EFFECTS OF COMMUNITY-BASED NURSING INTERVENTION ON ROUTINE CHILDHOOD IMMUNISATION COMPLETION IN IBADAN OYO STATE

Abstract

Vaccine Preventable Diseases (VPDs) account for high morbidity and mortality among under -five children in low-income countries, infant immunisation is considered essential for the prevention of VPDs to improve child survival. In Nigeria, despite the different immunisation strategies adopted, compliance, with immunisation schedule and completion is still low, hence many children die of VPDs. The use of Reminder/Recall (R/R) system has been proven as one of the effective ways of improving immunisation rates in developed countries. However, there is dearth of information on its use in Nigeria. This study was designed to evaluate the individual and combined effects of cell phone R/R and Primary Health Care Immunisation Providers' Training (PHCIPT) intervention on routine childhood immunisation completion among children aged 0-12 months in lbadan, Oyo state. The study design was a group randomised controlled trial with Local Government Area (LGA) being the unit of randomisation. Using ballot system, two LGAs from the urban area and two LGAs from the sub-urban areas were randomly selected out of the eleven LGAs in lbadan. The four selected LGAs were then allocated into three intervention groups of R/R group (A). PHCIPT group (B); combination of R/R and PHCIPT group (C) and control group (D). One ward was selected by ballot from each LGA and one PHC facility was purposely selected from each ward. A total of 605 children aged 0-12 weeks at their first immunization visits were consecutively recruited into the study within a period of 15 weeks. The primary outcome measure was the percentage of routine childhood immunisation completion and incompletion among the children at 12 months old. Immunisation knowledge and Practice were also assessed among the PHC immunisation providers using questionnaire and checklist. Analyses were done using linear mixed effects logistic regression model, paired t-test and repeated measure ANOVA at p=0.05 The children were lost to follow up hence 59 children were evaluated. Two hundred and eighty nine (43.6%) were male and 306 (50.6%) were female, mean age was 18.3 ± 16.6 days at baseline. At the study endpoint, immunisation completion rates were; group A, 98.6%; group B, 70%; group C, 97.3% and group D, 57.3%. After adjusting for socio-demographic characteristics such as family type, religion, maternal education and place of delivery as covariates, participants in groups A (OR 46.60. 95% CI 10.92-198.9) and group C (OR 31.38, 95% CI 10.57- 93.17) were more likely to complete immunisation than those in group D. However, the difference between groups B (OR 1.58, 95% CI; 0.96- 2.59) and D was not significant. The mean total knowledge and practice scores among immunisation providers in the two training intervention groups B and C improved significantly between time points. The use of cell phone reminder/recall was effective in improving routine childhood immunisation completion. The need for policy makers to consider the adoption of the strategy on a large scale to enhance immunisation completion is recommended.