FACTORS RESPONSIBLE FOR NON ACCEPTANCE OF IMMUNIZATION IN SHANAWA VILLAGE OF SHINKAFI LOCAL GOVERNMENT ZAMFARA STATE  CHAPTER ONE INTRODUCTION 1.1 Background to the Study View globally, vaccines are the most cost effective medical intervention to prevent death occurrences and disease related sickness (Word Bank, 2011). Therefore, immunization is the gateway to healthcare for all children who are at risk of disease. Immunization is a great public healthcare concern worldwide especially among young children (World Bank, 2000). It is in response to life threatening disease among young children that the World Health Organization (WHO) in 1974 set up a special program known as Expanded Programmed on Immunization (EPI) which was adopted in Nigeria as Federal Ministry of Health Policy code named National Programme on Immunization (NPI) on 1st September 1985. It is major objectives was to immunize all the children and particularly those under five years old against six killer disease which the WHO, United Nations International Children Education Fund (UNICEF) and various non-governmental organization have committed themselves to participate in the NPI exercise. The expanded program on Immunization was created in 1979 and achieved over 60% coverage with all vaccine by 1990. However, in 2006 the national coverage had declined, to 35% for third dose of diphtheria, pertusis and polio (USAID, 2008). The vaccination program is a typical example of public health measures. It has many qualities and it is an essential measure which may prevent the death of large number of children it improves the qualities of lives of many children by avoiding the physical disabilities (FMOH, 2008). Overall worldwide, immunization coverage in developed country has developed considerably during these past decade. WHO reported that immunization coverage maintain 90% immunization coverage in 2006 (WHO, 2008) and millions of death were avoided as a result of immunization during the period. Despite this advances, disease that are preventable through immunization remain major public health problem in many developing countries, by the end of the twentieth century, researchers established that in the developing world, more than 3 million children still died annually from measles, neonatal tetanus and pertusis while more than a quarter of a million were cripple by poliomyelitis annually (Henderson, 2009). Speculation made by people are that this may be due to either religious, economics, or other social reasons like the belief that says to have the disease is better than immunization among people (TBA, 2008). There could be many reasons for this persistence such as lack of knowledge allegation of secrete agenda in immunization, parent misconception that immunization are fuelled by western countries determine to impose population control on local Muslim communities and mothers pre-occupation with other test to take their children for immunization (TBA, 2008). According to Obadare (2005) in Nigeria, just as the campaign by WHO to kick polio out of Nigeria was at the Zenith, the Supreme Council for Islamic Affairs (SCIA), the Umbrella body of Nigeria Muslims claimed in 2003 to have learnt from some internet website that oral polio vaccine had been deliberately contaminated with carcinogenic anti-fertility and HIV/AIDs including pathogens. Immunization is basically a way of boosting up or building immunity against a disease via vaccination. Immunization is coordinated and controlled by National programme on Immunization (NPI) this body has been suffering recurrent setbacks due to many factors which will be discussed in this article (WHO, 2010). At the end of 2011, Nigeria was estimated to have a population of 167 million. The expanded programme on immunization (EPI). Introduced in 1978 with the aims of providing routine immunization to children less than the age of two years, recorded initial but intermittent successes. The optimal was recorded by the early 1990 with the country achieving a universal childhood immunization coverage of 81.5% but since that period of success, Nigeria has witnessed gradual but consistent reduction in immunization coverage which is perceived as a problem. By 1996, the national data showed less than 30% coverage for all antigens, and this decreased to 12.9% in 2003. This figure which is consistent with the 2003 national immunization coverage survey figures is among the lowest in the world and explains the poor health status of children in the country. It is the worst in the West African sub-region, only better than Sierra Leone. For instance, the polio epidemic in Nigeria is the worst in the African region and constitutes threat to other nations. Immunization and vaccination is necessary in order to reduce mortality and morbidity rate in the country. Over two million deaths are delayed through immunization each year worldwide. Despite this fact, vaccine preventable disease remains the most common cause of childhood mortality with an estimated three millions deaths each year’s (WHO, 2014). 1.2 Statement of the Problems An assessment of immunization services in Nigeria by international comparative data revealed that immunization is still low in Nigeria. Parent (includes members of minority/ethnic population and members of low socioeconomic status) of children age 2 and under, or couples who are thinking about having to have 90% vaccination coverage of all recommended vaccine preventable diseases for infant under the age of 2 years. This is particularly important for parent that faces multiple barriers to timely immunization (UNICEF, 2010). The optimum level was recorded earlier with the country achieving universal childhood immunization coverage of 81.5% but since that period of success, Nigeria has witnessed gradual but consistent reduction in immunization coverage. Immunization against childhood disease such as diphtheria, pertussis, tetanus, polio and measles is one of the most important means of preventing childhood morbidity and mortality. Achieving and maintaining high level of immunization coverage must therefore be a priority for health system (WHO, 2014). This research is therefore interested in finding the extent to which these cultural values and religious beliefs affect the response to immunization exercise in Nigeria, in general the issue of non acceptance of immunization cannot be attribute to one factor alone, hence it is a problem that need investigation. Therefore this study set to assess the factors responsible for non-acceptance of immunization in Shanawa village of Shinkafi Local Government of Zamfara State. 