The knowledge and attitude of nursing mothers towards immunization

CHAPTER ONE

INTRODUCTION

1.1       Background to the Study

Immunization is the process of protecting an individual or animal from a disease, especially by giving an injection or vaccine. Immunization is also defined as a process by which human being protect themselves from or against deadly disease such poliomyelitis, measles, tuberculosis, diphtheria, whooping cough. Immunization is done to make the body resist invasion of pathogenic microbes like bacteria, protozoa and virus. Immunization involves the injection of a small quantity of a dead parasitic organism into the body of a healthy person, the body recognizes the antigen as foreign response by realizing specialized protein called antibodies. These antibodies have specific properties and the body becomes immune against the disease that is caused by micro-organism (www.Grossarchive.com).

The World Health Organization (WHO) has defined immunization as the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine.The six child killer diseases identified by the World Health Organization (WHO, 2018) are tuberculosis, whooping cough, diphtheria, tetanus, poliomyelitis and measles. Yellow fever outbreak in Nigeria led to its inclusion in the latest immunization regime. Immunization today saves more than three million lives a year. However, millions of children still do not have access to basic immunization and die from diseases that can be prevented by available vaccines (WHO, 2018). Immunization is the process of conferring increased resistance to an infectious disease by a means other than experiencing the natural infection. Typically, this involves exposure to an agent designed to fortify the person’s immune system against that agent or similar infectious agent (Blakemore &Jemett, 2017).

Globally, vaccine preventable diseases (VPDs) account for nearly 20 percent of deaths occluding in children under five years of age (World Health Organization, 2019). This makes childhood immunization one of the most important public Health Interventions and a cost-effective strategy that has reduced both the morbidity and mortality associated with infectious disease in children (Babalola & Olabisi, 2017). Even though immunization is proven to be the most successful and cost-effective public health intervention in reducing childhood morbidity and mortality as it averts 2 to 3 million deaths every year, the global vaccination coverage has remained stalled at 86percent since 2016, with no significant changes during the past years (World Health Organization, 2018). Of the estimated 19.5 Million infants that were not reached with routine immunization services worldwide in 2016, 60percent of them lived in 10 countries including Nigeria (Nation Population Commission, 2016).

According to the National Demographic and Health Survey (2018), vaccination coverage in Nigeria has improved over the past 10 years. The percentage of children aged 12 – 23 months who received all basic vaccines increase from 23percent in 2018 to 31percent in 2018; while the percentage of children who received none of the basic vaccine decline from 20percent to 19percent during the same period. Although these trends show improvement in childhood vaccination coverage, they fall short of the sustainable development Goal 3, for which the target is achieving more than 90percent coverage of all basic vaccination among aged 12-13 months. According to the Nation Population Commission (2019), Vaccination coverage among children aged 12-23 months is highest in Anambra (76 percent) and lowest in Sokoto (39 percent), with Ebonyi State having a coverage rate between 34 – 48percent.

Nursing Mothers Knowledge and Attitude is an important predictor of childhood immunization (WHO, 2016). According to Abiak (2021) Parents especially nursing mothers do not get their children immunized. The superstitious belief or ideas that diseases are caused by witches and wizards are strongly rooted in their minds some belief that disease are caused by evil spirits and the only way to avoid is by offering sacrifice. Some parent know where and how obtain it but do not take their children to the clinic or health centres for immunization while other that made attempts to take their children for immunization may start and will not complete the normal dose they are suppose to give that child. In a particular health centre at Barracks Health centre in AkwaIbom State, between January 2007 – December 2010, fifty-six thousand, six hundred and forty(56,640) children were registered for different types of immunization. Out of these only thirty four thousand six hundred and twenty-two (34,622) children completed their immunization, the remain twenty-two thousand and twenty (22,020) failed to completed their immunization. Some parents later brought their child to complete their immunization after a long time. When asked why they did not their children ever since, the most popular reason they gave was that they were not chanced due to their jobs and responsibilities (www.Grossarchive.com).

Immunization services depends not only on the provision of these services but also on the knowledge and attitude of mothers towards immunization services (Toner &Bakirci, 2016; Anand&Bamighansen, 2017). Misconceptions of routine immunization, the influence of religion, attitude of community stake holders and members, poor communication and inadequate knowledge are frequent hindrances to immunization in Nigeria include AkwaIbom State. Nursing mothers have an important role to play in child care, so their awareness and involvement are a necessity to implement immunization programmes for a child’s wellbeing. Mother with sufficient knowledge, a favorable attitude and healthy practices towards a child’s overall development are good assets to our communities and nations. Assessing their knowledge and attitude towards childhood immunization becomes an important step to understanding and addressing some of the factors that contributes to low uptake of childhood in immunization (Vonasek et al., 2016).

