquired.
Active immunity according to Bradley (1997) is one where a person’s body defence mechanism is stimulated to manufacture its own antibodies natural in response to a stimulus. This stimulus, he said, can be in form of an attack of a disease where the body defence mechanism is stimulated to produce natural antibodies against the foreign bodies or antigens of the attacking disease. The antibodies so manufactured would protect the body against future attacks of the same disease. Jelliffe (1993) earlier stated that the stimulus could be given artificially in form of a vaccine that contains the disease agent or their products in a killed or attenuated and harmless form which is introduced into the body.
Bradley (1997) defined vaccine as a medicine made from a microorganism, which is administered to confer immunity against a dangerous disease. She acknowledged the fact that there are various types of vaccines viz: antitoxins, live vaccines or dead vaccines. Antitoxins are the altered harmless toxins of an organism that when injected into the body, stimulate it to produce antibodies (e.g. diphtheria and tetanus antitoxins). Live vaccines contain living but weakened microorganism (attenuated) grown especially in a laboratory (e.g., poliomyelitis, measles, tuberculosis (BCG) vaccines). Dead vaccines contain dead microorganisms. The body in response to the introduced vaccines (through immunization will be stimulated to manufacture its own antibodies against the disease agent contained in the vaccine (e.g., measles immunization in the routine immunization programme). This is known as active artificial immunity. Jelliffe (1993) confirmed that active immunity whether brought about by illness or vaccines lasts a long time, sometimes throughout life.
In passive immunity, ready-made antibodies are introduced into the body of a person to immunize and protect him against certain specific diseases, and could be acquired naturally or artificially. Obionu (1999) posited that in passive natural immunity, maternal antibodies pass from the mother to the child through the placenta. This will make the baby have some protection against some diseases at birth such as, neonatal tetanus, measles, and malaria). Obionu added that passive artificial immunity is giving the antibodies ready-made as vaccine like tetanus antitoxin for a person who already has the tetanus disease). When a person’s body defence mechanism is stimulated through the introduction of a vaccine to develop immunity that will prevent him from contracting an illness, the person is said to have received an immunization.
The World Health Organization-WHO (2002) defined immunization as a process of administering special medicine(s) into a person’s body to make the body resist certain vaccine- preventable diseases. Azubike and Nkanginieme (1999) suggested that immunization may be active or passive and confers some protection or immunity to the receipient. Onuzuluike (2002) posited that active immunization is a deliberate stimulation of the body’s defences against a specific harmful germ or bacteria. Obionu (1996) opined that it is the most powerful cost-effective means of preventing some deadly diseases of childhood and the best practical community-based health measure known today for protecting children against the major killer diseases. This study will be limited to active immunization which involves the administration of all or part of an infecting agent (that is, microorganism or a modified product of an infecting agent) using a vaccine.
Various types of immunizations could be given at different stages of a person’s life and for different purposes. Sing and Matthew (2006) classified available types of immunizations into four namely: 1. Adult immunization, 2. Travel immunization, 3. Influenza immunization and 4.Childhood immunization. Onuzulike (2002) opined that adult immunization is the type that is given to healthy persons aged 15 years or older especially in epidemic situations in spite of their previous immunization status to protect them against a disease. Lucas and Gilles (2003) defined travel immunizations as those given to international travelers to guard against the import and export of vaccine-preventable diseases. Influenza immunizations according to Jekel, Elmore and Katz (1996) are the ones given to all age groups to guard against influenza which occurs worldwide usually as a pandemic. Matsuda (2002) defined childhood immunizations as those immunizations given to children to protect them against the childhood killer diseases. Although these types of immunizations are available, the thrust of this study is on childhood immunization. Jekel, Elmore and Katz (1996) viewed childhood immunizations as a process of actively introducing vaccines into the bodies of healthy children early in life to enable them develop immunity against infectious diseases.
Delivery of immunization services according to Awosika (2004) is achieved through two broad categories namely: supplemental immunization and routine immunization.Supplemental immunizations are those given to boost the immunity of a person that has been immunized or vaccinated before for a particular or same vaccine-preventable disease. When childhood immunization is given at scheduled times or periods, it is called routine immunization. WHO (2001) conceptualized routine immunization as, the immunization that is given to children at health centres from birth and at various stages of childhood to protect them from having serious disabilities or possible death from the six killer diseases. For Nigeria and other developing countries, the recommended vaccines for routine immunization according to National Programme on Immunization- NPI (2005), consists of Bacillus Calmette Guerin (BCG) vaccine, Diphtheria, Pertussis, Tetanus (DPT) vaccine, Oral Poliomyelitis vaccine (OPV) vaccine, Hepatitis ‘B’ vaccine (HBV) , Measles vaccine, Yellow fever vaccine, Cerebro-spinal Meningitis (CSM) vaccine and Vitamin ‘A’ vaccine. In countries like Nigeria where prenatal transmission of neonatal tetanus is common, Obionu (1999) added that routine immunization with tetanus toxoid is given to women of childbearing age (15-55years) with the dual aim of protecting the unborn baby and the mother and preventing neonatal tetanus. Though supplemental and routine immunizations complement each other, this study is focused on routine immunization. For the purpose of this work, routine immunization is conceptualized as a deliberate introduction of vaccines into the body of a child at specified periods especially within the first two years of life. When correctly followed, children finish the schedule by one year of age and it is the right of every child to be fully immunized.