1.3 Significance of the Study At the end of this study, it is expected that the child mother, community and government will benefit from this study. The benefit of the study to the child There is increasing recognition that the first few years of a child life are a particularly sensitive period in the process of development. Laying of foundation in childhood and beyond for cognitive functioning, behavioural, social and self-regulatory capacities and physical health. Benefit of the study to the mothers The parental benefit is economic support to parent to help them care for their children. There are both whole and temporary parental benefits available. The parents also explore the continuous evidence that children of working mothers receive many educational, social, physical wellbeing and economic benefit. Benefit of the study to the Community The benefit to the community is to improved service delivery, home visit and community orientated primary healthcare. It also improved communication with patient and enhanced professionalism of the healthcare practitioners. The students also become involved in community upliftment project, there by acting as agent of change in these communities. Benefit of the study to the Government The benefit to the Government is to provide free education for those who cannot afford. It also provides physical health and wellbeing, food, clothes to children in other to improve their education. 1.4 Objective of the Study The aim of this study is to assess the factors responsible for non acceptance of immunization in Shanawa village of Shinkafi Local Government of Zamfara State. To achieve this aims, the following objectives are formulated; To access the level of awareness on importance of immunization among people in Shanawa village of Shinkafi Local Government, Zamfara State. To identify the factors responsible for non acceptance of immunization in Shanawa village of Shinkafi Local Government, Zamfara State. To find out the ways to improve the acceptance of immunization in Shanawa village of Shinkafi Local Government, Zamfara State. 1.5 Research Question What are the levels of awareness on importance of immunization among people in Shanawa village of Shinkafi Local Government? What are the factors responsible for non-acceptance of immunization in Shanawa village of Shinkafi Local Government? What are the possible ways to improve the acceptance of immunization in Shanawa village of Shinkafi Local Government, Zamfara State? 1.6 Scope of the Study The study is focused only on the factors responsible for non-acceptance of immunization in Shanawa village of Shinkafi Local Government, Zamfara State. 1.7 Operational Definition of Terms Factors: this can be defined as something that helps produces or influence a result. It can be refer to anything that cause something to happen. Immunization: This is a method of inducing immunity to protect person from being infected. Non-acceptance: Disagreeing to an offer on offer of immunization which is determined to a large extent by the preventing valves and practices of the people.  CHAPTER TWO REVIEW OF RELATED LITERATURE 2.0 Introduction This chapter was discussed under the following heading Concept of immunization Level of awareness on the importance of immunization among people Theoretical of some related literature Summary of some related literature 2.1 Concept of immunization WHO (2016) estimated that every year more than ten (10) millions children in low and middle income countries die before they reach their birthday. It is also said that over 60% of 129 million children death in the world each year, are caused by pneumonia, diarrhea disease or vaccine preventable disease (measles, diphtheria, whooping cough, poliomyelitis, tuberculosis and neonatal tetanus), or by some combination of the three. According to WHO 2010 the child survival strategies and intervention are in time with number four (4) of the millennium development goals which focus on reducing child mortality by 2/3 of children less than five (5) years before the year 2015. This agreement was made by 188members leader of the united nation in the year 2000. There are many factors that contribute to infant and child morbidity and mortality. Many of these deaths can prevent through health intervention programs such as immunization. Immunization is one of the major public health intervention for reducing morbidity and mortality of children. In 1974, the world health assembly (WHA) created a program called the expended programmed on immunization (EPI) to cover the immunization by all children in the world by the year 2000. It is an essential element of WHO strategy to attain health for all by the year 2015 (WHO, 2015). Nigeria federal ministry of health (FMOH) launched a program, called national programme on immunization which began in 1984 to immunize every child under five (5) years of aged, in addition, the number of immunization site was increased from national to state and from state from the local government area level’ the EPI was however faced with many obstacles such as incomplete immunization and rejection of vaccines by some communities (Grant, 2008). However effort to immunize children has been meet with a number of setbacks. Some of these setbacks in immunization coverage related to a number of factors such as level