IMMUNIZATION PRACTICES AMONG MOTHERS IN EZZA-SOUTH LOCAL GOVERNMENT AREA OF EBONYI STATE

DEPARTMENT OF HUMAN KINETICS AND HEALTH EDUCATION
i. Measles: This is an acute viral infection caused by micro­organism called Polynesia Mobillosa. Measles is virtually a universal diseases, but endemic in large metropolitan communities, more often, but not always occurring as an epidemic. It is characterized by prodromal or catarrh period. The incidence is higher in children under two years of age with the greatest risk of complication of blindness otitis media and encephalitis and death occurring in infant.

The reservoir of infection is man. The mode of transmission is person to person or by direct contact with contaminated articles such as toys or hanker chiefs. Measles is by far one of the most contagious diseases. It has an incubation period of 10 days with clinical signs that include:
First symptoms are, Coryza (running nose), pyrexia fever) conjunctivitis, bronchitis and cough for the first three days or followed by generalized rash, which lasts, from the fourth to the sixth day. There are also koplik sports in the mucous membranes of the month.

Immunization Against Measles: This is achieved by the use of attenuated like measles virus vaccine in powdered form, which can be diluted with cold diluents. It should be administered by subcutaneous infection is one dose of 0.5x given at nine months in the upper arm of the child. There are no contraindications for measles vaccination mild fever, diarrhoea and colds should not stop a child from being immunized.
One attack of measles produces life-long immunity. Infants born to mother who have had measles attack acquire passive immunity which lasts for approximately 6-8 months after which immunity disappears. If vaccine is given before the disappearance, there will be an inference reaction between the two antibodies leading to low immunological response. For this reason, the best age for the administration is nine (9) months when the maternal immunity is just beginning to ware completely.
ii. Tuberculosis: This is a chromic infections disease caused by a bacterium mycobacterium tuberculosis founded by Robert Koch. Occurrence is worldwide. This disease is aggravated by dense over crowding in rural communities. Reservoir of infection is man. The mode of transmission is by droplets from sputum of infected person or talking in close proximity, sharing the cup, spoons, meals with on infected person. Actions such as sneezing, coughing, signing and use of contaminated formites may promote discrimination of such droplets. The incubation period is 4-6 weeks.

Clinical Signs: Weigh loss, loss of appetite, profuse sweating at night, low grade fever and chronic cough. Haemoptysis is a late sign. A serious outcome of the infection is more frequent in infants and also among malnourished person.

Immunization Against Tuberculosis: Prevention of tuberculosis is by appropriate immunization with BCG (Bacillus Calmette Guerin) vaccine. It is given intrademally as soon as possible after birth at the upper arm or forearm. The vaccine is a life attenuated vaccine in freezes dried form.   Only a   single dose of  BCG   gives   a   long-lasting immunity. There is no contraindication.
iii. Poliomyelitis (Infantile Paralysis): Thus, otherwise known as infantile paralysis is an acute viral disease caused by an enterovirus, the poliovirus type II, III, and I. Type I is the most paralytrgenic and cause of most epidemics. Occurrence is worldwide. It is characteristically a disease of children but all ages can be affected. Where sanitation is poor, transmission is faeco-oral ie. Through ingestion of faecally contaminated water or food. The incubation period is commonly 7-12 days with a range from 3-21 days.
Clinical features: Fever, headache, gastro-intestinal disturbances (nausea, vomiting and diarrhoea) and stiffness of the back and next lasting for two to ten (2-10) days.
In paralytic case, these symptoms are accompanied by a sudden on set of paralysis commonly of the muscles of the limbs or any other muscles and usually affect one side of the limb more than the other.

Immunization Against Poliomyelitis: Two types of vaccine are used-salk (dead IPV, given parenterally) and sabin (life attenuated, given orally OPV). Both vaccines are trivalent, meaning that all the three strains of wild poliovirus are combined into are vaccine. The oral polio vaccine (OPV) is recommended and is.given 2-3 drops sublingually in 4, doses. The first dose, OPV-0 is given at birth followed by OPV1, OPV2, POV3 at 6 weeks and 14 weeks respectively. POV1-3 are given concurrently with DPT. It provides long lasting immunity. No contraindication.

IV. DIPHTERIA
This is an acute bacterial disease caused by a gram positive bacteria, the corgnebacterium diphtheria which produces toxin. It has a short incubation period of 2-5 days. It's occurrence is worldwide. Transmission is air borne or by direct contact through formites. Man is the reservoir of infection.

Clinical features: This includes fever, whitish pulse in the throat, difficulties  in  breathing  and  eventual  death  from suffocation. Inflammation of the mucous membranes of the upper respiratory tract.
V. TETANUS
Tetanus is an acute disease caused by the action of the toxin produced by clostridium tetani, a gram-positive anaerobic bacterium. Transmission is high contamination of wounds or openings in the body with soil or dust containing tetanus spores. In children, tetanus neonatrum transmission" is usually acquired through cutting of the umbilical cord with contaminated instruments or the use of contaminated dressing on the cord. Ear piercing; circumcision etc with contaminated instrument can also lead to infection with tetanus. The incubation period is commonly 7 days but may range from 4- 2 days, depending on character, extent and location of the wound.

Clinical features: It produces characteristic muscular spasm, especially of the master muscles of the jaw, leading to lock-jaw, stiff neck and high pitched crying. In the neonate, inability to suck the breast is the first obvious sign. A child that has began breast-feeding suddenly stops after some days. Other muscles can be affected, example, muscles of the face, leading to a peculiar grimace and muscle of the trunk, leading to opisthotonus. There is also abdominal rigidity, difficulty in swallowing, fever and convulsions. Involvement of the vital centers in the brain and brain stam can lead to respiratory failure.

