How Religious and Cultural Values Influence Polio Immunization Uptake in Northern Nigeria - Literature review Example

How Religious and Cultural Values Influence Polio Immunization Uptake in Northern Nigeria? Table of Contents 0. Literature Review 3 1. A Brief Overview of Polio Immunization Uptake in Northern Nigeria 3 1.2. Problem Formulation 4 1.2.1. Polio Immunization With Regard To Northern Nigeria 4 1.3. Literature Search 8 1.3.1. Influence of Religious and Cultural Values on Polio Immunization Uptake in Northern Nigeria 8 1.4. Evaluation of Findings 13 1.4.1. Consequences of Influence of Religious and Cultural Values on Polio Immunization Uptake in Northern Nigeria with a Focus on Determining the Evidence Gaps 13 References 17 1.0. Literature Review 1.1. A Brief Overview of Polio Immunization Uptake in Northern Nigeria Immunization, also acknowledged as vaccination, is duly considered as one of the best, well-known, affordable and easiest ways of controlling any communicable disease. As commonly referred in many studies like Plotkin (2011), immunization is a method used to eliminate risks to some severe health related complications including infectious and communicable diseases, polio and similar others. Studies [e.g. Onyebuchi (2013), Otieno (2013), Plotkin (2011), Yahya (2007), Oshinsky (2005)] have revealed that immunization has been quite fruitful in making deliberate efforts to eradicate infectious diseases such as poliomyelitis. However, it is noteworthy in this context that immunization has already been able to eliminate various regions throughout the globe, except in three particular countries, i.e. Pakistan, Afghanistan and Nigeria, which perhaps, might have been owing to the issues associated with religious as well as cultural values (Plotkin, 2011). Owing to its success and efficiency in mitigating risks of various controllable diseases, the importance of immunization has emerged as quite prominent in the recent phenomenon. Notably, it is often credited by medical practitioners to be directly related with the promotion of health and wellbeing of the people, which has in turn enhanced its efficiency and importance to a vast magnitude (Onyebuchi, 2013). Importance and positive effects of immunization is very much apparent in the region of Northern Nigeria. However, recent reports have revealed about the reluctance of people in Northern Nigeria to immunize their children with polio vaccination, principally owing to their religious and cultural orthodoxy (Otieno, 2013; Oshinsky, 2005). Contextually, as per the study of Otieno (2013), there is a degree of religious fear persisting amid the people in Nigeria to immunize their children and protect them from polio. Though the people belonging to the region of Northern Nigeria have made several deliberate efforts towards combating the disease, little positive results have been obtained. Consequently, conducting the process of polio immunization at an extensive rate in Northern Nigeria has been quite challenging for the concerned authorities owing to the fact that most of the people in this part of the world are gypsies and are thus, used to move from one place to other without having any fixed address. This makes it even more challenging for the practitioners to continually monitor the developments of these people and ensure that the immunization process is undertaken effectively. It would be vital to mention in this regard that Nigeria is among those few nations of the world wherein polio is endemic and therefore, demands immediate consideration from the practitioners (Yahya, 2007). 1.2. Problem Formulation 1.2.1. Polio Immunization With Regard To Northern Nigeria With reference to the above discussion, it can be ascertained that it has become quite a challenging task for the concerned authorities in Northern Nigeria to eradicate the growing number of instances of polio infected. Apart from their lifestyle, the challenges faced by the practitioners in this region have been influenced owing to the fact that in Nigeria, people are quite reluctant towards immunizing their children against polio owing to various social along with cultural and political hindrances (CDC, 2009). Notably, Nigeria is listed as one of the most populated nations of the world. Owing to inappropriate utilisation of the immunization programs, considerable number of deaths, accounted around 220,000 every year, has been recorded in Nigeria, exhibiting poor management of the entire process. Specially mentioning, certain credible initiatives have been undertaken by the respective government of the nation, owing to which, the region has been able to achieve DPT3 coverage of 56% amid the infants by the year 1990. However, in subsequent years, there has been a decline in the coverage of polio immunization owing to the reluctance of the people towards the same (Vaccin, 2013). Furthermore, by the year 2006, the northern part of Nigeria was observed to have experienced considerable decline in its DPT3 coverage results. In addition, survey results also depicted that in the year 2006, the immunization coverage for polio in Northern Nigeria became limited to around 36%, as compared to the year 1990, which accounted to 56%. In comparison to other regions, Northern Nigeria is often asserted to possess one of the lowest immunization coverage in the world. This can also be justified from the fact that a mere 10% of the children in this part of the world receive proper and routine immunization benefits, which is again considerably lower in comparison with other nations (Vaccin, 2013). In accordance with the report published by Jegede (2007), the World Health Organization (WHO) took an initiative to introduce certain developmental plans with an intention to eradicate polio from the African region with the help of Global Polio Eradication Initiative (GPEI). However, a strong boycott was observed in Northern Nigeria owing to the lack of trust of the people