Constraints of primary health care workers in the implementation of immunization in Enugu state

At the end of 2011, Nigeria was estimated to have a population of 167 million . The Expanded Programme on Immunization (EPI), introduced in 1978 with the aim of providing routine immunization to children less than the age of two years, recorded initial but intermittent successes. The optimum level was recorded by the early 1990s with the country achieving a universal childhood immunization coverage of 81.5%. But since that period of success, Nigeria has witnessed gradual but consistent reduction in immunization coverage. By 1996, the national data showed less than 30% coverage for all antigens, and this decreased to 12.9% 2003 . This figure which is consistent with the 2003 national immunization coverage survey figures is among the lowest in the world and explains the poor health status of children in the country. It is the worst in the west African subregion, only better than Sierra Leone. For instance, the polio epidemic in Nigeria is the worst in the African region and constitutes threat to other nations [3].

The vision of EPI in Nigeria is to improve the health of Nigerian children by eradicating all the six killer diseases, which are polio, measles, diphtheria, whooping cough, tuberculosis, and yellow fever. Between 1985 and 1990, as outlined in the national health plan for that period, the objectives of EPI were to strengthen immunization, accelerate disease control and introduce new vaccines, relevant technologies and tools. In1995 in line with the above, Nigeria became a signatory to the World Health Assembly, adopted the World Health Assembly Resolution (WHAR) and United Nations General Assembly Special Session (UNGASS) goals for all countries to achieve by 2005 (i) polio eradication, (ii) measles mortality reduction and (iii) maternal and neonatal tetanus elimination (MNTE). Nigeria also adopted the millennium development goals (MDGs) calling for a two-third reduction in child mortality, as compared to 1990, the year 2005. In addition to the above, the country ratified the United Nations General Assembly Special Session (UNGASS) goals urging Nigeria to achieve by 2010 (i) ensure full immunization of children under one year of age at 90% coverage nationally with at least 80% coverage in every district or equivalent administrative unit, and (ii) vitamin A deficiency elimination. In 1998 following from the above, Nigeria laid out the core activities of EPI policies which included the following: (i) monitoring of the performance, quality and safety of the immunization system through indicators; (ii) assessment of the current burden of vaccine-preventable diseases as well as the “future” burden of vaccine preventable diseases in terms of sickness, death and disability, as well as the economic burden; (iii) assessment of the impact of vaccination strategies, through on-going epidemiological surveillance and reliable laboratory confirmation, as well as impact assessments in Nigeria; (iv) monitoring of the national immunization policies, particularly the vaccines used in the country and the target population for these vaccines (immunization schedules); and (v) monitoring of the overall proportion of children and women who are vaccinated (immunization coverage) and ensuring that all districts of the country are well covered with vaccination. In 2000, following the African Regional Summit on EPI held in Harare in November 1999, the Federal Ministry of Health specifically stated its policies on the country’s initial visions for EPI as follows:
(i) Immunization System Strengthening: By the year 2004, Nigeria should achieve the EPI district-focused plan and attain 80% DPT3 coverage in all the states of the federation. The specific policy also stated that the government should ensure increased funding for EPI.
(ii) Accelerated Disease Control: By the year 2004, there should be no cases of acute flaccid paralysis associated with wild poliovirus in Nigeria. As for measles, by the year 2004 the country should have reduced measles morbidity by 90% and measles mortality by 95%; while the coverage for yellow fever is expected to increase to at least 80%.
(iii) Innovations: By the year 2004, Nigeria should include vitamin A and hepatitis B (HB) in its national immunization programmes; and the vaccination coverage should not be less than 80% as with other antigens. Under the new technology drive, the country should adopt the multi-dose vial policy (MDVP) and vaccine vial monitor (VVM) and also introduce new methods for monitoring its use.

Immunization against childhood diseases such as diphtheria, pertussis, tetanus, polio and measles is one of the most important means of preventing childhood morbidity and mortality. Achieving and maintaining high levels of immunization coverage must therefore be a priority for all health systems. In order to monitor progress in achieving this objective, immunization coverage data can serve as an indicator of a health system’s capacity to deliver essential services to the most vulnerable segment of a population .

