ABSTRACT

Introduction: Childhood vaccination is for child safety and physical well-being. Expanded Programme on Immunization (EPI) is a key strategy in prevention of vaccine-preventable diseases (VPD). There has been an increased in the number of unvaccinated children in recent time. Also, the refusal of vaccination has become very common amongst mothers, which has led to an increase in certain diseases like measles (WHO). Despite vaccination is essential, some parents still have misperception about vaccination Methods: A total of 361 mothers were enrolled in a household survey cross sectional study in Bwiteva community Buea.  Questionnaires were used to obtain data on socio-demographic characteristics, knowledge on EPI, attitudes, and practice of mothers of child bearing age towards EPI. Results: This study revealed that 86.24% had adequate knowledge about immunization and 90.6% knew that vacines save children from infectious diseases. However 46% of mothers had inadequate knowledge of the various vaccines given at each stage. Most of the mothers (79.77%) had a positive attitude EPI and 51% had attitude that EPI can eradicate vaccine preventable diseases. Most Mothers (85.87%) showed appreciable uptake toward EPI. Conclusion: Although a high proportion of mothers in Bwiteva community, Buea had good knowledge on EPI, current efforts on health education of EPI should be sustained and other strategies to improve knowledge on immunization need to be identified.

CHAPTER ONE

INTRODUCTION

1.1 Background

One of the most vital findings in medicine is vaccination. It is an aspect of public health considered as the most cost- effective in the reduction of the prevalence in life threatening diseases. Immunization is believed to save millions of lives every year. A vaccinated child is not only protecting his/herself but also others by preventing the transmission of vaccines preventable diseases (VPD). This is known as health immunity (Perla et al., 2020). The expanded program on immunization was launched in Pakistan in 1978 to protect children by immunizing them against childhood preventable diseases (Marium et al., 2017). Immunization is very vital aspect of public health intervention that leads to the reduction of child mortality and morbidity. The elimination, extermination and considerably the immunization of childhood vaccine- preventable diseases as well as the extending of life expectancy in many countries are an important output of immunization achievement (Gabre et al., 2021). However, building on the momentum of the small pox eradication the expanded program on immunization (EPI) was launched in 1974 to ensure that all children in all countries benefitted from the lifesaving vaccines (WHO 2021). In 1977 the aim was set for immunization against Diphtheria, Pertussis, Tetanus, Poliomyelitis, Measles and Tuberculosis available to every child in the world by 1990. Challenges faced include; lack of public and Governmental awareness of the scope and seriousness of the target diseases, ineffective program management, inadequate equipment and skill for vaccines storage and handling, and monitoring programs impact as reflected on increasing immunization coverage level and decreasing incidence of the target diseases (Keja et al., 1988)

Globally, it is estimated that about 22.6 million infant were partially protected. In 2016, the routine immunization services such as the Diphtheria 3 (DPT3) vaccine did not reach about 19.5 million children under 1 year of age. Also, about 70% of these children are in ten countries, and more than 50% of them are living in Africa including Ethiopia, Kenya and South Africa. Previous study carried out worldwide showed that death of children is more common in under developed countries. Among 9 million deaths of children worldwide as result of VPDs, a higher proportion happen in Sub-Saharan Africa, which was 4.4 million, from this; about 472000 children die every year before their fifth birthday largely from VPDs in Ethiopia (Gabre et al., 2021). However in Africa specifically in Ethiopia, EPI begun in 1980 and it has been recognized that vaccines preventable diseases are responsible for 16% under- five mortality. Two from five aged 12- 23 months (39%) had got fundamental immunizations at sometimes, and also (22%) have gained vaccines at suitable period of time (Ayele et al.,2019). The EPI was introduce in Cameroon in 1976. Since 2010 the national targets have been achieving a national coverage of 90%, and 80% at the health district (Ebile et al., 2016). Some of the indications of EPI; dropout rate, outreach, mobile services fixed site of vaccination, reported new cases of VPI. Some of the benefits of EPI include; herd immunity, reduced infant mortality and morbidity rate, improve community health, low rate of expenditure in health related issues.  However a slowdown in EPI leads to high infant mortality rate.

1.2 Problem Statement

 There has been an increase in the number of unvaccinated children in recent time. Also, the refusal of vaccination has become very common among mothers with children, which has led to an increase in certain diseases like Measles (WHO). In 2018 according to WHO, almost 20 million children were not vaccinated against Measles, Diphtheria and Tetanus etc.

Despite the proven benefits of immunization, vaccine-preventable diseases (VPDs) continue to pose a threat worldwide, evidenced by outbreaks of infectious diseases. Today, (Bedford, H. 2014) immunization seems to be the victim of its own success. In the past years, the level of immunized people dropped worldwide. Current immunization coverage rates in the WHO European Region are insufficient to ensure herd immunity and halt the spread of VPDs in the Region. In some countries with previously high coverage, rates have now fallen well below 95% of the WHO-recommended threshold. (Camargo Jr, K., & Grant, R. 2015). Therefore this current study sort to evaluate the knowledge, attitude and uptake of expanded program of immunisation among mothers with children.

1.3 Rationale

Immunization is a proven, cost-effective strategy for public health that protects both the individual and the entire community. At the same time, immunization has become a victim of its own success, because many vaccine-preventable diseases have become so rare that some people believe they have been eradicated forever, so they do not understand the benefits of immunization.

However, vaccine-preventable diseases still pose a threat around the world with traditionally high immunization coverage, the recurrence of measles rubella and whooping cough shows that these risks are real. There are numerous reasons for this phenomenon, but we know that some children are not vaccinated because their parents are insufficiently informed about the need for immunization (e.g. in the hard-to-reach populations) or have misconceptions about the safety and effectiveness of vaccines. Therefore this current study sort to evaluate the knowledge, attitude and uptake of Expanded Program of Immunisation among mother with children.

1.4 Research Questions

1. What is the level knowledge of mothers with children about EPI in the Bwiteva community?
2. 2. What are the attitudes of mothers with children in the Bwiteva community as regards to EPI?
3. 3. What are the uptakes of mothers with children in the Bwiteva community as regards to EPI?

1.5 Objectives

1.5.1 General objectives

To evaluate the Knowledge, attitude and uptake of mothers of with children of Expanded Program of Immunization in the Bwiteva community

1.5.2 Specific objectives

1. To assess the level of knowledge of mothers of with children concerning EPI in Bwiteva Community
2. To determine the attitudes of mother with children toward EPI in the Bwiteva community

3. To evaluate the uptake level of mothers with children in the Bwiteva community