VI. PERTUSIS (WHOPPING COUGH)
This is a disease of early childhood caused by gram-negative bacteria, the bordetella pertusis. It is particularly very dangerous in young children. Occurrence is worldwide. Transmission is primarily by droplet spread from respiratory tract of infected person. The incubation period is 6-12 days commonly sudden (7).
Clinical features: Manifest in three stages:
i.                    Catarrhal stage- lasts 1-2 weeks during which the child has mild but progressively increasing cough, coryza, sneezing and fever.
ii.     Paroxysmal stage- also lasts for 1-2 weeks, characterized        by repeated, attacks of cough that are followed by   prolonged sudden respiratory whop (whopping cough).           Whop is rarely present in young infants making clinical        diagnosis difficult in this stage. There is lose of appetite         and puffiness of the face and eyelids.
Complications include brouchi pneumonia, cerebral anoxia and convulsion.

iii. The final stage of convalescence lasts for about 2 weeks.

IMMUNIZATION    AGAINST    DIPHTHERIA,    PERTUSIS AND TETANUS
Immunization against these diseases is undertaken with the triple antigen (DTP) vaccine. The VD' and NT' components of the vaccine consists of killed partusis organism which protects the child against bordetella partusis infection. 0. 5ml of the DPT vaccine given intramuscularly on the right thigh at 6 weeks confer complete protection against the disease. No contraindication.
            In   contrast, neonatal   tetanus   can   be   prevented by immunization of women of childbearing age. Maternal antibody provides temporary immunity for the first 3 months of life. Up to 5 doses of tetanus toxoid (TT) are needed to provide protection through out the childbearing age. The first dose of TT should be given at first contact with the health system or as early as possible in pregnancy. The second dose should be given 4 weeks after the first and not later than two weeks before delivery. Minimum interval between TT2 and TT3 is six months and between TT3 and TT4 and TT5, one year or more. No contraindication.
Here below, is  a  tetanus  toxiod  (TT)   immunization schedule for women of child bearing age.


Dose

When to give

Percentage protection

Duration   of protection

TT1

At   first   contact   or   as early   as possible in pregnancy.

Nil

None

TT2

At least four weeks after TT1

80

3 years

TT3

At least 6 months after TT2

95

5 years

TT4

At least one year after TT3

99

10 years

TT5

At least one year after TT4 or during subsequent pregnancy

99

For life

23
 
TABLE 1: TT IMMUNIZATION SCHEDULE FOR PREGNANT WOMEN 
However, Akinsola (2002) discussed other communicable disease added  by National  Programme on immunization (NPI) such as yellow fever,  hepatitis B and cerebrospinal meningitis (CSM) as follows:
 VI. YELLOW FEVER
This is an acute viral infection that is caused by a virus known   as  Alfa-virus,   which  transmitted^ by  the   bites  of., infected Aedes Aegypti mosquitoes. The incubation period in man is 3-6 days.
The Clinical Features Include: Fever, headache, cough-suddenly about 3- 6 days after infection, limb pains and bloodshof eyes.
   Heart rate may remain slow inspite of the fever
   Occasional nausea and nose bleeds
·            As the seventy of symptoms increases there is an even-higher fever accompanied by pains in the neck, more severe headache than before and vomiting.
·            The pain spreads to the legs and the back.
   Damage    to    the    liver    causes    the    skin-yellowing
characteristics of advanced yellow fever, while damage to the kidneys may result in kidney failure.

Immunization    Against   Yellow    Fever:    This    can    be achieved by subcutaneous infection of the attenuated yellow
fever vaccine. 0 5mml of the vaccine administered into the left   upper arm from   the   age   of 9-11 months   confers immunity   against the infection for the (10) years.   The contraindications are pregnant woman and infants under 2 years.

VIII HEPATITIS B: This is a virus infection and one of the major diseases of mankind. It is more often known as serum hepatitis or homologous serum jaundice. It is caused by hepatitis B viruses that inhabit the blood and saliva of an infected person. Transmission is by sexual intercourse and by the use of unsterelized or in sufficiently sterilized needles during blood transfusion.

IMMUNIZATION AGAINST HEPATITIS B: This is been undertaken by intramuscular injection of the hepatitis B vaccines  (HBC)  0.5ml of the antigen  given  into the  left buttocks of the child in three doses at birth, at 6 weeks and 9 months, make for absolute protection against infection by hepatitis B virus.
CEREBROSPINAL MENINGITIS
This is a dangerous disease of worldwide incidence, which may occurJn sporadic, or in epidemic form. It is caused by gram-negative bacteria known as neisseria meningitis which are carried in the upper respiratory tracks of healthy people. Seven serotype of moningocci namely A, B, C, X, Y, Z, W135 exist, but most epidemic of cerebrospinal meningitis in Africa are due to group A and C strains. Some of the clinical features include fever, headache, stiff neck and budging and pulsating fontanels in children less than one year of age.

IMMUNIZATION AGAINST CEREBROSPINAL MENINGITIS: This can be achieved with the cerebrospinal meningitis type A and C vaccine. 0.5ml of the antigen given subcutaneously into the right upper arm at one (1) year of age provides desirable protection.

2.2 General Method for the Control of Communicable Disease
Dibia (2002) shared common view concerning the method for the- control of communicable disease. They stated the general methods for the control of communicable diseases to include the following:
1.   Preventive measures: These are measures taken to prevent the occurrence of disease such as:
a.         Health   Education   against   prevailing   diseases thigh awareness creation,
b.         Chlorination of water supplies
c.         Vaccination against epidemic disease example, yellow fever.
d.   Pahteurization of milk
e.   Control of rodents and pests.
f.   Immunization against endemic disease example yellow      fever,
g.          Improvement   of  environmental   sanitation     and personal hygiene,
h.         Chemoprophylaxis example, malaria, river blindness     with chlorozuine,  daraprim and ivermectin  (mectizan) respectively.

