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EFFICACY OF TELEPHONE CALL REMINDERS IN IMPROVING RATES OF ROUTINE IMMUNIZATION SERVICES UPTAKE BY MOTHERS IN TARABA STATE

NURSING SCIENCE PROJECT TOPICS AND MATERIALS

TABLE OF CONTENTS
Title Page – – – – – – – – – i
Certification – – – – – – – – – ii
Dedication – – – – – – – – – iii
Acknowledgement – – – – – – – – iv
Table of Contents – – – – – – – – v
List of Tables – – – – – – – – – viii
Abstract – – – – – – – – – x

CHAPTER ONE: INTRODUCTION
Background to the Study – – – – – – – 1
Statement of the Problem – – – – – – – 9
Purpose of the Study – – – – – – – – 11
Research Questions – – – – – – – – – 12
Hypotheses – – – – – – – – – – 13
Significance of the Study – – – – – – – – 13
Scope of the Study – – – – – – – – 15
Operational Definition of Terms – – – – – – – 15

CHAPTER TWO: LITERATURE REVIEW
Conceptual Review – – – – – – – – 18
– Concept of Routine Immunization – – – – 21
– Routine Immunization Targeted Diseases the Immunization Schedules- 24
– Immunization Uptake:Benefits – – – – 27
– Consequences of Lack/Low Routine Immunization Uptake – – 28
– Need for Improvement of Routine Immunization Uptake – 29
– Strategies for Improvement of Uptake of Immunization Services – – 30
– Reminders and Recalls – – – – – – 32
– Benefits of Reminders and Recalls – – – – – 32
– Benefits of Improving Immunization Uptake Rate – – 34
Theoretical Review – – – – – – – – 35
– The Health Belief Model (HBM) – – – – 35
– Application of the Theory to the Study – – – – 37
Empirical Studies – – – – – – – – 38
Summary of Literature Review – – – – – – – 46

CHAPTER THREE – RESEARCH METHOD
Research Design – – – – – – – – 48
Area of Study – – – – – – – – – 49
Population for the Study – – – – – – – 50
Sample – – – – – – – – – 51
Inclusion Criteria – – – – – – – – 51
Sampling Procedure – – – – – – – – 52
Instrument for Data Collection – – – – – – 53
Validity of the Instrument – – – – – – – 54
Reliability of the Instrument – – – – – – – 54
Ethical Consideration – – – – – – – – 55
Procedure for Data Collection – – – – – – 55
Pre-Intervention Data – – – – – – – – 55
Experimental Group–Intervention – – – – – – 56
Control Group – – – – – – – – – 57
Post Test – – – – – – – – – 57
Methods of Data Analysis – – – – – – – 58

CHAPTER FOUR: PRESENTATION OF RESULTS
Summary of Major Findings 74

CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion – – – – – – – – – 77
Implications of the Study – – – – – – – 84
Limitations – – – – – – – – 87
Suggestions for Further Study – – – – – 88
Summary of the Study – – – – – – – 88
Conclusion – – – – – – – – – 91
Recommendations – – – – – – – – 93
References – – – – – – – – – 94
Appendices – – – – – – – – – 100

LIST OF TABLES
Table 1: Summary of WHO position papers- recommended routine immunization
for children – – – – – – – – 24
Table 2: Nigeria’s Childhood Routine Immunization Schedule – – 25
Table 3: 2 x 2 Factorial Quasi Experimental Design – – – – 48
Table 4: Demographic Characteristics of Respondents – – – 60
Table 5: Pre and Post Intervention Rate of Immunization Uptake in the
Experimental Groups – – – – – – – 61
Table 6: Rate of Completion of the Three Scheduled Immunization Appointments
by Mothers in the Experimental Groups – – – – 63
Table 7: Pre and Post Intervention Rate of Immunization Uptake in the Control Groups – – – – – – – – 65
Table 8: Rate of Completion of the Three Scheduled Immunization Appointments
by Mothers in the Control Groups – – – – – – 67
Table 9: Comparison between the Post-intervention Rates of Uptake of the Experimental and Control Groups Controlling their Rates of Uptake
Pre-Intervention – – – – – – – 68
Table 10: Comparison between the Post-intervention Rates of Immunization
Uptake of the Experimental and Control Groups in the Urban
Community Controlling their Rates of Immunization Uptake
Pre-Intervention – – – – – – – – -69
Table 11: Comparison between the Post-intervention Rates of Immunization
Uptake of the Experimental and Control Groups in the Rural
Community Controlling their Rates of Immunization
Pre-Intervention – – – – – – – – 70
Table 12: Comparison between the post-intervention rates of immunization
uptake of the Experimental Groups’ In the Rural and Urban
Locations Controlling their Pre-intervention immunization rates – – 71
Table 13: Comparison between Post-intervention Immunization Uptake Rates
of the Experimental and Control groups in the Rural and Urban
Locations Controlling their Pre-Intervention Immunization Rates – 72
Table 14: Comparison between the Post-intervention Immunizations Rates of
Uptake of the Control Groups in the Rural and Urban Locations
Controlling their Pre-Intervention Immunization Uptake Rate – – 73

