ASSESSMENT OF POLIOMYELITIS IMMUNIZATION IN KADUNA

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ASSESSMENT OF POLIOMYELITIS IMMUNIZATION IN KADUNA STATE

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ABSTRACT

Poliomyelitis immunization is a public health measure which prevents the death of children under 5years of age. Despite the benefits of this immunization, it has been reported that there is still resistance to polio immunization. It is based on this, that this study was undertaken to assess the level of acceptance of polio immunization in Kaduna State being one of the endemic States in Nigeria, This study was premised on Symbolic Interactionism and Conspiracy Theory. Survey and in-depth interviews were the techniques used for data collection. Four hundred respondents were selected and the collected data were analysed using statistical package for the social sciences (SPSS) version 16.0. The findings revealed that acceptance is generally high in the study area and is greatly influenced by many factors such as religion, income, educational attainment of the respondents, birth position of the children, gift as motivating factor, as well as the role of religious, community and health workers. The non-acceptance was found to be more common among the Muslims of low income status. This study recommends that detailed sensitization programme through various media facilities should be carried out periodically to emphasize the reasons for the importance of paying more attention to polio immunization.

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	TABLE OF CONTENTS
*Contents*		*Page*
Title Page		i
Declaration		ii
Certification		iii
Dedication		iv
Acknowledgements		v
Abstract		vii
Table of Contents		viii -x
List of Figures		xi
List of Tables		xii
List of Appendices		xiii
Acronyms		xiv
CHAPTER ONE: INTRODUCTION
1.1	Background of the Study	1
1.2	Statement of the Research Problem	5
1.3	Research Questions	7
1.4	Aim and Objectives of the Study	7
1.5	Significance of the Study	7
1.6	Scope of the Study	8
1.7	Definition of Terms	9
CHAPTER TWO: REVIEW OF RELATED LITERATURE
	AND THEORETICAL FRAMEWORK
2.1	Introduction	10
2.2	An Overview of Polio Immunization	10
2.3	Acceptability of Immunization	12
2.4	Factors Influencing Acceptability and Non Acceptability of Polio
	Immunization	17
2.4.1	Education	18
2.4.2	Maternal Age	19

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2.4.3	Occupation of Parents	19
2.4.4	Sex of Child	19
2.5	Socio economic attributes of Parents of children affected by Polio	22
2.6	Theoretical Framework	23
2.6.1	Symbolic Interactionism	23
2.6.2.	Conspiracy Theory	26
CHAPTER THREE: RESEARCH METHODOLOGY
3.1	Location of the Study	29
3.2	Types and Sources of Data	30
3.3	Study population	31
3.4	Sampling Techniques	31
3.5	Methods of Data Collection	34
3.6	Location of Study/Questionnaires Distribution	36
3.7	Data Analysis	37
3.8	Ethical Considerations	37
3.9	Research Variables	37
3.10	Limitation of the Study	38

CHAPTER FOUR: ANALYSIS AND INTERPRETATION OF DATA

4.0	Introduction	39
4.1	Socio-Demographic Characteristics of Respondents	39
4.2	Level of Acceptance of Polio Immunization	44
4.2.1:	Awareness of polio immunization	46
4.3	Factors associated with acceptance and non-acceptance
	of polio immunization	51

4.3.1: Respondents‟ reasons for not taking polio immunization for
their children.	52
4.3.2: Preference for mobile vaccination to Hospital / clinic	58
4.3.3: Gift as a factor for acceptance of polio immunization	60
4.3.4: Manpower as a social factor for polio immunization	62
4.3.5: Funding of polio immunization as a factor	63
4.3.6: The Role of Health workers, Political leaders, Community
and Religious Leaders in Polio immunization	64
4.4: Socio–Economic Status of Parents of Children with Poliomyelitis	67

CHAPTER FIVE:		SUMMARY AND DISCUSSION OF
	FINDINGS, CONCLUSION AND RECOMMENDATIONS
5.0	Introduction		70
5.1	Summary of the Major Findings		70
5.2	Discussion of Findings		72
5.3	Conclusions		76
5.4	Recommendations		76
5.5	Suggestions for further studies		77
References			78
Appendices			84

	LIST OF FIGURES
Fig. 4.1.1:	Monthly Income of Respondents	43
Fig. 4.1.2:	Wards of respondents and acceptance level	45
Fig. 4.3.2:	Distance from Residence to Immunization Center	59