2.   Control measures: These are measures designed to prevent the spread of infectious matters to persons and the environment. They include the followings:
a.         Keep contact under surveillance during incubation period
b.  Keep carriers under control until found to be free of infectious agents,
c.   Isolation
d.   Concurrent disinfection
e.   Immunization of contact.
3.  Epidemic measure:  These are measure to limit spread of communicable diseases, which has developed widely in a group or community within an area, state or nation, this as follows:
a.   Notification of occurrence   to   the   appropriate
                   health authority,
b.   Mass immunization
c.   Health education
d.   Source and contact investigation.

4.  International Measures: These are measures for the control of international travelers, immigrants goods,    animals, product and other means of transportation.
a.         Internation immunization schedule by governments     and enforcing national laws.
b.    Monitoring of international immunization centers especially    
       centers located at the bounders.
c.  Monitoring of international passport and yellow cards        before issuance of visa. As you can observe,                immunization featured in all the measures mentioned              above. Therefore, immunization can be explained as one             of the method of preventing and controlling communicable disease. (Benensen 1981). Contrarily, Akinsola (1993) and Lucas and Gilles (1990) shared similar view concerning the method of communicable disease control. They outlined the three main  method of controlling a communicable disease to include thus:
1. Elimination of the reservoir of infection
2. Interruption of transmission
3. Protection of the susceptible host.
They however, expatiated on these three methods as viz.
1. Eliminate of the reservoir of infection, through:
a.   Isolation and treatment of infected person (cases or           carried)
b.   Quarantine
c.   Destruction of infected animals example, rabies, dogs.
2. Interrupt the patway of transmission: through:
a.   Elimination or control of vectors of disease
b.   Health education
c.   Environmental  sanitation  and  personal  hygiene example,
i.   Washing  of hands  after using  the  toilet and before food
ii. Good water supply.

3. Protection of susceptible host, through:
a. Active and passive immunity
b. Good nutritional polices and advice
c. Provision of potable water and
d. Environmental sanitation.

2.3 Artificial Immunization in the Control of Infection
All immunizable disease we are going to discuss here are covered in 2.1 in terms of aetiology, pathogenegis, treatment and control. Therefore and in accordance with mandel (1985) who stated that we are going to restrict ourselves to a little mention on the disease before introducing the vaccine that renders the body immune against these infections. In consonance with this, he stated that artificial immunity is the immunity acquired thigh or after exposure to an infectious agent while artificial immunization is the process of rendering an individual immune or resistant to a disease by the introduction of vaccine into the body by means of vaccination or injection or by mouth and also through disease attack.
Moreso, he pinpointed the immunicable disease and vaccines as follows:
1.         DXPHTERIA, PERTUSIS AND TETANUS: These are three different disease caused respectively by cornbacterium   diphtheria,   bordetella,   pertusis   and clostridium tetanus.
VACCINE: THE TRIPLE VACCINE; DPT VACCINE
DPT stands for Diphtheria, pertusis, tetani representing the names of the bacteria causing the disease being vaccine prevented. DPT vaccine is called triple vaccine because the preparation contains killed whopping cough bacteria and the toxoids of tetanus and diphtheria.
It is used to immunize infants and young school children against the three disease mentioned above. It is a three-in-one vaccine, hence the name triple vaccine.

ROUTES OF VACCINES ADMINISTRATION
Three initial intramuscular injection on the right buttock of 0.5ml, of this vaccine given at monthly intervals in order to provide complete immunity against the three diseases. This doses of 0.5ml or 1ml is given to the children below two years as first contact starting earliest 6 weeks after birth. It is given in three contact of monthly intervals that is, the 1.5ml or 3ml dosage is completed within 10 weeks and 14 weeks before full immunity is achieved.
2. MEASLES/RUBELLA: There is only one antigenic type of           measles virus and infection confers long immunity.         Rubella also confers life long immunity as only one                 antigenic type of the virus exists; notwithstanding the fact       that rubella is not a reliable index of immunity. However,             infection during early pregnancy may result in serious            abnormalities of the foetus including congenital      malformations and mental retardation. Immune mothers          transfer antibodies to their off-spring who are passively    protected for 4-6 months.

Vaccine: There are two known vaccines in the prevention of measles; they are the live attenuated and inactivated dead vaccine*..
The live attenuated virus vaccine is the one in common use nowadays which gives a long lasting protection of over seven years. While the immunity from the dead vaccine is very short, only six months, and require booster doses at the age of two and five and been given repeatedly to any child, whose previous vaccination has lasted six months.

ROUTES OF ADMINISTRATION
A dose of 0.5cc in any of those vaccine is given by injection subcutaneously on the left upper arm to infants of 9 months or latest 23 months according to national programme on immunization (NPI) with live attenuated vaccine. It is not advisable to children with serious fever.

3. POLIOMYELITIS:   In this infection, virus neutralizing antibodies from soon after exposure to the virus, often before the onset of illness, and apparently persists for life.

Immunization is of value only if it precedes the onset of symptom which are found in the paralytic stage as the virus in the brain and spinal cord is not influenced by high titres of antibodies in the blood.
Vaccines: Two types of vaccine are available for the protection of children against poliomyelitis. These are the salk and sabin vaccines.
Saik vaccine is a dead vaccine made from killed poliomyelitis virus. While sabin vaccine on the other hand is a live vaccine which contains the three virulent polio virus strains made harmless, but can still stimulate and infect the body to build its own antibodies against poliomyelitis.

