INTRODUCTION

1.1 Background to the Study

It is obvious that immunization is one of the most cost-effective public health interventions for reducing global child morbidity, mortality and life time disabilities (Lee, 2003) (Chen et al, 2004). Worldwide, immunization prevents more than 2.5 million child deaths each year (WHO/UNICEF and World Bank, 2009, WHO 2009). Global public health has greatly improved through the widespread use of vaccines, preventing millions of childhood hospitalizations and deaths each year rating immunization as a number one public health intervention (CDC, 2010 CDC 2009). Before the advent of immunization programs, infectious diseases such as measles, diphtheria, smallpox and pertussis were leading causes of child mortality (Stern et al., 2005). Tetanus toxoid vaccine is given to pregnant women to prevent against neonatal tetanus, which can be a major cause of infant deaths (KDHS 2014).

In the United States there has been a remarkable achievement in the control of vaccine preventable diseases resulting in decline in morbidity and mortality associated with vaccine preventable diseases (CDC 2010). In Africa, there has been tremendous improvement in the overall immunization coverage, though at a relatively slower rate (WHO 2004, WHO 2014). However, some African countries like Ghana, Morocco and Gambia have registered success in reaching coverage of over 90% (Ghana News Agency 2012, WHO 2014, UNICEF, 2014). The introduction of the immunization programme has led to continual reduction of vaccine preventable disease incidence.

Despite the remarkable achievements and improvements in immunization services, the agenda remains largely unfinished with large numbers of children (24 million) remaining unreached, unvaccinated or under-vaccinated (WHO, UNICEF & World Bank 2009). One-fifth of the world’s children which is about 22.4 million infants, are not immunized against VPD and 70 percent of these children come from 10 countries, Nigeria being one of them (WHO/UNICEF 2014), (UNICEF/WHO 2011), (UNICEF Australia 2013). One of the causes of high mortality rates in Nigeria are vaccine-preventable diseases. Previous studies have explored factors associated with implementation of childhood immunization programs, however most of these studies focused on the demand side factors. Some of the most cited demand-side factors that have been shown to influence functioning of immunization programs include parity, household income, ethnicity, place of delivery, mother’s level of education, distance to health facility, culture, religion, age and forgetfulness of guardian due to preoccupation with other activities, (Abdulraheem et al 2011.,Bbaale, 2013,Barman et al, 2009)(Bates, 1994)(Calhoun et al., 2014)(Kariuki, 2004) Mutua et al., 2011, Maina et al,. 2013, Ndiritu et al. 2007, Njeru, 2011, Ophori et al, 2014, Odusanya, et al 2003). There are relatively few studies examining supply-side factors affecting implementation of childhood immunization programs in the Nigerian context, particularly in predominantly rural areas. This study aims to fill this gap. The relatively poor health indices and large size of the county makes it a reasonable choice for understanding the factors affecting implementation of immunization programs in primary healthcare facilities in Nigeria.

1.2 Statement of the Problem

Immunization program is a key strategy for prevention of child and neonatal deaths and lifetime disabilities. Immunization prevents 2.5 million child deaths each year (WHO, 2009). Despite the global improvement in vaccine coverage that has seen 84% of children around the world receiving this life-saving intervention, 10 million children in low and middle level countries die before reaching age of five (Arevshatia et al, 2007) (WHO 2014). Full immunization potential has not yet been realized in many countries where 22.4 million Children around the globe are not fully immunized. Majority of not fully immunized children 70% are from 10 countries, Nigeria being one of them (WHO/UNICEF 2014). Low immunization coverage remains a challenge even in a committed country like Nigeria. This study sought to identify intervention targets for improving immunization coverage by investigating factors affecting the implementation of immunization in Jere Local Government Area of Borno State, Nigeria. The focus was to identify factors contributing to missed immunization and ways to reduce the number of missed opportunities for immunization at the health facilities. Much effort has been made to provide vaccines through the GAVI alliance, enabling states to acquire the recommended vaccines. In Nigeria for instance, vaccines are made freely available to the public, yet over 20 percent of Nigerian children are not immunized each year. There is a need to identify strategies for improving implementation of vaccination programs in the country, particularly at primary health care level in predominantly rural areas and this study aimed to fill this gap.