DETERMINANTS OF CHILD IMMUNISATION COVERAGE AMONG CHILDEN AGED 12 TO 23 MONTHS IN UMUNNEOCHI LOCAL GOVERNMENT AREA IN ABIA STATE, NIGERIA

Abstract

The high prevalence of vaccine preventable diseases and its attendant high rates of morbidity and mortality in children have been attributed to low routine immunisation coverage. This study was conducted to identify determinants of immunisation coverage among children aged 12 to 23 months in Umunneochi Local Government area of Abia state, which had witnessed poor immunisation service coverage. The sampling technique adopted was the modified Expanded Programmes on Immunisation (EPI) Probability Proportionate to Size (PPS) multistage cluster sampling technique used by the World Health Organisation (WHO) to evaluate immunisation antigen coverage. Five hundred and twenty five children were selected from five hundred and twenty five households. Mothers, whose children were selected, were interviewed using a questionnaire from the standardized WHO EPI infant cluster coverage form. Data were analyzed using chi square and logistic regression. Coverage for the various antigens were Bacillus of Calmette and Guerin (59.2%), Diphtheria, Pertussis and Tetanus 1, 2 and 3 (50.6%, 49.3%, 37.7% respectively), Oral Polio Vaccine 1, 2 and 3 (100.0%, 89.5%, 78.3 respectively) and Measles (76.0%). All the children had received at least one dose of an antigen while only 32.4% had completed the recommended immunisation schedule. Immunisation cards had been issued to 25.5% of the children at first contact. The decision to have a child immunised was taken by the mother alone in 57.3% of the respondents, by the father alone in 28.6% and both in 14.1%. Reasons for not completing the immunisation schedule included, lack of vaccines (19.2%), absence of vaccinators at the health centres (20.1 %), not knowing the time immunisation sessions were being conducted (18.9%), distance (19.6%) and cost (18.6%). Analysis using chi square showed that children were more likely to be fully immunised if their mothers were less than 30 years old (p <0.05), unemployed (p < 0.05), educated beyond secondary level (p < 0.05), had fewer children (p < 0.05), perceived immunisation as safe (p < 0.05), and had received relevant immunisation related information from the health workers at the point of child's vaccination (p = 0.031). When both parents participated in the decision to have a child immunised, these children had higher rates of completing the immunisation schedule (p < 0.05). Logistic regression analysis showed that, lower maternal age (OR=2.26, 95% Cl: 1.266-4.033), availability of an immunisation card at first contact (OR=7.72, 95% CI: 4.434-13.439), fewer offsprings (OR=2.219, 95% CI: 1.113-4.425), and maternal unemployment (OR=l.712, 95% Cf: 1.015-2.887) were significant predictors of completing the immunisation schedule. Maternal age, maternal employment status, number of siblings and possession of an immunisation card issued during the first vaccination are important factors for completion of immunisation. Identifying mothers whose children are "at risk" of not completing immunisation and educating them on the importance of completing the schedule will be an important strategy to improve antigen coverage and reduce defaulter rates.