ROUTES OF ADMINISTRATION
0.5cc of salk vaccine is given by several repeated subcutaneous infection before it can give immunity.
            Sabin vaccine is given orally, usually 2 or 3 days to children under two years according to NPL It is known given in four contacts (doses) at monthly intervals starting from birth. It is easier to administer, and fewer doses are required to give for life long immunity.

4.         TUBERCULOSIS
Unless a host dies during the first infection with tubercle bacilli, a certain resistance is required,, and there is an increase capacity to localize tubercle bacilli, retard their multiplication, limit their spread and reduce lymphatic dissemination. Antibodies also form against a variety of the cellular constituents of the tubercle bacilli detectable through serological tests.

VACCINE - BCG VACCINE
The term BCG means bacillus Calmette Guerin a name derived from the original makers of the vaccine. Dr. Calmette: The vaccine is a suspension of tubercle bacilli which have been specially treated such that they can no longer cause the disease but elicit antibody protection in the individual. It can be given to children of any age including the new born, or even babies of a day old, and also to adult with negative tuberculin skin test.

ROUTE OF ADMINISTRATION
It is given intradermally on the right deltoid region with a special syringe and needle known as BCG syringe and needle.
The immunization reaction consists of the formation of small painless pustule at the infection site which later bursts and discharges slightly, healing up on its own in about two months and leaving a small painless scar.

5. TETANUS TOXIOD- (T.T) VACCINE
Tetanus toxiod is very conveniently used in the immunization of people against tetanus. It can be given to people of my age group including babies from 6 weeks old but according to the national programme on immunization. It is mainly given to adult's especially pregnant women. It is given in five contacts before life long immunity is achieved.

ROUTE OF ADMINISTRATION: A dose of 0.5cc is given intramuscularly on the upper arm of pregnant women within the fourth month or. as soon as pregnancy is recognized. The second dose, which achieves full immunity at pregnancy, is given a month later. Subsequently, booster doses (TT3-TT5) should be given Gmohths after delivery, yearly or in subsequent pregnancies for life long immunity. Vaccination at pregnancy doubles as active immunization, for themselves and passive protection of these babies against tetanus, which they can easily contract as tetanus neonatrum through the umbilical-cord, which might be due to the use of unsterelized or contaminated instrument in cutting the cord.
In the event of an accident, the vaccine can be given along with ATS on different arms if the patient have not received full dosage of the vaccine.

6.   CEREBROSPINAL MENINGITIS- (CSM) VACCINE
At least 13 serogroups of meninigococci have been identified by immunologic  specificity of capsular  polysaccharides, The most important serogroups associated with disease in the man are A,B,C,Y and W.135. There are monovalent or quadrivalent vaccine licensed for else. These can be monovalent A or C or combined A and C vaccines or quadrivalent A, C, Y, and W-135. The immunizing antigens for the above serogroup are the capsular polysaccharides.

ROUTES OF ADMINISTRATION
A single dose of 0,5cc is given subcutaneously or by intramuscular route. This confers immunity for three years. C.S.M vaccine should not be given to children under year of age.
2.4 Immunization in Ezza-South Today
Ezika (2001) opined that national programme on immunization (NPI) is now a house hold word in Nigeria. He therefore stated that it's a very vital strategy adopted to enhance the achievement of immunization goals. He furthered that NPI is also designed to immunize the vulnerable target groups in our society that is, children 0.24 months and women, of childbearing age 15- 45 years against communicable disease such as tuberculosis, diphtheria, pertusis, tetanus, measles, poliomyelitis.
Federal Ministry of Health (1999) stated historically that the primary health care (PHC) approach to health care delivery, universally adopted by member state of the World Health Organization (WHO) after that Alma-Ata conference in 1978, has been launched as the cornerstone of Nigeria's health policy. Primary Health Care (PHC), he said is made-up of eight (8) component including the prevention of communicable diseases. Through immunization.
Moreso, he stated that expanded programme on immunization (EPI) started in Nigeria in 1979). And it is designed to vaccinate and protect children aged 0-2 years from measles, tetanus, polio, whopping cough, tuberculosis and diphtheria. He emphasized that problems emanating from vaccine supply, cold-chain and vaccine delivery, coverage was low 10-20% and disease impact minimal continuing, they said that in August 1983, a revised EPI  pilot project was tested in Owo Local Government Area, of Ondo state as a co-operative effort of the Local Government Area, Ondo state, federal ministry of health and UNICEF.
Beside, he stated that the EPI has now been launch and functional in all the 776 local government area (LGAS) in the*, country as an entry point to primary health care. He equally stated that the goal of the revised EPI is universal childhood immunization (UCI), 1990 that is, to vaccine 80% of all pregnant women are also expected to be vaccinating annually with tetanus toxiod vaccine.
Meanwhile, Obionu (1999) inferred that the prevention of disease by immunization,, a conventional public health measures is today the best known, practical, low-cost, community base way of protecting children against the major killer childhood disease, which is the brainchild of WHO, who formulated and launched the expanded programme on immunization (EPI) with the objective of., reducing drastically the number of deaths among children from preventable diseases.
Besides, Akinsola (1993) was of the view that high-mortality and morbidity rates among the under five children due to communicable diseases and malnutrition in developing countries and in order to solve this problems of continuous high mortality among children, the WHO desired some programmes which were called child survival programmes. He-stated that the programme is not new but it is designed to bring primary health care to the grass root level thereby ensuring health for all in the year 2000 AD.
Ezika   (2001)   identified  the  specific goals  of NPI  to conclude:
a.     100%   immunization   of the   vulnerable   target                          groups.
b.     Eradication of poliomyelitis
c.     Total elimination of neonatal tetanus
d.    95% reduction in death due to measles
e.   To .establish an efficient system of surveillance and          programme monitoring activities, to ensure reliable          and systematic procurement of vaccines.
f.      To    foster    inter    sectoral    co-operation     and            community involvement and participation in these activities at all levels, and they enhance the ability of the programme to sustain itself effectively.

