DETERMINANTS OF ROUTINE IMMUNIZATION COVERAGE AMONG 12-23 MONTHS OLD CHILDREN OF NOMADIC POPULATION IN AKWANGA LOCAL GOVERNMENT AREA, NASARAWA STATE, NIGERIA

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Department of Medicine

ABSTRACT
Routine Immunization coverage is generally low in several parts of Nigeria especially the northern region. It is even lower among people who live in hard to reach areas including nomads. Although the exact figures of RI coverage amongst the nomads are not available. There are many cultural/religious beliefs and also physical barriers such as distance to the health facility and migration which negatively affect immunization services. This study was carried out to assess the knowledge, attitude and practice of routine immunization among mothers of children 12-23 months in nomadic population of Akwanga, Nasarawa state, Nigeria. A cross-sectional descriptive study was conducted in April 2014. A sample of mothers of 501 children of nomads, 12-23 months of age, was selected using the WHO/EPI 30 by 7 cluster sampling technique and data were obtained through a structured interviewer administered questionnaire containing both open and close ended questions. Majority (89.0%) of the caregivers were aware of at least one vaccine preventable disease (polio) in the LGA. More than a fifth (21.8%) believed immunization is for preventive services and 70.1% believed immunization is safe and can be accepted for their children. Despite this, only 6.0% of the children were fully immunized, with 28.1% partially immunized and 65.9% not immunized at all. The BCG coverage was 23.2%, DPT3 24.0%), OPV3 24.2%, Measles 29.7%, HBV3 12.0% and Yellow fever 27.3%. The DPT drop-out rate was 15%. Factors associated with failure to immunize children include caregivers? family movement (nomadic) from one place to another (48.5%), distance to health facility (38.2%), lack of knowledge on routine immunization (23.6%), discouragement against immunization mainly by the husbands/child?s father (6.7%) and xiii personal disapproval by the caregivers (4.8%). The factors affecting routine immunization uptake among the study population are caregivers? age (OR=97.47, C.I=13.12-723.87), the sex of the child (OR=0.05,C.I=0.01-0.19), place of delivery (OR=0.03, C.I=0.01-0.09), distance to the nearest HF (OR=0.002, C.I=0.0003-0.015), and the duration of stay in the current location (OR=21.22, C.I=2.87-157.01).The significant predictors for the routine immunization uptake were caregivers? age (AOR=14.8,p-Value=0.02), the sex of the child (AOR=0.035,p-Value=0.002), and mother?s utilization of ANC services during the index pregnancy (AOR=5.2, p-Value=0.005). Others were the place of delivery (AOR=0.14,p-Value=0.001), the duration of stay in the current location (AOR=20.06,p-Value=0.01), distance to the nearest HF (AOR=0.0006, p-Value=0.0000), and the awareness of the number of visits to HF to complete the RI (AOR=4.77, p-Value=0.004). There is urgent need for sustained awareness campaigns of the importance of immunization and the use of mobile and outreach strategies on migration routes.