National Programme On Immunization Research Articles

Factors Responsible for Missed Opportunities of Immunization among Children 0-5 Years in Mgbundukwu Health Centre in Port Harcourt, Rivers State

Immunization over the years has been so effective that its ability to save lives of under-five children globally and more has promoted its usage all over the world especially in the developing countries. The aim of the study was to determine the factors responsible for missed opportunities of immunization among children of 0-5 years in Mgbundukwu Model Primary Health Center, Port Harcourt, Rivers State. The study was guided by four objectives and research questions. The study employed a descriptive survey design. A sample size of 120 was drawn using simple random sampling technique and data was collected using a self-developed structured questionnaire. The Standard World Health Organization, Expanded Programme on Immunization (WHO EPI) protocol was used for assessing missed opportunities for immunization. Data obtained were analyzed using frequencies and percentages. The result showed that majority of mothers (94.0%) have heard of National Programme on Immunization (NPI), mothers who had heard of immunization from the health facilities had the highest percentage of 55.0%. The result also shows an increased prevalence of missed opportunity for immunization 61(61.0%), missed opportunity for immunization was more common for OPV3 (13.33%) compared to other vaccines, the factors responsible for the missed opportunity for immunization were failure to attend antenatal care and home delivery, concern about vaccine safety, long distance trekking/walking to health center, long waiting time, lack of money, lack of vaccine at the health center when visited and lack of information about day of immunization. It was recommended that health awareness campaign targeted at caretakers on the importance of immunization should be carried out regularly and government should encourage community participation in immunization programmes.

Funding and Implementation of National Programme on Immunization in Nigeria: Case Study of Bekwarra Local Government Area, Cross River State

This study investigated how funding has affected effective implementation of National Programme on Immunization (NPI) in Bekwarra Local Government of Cross River State, Nigeria from 2003-2016. To achieve this objective, a research hypothesis was formulated. A total of 200 Health workers were randomly selected using survey inferential research design from the population of 320 Health workers in the study area. A well validated Likert type scale instrument called Immunization Related Issues Questionnaire (IRIQ) consisting of 22 items with a reliability index of 0.84 was the instrument for data collection. Data collected from the respondents were subjected to the Chi-Suare statistics to test the hypothesis in the study. The result of the test was significant at 0.05 level and it was concluded that funding significantly influences effective implementation of immunization programme in Bekwarra Local Government Area. The study noted that adequate funds are not provided for effective implementation of National Programme on Immunization (NPI), and whenever funds are provided, it is often mismanaged. Also, it was revealed that non-governmental organization (NGOs) should assist in funding immunization programme by providing logistics and technical equipment for effective programme implementation. It was recommended among others that both the government and health donor agencies should provide adequate funds for effective implementation of immunization programmes. Also, there should be a proper monitoring mechanism for utilization of funds meant for Immunization programmes.

Improving access to interventions among mothers screened positive for post-partum depression (PPD) at National Programme on Immunization (NPI) clinics in south-western and south-eastern Nigeria - A service development report.

We investigate the possibility of improving access to interventions among mothers screened positive for post-partum depression (PPD) at National Programme on Immunization (NPI) clinics randomly selected from Lagos and Enugu States in south-western and south-eastern Nigeria respectively. The principle of human centred design was employed by engaging the mothers screened positive for PPD to be part of the decision making regarding their further assessment and intervention services. The study brought intervention services to primary healthcare centre at the NPI clinics. Improvement in willingness to seek interventions was observed among the mothers screened positive for PPD in this study when compared to our observation in a previous report, where mothers diagnosed with PPD were referred and requested to visit a mental health facility closer to their NPI clinics for further assessment and interventions (95.2% versus 33.7%). Interventional services for the mothers diagnosed with PPD also impact positively on the growth parameters of their infants on follow-up. Principle of human centred design improved access to intervention services among the mothers and infants studied. NPI clinics at primary healthcare level would provide appropriate forum for early screening of mothers for PPD and interventions in low-resource setting like Nigeria. There would be improvement in maternal and child health coverage if the Nigerian Government can adapt human centred design principles employed in this study nationwide.

The prevalence of hepatitis B virus infection in Nigerian children prior to vaccine introduction into the National Programme on Immunization schedule.