THE IMPACT OF EP1 IN EZZA-SOUTH LOCAL GOVERNMENT AREA.
PAEHON (2004) stated that immunization has been found to be the most powerful and cost effective weapon against these preventable diseases that has considerably raised child mortality rate. They stated that the aim of the revised EPI or the universal child immunization is to 'vaccinate 90% of Nigeria children by 1990. To that effect several places of immunization campaigns have been organized to boost routine coverage.
Consequently, the ultimate goal of EPI, which is the  reduction of morbidity and mortality from the target disease, are thus being addressed. The routine disease notification systems are used to follow trends in incidence of diseases as well as to measure reduction in disease incidence.
However, the routine disease notification system in Ezza-South shows that the incidence and pattern of booth measles and pertusis has dropped considerably from 1986
on words for the other target diseases.
Moreover, in 1990 the NIDS, SID and LID were embarked on and 80% was achieved nationally thereby achieving the universal child immunization (UCI). Old Anambra State Ezza local government ranked 5th in the state with 60% (Anambra). Although this drastically declined to 40%, in 1991, 30% in 1992 and 38% in 1993 then the local government NPI unit re-assed the situation identified problem and proffer short and long-term solutions.
In 1994, the coverage rose to 64%, in 1995-1997 it was 68%, 74% and. 90% respectively. However, it has been a sixty percent over all declines in mortality from the target diseases.
Secondly, it has an overall impact on health care system. Thus the primary health care approach to health care delivery, which was universally .adopted by member states of WHO after the Alma-Ata conference in 1978, has been launched as the cornerstone of Nigerian's health policy, the fact that the EPI is the entry point to the nations primary health care programme cannot be over emphasized visavis its impact on the other sectors in the health system. To start with, Vaughan (1999) stated that one of the resources for EPI notably materials and manpower, have been usefully employed in the execution of other health care programme.
Thirdly, the activities of EPI have also extended to tile development and dissemination of health information about other sectors of health care delivery. For example, the major threats to live and normal, growth of children can be defected in large measures by informing and supporting parents themselves in such basic actions as getting their children, immunized, using oral therapies for diarrhea disease, maintaining exclusive breast feeding in the early months etc.
Summarily, most children malnutrition, as well as child deaths could now be prevented by parental actions which are almost universally affordable based on knowledge which is already available (Mgbodile, 2004).

FACTORS MILITATING AGAINST THE SUCCESS OF EPI PROGRAMME IN EZZA-SOUTH
Aiakiji (2002) submitted that the implementation of expanded programme on immunization (EPI) have suffered several set-backs, some of which are: —
1.         Problem of logistics supply
2.         Inadequate     managerial     capabilities    for    effective programme execution at the state level.
3.         Poor management of resources.
4.         Maintenance of the "cold chain".
5.         Huge   wastage   of vaccines  through   frequent   power failure without provision of back up power sources.
6.         Frequent   breakdown   of   vehicles   and   "cold   chain" equipment
7.         Lack of maintenance facilities.
8.         Insufficient supervision of field activities, resulting in generally poor performances in the local government area.
9.         Poor programme monitoring and control have been caused by inadequate surveillance activities.
10.       Generally, low reporting of immunization and total absence of Quality control and cost accounting.
11.       Management information necessary for planning, re-planning and evaluating state operations is inadequate.
12.       Low level of public enlightment campaign for the programme.
13.       Health education effort have been minimal and not carried out as an inbuilt component of the programme.
14.       Public co-operation has been taken for granted.
15.       There are no established mechanisms for involving the community in planning or implementation of EPI activities in the local government level.
16.       Motivating mothers to act, to go back repeatedly until full dose is completed.

2.5 Immunization Schedule
Cairn cross and Feechem (1993) was of the opinion that EPI planning will evolve children of 0-12 months of age and women of childbearing age. Child'rervQ-24 months will also be served during the initial years of operation.
Meanwhile, Benenson (1901) submitted that immunization schedule contains vital information to which health workers may wish to refer when deciding which types of vaccine to administer to a child and women off child bearing age (WCBA), He however, said that suggested schedule of immunization for developing countries and that currently used in Nigeria is shown in the table below:

TABLE  2, IMMUNIZATION SCHEDULE FOR CHILDREN
    47
 
 UNDER ONE YEAR
Contact


Minimum target age of a child
Type          of vaccine

Dosage

Route of administration
Site

1st

At birth

HBVI

0.5ml

Intra muscular

Upper arm





BCG

0.5ml

Intra dermal

RT.    Upper





OPVO

2 drops



arm

2nd

6 weeks of age

DPTI

0.5ml

Oral

Upper




OPV1.