LIST OF TABLES
Table 3.3.1: Zaria local government population and household distribution	32
Table 3.3.2: Kachia Local Government Population and Household Distribution	32
Table 3.6.1: Location of Study and Questionnaires Distribution	36
Table 4.1.1: Some Socio-demographic Characteristics of Respondents	40
Table 4.1.2: Employment status, monthly income and religion	42
Table 4.1.3: Number of children between 10 years and below	44
Table 4.2.1: Distribution of location of respondents by acceptance of
polio immunization	44
Table 4.3.1: Acceptance level by religious affiliations of respondents	51
Table 4.3.2: Acceptance level by income of respondents	53
Table 4.3.3: Acceptance by highest educational level of respondents	55
Table 4.3.4: Acceptance level by gender of the children	56
Table 4.3.5: Acceptance by position of the children and gender	57

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		ACRONYMS
AIDS	–	Acquired Immune Deficiency Syndrome
DPT	–	Diphtheria Pertussis Tetanus
FMOH	–	Federal Ministry Of Health
HIV	–	Human Immune deficiency Virus
UNICEF	–	United Nations Children‟s Educational Fund
WHO	–	World Health Organization

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CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Poliomyelitis, is an infectious disease caused by poliovirus, a member of the genus Enterovirus. There are three serotypes of poliovirus: that is, 1, 2 and 3, these three serotypes are mainly different in their virulence. The serotype 1 is the most virulent of the three types, while serotype 2 and 3 are more sporadic (National Primary Health Care Development Agency, 2015). Human cells contain specific protein receptors to which poliovirus may attach and thereby enter susceptible cells. The virus infects cells of the oropharynx, the tonsils, the lymph nodes of the neck, and the small intestines. Infection progresses through cycles of virus replication, resulting in destruction of the infected cells. Once infection is established, poliovirus can enter the bloodstream and invade the central nervous system through the blood/brain barrier, by spreading along nerve fibers, or by both routes (WHO, 1999). When non-immune persons are exposed to wild poliovirus (Wild Polio Virus is caused naturally and not caused by vaccine containing live virus) the results may include inapparent infection without symptoms, mild illness, aseptic meningitis, or paralytic poliomyelitis

The Poliovirus can be spread to others by droplets from the upper respiratory tract during the early days of infection. More commonly, infected persons pass large numbers of virus particles through their faeces, from where they may be spread indirectly, or directly to infect others .

Poliomyelitis is a serious public health problem. It has persisted in a few countries from where it has spread to a large number of countries and posed threat to health as it did earlier between the 1950‟s and 1980‟s. In the developing world, the disease presents a constant threat to underfives, resulting paralysis with devastating

consequences for social and economic development (Lucas and Gilles, 1990). Poliomyelitis is a highly infectious disease caused by a virus that mainly affects children under the age of 5 years. The disease is transmitted through fecal oral route to invade the nervous system and cause death or total paralysis in a matter of hours for those who survive (WHO, 2003). According to Debras, Stephanie, Penny and Mia (2005), Poliomyelitis is known to be one of the major causes of physical disability worldwide, hence the need for its eradication. Viewed globally, vaccines are the most cost-effective medical intervention to prevent death occurences and disease related to poliomyelitis (World Bank, 1990). Therefore, immunization is the gateway to health care for all children who are at the risk of this disease. The disease is of great public health concern worldwide especially among young children under 5 years of age.

The set date by WHO for polio eradication globally was the year 2000. However, this target was not achieved as about 3,500 cases of Wild Poliovirus were reported worldwide in 2001 with Nigeria contributing 27 cases (WHO Nigeria, 2001). Wild poliovirus is only endemic in six countries – Nigeria, India, Pakistan, Niger, Afghanistan and Egypt. Five States within Nigeria, India and Pakistan account for more than 75 percent of all new cases of polio worldwide and thus constitute the targets for the global eradication of the disease. The world‟s few remaining reservoirs of the poliovirus continue to pose significant risks due to the migration-imported polio virus, which can spread rapidly and threaten unprotected children (WHO, 2004).

