DETERMINANTS OF ROUTINE IMMUNIZATION UPTAKE AMONG CHILDREN AGED 12- 23 MONTHS IN INTERNALLY DISPLACED PERSONS SETTLEMENTS OF BAUCHI STATE NORTH EAST NIGERIA

ABSTRACT

Routine Immunization has been a cost-effective public health intervention that significantly reduced morbidities and mortalities associated with VPDs in children. Despite the remarkable improvement in its global coverage, Nigeria is far below the WHO recommendation of 90% which might have contributed significantly to the recent Measles, Pertussis and polio epidemics within the country especially in the North eastern region where insurgency have resulted in the internal displacement of over a million people. There is paucity of studies conducted in the region to ascertain the R.I uptake among the internally displaced persons (IDPs). This study therefore, aimed at determining the factors affecting R.I uptake among children aged 12-23 months in IDPs of Bauchi, one of the north eastern states affected by insurgency with only 14% of full R.I coverage. It was cross-sectional descriptive survey that involved mixed method of data collection conducted sequentially, the quantitative component involved administration of validated questionnaire to 391 participants and for the qualitative component, data was collected by using focus group discussions. Most of the respondents (63.7%) had good R.I knowledge however with poor vaccine preventable diseases knowledge, this finding conforms to the FGDs result. The uptake of various antigens were found to be; 78.0%, 63.7%, 53.5%, 44.2%, and 32.2% for BCG, PENTA1, PENTA2, PENTA3 and Measles, respectively. Only 29.9% of the children were fully immunized and up to 22.0% were not immunized. The statistically significant positive predictors of childhood full immunization status were; Living in urban settlement, ANC attendance more than three times, maternal income above poverty line, distance less than 5km to immunization centres, good R.I knowledge, child delivery in health facility and  immunization card availability. In conclusion, the R.I uptake was low and more strategies like community outreaches, mobile vaccine posts and health education should be employed to scale up the coverage. 

TABLE OF CONTENTS

Declaration----------------------------------------------------------------------------------------------i

Certification---------------------------------------------------------------------------------------------ii

Approval-------------------------------------------------------------------------------------------------iii

Acknowledgements-------------------------------------------------------------------------------------iv

Table of Contents---------------------------------------------------------------------------------------v

List of Tables--------------------------------------------------------------------------------------------viii

List of Figures-------------------------------------------------------------------------------------------ix

Abbreviations-------------------------------------------------------------------------------------------x

Abstract--------------------------------------------------------------------------------------------------xii

Chapter One1.0 Introduction----------------------------------------------------------------------------------------1

1.1 Background-----------------------------------------------------------------------------------------1

1.2 Statement of the Problem-------------------------------------------------------------------------5

1.3 Justification for the Study------------------------------------------------------------------------6

1.4 Research Questions -------------------------------------------------------------------------------8

1.5.0 Aim and Objectives of the Study--------------------------------------------------------------8

1.5.1 Aim------------------------------------------------------------------------------------------------8

1.5.2 Specific Objectives------------------------------------------------------------------------------8

Chapter Two2.0 LiteratureReview---------------------------------------------------------------------------------9

2.1 Literature Search Strategy------------------------------------------------------------------------9 

2.2 Burden of Internally Displace Persons---------------------------------------------------------9

2.3 Causes, Compositions and Effects of Internal Displacement--------------------------------13

2.4 Childhood Vaccine Preventable Diseases and Vulnerability in IDPs-----------------------16

2.5 Routine Immunization-----------------------------------------------------------------------------22

2.6 Maternal Knowledge of Routine Immunization-----------------------------------------------26

2.7 Routine Immunization Uptake Rate in IDPs---------------------------------------------------29

2.8 Routine Immunization Completion Rate among IDPs---------------------------------------33

2.9 Factors Affecting Utilization of R.I Services in IDPs----------------------------------------37

2. 9.1 General Factors---------------------------------------------------------------------------------37

2. 9.2 Maternal/ Care Givers Related Factors-----------------------------------------------------43

2.9.3 Child Related Factors--------------------------------------------------------------------------46

2.9.4 Conceptual Frame Work-----------------------------------------------------------------------47

Chapter Three3.0 Methodology---------------------------------------------------------------------------------------50

3.1 Study Area------------------------------------------------------------------------------------------50

3.2 Study Design---------------------------------------------------------------------------------------51

3.3 Study Population----------------------------------------------------------------------------------52

3.3.1 Inclusion Criteria--------------------------------------------------------------------------------52

3.3.2 Exclusion Criteria-------------------------------------------------------------------------------52

3.4 Sample Size Determination----------------------------------------------------------------------52

3.5.0 Sampling Technique----------------------------------------------------------------------------54

3.6.1 Instrument of Data Collection-----------------------------------------------------------------55

3.6.2 Data Collection and Storage-------------------------------------------------------------------56

3.7 Data Analysis--------------------------------------------------------------------------------------57

3.8 Ethical Consideration-----------------------------------------------------------------------------58

3.9 Limitations of the Study--------------------------------------------------------------------------59

Chapter Four4.0 Results-----------------------------------------------------------------------------------------------60

4.1 Socio-demographic Characteristics of the Respondents--------------------------------------60

4.2 Maternal Knowledge of R.I among IDPs Settlements of Bauchi State---------------------65

4.3 Routine Immunization Uptake Rate among IDPs of Bauchi --------------------------------68

4.4 Routine Immunization Completion Rate in IDPs of Bauchi---------------------------------69

4.5 Factors Affecting the Utilization of R.I Services among IDPs of Bauchi. ----------------70

4.5.1 Barriers to Childhood Full Immunization Status in IDPsof Bauchi----------------------70

4.5.2 Determinant of R.I Status of Children in Bauchi--------------------------------------------70

4.6 Findings of Qualitative Component-------------------------------------------------------------76

Chapter Five

5.0 Discussion-------------------------------------------------------------------------------------------95

Chapter Six6.1Conclusion------------------------------------------------------------------------------------------108

6.2 Recommendations------------------------------------------------------------------------------- 108

References----------------------------------------------------------------------------------------------110

Appendices---------------------------------------------------------------------------------------------117

Ethical Clearance--------------------------------------------------------------------------------------13