3 drops

Intramuscular

outer





HBV2

0.5ml



quadrant of











buttock,











Mouth

3rd

10     weeks    of  age


OPT2
OPV2

0.5ml
2 drops

Intramuscular
Oral

Upper    out
quadrant of
buttock Mouth

4th

14    weeks    of

DPT3

0.5ml

Intramuscular

Upper



Age  at birth 6, and 14 week


OPV3

3 drops

Oral

outer
quadrant of
buttock

5th

9-11 months

Measles

0.5ml

Subcutaneous

Left  upper arm





yellow  fever

0.5ml

Subcutaneous

Left  upper arm





ITBV2

0.5ml

Intramuscular

Upper arm







             48
 




 
 
2.7 Steps to Ensure Vaccine Potency
Dibia (2002) submitted that the steps that must be considered to ensure vaccine potency are as follows:
        i.         Store each vaccine at its storage temperature.
     ii.         Record temperature twice daily, that is, morning and evening
   iii.         Insept cold chain monitoring chart, which is designed to last for a whole yein, and in which provisions have been made for every day and monthly charting.
   iv.         Insert functional thermometer, which will enhance effective monitoring of temperature. The thermometer is calibrated to read either positive when it is refrigerated and negative when it is frozened. The thermometer must be kept whenever vaccines are stored.
      v.         Vaccine should not be compacted in shelves or compartment, for instance, vaccines that are to be kept frozen should be put in freezers, while the once that are not to be freezed should be put in. refrigerators.
   vi.         Tetanus toxoid (TT) vaccines; diphteria, pertusis, tetanus (DPT) vaccines, and hepatitis B vaccines (HBV) should be stored at +2°c to 4°c even up to 8°c in refrigerator.
 vii.         Oral polio vaccines (OPV); measles vaccine (MC), yellow fever vaccines and Bacillus calmette Guerine (BCG) vaccines should be stored at -15°c to 25°c.
viii.         All received and stored vaccines should be recorded accordingly.
   ix.          Vaccines should not be stored in refrigerators door. Similarly, Mandel (1985) emphasized that table would explain clearly the vaccine storage system in respect to level (place) of handling, temperature and duration (time) of storage in potent state.
The table is here below:
TABLE 3: TEMPERATURE AND DURATION OF STORAGE IN POTENT STATE 
Vaccine type

Storage Temperature/time of keep



LG.A     or

In   transit     to

Health

Out reach



state

health center

center

unit



storage







Polio, measles
yellow
fever cholera

Up   to   3 months at 20°c



- 20°c to +8°c

Up   to    1 month   at + to 80c


Up   to    1
week     at
+4°c  to 80c.



Moreover, Akinsola (1993) asserted that it's necessary that vaccines during administration at vaccination centers, should be handled with care to avoid the exposure to heat and light. This, he said involves the followings:
        i.         Selection of vaccination site that is as cool as possible preferably a room, but where that is not available, a shade should be chosen under a big tree. Do not vaccinate in the sunlight.
     ii.         You should open vaccine container and remove vaccine and diluents only when needed and collect one vials in silver or tin toil to protect vaccine from heat and light.
   iii.         Wrap the vial in silver or tin toil to protect vaccine from heat and light.
   iv.         The vial of vaccine in use should be on top of ice pack or a cup containing  ice cubes. Also the loaded spring  and needle in use should be placed on well frozen ice packs on the table.
      v.         At the end of-vaccination session, return all vials (opened and unopened) to the health center or store.
   vi.         If the temperature of the container is still within +4°c to 8°c or all the ice cubers are not melted after the session, mark unopened vials with red and return them to the refrigerator, to be used first during the next session otherwise discard especially the OPV and measles vaccine.
 vii.         Do not take same vials of vaccine out to the field for move than 3 times. .
viii.         Keep proper records of work, That is, the numbers of vaccine received, the number expended, the number broken, the balance and the number of people immunized.

Research Question 1


61
 
What are the Immunization Practices Adopted by Mothers in Ezza-South Local Government Area?
TABLE 4: FREQUENCY AND PERCENTAGE RESPONSES ON IMMUNIZATION PRACTICES OF MOTHERS IN EZZA SOUTH   LOCAL GOVERNMENT AREA.
ITEMS

RESPONSES



Yes

%

No

%

Total

1

40

0.4

10

0.1

50

2

40

0.4

10

0.1

50

3

36

0.36

9

0.09

45

4

32

0.32

8

0.08

40

5

32

0.32

8

0.08

40

6

8

0.08

2

0.02

10

7

36

0.36

9

0.09

45

8

32

0.32

8

0.08

40

9

36

0.36

9

0.09

45

10

36

0.36

9

0.09

45

11

12

0.12

3

0.03

15

12

12

0.12

3

0.03

15

13

36

0.36

9

0.09

45

14

12

0.12

3

0.03

15

Total

400
4

100

1

500

     62
 
Research Question II
Do Mothers level of Education Influences their Immunization Practices in Ezza-South Local Government Area?
TABLE 5:FREQUENCY AND PERCENTAGE RESPONSES    ON KNOWLEDGE OF MOTHERS BY LEVEL OF EDUCATION IN EZZA SOUTH LOCAL GOVERNMENT AREA.
Items

Non-formal Education  (N = )

Primary Education (N = )

Secondary Education (n = )

Post-Secondary (n = )

Total



Yes

No..

Yes    ..

No

Yes

No

Yes

No



1

8 (0.08)

-

10 (0.1)

-

12 (0.12)

-

14 (0.14)

-

44

2

8 (0.08)

-

10 (0.1)

-

12 (0.12)

-

14 (0.14)

-

44

3

8 (0.08)

-

9 (0.09)

-

10 (0.1)

-

12 (0.12)

-

39

4

8 (0.08)

-

8 (0.08)

-

10 (0.1)

-

12 (0.12)

-

38

5

8 (0.08)

-

9 (0.09)

-

10 (0.1)

-

12 (0.12)

-

39

6

5 (0.05)



2 (0.02)

2 (0.02)

3 (0.03)

2 (0.02)

5 (0.05)

2 (0.02)

21

7

8 (0.08)

-

9 (0.09)

-

10 (0.1)

-

13 0.13)

-

40

8

8 (0.08)

-

8 (0.08)

-

10 (0.1)

-

12 (0.12)

-

38

9

8 (0.08)

-

9 (0.09)

-

10 (0.1)

-

12 (0.12)

-

39

10

2 (0.02)

4 (0.04)

