CHAPTERR ONE: INTRODUCTION

Immunization is an effective public health intervention to reduce morbidity and mortality

among infants. It is an important means of controlling diseases and has been considered the

most cost-effective health intervention [1]. Immunization has brought sound health to many

children in the world, reduced the agony experienced by parents during child bearing and

reduced the mortality rate among children. The use of immunization services however

requires acceptability from the target community [2]. This means that for immunization

services to be used there must be a clear understanding of the benefits of vaccination among

community members, a readiness for providing vaccination by the health services and

interventions to overcome access barriers to immunization services [3]. Factors such as

knowledge, practices of parents contribute to the success or failure of immunization and

vaccination program. Such factors are lacking in developing countries [4]. In 1974, the World Health Organization (WHO) launched against six most common preventive

childhood diseases are diphtheria, pertussis (whooping cough), tetanus, polio, tuberculosis

and measles from the beginning of the program UNICEF significantly support to EPI. In

which immunization against vaccinated diseases through EPI is one of the most economical

public health interventions available [3]. UNICEF works with WHO to achieve universal

childhood immunization of six EPI vaccines. As a result of global immunization coverage

which increased from less than 20% to nearly 80% by 1990? Nearly 30 million children are

still not fully immunized every year. Nearly 2 million children still die needlessly each year

of vaccine preventable illness. This may be related to outrageous things about vaccines and

vaccination such as vaccination is a personal decision or vaccines are unnatural. Therefore,

children living in remote location and border areas are difficult to be reached. Other areas not

reached were displaced populations. Also, some people lack access to vaccination due to

social barriers, lack of information or inspiration to get vaccinated. The mothers play a major

role in promoting the health of children, several miss-conception, ignorance and inadequacy

of knowledge in relation to optional vaccine is prevalent among mothers especially under five

children [4].

1.1 Vaccination Practice by Mothers with Children Less than 5 years

In 2015, 19.4 million infants worldwide were not reached and 60% was from developing

countries [5]. However worldwide vaccination has greatly reduced prevalence of diseases and

has led to a 90% reduction in mortality across multiple vaccine preventable diseases [6]. An

additional 1.5 million deaths could be avoided if global vaccination coverage improves

diphtheria, measles, pertussis, poliomyelitis, tetanus and tuberculosis [7]. The purpose of the

EPI was to deliver multiple vaccines to all children through a simple schedule of child health

visits [6]. In Cameroon, the Ministry of Public Health adopted the Extended Program on

Immunization (EPI) as a pilot project in 1976. [5] This project was supported by the

Organization for Coordination of the Control of Endemic Diseases in Central Africa

(OCEAC) as well as the Centers for Disease Control (CDC), Atlanta. [5] In 1982 the

Government decided to extend the activities of the EPI over the whole of the country and to

turn it into a national program. In 1993 the vaccination activities were integrated into the

minimum package of activities of the Health Centre; since then [8], the World Health

Assembly 30.53 resolution of the World Health Assembly put forth the EPI goal of providing

immunization services for all children, [7] with the target of 90% coverage for all antigens by

the year 2000. [5] When it became clear in the late 1990s that this goal would not be achieved

globally, some supportive initiatives arose, including the Global Alliance for Vaccines and

Immunization (GAVI), a public-private partnership committed to improving access to routine

vaccines and to introducing new vaccines for children in low income countries [7]. On the

institutional level, the EPI has always been considered as a priority program, and vaccination

coverage as an indicator of the viability of the health system, and it has also served to reduce

child morbidity and mortality. Over two million deaths are delayed through immunization

each year worldwide [7 8]. The meeting of the World Health Organization held in Geneva in

May 2005 adopted the document entitled ―Global Immunization Vision and Strategy 2006-

2015‖. [8] This document, better known as ‗GIVS‘, insisted on the establishment of strong

links between vaccination and the other forms of health action, and examines the need to

surmount the systemic barriers which surround vaccination and affect the entire health sector

[9]. This is aimed at improving the performance of national vaccination programs in order to

provide reinforcement for national health systems, and all contributing to the achievement of

the Millennium Objectives for Development [10]. Despite the progress made in the course of

the 2001-2005 period, national vaccination programs conducted in the region are still

encountering numerous difficulties, worldwide about 29,000 children under the age of five

die every day, mainly from preventable causes. Moreover, even when a vaccine has been

proven to be safe and protective, questions regarding feasibility, acceptability and local

practices should also be addressed [8]. Clearly, immunizing an eligible child requires that the

mother is herself well mentally, physically and socially [10 11]. [12] Studied the beliefs,

attitudes and perceived control of parents and concluded that a mother who believes that

immunization protects is likely to have her child immunized. Uptake of vaccination services

is dependent not only on provision of these services but also on other factors including

knowledge and practices of mothers. About 85% of the deaths occur in developing countries

mainly in South Asia and Sub-Saharan Africa. [9] The Cameroon government under the

ministry of public health introduced the ROTA virus Vaccine in April 2014. But there is still

suspicion and mistrust of the vaccine amongst different communities in Cameroon [5]. The

National Immunization Program in Cameroon now administers vaccine for children and the

public thinks that this is exaggerated. [7] Although the child survival revolution of the 1980s

led to dramatic reductions in overall child mortality, it has had little impact on deaths taking

place in the first 28 days of life (the neonatal period). There are just fewer than 4 million

neonatal deaths, accounting for 38% of the 10.8 million deaths among children younger than

5 years of age taking place each year. 99% of these occur in low- and middle-income

countries. [13] Tackling neonatal mortality was therefore essential of the millennium

development goal of reducing child mortality by two-thirds between 1990 and 2015 was to be

achieved. Common direct causes of neonatal deaths in developing countries are known

infections such as pneumonia, neonatal tetanus, sepsis, and diarrhea [7].

