AN EVALUATION OF FACTORS INFLUENCING COMMUNITY PARTICIPATION IN IMMUNIZATION
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ABSTRACT
The study aims to assess the factors that impact community involvement in immunisation, with a specific focus on Orlu Local Government Area in Imo State. The study employed a survey methodology to gather data from both community people and health personnel in Orlu LGA. The community members (279) were picked using a convenient sampling method, whereas the health workers (19) were sampled using a purposive sampling method for the study. The data was analysed using frequency tables and mean scores, and the hypothesis was evaluated using the ANOVA statistical tool for social science (SPSS v.23). The study finds that community engagement can be influenced by various factors, including those related to the community itself, healthcare staff, and the specific programme being implemented. Additional aspects encompass the extent of the immunisation scheme, political considerations and stakeholder interests, administration of immunisation tools and resources, level of training provided to healthcare personnel, and remuneration. This study suggests that health personnel should be encouraged to strengthen their collaborative endeavours with both their colleagues and community people across all phases of immunisation initiatives. Furthermore, the Orlu Local Government Area directorate should enhance its efforts in delivering health education to community members regarding immunisation initiatives and the need of actively participating in these activities.
CHAPTER ONE
INTRODUCTION
Background of the Study
The escalating impact of infectious diseases among children under the age of five has prompted a global push for proactive preventative measures. In addition to personal hygiene and environmental sanitation, which have been extensively utilised to decrease the occurrence and prevalence of numerous contagious diseases, the immunisation programme is the predominant and proactive approach to prevent various communicable diseases. This programme involves administering vaccines to young children in order to enhance their immunity, given their susceptibility to such diseases. Immunisation is widely recognised as an effective method for managing and eliminating contagious diseases worldwide. There have been reports of successful eradication of certain severe childhood illnesses. Every country worldwide has a national immunisation programme, and in the majority of developing nations, children under the age of five receive the standard World Health Organization-recommended vaccines that safeguard against diseases such as tuberculosis, diphtheria, tetanus, poliomyelitis, measles, Pertusis, and others.
According to reports from WHO (2020) and UNICEF (2020), immunisations have effectively averted almost 2.5 million infant deaths each year. Immunisation is a crucial approach in attaining the millennium development goals (MDGs), particularly in decreasing child mortality. The immunisation rate of children against measles is a key metric for achieving the health Millennium Development Goals (MDGs) aimed at reducing child mortality and morbidity caused by measles (UN, 2020). It is crucial and necessitates immediate action to identify methods for enhancing vaccine coverage, namely by motivating parents to ensure their children receive complete vaccination.Among all the interventions aimed at infant survival, immunisation has shown to be the most successful thus far. Currently, 6 out of 10 children globally receive a complete vaccination by their first birthday. Therefore, it is crucial to prioritise the observation of the conduct of rural community residents whose children have not received complete immunisation or have not been immunised at all in order to enhance coverage. Community participation is a crucial component in the effective planning, implementation, monitoring, evaluation, maintenance, management, and financing of community programmes. It ensures that these programmes utilise human, natural, and man-made resources to benefit both the present and future generations (Putman, 2020). Community engagement lacks a singular definition; instead, it encompasses a multitude of definitions that differ depending on the level of involvement. Within this spectrum, the concept of "participation" encompasses a range of levels. At one end, there is a form of participation referred to as "co-opted" participation, where community members are merely symbolic representatives and have no influence in the decision-making process. At the other end, there is "collective" action, when local individuals initiate actions, establish agendas, and work together towards a shared goal. The word "community participation" often denotes the act of simply inquiring others about their health need. Key components of planning include delegating the actual planning execution and pretesting programmes. Opinions are often constrained to prefabricated formulas (Brunner, 2019).
Community engagement has been employed in the Expanded Programme on Immunisation initiatives as an established approach for addressing healthcare obstacles. The level of engagement, however, varies from one programme to another. In addition, despite the lack of success of numerous health programmes that were created without the involvement of target communities or groups, certain experts persist in questioning the importance of community members' participation in the formulation, implementation, and evaluation of programmes (Adinku, 2020). Consequently, it is recommended that there be enhanced engagement in two domains: establishing practical expectations between communities and health services regarding their contributions to health, and in the governance of the health system. Discussion between healthcare professionals and communities regarding their individual responsibilities and the necessary technical, resource, and social contributions needed to fulfil them.