9 (0.09)

2 (0.02)

10 (0.1)

2 (0.02)

12 (0.12)

2 (0.02)

43

11

2 (0.02)

4 (0.04)

3 (0.03)

2 (0.0 2)

4 (0.04)

2 (0.02)

6 (0.06)

2 (0.02)

25

12

1 (0.01)

4 (0.04)

3 (0.03)

2 (0.0 2)

4 (0.04)

2 (0.02)

6 (0.06)

2 (0.02)

24

13

8 (0.08)

-

9 (0.09)

-

11 (0.11)

-

13 (0.13)

-

41

14

6 (0.06)





5 (0.05)

2 (0.02)

4 (0.04)

7 (0.07)

1 (0.01)

25

Total

88

12

97

13

118

12

151

9

500


       63
 
Research Question III
Do   Mothers  Immunization   Practices  Influenced   by Parity in Ezza-South Local Government Area?
TABLE 6:FREQUENCY AND PERCENTAGE RESPONSES ON KNOWLEDGE OF MOTHERS BY PARITY  IN EZZA   SOUTH   LOCAL GOVERNMENT AREA.
Items

0  -  l(n = ) 

1   - 4(n = )

5 and above (n =)

Total



Yes

No

Yes

No

Yes

No



1

14 (0-14)

-

14 (0.14)

-

14
(0.14)

-

42

2

14 (0.14)

-

14 (0.14)

-

14 (0.14)

-

42

3

12 (0.12)

-

12 (0.12)

-

12 (0.12)

-

36

4

12 (0.12)

-

12 (0.12)

-

12 (0.12)

-

36

5

13 (0.13)

-

13 (0.13)

-

13 (0.13)

-

39

6

5 (0.05)

4 (0.04)

5 (0.05)

2 (0.02)

5 (0.05)

4 (0.04)

25

7

13 (0.13)

-

13 (0.13)



13 (0.13)

-

39

8

12 (0.12)

-

12 (0.12)

-

12 (0.12)

-

36

9

12 (0.12)

-

12 (0.12)

-

12 (0.12)

-

36

10

12. (0.12)

4 (0.04)

12 .(0.12)

2 (0.02)

12 (0.12)

4 (0.04)

46

11

10 (0.1)

-

6 (0.06)

2 (0.02)

6 (0.06)

4 (0.04)

28

12

6 (0.06)

4 (0.04)

6 (0.06)

2 (0.02)

6 (0.06)

4 (0.04)

28

13

13 (0.13)

-

13 (0.13)



13 (0.13)

-

39

14

6 (0.06)

4 (0.04)

8 (0.08)

-

8 (0.08)

2 (0.02)

28

Total

154

16

152

8

152

18

500



Research Question IV
  
    64
 
Do     Mothers     Religious     Affiliation     Influenced     their Immunization   Practices   in   Ezza-South   Local Government Area?
TABLE 7:FREQUENCY AND PERCENTAGE RESPONSES    ON KNOWLEDGE OF MOTHERS BY RELIGIOUS AFFILIATION IN EZZA SOUTH LOCAL GOVERNMENT AREA.
Items

Christian, Religion     (n = )

Moslems Religion  (n = )

Traditional Religion (n = )

Others Religion (n = )

Total



Yes

No ''

Yes

No

Yes

No

Yes

No



1

12 (0.12)

-

10 (0.1)

_

10 (0.1)

-

8 (0.08)

-

40

2

12 (0.12)

-

10 (0.1)

-

10 (0.1)

-

8 (0.08)

-

40

3

10 (0.1)

-

9 (0.09)

-

9 (0.09)

-

8 (0.08)

-

36

4

10 (0.1)

-

8 (0.08)

-

8 (0.08)

-

8 (0.08)

-

34

5

10 (0.1)

-

8 (0.08)

"

8 (0.08)

-

8 (0.08)

-

34

6

3 (0.03)

5 (0.05)

2 (0.02)

4 (0.04)

2 (0.02)

5 (0.05)

1 (0.01)

6 (0.06)

28

7

10 (0.1)



9 (0.09)

-

9 (0.09)



8 10.08)

-
36

8

10 (0.1)

-

8 (0.08)

-

8 (0.08)

-

8 (0.08)

-

34

9

10 (0.1)

-

9 (0.09)

-

9 (0.09)

-

8 (0.08)

-

36

10

10 (0.1)

5 (0.05)

9 (0.09)

4 (0.04)

9 (0.09)

5 (0.05)

2 (0.02)

6 (0.06)

50

11

4 (0.04)

5 (0.05)

3 (0.03)

,4 (0.04)

3 (0.03)

5 (0.05)

2 (0.02)

6 (0.06)

32

12

4 (0.04)

5 (0.05)

3 (0.03)

4 (0.04)

3 (0.03)

5 (0.05)

1 (0.01)

6 (0.06)

31

13

11 (0.11)



9 (0.09)

-

9 (0.09)



8 (0.08)

-

37

14

5 (0.05)

4 (0.04)

5 (0.05)

2 (0.02)

4 (0.04)

4 (0.04)

4 (0.04)

4 (0.04)

32

Total

121

24

102

18

101

24

82

28

500




65
 
Research Question V
Do Mothers age Influences their Immunization Practices in
Ezza-South Local Government Area?
TABLE 8: FREQUENCY  AND    PERCENTAGE    RESPONSES    ON KNOWLEDGE OF MOTHERS  BY AGE IN  EZZA  LOCAL  GOVERNMENT AREA.
Items

15 yrs -,25 yrs (n = )

26yrs - 35 yrs (n = )

30 yrs - 45 yrs (n = )

46yrs         and above (n = )

Total



Yes

No

Yes

No

Yes

No

Yes

No



1

10 (0.1)