IntroductionHepatitis B virus infection is a major global health problem of public health importance. In a bid to control the infection, the Nigerian government in 2004 introduced hepatitis B vaccine into the National Program on Immunization. There are no studies on the prevalence of hepatitis B in adolescent prior to 2004. The study was aimed at determining the seroprevalence and predictors of viral Hepatitis B in Nigerian children aged 11-19 years.MethodsA cross sectional analytical study was conducted in July 2014. Multi-staged sampling technique was used to select 749 children from six secondary schools in Calabar, Cross River State, Nigeria. Ethical clearance was obtained from the Cross River State Medical Ethical Committee. A validated structured interviewer administered questionnaire was used to obtain information from participants following parental consent. Blood samples were obtained for qualitative detection of HBsAg using rapid chromatographic immunoassays with test kits from ABON (China) having sensitivity, specificity and accuracy of >99%, 97% and 98.5% respectively. Data was analyzed using SPSS version 20.2.ResultsNine of the749 students screened were positive for HBsAg giving an overall prevalence of 1.2%. The sex specific prevalence was 0.8% for males and 1.8% for females. After multivariate analysis, age was the predictor of hepatitis B infection (OR 3.92; 95% CI 1.22-12.63; p-value 0.02).ConclusionThe prevalence of HBV infection was low. Despite the low prevalence, the introduction of the vaccine is justifiable in view of the public health importance of the infection.

Current trends of immunization in Nigeria: prospect and challenges.

Immunization is aimed at the prevention of infectious diseases. In Nigeria, the National Programme on Immunization (NPI) suffers recurrent setbacks due to many factors including ethnicity and religious beliefs. Nigeria is made up of 36 states with its federal capital in Abuja. The country is divided into six geo-political zones; north central, north west, north east, south east, south west and south south. The population is unevenly distributed across the country. The average population density in 2006 was estimated at 150 people per square kilometres with Lagos, Anambra, Imo, Abia, and Akwa Ibom being the most densely populated states. Most of the densely populated states are found in the south east. Kano with an average density of 442 persons per square kilometre, is the most densely populated state in the northern part of the country. This study presents a review on the current immunization programme and the many challenges affecting its success in the eradication of childhood diseases in Nigeria.

Introducing depression and developmental screenings into the National Programme on Immunization (NPI) in southeast Nigeria: an experimental cross-sectional assessment

ObjectivesThis study investigates the possibility of introducing depression and developmental screening tools into the National Programme on Immunization (NPI) in southeast Nigeria. The specific objectives were to determine the prevalence of postpartum depression (PPD) among mothers attending immunization clinics and to assess the association of maternal PPD and infant growth in relation to World Health Organization (WHO) recommendations. MethodsFour hundred and eight (408) mothers completed the sociodemographic questionnaire and the self-report Edinburgh Postnatal Depression Scale (EPDS). The weights, lengths and head circumferences of their infants were recorded, while the WHO recommended equivalents at 50th percentiles were also recorded for each child. The mothers were then interviewed with the major depressive episode module of Mini International Neuropsychiatric Interview (M.I.N.I.) to make diagnosis of depression. ResultsAbout 24.8% and 15.2% of the mothers were found to be depressed using EPDS and major depressive episode module of M.I.N.I., respectively. It was found that maternal PPD is significantly associated with the growth parameters of weights and lengths of the infants studied but not their head circumference. ConclusionsNPI may provide appropriate forum for early screening of mothers for PPD and interventions in Nigeria. The NPI would also serve a useful avenue of screening for developmental concerns in Nigerian children.

Seroepidemiology of Rubella IgG among Unvaccinated Pregnant Women Attending Antenatal Clinics from Two Rural Communities in Plateau State, Nigeria