N4500

Download Full Material-N5000

Factors Affecting Completion of Childhood Immunization in North West Nigeria pdf & doc free download

Abstract

North West Nigeria has the lowest vaccination rate of the geopolitical regions of the country. The purpose of this cross-sectional study was to examine associations between the parents’/caregivers’ biological, cultural, and socioeconomic factors and the completion or noncompletion of routine immunization schedules. Andersen’s behavioral model provided the framework for the study. Data were obtained from the 2013 National Demographic Health Survey. Descriptive statistics were calculated for all variables. Chi- square tests were used for categorical predictor variables, simple logistic regression models were used for the age variable, and multiple linear regression models were used for the biological, cultural, and socioeconomic variables to assess the relative importance of factors within each category. Findings indicated a statistically significant association between 4 factors (education, wealth index, religious affiliation, and cost of health care) and completion of immunization schedules. Findings may be used to improve the likelihood of immunization of children in North West Nigeria and reduce the levels of childhood morbidity and mortality. Policy makers and immunization programmers can strengthen social services such as women’s education, income generation, especially in the agricultural sector and other culturally sensitive interventions with community collaboration to bring the required social change

Download Full Material-N5000

Factors influencing poor hygiene among secondary School students in Nigeria

CHAPTER ONE/INTRODUCTION

According to Ministry of Public Health and Sanitation and the Ministry of Education (2009), hygiene is the practice of keeping oneself and ones surroundings clean so as to prevent illness or the spread of preventable diseases. The practice may include hand washing with soap, proper use of sanitation facilities, proper disposal human waste and menstrual hygiene management.

Since its inception in 2008, The Global Hand Washing Day has been reinforcing the call for improved hygiene practices worldwide (UNICEF and WHO, 2008). Its key vision is the implementation of a local and global culture of hand washing with soap as a major strategy in reducing diarrhea infections by 30-50% (Cairncross and Valdmanis, 2006). However, studies have shown that globally, the rate at which hands are washed with soap ranges from 0-34% (Parker, 1993).This is a very insignificant number compared to the total world population.

According to Crofts and Fisher (2011), menstrual hygiene management has been an issue for almost half of the world’s adolescent girls. It has been a cause of shame, stigma, and school absenteeism and contributes greatly to reproductive tract infections. Addressing these hygiene practices particularly in public schools can bring the much needed international attention to focus on these neglected issues. Schools, particularly those in rural areas often have inadequate water, toilets, hand washing soap and hand washing facilities making it difficult for some students to practice proper hygiene. Boys and girls are likely to be affected in different ways by this inadequacy and this may contribute to unequal learning opportunities. Sometimes girls fail to practice proper hygiene as was observed by Parker (1993) in a study carried out in  Libode district in Zimbabwe where some girls reported dropping used sanitary towels in the pit latrines or throwing them in the nearby bushes since their sanitary towel disposal bins were always full and dirty. A study carried by Parker (1993) in West Bengal showed that girls missed school during menstruation since they could not use the sanitary towel disposal bins which were dirty and smelly. These practices interfere with the achievement of one of the Millennium Development Goals on ensuring environmental sustainability since this disposal of used sanitary towels is not ecologically friendly. Another Millennium Development Goal on the promotion of gender equality will also not be achieved since girls, unlike boys, miss school during menstruation period.

In most public schools, latrine to student ratio is a core concern with hundreds of students sharing a single toilet thus affording inadequate privacy especially for the girls. This is in contrast to recommendation by The Ministry of Public Health and Sanitation and Ministry of Education (2009) which recommend a ratio of 1 toilet for every 25 girls and 1 toilet for every 30 boys in order for the sanitation facilities to provide adequate privacy to all students. A study conducted in Machakos showed that an average of 64 students was sharing one toilet (WHO, 2009). Another study carried out by Curtis and Cairncross (2003) showed that in most public schools, toilets were divided into cubicles with no doors and had an open roof. Most of the toilets were dirty with feces on the walls and urine on the floor. Such conditions do not favor proper hygiene practices. There is therefore need to build separate gender-appropriate toilets that provide privacy, adequate hand washing water, soap and disposal facilities for the entire school community. In addition, proper hygiene practices should be instigated in public schools since sanitary conditions and basic personal hygiene practices such as hand washing using soap, proper

disposal of used sanitary towels and proper use of toilets are still not widely practiced among students. Schools should provide an enabling environment where the students can learn these practices and implement them both in school and even at home.

