CHAPTER ONE 

Introduction

1.1 Background of the study

In 1979 Nigeria’s Expanded Programme on Immunization (EPI) was initiated, and was placed within the Department of Public Health and Communicable Disease  1 Control of the Federal Ministry of Health (FMOH) . It was re-launched in 1984 due 2 to poor coverage. In 1996 it became the National Programme on Immunisation (NPI), launched by the then First Lady, Mrs Abacha. Following a review of EPI, Decree 12 of 1997 created NPI as a parastatal. NPI has a sole responsibility of supervising and  2 enhancing routine and supplemental immunisations in Nigeria.   Routine immunisation (RI) is provided largely through the public health system, with significant variations between the 36 States and Federal Capital Territory (FCT); 3 private or NGO providers are the source of up to one-third of RI in Anambra state. Public sector provision is by health staff based at facilities run by the 21 Local Government Areas (LGAs) who have a Primary Health Care Coordinator (PHCC), a Local Immunisation Officer and a Cold Chain Officer. These staff members are under the control of the Head of Local Govt Administration and are employees of the State Government (Ministry of Local Government and Local Government Service Commission).    Routine immunisations are done at the fixed posts in the health centres, health posts, General hospitals and tertiary health facilities in the State. Supplemental immunisations in the State are aimed at boosting the immunisation coverage and 2         2 mopping up missed opportunities. It also becomes imperative in epidemics. These supplemental immunisations are achieved through National Immunisation Days (NIDs), Local Immunisation Days (LIDs), Immunisation Plus Days (IPDs) and Child  2 Health Week.

1.2     STATEMENT OF THE RESEARCH PROBLEM

Since they were first introduced in 1956, immunization activities in Nigeria have been 1 characterised by intermittent successes and failures. The expanded programme on immunisation (EPI) introduced in 1979 with the aim of providing immunisation services to children aged 0 – 23 months, experienced some initial success. However, a few years after the programme started, it became obvious that it was no longer  2 achieving its stated objectives and had to be re-launched in 1984.  As a result of concerted efforts of the Federal Ministry of Health, State agencies, and International Organisations, Nigeria attained universal childhood immunisation (UCI)  2 with 81.5 percent coverage for all antigens in 1990. The success was not to last long and by 1996, immunisation coverage had declined substantially to less than 30 percent for DPT3 and 21 percent for the three doses of oral poliovirus vaccine 2 (OPV). The situation has become even worse since then despite considerable donor and Federal Government efforts to improve the provision and promotion of immunisation services.    Today, coverage rates for the various childhood vaccines in Nigeria are among the 3 lowest in the world. Nigeria is now considered the greatest threat to the global eradication of polio and there is an urgent need to address the problems facing 3 immunisation activities in the country and increase coverage.   Research in other parts of the world has shown that social factors, economic factors, community and systemic factors affect immunisation coverage. These factors are potentially modifiable.  Anambra State, centrally located in the south eastern zone of the Federal Republic of Nigeria is not immune to the catalogue of problems facing immunisation uptake in Nigeria. Since the mid-1990s, Anambra State has continued to witness fluctuations in immunisation coverage for all vaccine-preventable diseases and this has had grave consequences on children’s health and survival. Data from the 2003 National Immunisation Coverage Survey reveal a very gloomy picture with only 12.7 percent of children aged 12-23 months receiving full immunisation service. Of great significance and concern is the emerging status of Nigeria as the country with the highest number of Wild Polioviruses (WPV) in the world. Increased widespread transmission of the WPV was reported in the highly endemic States of Kano, Katsina, Jigawa, Kaduna and Bauchi, while a fresh outbreak of WPV was confirmed in Kebbi. Of epidemiological importance to Anambra State is the recent incident of WPV outbreak in the neighbouring state of Enugu.   Against this background, the goal of this study is to provide data that would assist programme staff and policy makers to design strategic interventions to improve immunisation coverage in Anambra State in particular and Nigeria in general.

1.3      RATIONAL FOR THE STUDY

Routine immunization against DPT, measles, polio and TB is proven to be one of the most cost-effective interventions for reducing childhood illness and mortality, especially with the addition of other vaccines such as CSM and yellow fever in 1 endemic areas and TT injections for pregnant women and yet national coverage in Nigeria for full immunization is less than 13%, one of the lowest rates in the world, 4 even lower than many countries in conflict, such as DRC. Some states in northern Nigeria have coverage rates below 1%, and the average for the whole North West Zone is just 4%. These coverage figures are much worse than in the neighbouring countries of Benin, Niger, Chad and Cameroon. Both the Nigeria Demographic and Health Survey (NDHS 2003), conducted by the National Population Commission, and the Nigeria Immunization Coverage Survey (NICS 2003), conducted by the National 8 Programme on Immunization (NPI), provide the same irrefutable evidence. Nigeria’s performance on routine immunization has continued to decline since the high point achieved around 1990.

Vaccine-preventable deaths

8 In Nigeria, one child in five dies before its fifth birthday. This represented about 872,000 childhood deaths in 2002. Vaccine-preventable diseases (VPDs) account for 4 about 22% of deaths, therefore over 200,000 children a year are dying needlessly of VPDs. Various well meaning researchers have conducted credible studies with a view to unravelling the root cause of this decline in immunisation uptake. This research study in three selected Local Government Areas in Anambra State is at discovering the possible local causes of this decline in immunisation uptake in Anambra State. The result of this research is meant to inform the health policy makers of the state on areas of hence enhance rational resource allocation. The public will benefit from this research as the result when published will show statistically the state of immunisation activities in these selected LGAs.

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