It is in response to this threat of rapid spread that the WHO in 1974 set up a special programme known as the Expanded Programme on Immunization (EPI) which was adopted in Nigeria as Federal Ministry of Health policy code named National Programme on Immunization (NPI) on 1^stSeptember, 1985. Its major objective was to immunize all the children and particularly those under one year old against the six killer

diseases which the WHO, United Nations Children‟s Fund (UNICEF) and various government and non-governmental organizations have committed themselves to participate in the NPI exercise The Expanded Program on Immunizations was created in 1979 and achieved over 60% coverage with all vaccines by 1990; however, in 2006 the National Coverage had declined to 35% for the third dose of Diphtheria, Pertussis, and Polio. Polio Eradication activities began in 1998 and continued to progress until 2003 when resistance in the north to Polio Eradication began and supplemental immunization days were suspended in some northern States. Polio activities resumed in 2005 and in 2008 a new strategy of Immunization Plus Days (IPDs) was introduced

as well as the use of Monovalent Oral Polio Vaccine (USAID, 2008). . The vaccination programme is a typical example of a public health measure. It has many qualities and it is an essential measure which may prevent the death of large number of children. It improves the quality of lives of many children by avoiding the physical disabilities produced by this disease (FMOH, 1988).

Overall, worldwide, immunization coverage in the developed world has improved considerably during these past decade. WHO reported that immunization coverage maintained over 90% immunization coverage in 2006 (WHO, 2008) and millions of deaths were avoided as a result of immunization during this period Despite these advances, diseases that are preventable through immunization remain major public health problem in many developing countries. By the end of the twentieth century, researchers established that, in the developing world, more than 3 million children still died annually from measles, neonatal tetanus and pertussis, while more than a quarter of a million children were crippled by poliomyelitis annually (Henderson,1999).

Efforts to eradicate poliomyelitis have been going on. Success has been achieved in

Latin American and the Carribean countries, but Nigeria lags behind in achieving this success. Nigeria had the highest number of polio cases globally (99 cases in January 2004). A significant number of cases were found to be predominantly in the northern states (Niger, Bauchi, Kano, Zamfara and Kaduna (WHO, 2004). Speculations made by people are that this may be due to either religious, economic or other social reasons like the belief that to have the disease is better than immunization among the people (FBA, 2005). The country had witnessed a 95% decline in the number of polio cases in 2010 and was so close to the finishing line for polio eradication. However, as at July 11, 2012, Nigeria has recorded 54 new cases of wild poliovirus in 10 states compared to 25 cases during the same period in 2011. In 2012, the country declared polio

eradication a national emergency (UNICEF, 2012). It is therefore imperative for a social scientist to investigate why poliomyelitis persists among communities in Northern Nigeria. There could be many reasons for this persistence such as lack of knowledge, allegations of secret agenda in immunization, parents‟ misconception that immunizations are fuelled by western countries‟ determined to impose population control on local Muslim communities, and mothers‟ preoccupations with other tasks to take their children for immunization (Gedlu and Tesemma 1997; Hennessey, 2000; and FBA, 2005).

According to Obadare, 2005 in Nigeria, just as the campaign by WHO to “kick polio out of Africa” was at its zenith, the Supreme Council for Islamic Affairs (SCIA), the umbrella body of Nigerian Muslims claimed in 2003, to have learnt from some internet websites, that the oral polio vaccine had been deliberately contaminated with carcinogenic, anti fertility and HIV/AIDS inducing pathogens.. Consequently, Polio Eradication Initiative (PEI) was faced with community-led opposition in several northern Nigerian states to the free Oral Polio Virus (OPV) vaccine being administered

by public health workers. Political and religious leaders began disseminating the information that the polio vaccine was adulterated / contaminated with anti-fertility agents (estradiol hormone), HIV and cancerous agents. These leaders urged the Muslim parents in the Northern states to stop the immunization of their children in order to protect their lives (Science in Africa, March 2004).

On the disagreement over the safety of Oral Polio Vaccine, the World Health Organization (2008) indicated that it has been characterized by fluctuating levels of acceptance in some parts of northern Nigeria. In Kaduna state for example, Vaccination Report (WHO, 2008) showed that there was a drop in number of children immunized as experienced in Kano, Zamfara and Bauchi states; polio immunization coverage in Kaduna State shows that 502,631 children were immunized with oral polio vaccine, in 2009, there was an improvement in the coverage with 668,175 children covered, the trend continued in 2010, the coverage increased to 692,396, while in 2011 the coverage dropped to 565,554 (WHO, 2012). Notwithstanding the fluctuation of immunizations across years, Nigeria’s poliomyelitis eradication activities have significantly reduced the poliomyelitis disease burden but have not had the anticipated result of eradicating the disease. This situation has prompted the need for this study which intends to assess parents‟ responses to acceptance of polio immunization in Kaduna state, Northwest Nigeria.