 Objectives of the Study

The study was guided by the following objectives

1. To establish whether availability of safe water influences implementation of hygiene practices in public secondary schools in Ebonyi state
2. To establish whether availability of soap influences implementation of hygiene practices in public secondary schools in Ebonyi state
3. To establish the relationship between availability of toilets and the implementation of hygiene practices in public secondary schools in Ebonyi state
4. To investigate the relationship between availability of sanitary towel disposal bins and implementation of hygiene practices in public secondary schools in Ebonyi state

Research Questions

The study addressed the following research questions

1. To what extent does the availability of water influence implementation of hygiene practices in public secondary schools in Ebonyi state?
2. To what extent does the availability soap influence implementation of hygiene practices in public secondary schools in Ebonyi state?
3. To what extent does the availability of toilets influence implementation of hygiene practices in public secondary schools in Ebonyi state?
4. To what extent does the availability of sanitary towel disposal bins influence implementation of hygiene practices in public secondary schools in Ebonyi state?

Hypotheses

1. There is no significant relationship between availability of water and implementation of hygiene practices in secondary schools in Ebonyi state
2. There is no significant relationship between availability of soap and implementation of hygiene practices in secondary schools in Ebonyi state
3. There is no significant relationship between availability of toilets and implementation of hygiene practices in secondary schools in Ebonyi state
4. There is no significant relationship between availability of sanitary disposal bins and implementation of hygiene practices in secondary schools in Ebonyi state

   Scope of the Study

The research study confined itself to the factors influencing implementation of hygiene practices in public secondary schools in Ebonyi state namely availability of soap, safe water, toilets and sanitary towel disposal bins. The study may not have been generalized to cover tertiary institutions and universities since factors influencing implementation of hygiene practices in these institutions may be significantly different.

Data was collected from form two and three students only but not from form one and four students. This is because the form two and three students had stayed in the school long enough and had familiarized themselves with the school environment and therefore knew where most of sanitation facilities were unlike the form one students who were still be in the process of being oriented in the school. The form four students were revising for their mock examination and therefore seemed too busy to fill the questionnaires.

There are moderating variables that may influence implementation of hygiene practices. These include students’ attitudes, background, beliefs, knowledge and perception towards hygiene but due to limited time and other resources, this study did not collect data on them.

  Significance

The findings of this study may be of help to several groups of people: Firstly, it may provide the curriculum planners and developers and all the stakeholders in the education sector with a better understanding of factors influencing implementation of hygiene practices in schools. The curriculum planners may then use the study findings to develop appropriate national standards of toilets and other hygiene facilities that are relevant to secondary schools in Kenya.

Secondly, the ministry of education may use the study findings to develop a school program with guidelines for hygiene practices. These guidelines may be approved by the ministry and send to teacher training colleges where they may be used to prepare teachers and help them develop

 

curricular materials related to hygiene. The trained teachers may then use the materials and the guidelines to incorporate the theme into their subjects and encourage students to practice the knowledge gained both in school and at home.

Thirdly, the community health workers may use the research findings to educate the general public on good hygiene practices and factors that influence their implementation. They may as well use the findings to persuade individuals, families and social groups to adopt new, healthier and better hygiene practices.

Fourthly, the research findings may also provide a foundation for policy makers and project managers to make rational decisions on improving adolescent reproductive health both in school and in the communities.

Finally, heads of learning institutions and the teaching and non-teaching staff may use the research findings to re-assess hygiene facilities in their institutions and perhaps apply recommendations made by the researcher to better these facilities and also emphasize on improving hygiene practices in their own schools.

Download Full Material-N5000