-

12 (0.12)

-

10 (0.1)

-

10 (0.10)

-

42

2

10 (0.1)

-

12 (0.12)

-

10 (0.1)

-

10 (0.10)

-

42

3

9 (0.09)

-

10 (0.1)

-

9 (0.09)

-

9 (0.09)

-

37

4

8 (0.08)

-

10 (0.10)

-

8 (0.08)

-

8 (0.08)

-

34

5

8 (0.08)

-

10 (0.10)

-

8 (0.08)

-

8 (0.08)

-

34

6

2 (0.08)

4 (0.04)

3 (0.03)

4 (0.04)

2 (0.02)

4 (0.04)

2 (0.02)

4 (0.04)

25

7

9 (0.09)

-

10 (0.1)

-

9 (0.09)

-

9 (0.09)

-

37

8

8 (0.08)

-

10 (0.10)

-

8 (0.08)

-

8 (0.08)

-

34

9

9 (0.09)

-

10 (0.1)

-

9 (0.09)

-

9 (0.09)

-

37

10

9 (0.09)

4 (0.04)

10 (0.1)

4 (0.04)

9 (0.09)

4 (0.04)

9 (0.09)

4 (0.04)

53

11

3 (0.03)

4 (0.04)

.4 (0.04)

4 (0.04)

3 (0.03)

4 (0.041

3 J0.03L

4 (0.04)

29

12

3 (0.03)

4 (0.04)

4 (0.04)

4 (0.04)

3 (0.03)

4 (0.04)

3 (0.03)

4 (0.04)

29

13

9 (0.09)

-

11 (0.11)

-

9 (0.09)

-

9 (0.09)

-

38

14

2 (0.02)

5 (0.05)

6 (0.06)

2 (0.02)

6 (0.06)

1 (0.01)

4 (0.04)

3 (0.03)

29

Total

99

21

122

18

103

17

101

19

500



Hypothesis I

      66
 
TABLE 9: CHI SQUARE (X2) ANALYSIS OF INFLUENCE OF LEVEL OF EDUCATION ON KNOWLEDGE OF MOTHERS ON IMMUNIZATION PRACTICES IN EZZA SOUTH LOCAL GOVERNMENT AREA.

Variables

Yes

No

Total

Non formal education

88 (90.8)

12 (9.2)

100

Primary education

97 (99.88)

13 (10.12)

110

Secondary education

118 (118.04)

12 (11.96)

130

Post secondary education

151 (145.28)

9 (14.72)

160

Total
454
46

500


Probability level 0.05; df 3; cal x2 = 2.41 critical x2 7.82 Since  the  calculated  x2  is  less than  the  critical  x2,  the
hypothesis is to say that mothers level of education attainment have no any significant influence on their immunization practices in Ezza South Local Government Area.

Hypothesis II
  
       67
 
TABLE 10: CHI SQUARE (X2) ANALYSIS OF INFLUENCE OF PARITY ON KNOWLEDGE OF MOTHERS ON IMMUNIZATION PRACTICES IN EZZA SOUTH LOCAL GOVERNMENT AREA.
Variables

Yes

No

Total

0-1

154 (155.72)

16 (14.28)

170

1-4

152 (146.56)

8 (13.44)

160

5 above
152 (155.72)
18 (14.28)


170
Total

458

42

500 


There is no significant influence    of    level    education attainment on the immunization practices of mothers in Ezza South Local Government Area. Probability level 0.05; df 2; cal x2 = 2.339; critical x2 5.99
Since the calculated x2 is less than the critical x2, the hypothesis is to say that mothers parity have no any significant influence on their immunization practice in Ezza-South Local Government Area.

Hypothesis III

  68
 
TABLE 11: CHI SQUARE (X2) ANALYSIS OF INFLUENCE OF RELIGIOUS AFFILIATION ON KNOWLEDGE OF MOTHERS ON IMMUNIZATION PRACTICES IN EZZA SOUTH LOCAL GOVERNMENT AREA?
Variables

Yes

No

Total

Christian religions


121  (117.74)


24  (27.26)

145

Moslem religions

102  (97.44)

18 (22.56)

120

Traditional  religions


101 (101.5)


24 (23.5)
125

Others religions

82 (89.32)


28 (20.68)


110

Total

406

94

500



Hypothesis IV:

69
 
TABLE 12: CHI SQUARE (X2) ANALYSIS OF INFLUENCE OF AGE ON KNOWLEDGE OF MOTHERS ON IMMUNIZATION PRACTICES IN EZZA SOUTH LOCAL GOVERNMENT AREA?
Variables

Yes

No

Total

15yrs-25yrs

99(102)

21(18)

120

26yrs-35yrs

122(119)

18(21)

140

36yrs-45yrs

103(102)

17(18)

120

46yrs above

101 (102)

19(18)

120

Total

425

75

500


Probability level 0.05; df 3; cal x2 = 0.566; critical x2 7.82
Since the calculated x2 is less than the critical x2, the hypothesis is to say that mothers Age have no any significant influence on their immunization practices in Ezza- South Local Government Area.

TABLE 1: TT IMMUNIZATION SCHEDULE FOR PREGNANT WOMEN 
Dose
When to give
Percentage Protection
Duration of Protection
TT1
At first contact or as early as possible in pregnancy
Nil
None
TT2
At least four weeks after TT1
80
3 years
TT3
At least 6 months after TT2
95
5 years
TT4
At least one year after TT3
99
10 years
TT5
At least one year after TT4 or during subsequent pregnancy
99
For life

            However, Akinsola (2002) discussed other communicable disease added by National Programme on immunization (NPI) such as yellow fever, hepatitis B and cerebrospinal meningitis
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