towards public health commitments of WHO. Notably, in this particular region, religious and political leaders in the states of Kano and Zamfara were alleged to have negatively influenced parents not to immunize their children for polio that has in turn acted as a discouragement to the polio immunization campaigns undertaken in this region. It is often observed that most of these leaders define polio vaccine as contaminated with HIV as well as cancerous agents that impose ill effects on the health of the children rather than helping in their overall betterment. In an interview conducted with the Governor of Kano, the Governor stated that the ‘Muslim world’ could not trust any of the conducts of the ‘western world’ post 9/11 attack on the US, signifying a major cultural hindrance to the ongoing polio vaccination campaigns in the nation. The Governor further quoted that polio immunization is one of such approaches of the western world, which must not be trusted by any of the Muslim communities, as the Governor holds the perception that polio vaccines are diluted with anti-fertility drugs, which are considerably harmful for the people. Certainly, such an assertion from a reputed leader indicates that culturally, the people are influenced negatively that in turn fuel their reluctance towards promoting polio immunization campaigns in Northern Nigeria (Jegede, 2007). The report of Centres for Disease Control and Prevention (2013) provided a more apparent overview of the present state of polio immunization in Northern Nigeria. The report presented certain facts relevant to N-STOP Program in Nigeria, which was initiated to comply with the initiatives of GPEI to eradicate polio prevalent in the region. The N-STOP program intended towards providing technical assistance to Nigerian citizens with regard to foster the approach further. The program also worked towards monitoring, implementing as well as strengthening the routine procedures of polio vaccination for the children in Northern Nigeria. Subsequently, by the year 2013, in excess of 1,782 workers were trained to work for eradicating the disease about how the routine immunization process can be developed in support with the respective local government of the northern Nigerian region (Centers for Disease Control and Prevention, 2013). The central aim of the N-STOP program was to ensure polio vaccination for each and every child, which may result in completely eradicating the risk of such a disease from the region in the long term. As per the survey conducted prior to the implementation of the N-STOP program, 99% of the children were observed as rigidly reluctant to avail polio vaccines or get immunized as per schedule programs of WHO. One of the barriers towards providing polio vaccines to the children within the specified schedule can be relevant owing to the improper transportation system. There are several regions in Northern Nigeria, wherein campaigns are often hindered because of communication problems amid the healthcare workers. This further hinders the deliverance of effective and scheduled polio vaccines to the children. It has also been apparently identified that owing to the prevalence of nomadic culture within Northern Nigeria, people frequently change or shift their shelter from one place to other, which further indicates their somewhat nomadic lifestyle. Hence, due to the absence of fixed locations, it often becomes quite difficult to provide polio vaccines to the children within the scheduled time of WHO. In this context, the report of Centres for Disease Control and Prevention (2013) revealed that parents who are residing in the remote areas are not able to get complete access to the scheduled polio vaccine programs of WHO, owing to their lack of awareness about the same (Centers for Disease Control and Prevention, 2013). With regards to the report published by Malik & Mansoor (2013), owing to the Islamist Boko Haram movement in Northern Nigeria, proper implementation of polio eradication program has become quite a challenging task. The movement acquired greater strengths since the year 2011 after the problems emerged post-election. A few of the common and major problems persisting in Northern Nigeria include poverty, lack of proper housing, sanitation and water supply. These problems further leave little scope for the people to become less concerned about polio eradication along with other healthcare related issue faced by their children. It can be affirmed in this similar concern that cultural notions preached by the Islamist Boko Haram movement and social along with cultural challenges further influenced people of Northern Nigeria to refuse polio immunization uptake or prevent the disease. People in this region believe that polio is less threatening than the other problems, which they are facing in the present day context (Malik & Mansoor, 2013). Furthermore, the offensive approach of the Islamist Boko Haram movement towards the health workers associated with polio vaccination and other similar programs also hinders the chances of successful execution of these campaigns, being a combined effort of both the local government of Northern Nigeria and WHO. It has been apparently noted in this regard that the anti-social workers associated with the movement have strongly influenced parents by stating that a polio eradication program is an approach of the agents of their enemy i.e. the western world, imposing adverse effect on the health of their children. This indicates that the leaders tend to combine the notions of warfare culture and healthcare strategies that further inhibits the effectiveness of the undertaken campaigns. The workers associated with the movement also influence the people on the basis of the perception that polio eradication programs have been approach by the western world to reduce the population of poor countries, further limiting their strengths in the global world. These aspects undoubtedly posses severe challenges to the successful execution of polio eradication programs in Northern Nigeria (Malik & Mansoor, 2013). 