ABSTRACT
The need to improve uptake of routine immunizations by mothers using reminder and recall strategies so as to prevent childhood vaccine-preventable diseases is a global public health concern. Globally, about 1.5 million children still die yearly from vaccine-preventable diseases. In Nigeria, 62.8% children are not immunized while 36.4% of children were partially immunized due to poor uptake. The Taraba State W.H.O. reports for 2011-2014 showed hat uptake of routine immunization was less then 50% in 14 out of the 16 L.G.As as about 87.5% of mothers missed their routine immunization appointments. Previous empirical studies have found that reminding and recalling mothers for their immunization appointments improve their rate of immunization uptake but no such studies have been done in Taraba State. The study was designed to find the efficacy of telephone call reminders and recalls in improving uptake of routine immunization services in Taraba State. Five objectives were formulated, five corresponding research questions posed and five hypotheses postulated for verification. A quasi-experimental research design was used for the study. The instruments for data collection were two pre and post-intervention immunization checklists. Reliability test yielded a co-efficient index of 0.72. The population was 1000 while the sample size was 100 mothers of 0-1 year olds coming for routine immunization at the time of the study. Data was analyzed using descriptive statistics, the McNemar’s test and ANCOVA. The major results of the study were that: the total mean rate of uptake for the scheduled visits for the three antigens by the experimental groups pre-intervention was 1.50+0.71 and 2.74+0.44 post-intervention and for the control groups pre-intervention, it was 1.74+0.53 and 1.98+0.62 post intervention; there was a significant difference between the pre and post-intervention uptake of the experimental groups; there was no statistically significant difference between the rate of uptake of majority of the antigens by the control groups in the pre- and post-invention periods; there was a significant difference in the rates of uptake between the experimental and control groups; there was no significant difference between the uptake of the experimental groups in the rural and urban locations; there were no significant difference between the rate of uptake of the experimental and control groups in the rural and urban locations. Recommendations were that effective current communication strategies like telephone calls used to remind and recall mothers to ensure improvement in uptake of routine immunization services in both rural and urban locations.

CHAPTER ONE
INTRODUCTION
Background to the Study
The need to use immunization reminders and recalls for mothers to ensure continued uptake of routine immunization of their infants cannot be over-emphasized. It has been found that immunization reminder and recall system is one of the effective ways of improving immunization uptake rates (Brown, Oluwatosin&Ogundeji, 2015). Immunization has been defined by the Centre for Disease Control (CDC, 2014) as “an act of introducing a vaccine into the body through vaccination to produce immunity to a specific disease. Schuchat& Bell (2008) posited that immunization is aimed at producing immunity to specific diseases and improving control of vaccine preventable communicable diseases thereby preventing their spread. Immunization can also be defined as the use of vaccines through immunization programmes to enable the body to develop immunity so as to resist vaccine-preventable infections and prevent their spread.

There are various types of immunization. These have been identified by Hamm (2015) as including adult immunization, travel immunization, influenza immunization and routine childhood immunization. Routine childhood immunization according to UNICEF (2015) is one of the most cost-effective public health interventions to date against vaccine-preventable diseases (VPDs) as it averts about 2-3 million deaths and disability of children each year. Castillo (2013) also stated that approximately 29 per cent of deaths of under-5 children are preventable through routine immunization. The vaccine-preventable diseases targeted by routine immunization according to Antai (2012), include infantile tuberculosis, diphtheria, pertussis (whooping cough), poliomyelitis, pneumococcal diseases, rotavirus, vitamin A deficiency, measles, yellow fever and cerebro-spinal meningitis.

However, Offit (2014) observed that approximately 1.5 million children still die each year from vaccine-preventable diseases. Also CDC (2013) hinted that polio is still paralyzing children in several African countries and that more than 350,000 cases of measles were reported from around the world in 2011. Balogun, Sekoni, Okafor, Odukoya et al (2012) observed that about 22 per cent of under-five mortality is still caused by vaccine-preventable diseases in Nigeria even close to the end of the 2015 deadline set aside for the achievement of the fourth Millennium Development Goals (MDGs).The possible reasons for the continued prevalence of VPDs as observed by Gilbert (2012) could be that some vaccines used for immunization are less effective and some communicable diseases are unlikely to be controlled by immunization because of pathogen, host or population characteristics. He also observed that some parents could be complacent and this may culminate in low uptake of immunization by them.

The aim of using vaccination routine immunization to avert VPDs may be difficult to achieve if mothers are complacent about their children’s immunization or they do not present their children for immunization which may make their uptake of routine immunization services low. For instance, UNICEF (2013) observed that out of five infants worldwide, nearly 20 per cent still do not receive the three life-saving doses of diphtheria, tetanus and pertussis vaccine due to lack of adequate uptake of vaccines by mothers for their children and this could make the unreached children defenseless against these killer vaccine-preventable diseases. Also, the World Health Organization (WHO, 2015) observed that in 2013, an estimated 21.8 million infants worldwide did not complete their routine immunizations and 21.6million children in the same age group had not been presented to receive the single dose of measles-containing vaccine due to low uptake of immunization services by mothers. UNICEF (2013) stated that one out of every five infants worldwide still did not receive their complete recommended routine immunization doses in a series. Referring to Taraba State, Ophori (2011) observed that their OPV3 uptake rate was the lowest in the country in 2010 (18.75 per cent). This was collaborated by the yearly routine immunization report for the past four (4) years which revealed that majority of the children (87.5 per cent) who started the immunization schedule did not finish them as shown by the high drop-out rates and that majority of the LGAs performed poorly with regards to uptake of immunization services by mothers. This study conceptualizes a poorly-performing LGA as one that their immunization uptake is below 80 per cent.

 

 

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