DEPARTMENT OF
HUMAN KINETICS AND HEALTH EDUCATION
TABLE 1: TT IMMUNIZATION
SCHEDULE FOR PREGNANT WOMEN
UNDER ONE YEAR
What are the Immunization Practices Adopted by Mothers in
Ezza-South Local Government Area?
Research Question II
Research Question III
Do Mothers Religious Affiliation Influenced their Immunization Practices
in Ezza-South Local Government Area?
Research Question V
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.
TABLE
10: CHI SQUARE (X2) ANALYSIS OF INFLUENCE OF PARITY ON KNOWLEDGE OF
MOTHERS ON IMMUNIZATION PRACTICES IN EZZA SOUTH LOCAL GOVERNMENT AREA.
TABLE
11: CHI SQUARE (X2) ANALYSIS OF INFLUENCE OF RELIGIOUS AFFILIATION ON
KNOWLEDGE OF MOTHERS ON IMMUNIZATION PRACTICES IN EZZA SOUTH LOCAL GOVERNMENT
AREA?
TABLE
12: CHI SQUARE (X2) ANALYSIS OF INFLUENCE OF AGE ON KNOWLEDGE OF
MOTHERS ON IMMUNIZATION PRACTICES IN EZZA SOUTH
LOCAL GOVERNMENT AREA?
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
|
|
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
|
|
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
|
|
||||
|
||||
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
|
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
|
|
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
|
|
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
|
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
|
|
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
|
|
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
|
|
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
|
|
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:
|
|
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