KNOWLEDGE AND PRACTICE OF CAREGIVERS AND IMMUNIZATION SERVICE PROVIDERS ON ROUTINE IMMUNIZATION IN GWAGWALADA LOCAL GOVERNMENT AREA, FCT-ABUJA, NIGERIA

Abstract

Millions of children are at risk of vaccine preventable diseases (VPDs) in Nigeria. Yet, the factors which influence the provision and acceptance of immunization services have not been fully explored. This cross-sectional study was conducted at select health facilities in Gwagwalada Local Government Area, Abuja, Nigeria to assess the knowledge and practice of caregivers and Immunization Service Providers (ISPs) on routine immunization (RI). Random sampling technique was used in selecting 70 ISPs and 436 consenting caregivers (parents) who used the health facilities between October 2006 and March 2007. A validated semi-structured questionnaire containing a 4-point knowledge scale and best practices on childhood immunization was used to collect data from the caregivers while data collection from ISPs was done with another validated semi-structured questionnaire with a 14-point knowledge scale. Analysis of the data was done using descriptive, t-test and ANOVA statistics with 0.05 set as level of significance. The caregivers· mean age was 27.3 ± 4.3 years. their children's mean age was 5.6±4.4 months. while the mean age of the ISPs was 31.5±8.3 years. Most (97.5%) caregivers were females and 61.0% had at least primary education. Only 17.2% of the caregivers knew that a child should receive four doses of oral polio vaccine OPV. A few (25.5%) of them correctly mentioned that a child should receive three doses uf diphtheria-pertussis-tetanus (DPT) vaccines. Only three (0.7%) correctly mentioned that a child should receive one dose of Measles vaccine (MV) at 9 months of age. Majority (63.5%) of them affirmed that they were aware of the specific immunization side effects on their children but a few (34.4%) also registered their ignorance. No significant difference existed in caregivers' mean knowledge scores by age (p>0.05). The mean knowledge score of caregivers who were Christians (2.2±1.3) was significantly higher than the Muslims (1.7±1.5), (p<0.05). There was a statistically significant difference between education and mean knowledge score of the caregivers. Caregiver's reasons for heath facility visits on the days they were interviewed included: child·s immunization only (56.2%). child"s illness only (28.0%), and 15.8% for both child's illness and immunization. Vaccines already given to the children included BCG (63.5%), OPVI (78.6%), HBVI (78.8%) and DPTI (79.4%).DPT3 (12.5%), OPV3 (11.3%). HRV3 (5.8%), and MV (1.2%). Majority (93%) of mothers had ever received tetanus toxoid (TT). Only 5% of the caregivers mentioned they would not visit the same facility for next immunization appointment and their reasons included change of residence (23.9%), too long waiting time (26.8%) and repeated vaccines stock-out (9.8%). Most ISPs correctly identified Poliomyelitis (94.3%), Measles (85.7%), Diphtheria (84.3%) among others vaccines preventable diseases (VPDs) but a few ISPs did not know that Tuberculosis (24.3%), Tetanus (20.0%) and Pertussis (17.1%) were preventable hy vaccination. Correctly identified VPDs presenting with fever by the ISPs included Measles (80%), Poliomyelitis (60%) and Pertussis (55.7%); 54% of ISPs stated correctly that a sick child should be brought for immunization. Majority 88.6% knew that a parent of the immunized child should be informed of what side effects may occur. The overall mean knowledge score of the [SPs was 10.1±2.0. The ISPs mean knowledge scores by training, rank. or years of working experience were not significantly different (P>0.05). Indicators on selected best practices among ISPs showed that: 92.2% stored vaccines in cold boxes and maintained the cold chain: 78.4% filled out the stock sheet according cold chain maintenance whenever vaccines are moved: 77% estimated the target population for RI; 98% properly disposed of used safety boxes and other wastes shortly after immunization sessions; 94% informed the caregivers about VPDs and the importance of the RI scheme. Overall knowledge about RI is low among both the caregivers and ISPs in this study. Limiting factors relating to health system may hinder continued provision and acceptance of immunization service delivery in the study area. Suitable and sustainable health care resources and interventions to strengthen the health system, increase the RI demand from the recipient community and effective delivery of RI services at both the public and private primary health care centres are strongly recommended.