Determinants of vaccination coverage in rural Nigeria

Department of Community Health & Primary Health Care, Lagos State University College of Medicine, P,M,B, 21216, Ikeja, Lagos State, Nigeria.
BMC Public Health (Impact Factor: 2.32). 12/2008; 8:381. DOI: 10.1186/1471-2458-8-381
Source: PubMed

ABSTRACT Childhood immunization is a cost effective public health strategy. Expanded Programme on Immunisation (EPI) services have been provided in a rural Nigerian community (Sabongidda-Ora, Edo State) at no cost to the community since 1998 through a privately financed vaccination project (private public partnership). The objective of this survey was to assess vaccination coverage and its determinants in this rural community in Nigeria
A cross-sectional survey was conducted in September 2006, which included the use of interviewer-administered questionnaire to assess knowledge of mothers of children aged 12-23 months and vaccination coverage. Survey participants were selected following the World Health Organization's (WHO) immunization coverage cluster survey design. Vaccination coverage was assessed by vaccination card and maternal history. A child was said to be fully immunized if he or she had received all of the following vaccines: a dose of Bacille Calmette Guerin (BCG), three doses of oral polio (OPV), three doses of diphtheria, pertussis and tetanus (DPT), three doses of hepatitis B (HB) and one dose of measles by the time he or she was enrolled in the survey, i.e. between the ages of 12-23 months. Knowledge of the mothers was graded as satisfactory if mothers had at least a score of 3 out of a maximum of 5 points. Logistic regression was performed to identify determinants of full immunization status.
Three hundred and thirty-nine mothers and 339 children (each mother had one eligible child) were included in the survey. Most of the mothers (99.1%) had very positive attitudes to immunization and > 55% were generally knowledgeable about symptoms of vaccine preventable diseases except for difficulty in breathing (as symptom of diphtheria). Two hundred and ninety-five mothers (87.0%) had a satisfactory level of knowledge. Vaccination coverage against all the seven childhood vaccine preventable diseases was 61.9% although it was significantly higher (p = 0.002) amongst those who had a vaccination card (131/188, 69.7%) than in those assessed by maternal history (79/151, 52.3%). Multiple logistic regression showed that mothers' knowledge of immunization (p = 0.006) and vaccination at a privately funded health facility (p < 0.001) were significantly correlated with the rate of full immunization.
Eight years after initiation of this privately financed vaccination project (private-public partnership), vaccination coverage in this rural community is at a level that provides high protection (81%) against DPT/OPV. Completeness of vaccination was significantly correlated with knowledge of mothers on immunization and adequate attention should be given to this if high coverage levels are to be sustained.

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    ABSTRACT: Introduction En 2011 le district de santé de Djoungolo a connu deux épidémies de rougeole avec un taux de complétude vaccinale de 69% selon les données du district. L'objectif de cette étude était de déterminer la couverture vaccinale et les facteurs associés à la non complétude vaccinale des enfants de 12 à 23 mois du district de Djoungolo en 2012. Méthodes Une étude transversale à base communautaire a été menée en 2012. Au total 210 mères / nourrices d'enfants de 12 à 23 mois du district de Djoungolo, sélectionnées selon la méthode OMS de sondage en grappe 30 X 7, ont été interrogées sur les vaccins reçus par l'enfant avant l’âge d'un an et les raisons de non vaccination à l'aide d'un questionnaire structuré. Une analyse de régression logistique multivariée de type backward a été faite pour les variables ayant obtenu une valeur p < 0,2 à l'analyse univariée en utilisant le logiciel EPI Info version 3.5.3. Une association était significative lorsque p < 0,05. Résultats La complétude vaccinale était de 64,3%, variant de 85,7% pour le BCG à 66,2% pour le Vaccin anti rougeoleux. La régression logistique multivariée a montré que les mères qui avaient peur des effets secondaires (P=0,0454), qui ne connaissaient pas l'importance de la vaccination (P=0,0139), qui avaient connu des occasions manquées de vaccination (P=0,0055), qui mettaient plus d'une heure pour vacciner leur enfant (P=0,0005) et qui ne maitrisaient pas le calendrier de vaccination (P=0,00001) étaient significativement associées à la non complétude vaccinale des enfants. Conclusion La couverture vaccinale du district est en deçà des objectifs. Pour l'améliorer nous recommandons le renforcement de l’éducation des parents et une réorganisation des services de vaccination.
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