AN EVALUATION OF FACTORS INFLUENCING COMMUNITY PARTICIPATION IN IMMUNIZATION: A CASE OF ORLU LOCAL GOVERNMENT AREA, IMO STATE

CHAPTER ONE

INTRODUCTION

Background of the Study: The increasing effects of communicable diseases among young children of under five years of age has led to the aggressive process of prevention all over the world. Apart from personal hygiene and environmental sanitation that have been copiously employed to reduce the incidence and prevalence of many communicable diseases, immunization programme is the most common and active strategy to prevent many communicable diseases with the use of vaccines to build immunity among young children because of their vulnerability. Immunization has been said to be a proven tool for controlling and eradicating communicable diseases all over the word. It has been reported that a number of serious childhood diseases have thereby been successfully eradicated. All countries of the world have national immunization programme, and in most developing nations of the world, children under age five years are immunized with the standard World Health Organization recommended vaccines that protect against diseases like: tuberculosis, diphtheria, tetanus, poliomyelitis, measles, Pertusis, among others. WHO,(2020) & UNICEF, (2020) have reported that the vaccines have prevented more than 2.5 million deaths among children annually. Immunization is one of the key strategies to achieve the millennium development goals (MDGs) specifically to reduce child mortality. The proportion of children immunized against measles is one of the indicators of health MDGs target for decreasing the child mortality and morbidity from measles (UN, 2020). It is therefore pertinent and requires urgent attention to find ways of increasing vaccination coverage and particularly to encourage parents to have their children fully vaccination.

Of all the child survival interventions, immunization generally has the greatest success thus far: 6 out of 10 children worldwide are now fully vaccinated by their first birthday. It is therefore imperative to focus attention on the behaviour of rural community dwellers whose children have not been fully immunized or not immunized at all to increase coverage. Community participation as a developmental strategy is an important cog in the wheel of ensuring that community programs are well-planned, implemented, monitored, evaluated, maintained, managed, and financed for the benefit of the current generation and future generations, using human, natural, and man-made resources (Putman, 2020). There is no single definition of community engagement; rather, there are a plethora of definitions that vary based on the degree of participation. In this continuum, "participation" spans from minor or "co-opted" participation, in which community members serve as token representatives with no say in decision-making, to "collective" action, in which local people start actions, set agendas, and strive toward a common objective. The term "community participation" is frequently used to refer to merely asking people about their health needs. Delegating the actual planning execution and pretesting programs are key components of planning, and opinions are frequently limited to prepackaged formulas (Brunner, 2019).

Community participation has been used in the Expanded Programme on Immunization activities as a proven strategy for tackling healthcare challenges. The quality of participation, on the other hand, differs from program to program. Moreover, despite the failure of many health programs that were developed without the input of target communities or groups, some experts continue to dispute the relevance of community members' participation in the development, implementation, and evaluation of programs (Adinku, 2020). As a result, it is advocated that involvement be improved in two areas: setting realistic expectations between communities and health services in terms of their contributions to health and in health system governance. Dialogue between health-care providers and communities about their respective roles and the technical, resource, and social inputs required to fulfill them.

​​​​​​​Statement of the Problem

Over the years, the primary healthcare in ORLU LOCAL GOVERNMENT AREA, IMO STAT  have worked to engage communities in health-related activities. it became obvious that communities were not participating in EPI programs as intended. The majority of health-care providers expressed concern that communities do not use immunization services. Effective community participation in EPI programs would enable service providers to reach every eligible kid in the EPI program and fully immunize them against childhood immunizable illnesses (Ghana Health Service, 2018).

According to reports from service providers in the Elmina sub-District on community participation, (a) community members do not come for EPI services during outreach services, (b) pregnant women, mothers, and care givers do not come for routine immunization services as expected despite the fact that immunization is free, and (c) community members do not appear to be ready to mobilize and organize (Elmina Urban Health Centre, 2021; 2018).

Although severalstudies abound on social and cultural factors affecting immunization covereage, in recent time tim thr is death on literature regarding determinant s of community participation  in immunization  with reference to Orlu Loal Government. Upon this premise the researcher seeks to evaluate factors influencing community participation in immunization (a case of Orlu Local Government Area, Imo State.

​​​​​​​Aim & Objective of the Study

The aim of the study is in an evaluation factors influencing community participation in immunization (a case of Orlu Local Government Area, Imo State. Specifically, th study objectives seeks:

1. To assess the extent of community member's  involvement in EPI in Orlu. Local government, Imo state.

2. To find out  community related factors influencing community participation in the EPI programme in  Orlu. Local government, Imo state.

3. to examine health worker factors influence community participation in EPI programme in in  Orlu. Local government, Imo state.

4. To determine programme-based factors influence community participation in EPI programme in in  Orlu. Local government, Imo state.

1.4 Research Questions/Hypotheses

the research is guided by th following research questions constructed in line with the research objectives

1. What is the extent of community member's  involvement in EPI in Orlu. Local government, Imo state?

2. What are the community related factors influencing community participation in the EPI programme in  Orlu. Local government, Imo state?

3. What are the health worker factors influence community participation in EPI programme in in  Orlu. Local government, Imo state?

4. What are the programme-based factors influence community participation in EPI programme in in  Orlu. Local government, Imo state?

Hypotheses

1.Educational exposure of community members is not  significant determinant of community participation in EPI programmes.

2.Health-worker factors is not  significant in influencing community participation in EPI programmes than community based factors.

1.5 Significance of the Study

The EPI programme needs high community participation in order to achieve its expected goal. Therefore it is vital for health planners to measure changes in community self-efficacy or changes in local capacity to identify and solve problems facing the EPI programme. The findings may be useful to the local, state and federal health planners and policy makers in developing special intervention programme for the Local community dwellers to improve accessibility to health care services.

To community members, findings of the study will ehelp increase their awareness on the need for change of attitude to immunization programmes introduced tocommunities for the betterment of rural lives and alleviate mortality rate

Additionally, The result of the study may assist the vaccinators at the local government level to design a comprehensive forum through which the local dwellers can better be assessed.

Furthermore, The result of this study may also create awareness for all collaborators in the public health project to develop a more comprehensive programme with up-to-date facilities to cater for all citizens irrespective of their dwellings and location.

Empirically, this study will therefore add to the existing literature on factors that influence community participation in the EPI programmes,  serve as as reference material  for researchers and acadmia in the field of health . Lastly it may create an avenue through which further studies can be designed for the purpose of boosting immunization coverage in rural communities of Nigeria.

1.6 Scope and Limitation  of the Study

The results of this study are from survey describing community participation and factors influencing it in Orlu Local Government. Therefore, community participation may not be explored into detailed. Caution should also be taken in making generalization based on the results and findings from this study since data were collected from few community health workers such as nurses and not medical officers. Furthermore, the purposive and convenient procedures used for selecting the study participants called for careful interpretation of the study. In addition, data were collected from more females than males, more low educated participants than higher educated ones. Thus, the results and the findings are likely to represent the views of females rather than that of the general population.

1.8 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.