CHAPTER ONE: INTRODUCTION
1.1 Background
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. These vaccines help to stimulate the body’s own immune system to
protect the person against subsequent infection or disease (WHO, 2013). Immunization therefore
depicts the ability to develop immunity. Immunity being the state of having sufficient biological
defenses to avoid infection, disease, or other unwanted biological invasion (Gherardi E, 2013).
Immunity also depicts the capability of the body to resist harmful microbes from gaining access
into it.
Immunization is considered as one of the biggest achievements of the twentieth century and as
one of the most cost effective measures in the prevention of childhood diseases (Muhsen K et al,
2012). In 1974, the World Health Organization (WHO) launched a worldwide vaccination
program known as the Expanded Program of Immunization (EPI), which has been considered
one of the major public health interventions aimed at reducing infant morbidity and mortality
(Bos E et al, 2000). During the launching of the EPI in 1976, only about 5% of infants
throughout the world were protected against six diseases (diphteria, measles, pertussis,
poliomyelitis, tetanus, and tuberculosis). By 2013, the number of protected infants was more
than 80% in many countries. It is estimated that vaccination helps to prevent 2 to 3 million infant
deaths each year (WHO, 2016).
The Expanded Program of Immunization started in Cameroon in 1976 as a pilot project and
targeted infants from 0 to 11 months. Initially it targeted 6 diseases (diphtheria, measles,
pertussis, poliomyelitis, tetanus, and tuberculosis), and other vaccines were gradually introduced;the last to be introduced in the EPI was IPV in 2015. Presently, it has vaccines against the
following diseases: tuberculosis, diphteria, tetanus, poliomyelitis, pertussis, viral hepatitis B,
type b Hemophilus influenza infections, pneumococcal infections, diarrhoea caused by rotavirus,
measles, yellow fever, and rubeola. An infant is completely immunized when he or she has
received all the vaccines in the EPI. Ensuring that all the doses are not only administered, butgiven at the appropriate ages, is of crucial importance in ensuring the efficacy of the vaccine in
disease prevention (Lernout T et al, 2014). An infant is correctly vaccinated when he or she has
received all the vaccines at the recommended ages. Many infants still do not complete their
vaccination schedules or are vaccinated after the recommended ages (Ba Pouth SFB et al 2014).
Given the importance of vaccination in reducing morbidity and mortality in children, we decided
to assess the knowledge, attitudes and practices of mothers regarding immunization to chldren 0
– 12 months in Bonassama Health District of the Littoral region of Cameroon. This will
ultimately improve the vaccine coverage and reduce obstacles which might hinder effective
implementation of vaccination strategies.
1.2 RESEARCH PROBLEM
The Expanded Program on Immunization (EPI) was introduced in Cameroon in 1976 (Ba Pouth
SFB et al 2014). Since 2010, the national targets have been to achieve a national coverage of
80%, and 90 % at the level of health districts (Bofarraj AMM, 2008). To achieve these
objectives, several vaccination strategies have been adopted, and recommended to be used in
health facilities. These strategies includes; organizing vaccination at fixed posts, outreach
vaccinations, mobile and supplementary vaccination activities (Barreto TV et al, 1992).
Despite adoption of these strategies, in an attempt to achieve a universal coverage in the EPI,
access of populations to vaccination services remains low. In fact, based on the WHO definition,
only 53 % of children aged between 12 and 23 months were completely vaccinated, 5 % did not
receive any antigen of the EPI, 42 % were only partially vaccinated and 5 out of the 9 antigens
had national coverage rates lower than 80 %, far below the national targets (Chidiebere ODI et
al, 2014). 

1.3 RESEARCH QUESTION
Do mothers of children of vaccination age have adequate knowledge and good practices with
regards to immunization? Why is vaccination coverage rate in Bonassama Health District hardly
100 percent?

1.4 RESEARCH HYPOTHESIS
HA: Mothers of children of vaccination age (0 – 12 months) have adequate knowledge posses
good attitude and exhibit practices with respect to Immunization.
Ho: Mothers of children of vaccination age (0 – 12 months) have inadequate knowledge, posse’s
improper attitude and exhibit inappropriate practices with respect to Immunization.
1.5 RESEARCH OBJECTIVES
1.5.1 GENERAL OBJECTIVE
To assess knowledge, attitude and practices of mothers towards immunization of children 0 – 12
months of age in Bonassama Health District.
1.5.2 SPECIFIC OBJECTIVES
1. To assess knowledge of mothers of children 0 – 12 months old regarding immunization.
2. To assess the attitude of mothers of children 0 – 12 months of age with respect to
immunization.
3. To assess the practices of mothers of children 0 – 12 months towards immunization.
4. To establish a correlation between mother’s educational level and knowledge of children
vaccinations