1.3. Literature Search 1.3.1. Influence of Religious and Cultural Values on Polio Immunization Uptake in Northern Nigeria The above analysis clearly exhibits that proper execution of polio eradication program has been a major challenge for the local government and WHO in Northern Nigeria. In accordance with the studies conducted by Centres for Disease Control and Prevention (2013) and Malik & Mansoor (2013), it can be ascertained that there are several challenges, which may hamper proper implementation of polio eradication programs in the Northern Nigerian region. In this regard, a few of the challenges presented by the aforesaid studies include poverty, improper housing facilities and most crucially, the prevalence of the Islamist Boko Haram movement among others. Based on the understanding of the above-discussed studies, it is quite evident that these critical aspects may hinder successful execution of the scheduled polio immunization programs in Northern Nigeria by a considerable degree. Nevertheless, there are certain other specific political, religious as well as cultural aspects, which make people reluctant towards immunizing their children with polio vaccines in this region (Centers for Disease Control and Prevention, 2013). In this similar context, the research conducted by Kaufmann & Feldbaum (2009) will be vital to consider for discussion. Kaufmann & Feldbaum (2009) presents an extensive understanding about polio immunization boycott in Northern Nigeria. Political unrest of the nation is also deemed as a major aspect, contributing towards making people reluctant in embracing polio vaccines. It is in this context that political and religious tensions within Northern Nigeria have been the major determinants of success potentials of such campaigns, related with the reluctance of the people towards embracing polio immunization (Centers for Disease Control and Prevention, 2013). With reference to the study of Kaufmann & Feldbaum (2009), it can be ascertained that Mr. Olusegun Obasanjo was brought into the term as the new Governor of the nation, replacing General Muhammadu Buhari. This situation further reflected as well as worsened the political tensions that eventually gave birth to regional disparities. This particular occurrence negatively influenced the healthcare service sector, which again resulted in poorer healthcare outcomes in the region. The study of Kaufmann & Feldbaum (2009) argued that a group of people, during the political tension in Northern Nigeria, had presented a memo, wherein it was stated that polio vaccinations program initiated by the local government is an approach of the western world to depopulate the northern region of Nigeria, especially the people belonging to the Muslim community. This illustration apparently signifies the religious and cultural hindrances facing the campaigns. Hence, this religious based factor has further influenced people belonging to diverse Muslim communities to show greater reluctance towards taking polio vaccines for their children. Furthermore, a few of the anti-social and religious groups also claimed that there is a suspect of contamination of HIV AIDS and anti-fertility substances in polio vaccines, which can be regarded as extremely dangerous, affecting the health as well as safety of the children being immunized. This aspect also contributes in enhancing the level of reluctance of the people towards polio vaccination at large (Kaufmann & Feldbaum, 2009). Correspondingly, Salim (2012) portrayed the importance of local as well as cultural comprehension of the people with regard to any form of disease. Notably, people in remote areas of different nations have been observed to prefer traditional treatment approaches to that of any other artificial means. This kind of perceptions has further been alleged to contribute in hampering proper and scheduled vaccination of the children (Salim, 2012). In accordance to the similar situation, Ozohu-Suleiman (2009) affirmed that amid the several key factors posing challenges towards successful execution of polio immunization programs, cultural and religious aspects are amid the prime ones to make people reluctant to accept such help. As per the study conducted by Cooke & Tahir (2009), any culture forms a set of beliefs amid the people that are the extensively conveyed to each people within a particular community. Owing to the prevalence of numerous distinct ethnic groups and cultures, there are diverse set of beliefs and values with regard to medicines or diseases. These diverse beliefs of people belonging to dissimilar cultures further make them reluctant towards accepting western therapies, such as polio immunization. In agreement to this notion, Cooke & Tahir (2009) represented the role of religion as a factor, which can impose adverse impacts on the attitude of people residing in Northern Nigeria concerning their readiness to accept westernised therapies including polio immunization. Notably, the region mainly comprises people belonging to Muslim religion and a few from Christianity (Cooke & Tahir, 2009). With these studies indicating strong influence of religious and cultural beliefs on the reluctance of people to accept polio vaccination, it can be concluded that prevalence of continuous interreligious conflicts have been one of the major reasons for these hindrances to the effectiveness of the campaigns undertaken. The study of Osazuwa-Peters (2011) provided a more in-depth understanding about the role of religion as an imperative factor in the domain of embracing polio vaccination by the people of Northern Nigeria. Since most of the people in this part of the world lack proper education, they hold a negative perception that polio immunization, which is an idea of the western world, is an evil process that demands blood of