The prevention of diseases by immunization is a well-known public health measure that cannot be overemphasized. This is because through immunization communicable diseases like smallpox that threatened about 60 per cent of the world’s population and killed every fourth victim has been eradicated (WHO, 2004). When routine immunization is correctly and rightly administered following the schedule, it has many benefits. Ghulam (1999) listed the benefits of immunization to include partial or complete protection against the consequences of infection for the vaccinated person, as well as overall benefits to society as a whole. It also includes protection from symptomatic illness, improved quality of life and productivity, and prevention of death. Societal benefits include creation and maintenance of herd immunity against communicable diseases, prevention of disease outbreaks, and reduction in health-care-related costs. Herd immunity results when a vaccine not only prevents the vaccinated person from contracting the disease but also prevents him from spreading or transmitting the disease to others. This will cause the prevalence of the organism in the entire population to decline. This is because as Jekel, Elmore and Katz (1996) and Ibezimako (2002) observed, when some vaccines are given, they not only provide the immunized person with some level of individual immunity to a specific disease but also reduce or prevent the shedding (spread ) of infectious organisms from an immunized person to others.
Mothers usually adopt varied RIS for their children. However, it is not uncommon for mothers not to adhere strictly to the routines of immunization as a result of many factors or characteristics. These factors or characteristics influence the probability of their adopting RIS successfully or not and their child receiving a complete series of immunization or not. Several of these factors interact with the characteristics of these mothers to positively or negatively influence the outcome or determination of their adoption of routine immunization services for their children. These characteristics include may age, educational status, marital status, religious affiliation, occupation, parity of mother, culture, economic status, social class , and location or place of residence of the mother Akinsola,1993).
Age of the mother could have implication on the knowledge and adherence to the immunization schedule. Teenage mothers with no experience on child-rearing and single mothers may not be bothered with the welfare of the child because they may not know the value of immunizing their children. Akinsola (1993) is of the view that these very young mothers may not present their children for immunization. Reinhardt and Quinn (1990) posited that babies of very young mothers may not be presented for immunization and are likely to suffer.
According to Akinsola (1993) a mother’s level of education could determine her knowledge and perception of immunization and its benefits. This could consequently impact on her adoption or non-adoption of it for her children as illiterate and less educated mothers could be less knowledgeable and aware of the availability of the health promotive services available in their area.
In line with this, Chen and Liu (1984) posited that educated women are better able to break away from tradition to utilize modern services like immunization services to safeguard their health and that of their children. They equally acknowledged that lack of education could also lead to ignorance about causes of diseases and the relationship of immunization to elimination of diseases.
The marital status of a mother could also determine the support she gets or not towards immunizing her child and consequently how she adopts it. This is because as Bates and Wolinsky (2004) put it, a married woman who gets the support of her husband and relations is more likely to afford the financial requirements of services that may be charged like cost of transportation. They also posited that they might have less control over their lives because of their marital status and family environment. It could therefore be said that unmarried mothers are more likely to have under-vaccinated children even as Bates &Wolinsky (2004) suggested that they may be less bothered with their child’s health care especially without the support of a spouse.
Religious status could be a reason for a mother to have or not have access to an immunization facility. This is because Babalola and Aina (2004) warned that religious misconceptions about immunization could be a barrier to adoption of immunization. This is because they felt that certain religious restrictions (e.g. some Muslim women not wishing to see a male health worker or women not being given permission by their husbands to visit a health facility with their child) could affect their adoption of immunization.
Location or residence of mother and distance to the health care facility for immunization as observed by Weathers, Cynthia, Campo and Dinner (2003), could also be a factor in the adoption or non-adoption of immunization services. This is because such physical factors as terrain of an area, or even the distance to get to the nearest health facility for immunization may determine the rate of adoption or non-adoption of such services.
The mother’s occupation could have serious implications for her adoption or non-adoption of routine immunization services. Equally, the nature of the mother’s job, (e.g. farming) may be such that it does not give her time off to take her child for immunization at the appropriate time. Onuzulike (2002) posited that this is disastrous because the baby may be exposed to childhood killer diseases.
Jalingo LGA in nature is made of both urban and rural areas. From a pilot study conducted by the researcher on health facilities offering routine immunization services in Jalingo LGA, there are about twenty-five (28) health facilities scattered over the LGA with only about twenty-five (25) offering routine immunization services and they have available many types of RIS that they offer regularly (see Appendix II) . The LGA is inhabited by people especially mothers with varying age limits, educational and marital statuses, occupational and religious backgrounds in both the urban and rural areas. This means that their decisions to adopt or not to adopt routine immunization for their children could vary or be determined by their diverse socio-demographic characteristics.
As Chen and Liu (2002) puts it, the socio-demographic characteristics used to describe mothers and caregiver of children who automatically make decisions for the use of routine immunization, have been found to have significant influence or bearing on whether a child receives full immunization or not. This study therefore intends to examine the relationships of the socio-demographic characteristics of mothers in Jalingo, Taraba State to the adoption or non-adoption of routine immunization services for their children.
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