Background: Rubella is a mild illness with most cases goes undiagnosed because of its sub clinical nature. However, the disease poses serious threat such as congenital rubella defects, abortions, and still birth if a pregnant woman contracted the infection during her first trimester. Unfortunately lack of sufficient data on its prevalence and incidence with unavailability of rubella vaccines in our antenatal clinics is of great dangers to our sero-negative women with their unborn babies. Objective: To determine the sero-prevalence of rubella IgG within the two Nigerian communities. Methods: Two hundred and sixty seven (267) pregnant women attending antenatal clinics in Mangu and Pankshin General Hospital and Primary Health Care (PHC) Clinics were screened for Rubella IgG using ELISA Test kit (Globalemed, Alexandria VA USA) based on the manufacturer’s instructions. Questionnaires were also used to obtain other vital bio-data of patients and results analyzed using SPSS version, 13.0 statistical software package. Results: Out of all the samples screened, 247(92.51%) were seropositive for rubella IgG. Rubella IgG was detected in all age groups and occupational status considered and the results indicated a significant relation with the presence of the antibody (P 0.05).Conclusion: This work indicates that most of the women screened (92.51%) were already immune due to natural exposure to the virus. The remaining 7.49% needs to be protected from being infected with the virus especially during the first trimester of pregnancy which can result to congenital defects with fatal consequences. As such, there is need for more sero-surveys on rubella in the country to support the advocacy for the inclusion of rubella vaccination in the National Programme on Immunization (NPI).

Neonatal tetanus in Sagamu, Nigeria during the Expanded Programme on Immunization and the National Programme on Immunization eras: A comparative analysis.

Background: It is essential to continually study the pattern of occurrence of neonatal tetanus (NNT) for better control measures. Objective: To compare the prevalence rates and outcome of NNT in a Nigerian tertiary hospital over two periods characterized by different national immunization programmes the Expanded Programme on Immunization (EPI) and the National Programme on Immunization (NPI). Methods: The records of babies hospitalized with NNT between 1991 and 1996 (EPI period) and between 1997 and 2005 (NPI period) were studied. Results: The prevalence rates for the EPI and NPI periods were 6.4 percent and 2.9 percent respectively. Most of the mothers did not receive ante-natal care (81.4 percent for EPI and 75.6 percent for NPI), did not take anti-tetanus vaccines in pregnancy (87.7 percent for EPI and 88.4 percent for NPI) and delivered their babies outside the health facilities (86.6 percent for EPI and 83.3 percent for NPI). The Case Fatality Rate was 49.5 percent and 61.5 percent for the EPI and NPI periods respectively. Conclusion: The prevalence and mortality of NNT remains high in Nigeria despite a change in immunization programme.

Community Pharmacies As Possible Centres For Routine Immunization

Nigeria has embraced the primary healthcare movement and has committed its resources to the provision of cost effective community based primary healthcare strategy which recognizes the need for effective partnership between public and private sector. Immunizations are important part of this effort, especially the provision of the vaccines incorporated into the national Expanded Programme on Immunization (EPI) which has now metamorphosis to National Programme on Immunization (NPI) due to decline in immunization coverage. Community pharmacies can be involved in immunization to improve coverage as has been shown in the United States of America (U.S.A) that this led to great improvement in immunization coverage. The need to find out if this can also be adopted in Nigeria is the objective of this work. This study therefore aimed to have an insight into current interest of community pharmacists to be involved in routine immunization and assess their physical structures for possible adaptation for use in routine immunization. Sixty (60) pre-tested questionnaires were randomly administered to community pharmacists. Forty-three (43) questionnaires were retrieved for analysis. The study revealed that the use of community pharmacies as places where routine immunization services can be provided is feasible as shown by 95.3% interest expressed by community pharmacists. Most of the required infrastructures to carry out these services are on the ground as shown by availability of adequate space (88.4%), stand-by generator (83.7%) and functional fridge/ freezer (95.3%). Community pharmacists (88.4%) expect to be remunerated for providing this service. This study has shown the willingness of community pharmacists to participate in immunization efforts and the possibility of using pharmacies in routine immunization.

Short Communication: Age at BCG administration during routine immunization

In Nigeria, as part of the National Programme on Immunization (NPI), BCG should be given at birth. A survey of the ages at which mothers bring their children for BCG vaccination showed that only 22% of children receive their BCG within the first 3 days of life and 36.2% within the first 7 days of life. The place of birth and whether a child was sick enough at birth to require hospital admission appears to be an important factor affecting the age at BCG administration. Key Words: Age at administration; BCG Journal of Community Medicine & Primary Health Care Vol.16(1) 2004: 33-35

Comparative Analysis of Measles Morbidity and Mortality in Calabar during the Expanded Programme on Immunization and the National Programme on Immunization Eras

