CHAPTER ONE

INTRODUCTION

1.1 Background    

One of the most important discoveries in medicine is vaccination. It is one aspect of public health that is considered the most cost-effective in reducing the prevalence of life-threatening and contagious diseases. is believed to save between 2 and 3 million lives each year. The concept of immunization is not limited to one person but concerns the community as a whole: a vaccinated child is not only protecting himself but also others by preventing the transmission of vaccine preventable diseases (VPD).  A decrease in multiple VPD has been noticed for multiple years, with an increase in the number of unvaccinated children reported recently. In  1974, the  World Health Organization (WHO) launched a Worldwide vaccination program known as the Expanded Program on Immunization (EPI), which has been considered one of the major public health intervention aimed at reducing infant morbidity and mortality. During the launching, the EPI in 1976, only 5% of infants throughout the world were protect against six diseases ( diphtheria, tetanus, pertussis, poliomyelitis, measles ,and tuberculosis). By 2013, the number of protected infants was more than 80% in many countries. The EPI started in Cameroon in 1976 as a plot project and targeted infant from 0_11 months. Initially, it targeted six diseases diptheria, measles, pertussis, poliomyelitis, tetanus, and tuberculosis and other vaccines were gradually introduced. The last to be introduced in the EPI was Injectable Polio Vaccine (IPV) in 2015. Presently, it has vaccines against the following diseases, tuberculosis, diptheria, tetanus, poliomyelitis, pertussis, viral hepatitis, viral hepatitis B, type b hepatitis, influenza infection, diarrhea caused by rotavirus , measles, yellow fever and rubella. An appointment infant is completely immunized when he/she has received all the vaccines in the EPI ensuring that all the doses are not only administered, but given at the appropriate age, it’s of caucial importance in ensuring the efficacy of the vaccines in disease prevention. An infant is correctly vaccinated when he/she has received all the vaccines at the recommended age. Many infants still do not complete their vaccination schedules or are  vaccinated after three commended ages.

The  EPI was  introduced in Cameroon in 1976, since 2010, the national targets have been to achieved national coverage of 90%, and 90% at the level of health district To achieved these objectives, several vaccinations strategies have been adopted and recommended to be used in health facilities.These strategies include organizing vaccinations at fixed posts, outreach vaccination, mobile and supplementary vaccinations activities.

The development and use of vaccines has been one of the greatest achievements in public health over the past two centuries. It has been cited as one of the most successful and cost-effective public health interventions for preventing infectious diseases and their complications.

Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease. Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is act of making immune, especially by the  inoculation of the vaccines produce their protective effect by inducing active immunity and providing immunological memory. Immunological memory enables the immune system to recognize and respond rapidly to exposure to natural infection at a later date and thus to prevent or modify the disease. Antibodies can be detected in blood or serum, but, even in the absence of detectable antibodies, immunological memory may still be present (Salisbury, 2006). Immunity further can be divided into active and passive immunity. Naturally acquired active mmunity occurs when the person is exposed to a live pathogen, develops the disease, and becomes immune as a result of the primary immune response. Artificially acquired active immunity can be induced by a vaccine, a substance that contains the antigen. A vaccine stimulates a primary response against the antigen without causing symptoms of the disease. Artificially acquired passive immunity is a short-term immunization by the injection of antibodies, such as gamma globulin, that are not produced by the recipient’s cells. Naturally acquired passive immunity occurs during pregnancy, in which certain antibodies are passed from the maternal into the fetal bloodstream. Immunologic tolerance for foreign antigens can be induced experimentally by creating conditions of high-zone tolerance, i.e., by injecting large amounts of a foreign antigen into the host organism, or low-zone tolerance, i.e., injecting small amounts of foreign antigen over long periods of time ( Panikar, 2005).

