CHAPTER ONE

INTRODUCTION

1.1 Background

Vaccine-preventable diseases are a significant source of both morbidity and mortality in the general population. Vaccinations are universally recognized as one of the most effective preventive measures in public health (CDC, 2015).  Immunization programs can reduce the burden due to preventable infectious diseases and can decrease the related morbidity, mortality, and healthcare costs. Moreover, achieving a 95% vaccination coverage rate is likely to avoid disease incidence and to protect also the unimmunized population segment (WHO, 2020). Unlike most medications, whose benefit is restricted to the individual who takes it, prophylactic vaccines have the potential for far-reaching effects that encompass health service utilisation, general health and wellbeing, cognitive development and, ultimately, economic productivity. The impact of immunisation is measured by evaluating effects directly on the vaccinated individual, indirectly on the unvaccinated community (herd protection), the epidemiology of the pathogen (such as changing circulating serotypes or prevention of epidemic cycles), and the additional benefits arising from improved health. Aside from protection of the individual, the broader success of immunisation is dependent on achieving a level of coverage sufficient to interrupt transmission of the pathogen. (J.L Schwartz, 2012). Introduction:

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, 2017).

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. Immunity also depicts the capability of the body to resist harmful microbes from gaining access into it.

In 2010 it was estimated that 1.7 million children died from vaccine preventable diseases. It was also noted that 19.3 million children had been incompletely vaccinated, leaving them susceptible to vaccine preventable disease mortality and morbidity. Approximately 50% of all under vaccinated children live in three countries, India being one of them.

Vaccination is an act of administering the vaccines that produces immunity in the body against the organism. Immunization is a process where one becomes protected from a disease (WHO, 2011). The promotion of health is a social as well as an individual responsibility. The mother plays a major role in promoting the health of children. Several misconception, ignorance, and inadequacy of knowledge on the importance of vaccines are prevalent among mothers especially for under 1year children (kmatov, 2010). Vaccines are the greatest boon and achievement of modern medicine. It has been known that 5million children were dying each year and another 5million were disabled by infectious diseases (WHO, 2011). The growth and development of children is a long-term contribution of a country as a whole. The key to attain the goal of health for all primary health care emphasizes on the preventive principles and one of the most cost-effective health interventions is vaccine for all infectious diseases. Vaccination is a high priority area in care of infants and children. High vaccination rates have almost eliminated many infectious diseases which used to decimate sizable of the population for countries. A number of deadly and disabling infectious diseases can be prevented by timely administration of vaccines. When the child is effectively vaccinated at the right age, most of these diseases are either entirely prevented or at least modified so that child suffers from a mild disease without any disability. (Wong, 2011).

Vaccination is one of the most effective, safest and efficient Public health interventions in Cameroon and all over the world. While impact of vaccination on childhood morbidity and mortality has been great, full potential has not yet been reached. Still, thousands of infants die from vaccine-preventable diseases each year. (Haneef, 2016). It’s the responsibility of mothers to ensure the healthy growth and living of their children and vaccines are there to help protect and prevent them from infectious disease. Vaccinating children has lots of importance to the health and wellbeing of the children: Vaccines prevent children from diseases such as measles, mumps and whooping cough which are still a threat and continue to infect children resulting in hospitalization and death every year. Furthermore, vaccination leads to a drastic decline of cases of severe infectious diseases and the outbreak of preventable disease which occur when children are not vaccinated. Moreover, vaccination protects others who can easily be contaminated by the infectious disease and have weak immune system like parents, sibling and grandparents. Vaccination also shows public health commitment to the community to protecting children thereby protecting their family members (kmatov, 2010)

Various reasons have been adduced by mothers for incomplete vaccination of their children. These include long waiting time at the health facility, lack of vaccine on the appointment day, absence of health personnel at the health facility, child ill health at the time of vaccination, lack of information about the days for vaccination, forgetting the days of vaccination, long distance walking, mother’s illness on the day of vaccination, social engagement, lack of money, schooling mothers, disagreement about vaccination safety (Abdulraheem et al, 2010). According to the Centre for Disease Control and Prevention CDC (2009), the outbreak of infectious diseases like pertussis, measles and many more provide health information to effect vaccinations in full coverage particular to children. The child’s immune system is vulnerable without vaccination and children could become seriously ill or even die from diseases such as Measles Mumps Whooping cough, Rubella and Hepatitis etc.

The extended program on immunization (EPI) started by the WHO in 1974 and has improved coverage for BCG, DPT, Polio and Measles to about 80% in developing countries (Loevinsohn and Hong 2016). Cameroon is amongst countries that benefit from EPI which offers free vaccination for children between the ages of 0 to 9 months old. Unfortunately, many people are still unaware of the vaccination schedule and its importance which might have accounted for the low coverage rate as well as refusal of vaccination by some parents. (Expanded Programme on Immunization, 2011). The objective of the expanded program of immunization is to achieve 90% routine immunization coverage of all EPI antigens with at least 80% coverage in every district so that mortality and morbidity can be reduced from the EPI targeted diseases by immunizing children between the age 0 to  11 months.  This study therefore sought to determine the level of knowledge of mothers with infants between the ages of 0 and 5years resident in Bueacommunity on the vaccination which special reference to the EPI vaccines and schedule.

1.2 Problem Statement

Immunization programs are still facing substantial challenges in achieving target coverage rates and this can be attributed to the growing negative individual vaccination attitudes and behaviours as well as lack of adequate information on vaccination. Despite the strategies put into action by the Cameroon Ministry of Public Health on the Extended Program on Immunisation (EPI), they still exist many cases of refusal from mothers who prevent their babies from being vaccinated resulting in low EPI coverage. Infant immunization is aimed  at protecting children from infectious disease. Several cases of missed vaccines were reported during our school community internship at the Buea community. With the above observation, this study has been designed to assess knowledge, Altitude and practice of  mothers’ knowledge on vaccination specifically related to the EPI program and identifying their challenges with respect to vaccination.

1.4 Research Questions

1.4.1 General Research Question

1. What knowledge, attitude and Practices do mothers have regarding the extended program of immunization among community women in Buea?

1.4.2 Specific Research Questions

1. What is the knowledge level of mothers in the Buea Molyko community have on the Extended Program of Immunization for children?
2. What is the attitude of mothers in the Buea Molyko community as regarding the extended program of immunization among community women in Buea?

• What are the practices of mothers in Buea Molyko community as regarding the extended program of immunization for children

1. What are the challenges mothers in the Buea molyko Community face in following the Extended Program of Immunization for children?

1.5 Objectives of the Study

1.5.1 General Objective

The general objective of this study is to determine knowledge, attitude, practices and challenges of mothers regarding the extended program of immunization among community women in Buea Molyko Community

1.5.2 Specific objectives

1. To assess mothers’ knowledge on the Extended Program of Immunisation for children.
2. To determine the attitude and practices of mothers in the Buea community as regarding the extended program of immunization among community women in Buea

To identify the challenges mothers in the Buea Community  faced in following the Extended Program of Immunization for children