Abstrakt

Immunization coverage and its determinants in urban and rural populations of South-Eastern Nigeria.

Omeaku Maris,Onuoha Franklyn, Achigbu Kingsley

Background: Immunization against childhood Vaccine Preventable Diseases (VPDs) is an important public health intervention which averts an estimated 2-3 million deaths annually. Despite this and disproportionately too, nearly one in five children miss out on basic vaccines. Aim: This study aimed to contribute towards achieving the global vaccine action plan, a framework to prevent millions of deaths by 2020 through equitable access to existing vaccines; by determining the immunization coverage of eight childhood VPDs among children 0-11 months (under-one), in the urban and rural populations of south-eastern Nigeria.

Methods: A cross-sectional community based descriptive study was conducted in Ideato North Local Government Area (LGA) and Owerri municipal council of Imo State, south-east Nigeria. This covered the period from January 2013 to December 2017. Ideato North LGA represented the rural community while Owerri municipal council represented the urban community. A modified WHO-expanded programme on immunization cluster sampling methods were used for household selection using a sample design for multiple levels of geographic hierarchy. After adjustment by using finite population correction formula with addition of 10% non-response rate and design effect of 2.3, the minimum sample size was 590 children and their corresponding mothers/caregivers, 295 (50%) per LGA. Data was collected using a pre-tested interviewer administered questionnaire, focused group discussions, documentation of findings from the immunization cards and review of existing records in the National Program on Immunization units, public health care departments of the LGAs of study. Factors associated with full immunization coverage were identified following bivariate analysis. Independent predictors were investigated by controlling for possible confounders and level of significance was set at p-value of 0.05.

Results: More than three fourths (81.1%) of the children were fully immunized by immunization card-plus history with immunization coverage of 129.4% by review of records, in the urban LGA. In the rural LGA however, only 18.9% of the children were fully immunized by immunization card-plus history and 0% from the review of records. Maternal education level, methods of data cataloging, place of residence, socio-economic class and maternal health care utilization were observed as factors significantly associated with full immunization.

Conclusion: Immunization coverage of infants in the urban community gets improvement towards the WHO target goal of 90% that of the rural community was abysmally poor. Salient areas need improvement and concerted efforts need be made to improve immunization coverage in the rural communities of Imo State, Nigeria.