Statement of the Problem
Over time, the primary healthcare services in the Orlu local government region have made efforts to involve communities in health-related activities. Evidently, communities were not actively engaging in immunisation programmes as originally envisaged. A significant proportion of healthcare providers have expressed apprehension regarding the underutilization of immunisation services by communities. Facilitating active community involvement in immunisation programmes would empower service providers to effectively reach and vaccinate all eligible children against preventable childhood diseases (Ministry of Health, 2018). Service providers in the Orlu LGA have reported that community members are not attending immunisation services during outreach programmes. Pregnant women, mothers, and carers are also not attending routine immunisation services, despite the fact that immunisation is provided free of charge. Additionally, community members do not seem willing to mobilise and organise for immunisation services. While there have been numerous research on the impact of social and cultural factors on immunisation coverage, there is currently a lack of literature specifically examining the factors influencing community engagement in immunisation within the Orlu Local Government area. The researcher aims to assess the elements that affect community involvement in immunisation.
Aims and Objectives of the Study
The aim of this study is to evaluate the factors influencing community participation in immunization. Specifically, this study seeks:
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To assess the extent of community involvement in immunization in Orlu LGA.
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To find out community related factors influencing community participation in the immunization programme in Orlu LGA.
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To examine health worker factors influencing community participation in immunization programme in Orlu LGA.
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To determine programme-based factors that influence community participation in immunization programme in Orlu LGA.
Research Questions
This research is guided by the following research questions constructed in line with the research objectives:
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What is the extent of community participation in immunization in Orlu LGA?
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What are the community related factors influencing community participation in the immunization programme in Orlu LGA?
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What health worker factors influence community participation in immunization programme in Orlu LGA?
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What programme-based factors influence community participation in immunization programme in Orlu LGA?
Research Hypotheses
Ho1: Educational exposure of community members is not significant determinant of community participation in immunization programmes.
Ho2: Health-worker factors is not significant in influencing community participation in immunization programmes than community based factors.
Significance of the Study
Attaining the desired objective of the immunisation programme necessitates substantial community engagement. Thus, it is imperative for health planners to assess alterations in community self-efficacy or changes in local ability to detect and address challenges encountered by the immunisation scheme. The findings could be valuable to local, state, and federal health planners and policy makers in creating a targeted intervention programme for the local community residents to enhance their access to healthcare services. The study's findings will enhance community members' understanding of the necessity to modify their attitudes towards immunisation initiatives implemented in rural areas, with the aim of improving the quality of life and reducing mortality rates. Moreover, the findings of the study can aid local government vaccinators in developing an inclusive platform for evaluating the local population more effectively.
Moreover, the findings of this study can also raise awareness among all participants in the public health initiative to establish a more inclusive programme with state-of-the-art infrastructure to accommodate all individuals regardless of their residences and geographical areas. This study will contribute to the current literature on factors that affect community engagement in immunisation initiatives. It will also serve as a reference for researchers and academics in the field of health. Finally, it can provide a pathway for the development of more research aimed at increasing immunisation rates in rural areas of Nigeria.
Scope and Limitation of the Study
The findings of this study are derived on a survey that describes the level of community engagement and the factors that influence it in Orlu LGA. Thus, a thorough exploration of community participation may not be undertaken. It is important to exercise caution when making generalisations based on the outcomes and findings of this study, given the data were collected from a limited number of community health workers, specifically nurses, and not medical officers. Moreover, the deliberate and practical methods employed to choose the study participants necessitated meticulous analysis of the study. Furthermore, the data were gathered from a greater number of girls compared to males, as well as a larger proportion of participants with lower levels of education compared to those with higher levels of education. Therefore, it is probable that the conclusions and findings mostly reflect the perspectives of females rather than those of the overall population.
Definition of Terms
Community: This comprised a group of people with similar or near similar socio-cultural or ethnic identities, and values.
Community participation: Is the process by which individuals, families, or communities assume responsibility for their own welfare by contributing actively to planning, implementation of health intervention programmes in their communities (Burns, Heywood, Taylor, Wilde & Wilson, 2022).
Community-based factors: These include factors such as culture, religious beliefs, and attitude of community members that influence the planning and implementation of the routine immunization programmes.
Health worker-based factors: These are the attitude, collaboration or involvement of the community members by the health workers in the community health intervention programmes.
Programme-based factors: These factors include timing of the programmes, dosage of vaccines, the whole structure and implementation of the community health programmes.
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