of sensitization by heath workers and lack of political leaders to mobilize and support immunization services (Waisbord 2009). According to world health organization (WHO) 2017 immunization is the process whereby an individual respond to immune or resistant to a particular infectious disease, by the administration of vaccine. According to national program on immunization (2009), immunization is also known as vaccination or inoculation is a method of stimulating resistance in the human body to specific disease using micro-organism such as bacteria, virus that weakened or killed. IMPORTANCE OF IMMUNIZATION: Vaccine:- are responsible for the control of many infectious disease that were once common in the country. Vaccine prevent disease in the people who receive them and protect those who come in to contact with un-vaccinated individual. Vaccine are effect in eradicating disease such as small pore which had been eradicated in Nigeria. Vaccination:- is one of most effective tools ever created to help people live longer and have healthier lives. Immunization:- Is a tools use in public health intervention to protect the population against infection disease (Adewole, 2011). According grant, (2008) immunization is the cheapest technology that can prevent children from dying by these deadly disease of childhood while improved standard of living is a contributing factor that can reveal the severity of these disease. Immunity:- this is ability of the body to resist infections. Immunity is said to occur when there are sufficient antibodies within the body to prevent the successful invasion particular type of disease or pathogen (WHO, 2008). Types of immunity:- there are two types of immunity which are natural acquired immunity and artificial immunity. Natural acquired immunity:-it can be passive or active, the natural active immunity can be due to clinical disease or sub clinical infectious. The individual acquires immunity is against the disease after he/she has suffered from the disease e.g long life immunity is acquired against measles after the individual has suffered the disease (WHO 2008). The natural acquired immunity is a form of immunity that mother passes to her baby or inherited by the member of the same racial group. The individual play no role in the production of antibodies. They already made antibodies formed in the mother is transferred to the baby through the placenta e.g baby acquire passive immunity against measles while in the uterus, which protect the baby after delivery until the baby is 9 month. (Christopher, 2013). Artificial immunity:-can be active or passive. Artificial immunity. These types of immunity are the response of the body to injection of a suspension of killed or alternated micro-organism or by injection of toxins tetanus taxied. Artificial passive immunity:- this is achieved by injection of animal human serum with an already formed immunity into a susceptible host for protection e.g anti tetanus serum (ATS). National program on immunization target disease and their vaccine.  IMMUNIZATION SCHEDULE TABLE (MALAMA HADIZA MUSTAPHA, 2016 Type vaccine Against When given Site Dosage Storage BCG, OPVo, HEPBo Tuberculosis, poliomyelitis hepatitis. At birth Intradermal, left upper arm, orally, left upper outer thigh, intramuscular. 0.05mls 2drops 0.5mls 2+8oc OPV 1, PENTA 1, PCV1 Hepatitis, DPT HIB poliomyelitis At 6 weeks Orally, left upper outer thigh 2 drops 0.5mls 2+8oc OPV 2, PENTA 2, PCV 2 Hepatitis, DPT HIB poliomyelitis At 10 weeks Orally, left upper outer thigh 2 drops 0.5mls 2+8oc OPV 3, PENTA 3, PCV 3 Hepatitis, DPT HIB poliomyelitis At 14 weeks Orally, left upper outer thigh 2 drops 0.5mls 2+8oc Vitamin a Blindness At 6 month Orally 2,000 iii 2+8oc Measles vaccine Measles At 9 m0nth Subcutaneous left upper arm 0.5mls 2+8oc Yellow fever vaccine Yellow fever at 12 month Subcutaneous right upper arm 0.5mls 2+8oc MMR vaccine Measles mumps rubella, chicken pox (optional) At 15-18 month Left upper thigh intramuscularly 0.5mls 2+8oc Meningitis and typhoid fever vaccine (optional) Meningococcal neisseria meningitis and typhoid fever At 24month Left upper thigh intramuscularly 0.5mls 2+8oc 2.2 Level of awareness on importance of immunization among people in Shanawa. Immunization is an importance part of ensuring that public health is protected and maintained, when educating or obtaining individual information about the importance of immunization, start by explaining the basic of the process. Be clear about what immunization is and how vaccine can people healthy. Plays videos, posters and pamphlets to helps people understanding the immunization process and the consequence of not getting immunized (Chrism 2017). Immunization is important for decreasing mortality and morbidity due to other disease as covered under immunization the opportunity presented by the selected cohort of under five children being brought to study the knowledge level of accompanying people about immunization. Nearly two thirds of the subjects ware mother or father of under five children. It was found that the proportion of respondent who were aware about various aspect of immunization was quit low (Sign, 2015) had found in his study that mothers had fair knowledge regarding that it prevent. A UNICEF report had identified “care givers not knowing the value of vaccines and times and place of administration as the top challenge to immunization programmed worldwide. A declining trend in awareness about disease covered under immunization was observed, especially the age at which the vaccine is administered. The only exception was tuberculosis; the awareness about it was lower, probably because we ask about “tuberculosis” not BCG. However, this is in self may be a significant finding that may people do not associate BCG with the disease, it is actually meant for. This should be made a component in the training of health personal being posted at the community and any health care facility. Good ideas