CHARACTERISTICS OF NON-COMPLIANT HOUSE-HOLDS DURING NATIONAL IMMUNIZATION PLUS DAYS

(A CASE STUDY OF SOKOTO STATE, NIGERIA)

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Author

Presented To

Department of Medicine

ABSTRACT
In1989, World Health Assembly (WHA) resolved to eradicate poliomyelitis from the world by year 2000. By 2008 only 4 countries were still endemic for Wild Polio Virus (WPV) namely Nigeria, India, Pakistan and Afghanistan. Nigeria the only African country still endemic for polio exported WPV to neighboring countries previously declared polio free. To break WPV transmission, Nigeria adopted Immunization Plus Days (IPD) a strategy used to deliver OPV (Oral Polio Virus) together with other vaccines as well as other child survival health interventions. Refusal of vaccination by parents or guardian of children eligible for polio vaccination (Non compliance) threatened to undermine polio eradication drive. This study was constructed to determine the socio-demographic correlates of non-compliant households during IPD as compared with controls in Sokoto north and Sokoto south of Sokoto state and to compare the knowledge, attitude and practice on IPD of heads of non-compliant house-holds and that of their controls. Finally an assessment for other risk factors associated with non-compliance in Sokoto north and south LGA was done The study was case-control with 124 study participants (62 cases and 62 controls). Cases were defined as “House-hold refusing OPV vaccination in last three rounds of IPD in Sokoto north and south local governments”, while controls were “House-holds to the right of the cases allowing OPV vaccination”. Study participants were interviewed with a pre-designed questionnaire with sections on socio-demographics, media habits, knowledge of IPD, and reasons for refusal A total of 130 interviews were conducted out of which 9 were disqualified. The mean age of cases (47.7years) and controls (44.3 years) were similar (χ2 = 1.81, p=0.179, df = 1). Cases were more likely to lack tertiary education OR=3.74 (1.55-9.15), but religion, age and type of marriage was not statistically significantly different among the cases and control. A total of 45 cases and 14 controls lack knowledge of the benefit of immunization which was shown to be a statistically significant difference OR=35.32 (9.75-141.18). Cases were also more likely to lack knowledge of Global nature of polio eradication OR= 18.98 (6.91-54.09) and knowledge of other childhood survival strategies attached to Immunization Plus Days (IPD). Cases were more likely to have a negative attitude towards OPV OR=22.4 (7.11-75.56) and believe that government promote IPD for selfish interest OR=4.36 (1.81-10.67). Cases were significantly more likely to lack access to functional television and radio and source there information from town criers It was concluded that lacking tertiary education was a risk factor for non compliance and that non compliant house hold heads had unsatisfactory knowledge and negative attitude towards IPD. There was a general lack of knowledge among them about the global nature of polio eradication initiative and they also have insufficient knowledge about other IPD initiatives for child survival. Sourcing information about IPD from town crier and lacking access to functional radio and television were other risk factors associated with non compliance. Majority of the controls who were previously not vaccinating their children were convinced to start accepting polio vaccines by the persuasiveness of their traditional rulers. I recommended that community dialogue targeted at identified high risk group precede every round of IPD. Involvement of traditional rulers and religious leaders should be scaled. Communication message of the town criers should be standardized and the town criers trained in communication skills.