Attitude towards immunization refers to the behavior of nursing mothers towards immunization of children against the killer diseases. Some nursing mothers have unconcerned or nonchalant attitude towards matters that concerns the immunization of their children. The center for disease control and prevention (CDC,) (2019) stated that the general attitude of parents was negative among most of them towards childhood vaccination programs. Moreover, some parents thought that polio immunization will decrease the fertility rate of their children thus, the parents attitude plays important role in vaccination process as they are the decision makers for their children (Falade, 2016).

Knowledge is an important factor influencing immunization. A number of studies indicate that nursing mothers who have inadequate knowledge about immunization and immunization schedules are more likely to have children who are not immunized or partially immunized. Marfe (2017) explains that parents’ knowledge and understanding of immunization is important so health care providers can provide support. Most nursing mothers are not aware of the vaccine preventable childhood diseases and as such avoid immunization programmes. Different researching have reported husband’s refusal, not remembering vaccination day, unaware of the need for vaccination, lack of vaccination information provided to parents and lack of understanding of the vaccine and its importance are the commonest reasons for missing vaccine (Tagbo et al., 2016; Al-lela et al., 2016; Birhanu et al., 2016; Mugada et al., 2017; Awosan et al., 2018).

Despite the growing campaigns on Immunization awareness in Nigeria, the practices of immunization among nursing mothers is still very low. This is as a result of inadequate knowledge and negative attitude towards immunization, religious background and socio-demographic factors. Available Literature reviewed that nursing have poor practice of immunization for their children both in consistency and timing, often in the light of a poor knowledge of immunization (Onyebuchi, 2015). In Nigeria assess to Health care services especially immunization services is very low though available and there is need for an intervention study to enhance the knowledge and attitude of nursing mothers toward childhood immunization (Onwere, Okoro&Chigbue, 2016). Based on the above facts, the present study is therefore designed to examine the knowledge and attitude of nursing mothers towards immunization in Uyo Local Government AreaAkwaIbom State.

1.2   Statement of the Problem

Though many nursing mothers may have been informed about childhood immunization through the sensitization, awareness programe and mass media e.g. radio, television, newspapers, there is negative attitude and little practice of immunization among nursing mothers. Most of them are skeptical about the exercise having different perspectives about it let alone promoting and urging their followers to key into the program for their children. Moreover, religion and culture also contribute to the attitudes of nursing mothers toward childhood immunization. Childhood immunization is seen as a western strategy to control their population which goes contrary to religious injunction to ‘multiply and fill the earth’. This makes the acceptance of childhood immunization difficult. Also, the attitude of nursing mothers in terms of attending antenatal care (ANC) from trained health personnel is shaped by their culture. Nursing mothers in the rural areas and even some in urban areas patronizes traditional birth attendants (TBA) when pregnant and at the time of delivery than western health institutions. Attending antenatal care gives  nursing mothers the opportunity of knowing about childhood related illnesses and measures to overcome them. But when mothers prefer traditional birth attendance due to culture or distance, denied them the opportunity to have knowledge of pregnancy related issues including childhood killer diseases and immunization which guarantees child survival (Abidoye, 2018).

In Nigeria, a recent review of National Population Commission registration reported a 95 percent increase in the incidence of childhood death (WHO, 2017) The rising trends has been linked to factors such as lack or inadequate knowledge and negative attitude towards immunization, religious belief, socio-cultural environment and poor level of education (Onyebuchi, 2015). This necessitates for study focus on knowledge and attitude of nursing mothers towards immunization. This study aims to articulate the level of knowledge and attitude of nursing mothers towards immunization in Uyo Local Government Area.

1.3       Objectives of the Study

The main objectives of the research work is to examine the knowledge and attitude of nursing mothers towards immunization. Other specific objectives of the study include:

1. To examine the knowledge of nursing mothers towards immunization in Uyo Local Government Area.
2. To assess the attitude of nursing mothers towards immunization in Uyo Local Government Area.
3. To examine the influence of nursing mothers knowledge and attitude toward immunization.
4. To examine the influence of religion on nursing mothers attitude toward immunization.

1.4   Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives of the study. The research questions for the study are stated below as follows:

1. What is the knowledge of nursing mothers about immunization in Uyo Local Government Area?
2. What is the attitude of nursing mothers towards immunization in Uyo Local Government Area?
3. To what extent does nursing mothers knowledge and attitude influence immunization in Uyo Local Government Area?
4. To what extent does religion influence of nursing mothers attitude towards immunization in Uyo Local Government Area?

1.5       Research Hypothesis

The following hypotheses are formulated to guide the study and tested at.05 level of significance

1. There is no significant influence of nursing mothers’ knowledge towards immunization.
2. There is no significant influence of nursing mothers’ attitude towards immunization
3. There is no significant influence of  nursing mothers knowledge and attitude on immunization
4. There is no significant influence of religion on nursing mothers’ attitude towards immunization.