1.2 Mother’s knowledge on immunization and vaccination

Mothers may sometimes not complete the vaccination schedule for their children

despite their positive attitude because of their poor understanding of the concept of

vaccination, which health personnel do not take time to explain to them clearly. According to

the research of [13] the knowledge and practice of mothers on the vaccination and

immunization is higher in urban areas as compared to rural areas. In our setting as an under

developed country which still has mothers with suboptimal understanding of the vaccination

schedule, raises and abated practices towards the vaccination and immunization of their child.

The experiences of mothers in our Cameroonian setting on the process of abstention of

vaccines for their children at health facilities greatly affect mother practices towards the

vaccination schedule. A study evaluated the knowledge, attitude, and practices of mothers

regarding the immunization of 841 infants who attended public kindergarten in Casino and

Crotone, Italy. Overall, 57.8% of mothers were aware about all mandatory vaccinations for

infants [14].

Hence, the study was carried out to assess the level of knowledge, investigate the practice and

the factors that positively and negatively influences immunization and vaccination by

mothers of under five children and at the same time mothers will be motivated by updating

their level of knowledge regarding the importance of immunization and vaccination.

1.3 Factors influencing immunization practices

Immunization is the main health intervention to reduce child mortality. One quarter of

the 2002 under five- mortality rate is attributable to vaccine preventable diseases [15]. Low

rate of immunization not only leave many young children at risk for various serious vaccine-

preventable diseases but also serve as an indicator of an inadequate of other preventive health

care [16]. Factors influencing compliance to the recommended immunization could be

divided into client factors, provider factors and external or environmental factors [17]. Client

factors include lack of knowledge or inaccurate perception about the importance of the

diseases prevented by vaccines, socioeconomic status, high birth order and big family size,

single parent and families who lives in temporal housing or who migrate between jobs [18].

The provider‘s factors include waiting time, motivation of service providers, suitability of the

timing of immunization sessions, attitude of service providers, reaction to side effects and

charges for the services. The external or environmental factors included logistic barriers,

limited accessibility to health care due to poor roads or inadequate public transportation,

preparedness of community for immunization sessions, information dissemination among the

community and inter-sectorial collaboration [18].

1.4 STATEMENT OF THE PROBLEM

Immunization is one of the most effective intervention, strategies to reduce child mortality

and morbidity [19, 20]. In recognition of the benefits of immunization, there has being need

to extend it coverage worldwide, especially in low income countries with the highest child

mortality rate. Since its lunching in 1974 [21]. Immunization currently averts more than 2.5

million deaths every year among age groups 0 to 5 years [22]. Some children after

immunization usually develop low grade fever thus disturbing their parents. This may

discourage some parents from not vaccinating their children; this may also be a reason why

the vaccination coverage even in urban areas hardly attends a 100% [22]. The expanded

program on immunization (EPI) was introduced in Cameroon in 1976 [23]. Since 2010, the

national target has been to achieve a national target of 90 and 80 percent at the level of health

districts [24]. To archive this objectives, several vaccination strategies have been adopted

and recommended to be use in health facilities. These strategies include, organizing

vaccination at fixed post, out reached vaccination, mobile and supplementary vaccination

activities [25]. Despite the adoption of this strategies, in an attempt to achieve the universal

coverage in the EPI. It would appear that improving communication on immunization will

therefore increase the vaccination coverage. This research therefore will help to assess

knowledge, to investigate the practice and the factors that positively and negatively influence

immunization and vaccination by mothers of children 0-5years.

1.5 Specific research questions

-What knowledge do mothers have on immunization and vaccination of children 0 to 5 years

attending Infant Welfare Clinic at Tubah District Hospital Bambui?

-What are the practices of mothers on immunization and vaccination of children 0 to 5 years

attending Infant Welfare Clinic at Tubah District Hospital Bambui?

-What are the factors influencing the practices of mothers on immunization and vaccination

of children 0 to 5years attending Infant Welfare Clinic at Tubah District Hospital Bambui?

1.6 General objectives

-To assess knowledge on immunization and vaccination practice by mothers of children 0 to

5 years attending Infant Welfare Clinic at Tubah District Hospital Bambui.

-To investigates mothers practice on immunization and vaccination of children 0-5 years

attending Infant Welfare Clinic at Tubah District Hospital Bambui.

-To identify factors influencing practices of mothers on immunization and vaccination of

children 0 to 5 years attending Infant Welfare Clinic at Tubah District Hospital Bambui.