1.2 Statement of the Research Problem

The presence of poliomyelitis in Nigeria is well established (Jacques, .2011). Although the Nigerian government has made and is still making efforts to eradicate poliomyelitis, the condition persists in many parts of the country. Consequently, there is the need to investigate the prevalence of the disease in view of the quarterly national polio immunization exercise. An Assessment of immunization services in Nigeria by

international comparative data revealed that immunization coverage is still low (UNICEF 2001). What are the factors responsible for this low coverage? Oyewole (2013) pointed that every culture has its system of health care which explains the causes of illness and its treatment. The cultural and religious beliefs of the people in Kaduna state have been observed to have greater influence on health matters. For instance, among Hausa communities, poliomyelitis is known as Shan-inna. According to Renne (2006) shan inna (polio) literally mean an ailment of the spirit world, in which the spirit (inna) belong to a cult known as Bori is believed to cause shan inna/polio. The spirit consumes the blood of the victim‟s limbs thereby causing paralysis. Traditional healers have special powers that enable them interact with the spirit world and thereby tries to appease the spirit by providing her demands in returns to restore the victim‟s limbs. Similarly, it is a cultural belief that Inna is a female spirit, and a loving mother. Her love for children drives her to carry them in her arms in the spiritual world (as most Hausa mothers would carry other women‟s children, even when they are not known to each other). In the case of Inna, her love for embracing and constant carrying of children in her arms make the children‟s limbs shrink because she does not allow them to walk (Yahaya, 2007). Some Hausa therefore believe that immunization cannot prevent poliomyelitis. Similarly, on religious grounds the Muslims in the northern part of Nigeria are said to believe that polio immunization is a Western ploy to make the Muslim population infertile. The researcher is interested in finding the extent to which these cultural values and religious beliefs affect the response to polio immunization exercise in Kaduna State.

In general, the issue of rejecting polio immunization cannot be attributed to one factor alone, hence it is a problem that needs investigation. This study is therefore set to

assess the level of acceptance of the polio vaccine by parents for their children. Therefore, the study will address the following questions-

1.3 Research Questions

What is the level of acceptance of polio immunization in Kaduna State for children?

What are the factors associated with acceptance and non acceptance of polio immunization in Kaduna state?

What are the socio-economic status of parents of children that have been afflicted with polio in Kaduna state?

1.4 Aim and Objectives of the Study

The aim of this study is to assess the level of acceptance of polio immunization State.

To achieve this aim, the following specific objectives are formulated:

To assess the level of acceptance of polio immunization in Kaduna State.

2.	To identify the factors associated with acceptance and non acceptance of	Polio
	Immunization in Kaduna state.

To find out the socio-economic status of parents of children that have been afflicted with polio in Kaduna State.

1.5Significance of the Study

The study identified social factors that are responsible for persistence resistance of people to polio immunization. The results of the findings shall form an objective policy framework for campaigns to create an awareness and conviction of the essence of the oral vaccination in Kaduna State. In addition, it is believed that the findings of this study will guide the Government, Non-Governmental Organizations and other sponsors of polio immunization in future plan and measures to take in planning and executing a similar health related projects in Kaduna state. Similarly, it is hopeful that this study will serve as a future reference point for further researchers in this area.

1.6 Scope of the Study

This study is limited to Kaduna State because it is one of the polio endemic states in Nigeria (WHO, 2006). It covered two Senatorial zones which are Northern and Southern senatorial zones. The study considered the social aspect of polio immunization such as the factors influencing immunization and socio economic attributes of parents of children that have been afflicted with polio disease.

1.7 Definition of Terms

Assessment: It is a process of using an instrument capable of measuring how people are influenced by culture, religion and politics. It will explain how these social factors and values affect people‟s action and interaction regarding their decision on acceptance or rejection of polio immunization. Wagenaar (2004) stated that it is a development of comprehensive instrument to authentically assess an issue. In his work, he presented an assessment instrument which could be used to profer essential goals for undergraduate education in Sociology. In this study, it will be used to assess the sociological factors that influence the acceptance or non acceptance of polio immunization in Kaduna State. Polio immunization: Is a method of inducing immunity to protect the person from being infected with poliomyelitis.

Crisis: The interruption in the normal process of public health intervention (polio immunization); when the Supreme Council for Islam Affairs (SCIA) claimed to have learnt that the oral polio vaccine championed by the World Health Organization (WHO) and the United Nations Children Fund (UNICEF) has been deliberately contaminated and thereby embarked on campaign to stop the immunization exercise.

Acceptance: Agreeing to an offer of polio immunization which is determined to a large extent by the prevailing values and practices of the People.

Wild poliovirus: This is naturally circulating poliovirus that is not caused by the

Vaccine containing live virus.

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