According to World Health Organization (2015) vaccine is one of the most cost-effective investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change (WHO, 2015). It has eradicated smallpox by approximately 99%, and achieved dramatic reduction in illness, disability and death from diphtheria tetanus, pertussis and measles in many regions of the world. The World Health Organization has estimated that 2 million child deaths and additional 600,000 hepatitis B-related deaths from liver cirrhosis and liver cancer in adults were prevented globally by immunization. Nearly a quarter of global under-5 mortality is attributable to vaccine-preventable disease. Hence, vaccination will help achieve Millennium Development Goal reducing child mortality and morbidity. Vaccination provide health benefits to the child and community. It is identified as one of the key practices that can help promote child survival, health and nutrition in communities. It is important to vaccinate every child, especially the marginalized and hard-to reach. Under the comprehensive and multi-year National Immunization Programmed (NIP), access to routine vaccination against vaccine-preventable diseases (VPD) has improved in both villages and municipalities. This programme vaccinates children free of cost. Despite the success of the immunization programs worldwide, global estimates of mortality and morbidity due to vaccine-preventable diseases and low coverage in many countries is still larger. In 2007, it was estimated that 24 million children under 1 year old, accounting for almost 20% of the children born every year were not reached by currently available  vaccine.(http://www.who.int/bulletin/ volumes/86/2/07-040089/en/).

1.2 Problem Statement

Every child below 5 years should be immunized to maintain good health (WHO, 2015). However, in Buea, a number of children missed immunization despite having immunization services available and accessible. Statistics showed that, immunization ranged from 56-65% in 2014 (http://doi.org/10.1155/2020/9605492). As a result there were increasing numbers of children suffering from immunizable diseases. These mainly included; (67%) pneumonia, (17%) measles,(0.8%)tetanus, and (0.003%) poliomyelitis. Local statistics showed that, 67% of children below 5 years were not fully immunized Molyko Health Centre, 2015, (http://www.hindawi.com/journals/ijpedi/2020/9605492/).  These predisposed children under 5 years to immunizable diseases especially measles, pneumonia, whooping cough and diphtheria.

Health reports from Buea, indicated that, in 2014, immunizable disease visits accounted for 62% of total visits, in 2015 immunizable disease visits accounted for 67% of total visits and in 2015, immunizable disease visits accounted for 72% of total visits (http://www.afro.who.int/sites/default/files/2017-07/profile_cameroon_2016_ENG). This increased health care sector expenditure, infant mortality, family income constraints due to loss of time for work and high expenditure on health, stagnant growth in children and co-morbidities.

The ministry of Health through Child Care Programme stepped up efforts of massive education and sensitization on importance of immunization, use of Village Health Team, dissemination of information on primary health care through different media channels and health talks to mothers. Despite this, low immunization coverage was still persistent in the area and the reasons for this low EPI services in the area are not clearly defined. It is against this back ground that this study sought to assess the under five mothers’ knowledge, attitude and practice regarding the EPI  in the town of Buea so as to improve on it’s coverage.

1.3  Rational

Immunisation is safe, effective, and can save the life of a child, family, money and time, so it is important to immunize. This study will help to determine knowledge, attitude and practices of mothers of under five children in Buea. This data will provide evidence to stakeholders for particular intervention strategies which will increase immunization coverage.

1.4 Research Questions

The study answered the following research questions;

1). What is the knowledge level of mothers of under five children concerning EPI in Ndongo community, Buea?  

2). What is the attitude of mothers of under five children toward the EPI in Ndongo community, Buea?

3). What are the practices of mothers of under five children with regards to EPI in Ndongo, Buea?

4). What are the relationship between knowledge, attitude and practices of mothers of under five children about the EPI in Ndongo community, Buea?

1.5.  Objectives of the study

1.5.1. General objective

To assess the knowledge, attitude and practices of mothers of under five children regarding the EPI in Ndongo community, Buea

1.5.2. Specific objectives

The specific objectives included.

• To assess the knowledge of mother’s of under five children in Ndongo community, Buea concerning the EPI
• To find out the attitude of mothers of under five children towards the EPI in Ndongo community, Buea
• To assess the practices of mothers of under five children with regards to EPI in Ndongo community, Buea.
• To assess the relationship between knowledge, attitude and practices of mothers of under five children about EPI in Ndongo community, Buea