Background: In an apparent desire to improve the routine immunization coverage in the country, the Nigerian Government in 1997, launched the National Programme on Immunization (NPI) in place of the existing Expanded Programme on Immunization (EPI). Aim: The aim of the present retrospective study was to determine whether the desired goal was achieved, by comparing the hospital incidences, morbidities and mortalities from measles infection during the EPI (January 1992 to December 1996) and NPI (January 1997 to December 2001) eras. Subjects and Methods: The subjects were children admitted with measles infection to the University of Calabar Teaching Hospital, Calabar, during the period. Data were extracted from the relevant case files. Results: One hundred and twenty cases (representing 24 cases per year), and 36 cases (representing 7.2 cases per year) were admitted during the NPI and EPI eras, respectively (P

Promotional Model

The National Programme on Immunization (NPI), which was formerly known as the Expanded Program on Immunization (EPI), and Oral Rehydration Therapy (ORT) were relaunched in 1984 after the problems of vaccine supply had been corrected. The aim of the NPI was to protect children against six childhood killer diseases and ORT to rehydrate the dehydrated child caused by diarrhoea. In order to achieve these objectives, a Partner-in-Health strategy was set up to educate, convince and motivate mothers, pregnant women and the community to accept the programme. To assess the effect of the promotional strategy, the government decided to conduct a National Immunization Coverage survey. The results showed that some states were able to reach the target while some were not. The survey also reported that 32% of the reason for immunization failure was due to lack of information and that 9% was lack of motivation. It therefore became necessary to design a promotional model for effective and rapid implementation of the programme. After an evaluation of the promotional strategy set up by the government, a pilot survey was conducted from which nine promotional elements were selected. These promotional elements were regarded as sources of information and motivation. Based on these, a promotional model was set up which stated that promotion depends on consumer information which in turn depends on the extent of interaction between the consumer and the promotional elements. The implication of the model is the need for the formation of a Public Health Organisation with a Public Health Committee at all levels of government.

An Assessment of the Effect of Promotional Strategy for National Programme on Immunization (NPI ) and Oral Rehydration Therapy(ORT) in Nigeria

The National Programme on Immunization (NPI) and Oral Rehydration Therapy (ORT) was launched in 1978 in Nigeria. NPI aimed to immunize 80% of all children age 0-24 months before 1990 and to vaccinate 80% of all pregnant women against tetanus, while ORT aimed to teach at least 50% of parents with children age 0-5 years to prevent death from diarrhoea. In 1990 a national survey was conducted, which revealed varied achievement levels of NPI and ORT by state. To assess the effect of the promotional strategy, after a pilot survey and a thorough evaluation of the promotional strategy two areas from state capital in addition to two local government areas were selected for a statistical study. The study revealed that most people in Nigeria were found to be aware of the NPI/ORT programmes and some were even convinced of the value of the programme, yet were not ready to voluntarily participate in them. Health workers should be more intensively and extensively used to promote and sustain the programme, while the Government should intensify mass literacy campaign.

Motivating consumers for National Programme on Immunization (NPI) and Oral Rehydration Therapy (ORT) in Nigeria.

The Expanded Programme on Immunization (EPI) (changed to National Programme on Immunization (NPI) in 1996) and Oral Rehydration Therapy (ORT) were launched in Nigeria in 1979. The goal of EPI was Universal Childhood Immunization (UCI) 1990, that is, to vaccinate 80% of all children age 0-2 years by 1990, and 80% of all pregnant women were also expected to be vaccinated with Tetanus Toxoid Vaccine. The Oral Rehydration Therapy was designed to teach parents with children age 0-5 years how to prepare and use a salt-sugar solution to rehydrate children dehydrated by diarrhoea. Nigeria set up Partners-in-Health to mobilize and motivate mothers to accept the programme. In 1990 a National coverage survey was conducted to assess the level of attainment. The results show that some states were able to reach the target and some were not. It therefore became necessary to evaluate the contribution of those promotional elements adopted by Partners-in-Health to motivate mothers to accept the programme. The respondents were therefore asked to state the degree to which these elements motivated them to accept the programme. The data were collected and processed through a Likert rating scale and t-test procedure for test of significance between two sample means. The study revealed that some elements motivated mothers very strongly, others strongly, and most moderately or low, with health workers as major sources of motivation. The study also revealed that health workers alone can not sufficiently motivate mothers without the help of religious leaders, traditional leaders and mass media, etc. It was therefore recommended that health workers should be intensively used along with other promotional elements to promote the NPI/ORT programme in Nigeria.