to promote immunization can also be adopted from other countries of the world. For example, USA has a national immunization awareness month (NIAM) each year to increase awareness about immunization (United Nation 2014). Each summer, the national public health information coalition (NPHIC) highlights the importance of vaccines and why people of all ages should stay up to date. Getting immunized not only protect you from getting a serious or life treating disease but it also helps protect others who are not eligible for vaccination due to certain factors like illness, age, pregnancy, or allergic reaction. Four reasons to get vaccinated. Reduce the risk of contracting serious disease. Prevent passing on a serious disease to the friends or loved ones. Help to protect those who can’t get vaccinated. Avoid the medical cost of getting sick. A research conducted by Samanta (2018), on factor responsible for acceptance of immunization in Janyo village “using 200 population and using structured questionnaire as a tool for data analysis. He finagled that 59% of the respondent have personally benefited from the development of vaccine over the last 50 years, compared to 75 of respondent stated ten years earliest in the survey, 71% of respondent states that they believed it is very important for parent to vaccinate their children an 11 percentage point decrease from when the same question was asked ten years ago these data point to the need for vaccine researchers and advocated to engage and educate the public about the value of immunization. 2.3 Factors responsible for non acceptance of immunization A researchers conducted by Gandi (2015); on perceived effects of lack of knowledge in non acceptance of immunization in “Jauri village”, he resulted that there are some factors which affect the acceptation of immunization which are pronounced in northern part of Nigeria through other part of Nigeria. Equally the most common factors which prevent the acceptance of immunization in any research area as follows, cultural factors, religious factors, socio economics factors, ignorance, poverty. A research conducted by Lombard (2017), on possible ways to improve acceptance and utilization of immunization in Kazaure, He says that some of the major challenge are poorly articulated and coordinate policy on poverty reduced poor funding of poverty reduction programmed, inadequate rural intra structure such as electricity and road, with attributes we believe that poverty have an influence on parent not to accept immunization. Behavior and attitude of some health personnel;-behavior is a way somebody behave at a particular situation some health personal behave negatively and some collect some money from parent during immunization. Some health, personnel fails to cover some area where suppose to be covered because of their laziness and personnel interest, most of the health ministry employed people that are not health oriented. (John 2014). A research conducted by John (2012), he finalized that behavior of personnel will promote the non acceptance of immunization because these personnel sometime they dispose the vaccines and records untrue data. Therefore behavior of vaccinator has promote the parent not accept the immunization. Poor communication/language barrier:- a physician nurses/midwifery and other providers of primary health care have a unique opportunity to educate parent. See them as the most information about immunization, but if they (i.e physician nurses/midwifes and other primary health care provides) disseminated information wrongly, this will cause short coming of parent to immunize their children. Sometime language barrier occurs when the health care provider who are responsible to administer the does or the vaccine to the children in a community where by the people can communicate with other health providers in an official language, this slow down the exercise, but the federal government should be able to make health staffs and lady workers (LHWS) in the immunization team and post campaign reviews involving zonal visitors at every meeting might help to ensure their accountability (valley adverse effect following immunization) AEFI as vaccine, further more technological advances and continuously increased knowledge about vaccines have lead to investigation focused on the safety of existing which sometimes created a climate of concern. Allegation regarding vaccine related adverse effects that are not rapidly and effectively cause death, which can undermine confidence in vaccine and ultimately have dramatic consequences for immunization coverage and disease incidence alternatively vaccine associated adverse effect healthy individuals and should be promptly identified to allow addition research and appropriate action to take place. 2.4 Possible ways to improve the acceptance of immunization the conventional strategy: The conventional prolonged strategy has succeeded in eradicating some disease from large part of the world this strategy involves in maintaining high coverage of vaccine with at least three dose of live oral polio vaccine, providing supplement at rounds of vaccination establishment an effective mechanism for surveillance of acute fluid paralysis (AFP) and house to house immunization “map up” carried out at the final stage in limited time. High level political advocacy and mass mobilization been used to optimum benefits in this program, simple management like non monitory incentives should be used to large extent, supplementary immunization activities, house to house activities and enhance surveillance should later include to the program (WHO, 2016). Effort should be made to maintain and increase the current immunization coverage to reach the indented target. Supervision and monitoring of the rural population in routine should be  To Get The Complete Material Contact: Phone No.: 07036865010 07086898644 07050702793 08141967126 Gmail: abdullateefmusliu1@gmail.com, greenmoney2029@gmail.com 19