the people and their children. Contextually, owing to the significance of religious factor, almost 80% of the people prefer traditional treatment with native medicines to modern day offerings of healthcare sector. These aspects further pose challenges for successful execution of polio immunization programs particularly in Northern Nigeria. Again, owing to the remoteness of the region, mothers of children possess very little knowledgeable about the immune needs of their children. This can be better comprehended from the fact that around 70% of the mothers in Nigeria are knowledgeable about the immune needs of their children, while in the northern region, only 50% of them are aware regarding the same (Osazuwa-Peters, 2011). According to the viewpoints of Vaccin (2013), religion is one of the fundamental factors, which has been observed to influence the beliefs and values of people in any part of the world. Correspondingly, it has also become one of the most common factors, which contribute in letting down the immunization programs initiated by WHO in Northern Nigeria. It is strongly believed that owing to the differences persisting in the culture and the religion of the people, they possess orthodox or unorthodox understanding about any particular disease and consequently, develop misconceptions to cure the same (Osazuwa-Peters, 2011). Furthermore, the research of Vaccin (2013) also revealed that most of the cultures and religions of Northern Nigeria have misconceptions regarding the aetiology of polio disease, which further influenced polio immunization uptake in this particular region. Revealing similar viewpoints to that of Vaccin (2013), the report published by the World Health Organization (2014) highlighted the importance of cultural attitudes of the parents in Northern Nigeria on their choices of immunization and treatment of diseases for their children. For example, people belonging to the Javanese or the Acehnese culture have negligible understanding and knowledge regarding vaccination for polio or any other disease. This particular aspect is quite likely to affect their decisions further, in the domain of polio immunization uptake. From a critical point of view, it is quite likely that this will work against the wellbeing or the success of the polio immunization programs initiated by the WHO and the local government of Northern Nigeria (World Health Organization, 2014; Vaccin, 2013). Again, the report of World Health Organization (2014) also emphasised the role of the religious leaders in influencing the people to show reluctance towards polio immunization uptake, which are offered by the respective governmental bodies of the region. To be noted in this regard, with reference to the report by World Health Organization (2014), in the year 2003, in Northern Nigeria, religious leaders were witnessed to raise strong voice in opposition to the immunization campaigns organized by WHO. According to the report, the opposition was mainly grounded on the perceptions held by the people about polio immunization uptake. Illustratively, there is a perception existing in the local community that polio vaccination, which is being offered by the western world, may cause AIDS and sterility for the children. There are also certain religious groups, which hold the belief that the approach of polio immunization is an attempt of the western world to depopulate or reduce the populaces of the Muslim community in the northern region of Nigeria (World Health Organization, 2014). These findings further suggest that dissimilar religious as well as cultural values have strong negative influence on polio immunization uptake specifically in Northern Nigeria. 1.4. Evaluation of Findings 1.4.1. Consequences of Influence of Religious and Cultural Values on Polio Immunization Uptake in Northern Nigeria with a Focus on Determining the Evidence Gaps From the analysis of numerous literatures, journals and articles, several key aspects, as relevant to polio immunization uptake in Northern Nigeria have been determined. Notably, with reference to the previous discussions, it can be stated that over the years, polio immunization or vaccination has remained one of the major point of concerns for the global healthcare sector. It is noteworthy in this context that governments of each and every nation are working in alignment with WHO to eradicate the disease of polio from their respective nations. However, taking the example of Nigeria, it is apparent that there are certain countries wherein the issue of polio is still prevalent in an extensive manner (Renne, 2010). According to Adeyinka & et. al. (2013), immunization is one of the safest as well as the most effective means of ensuring proper health of people. This can be regarded as a precautionary measure to deal with any particular disease well in advance. Contextually, it is strongly believed that governments of these nations can save millions within the healthcare sector through conducting proper immunizations campaigns. Polio is also regarded as one such disease for which governments belonging to varied nations usually adopt the precautionary measure of vaccination for the children, below a particular age group, to strengthen their immune system and fight against the disease (Adeyinka & et. al., 2013). However, in Northern Nigeria, polio immunization campaigns have not been able to attain maximum success owing to the religious and cultural attitudes of the people opposing the effectiveness of polio immunization program, which further makes them reluctant towards embracing such developmental changes. As a consequence, despite continuous attempts of the local government and WHO to eradicate polio from this region, very little positive results have been gained, which further influences negatively towards the wellbeing of the people living in this part of the world in terms of health (Renne, 2010). However, the present day situation in Northern Nigeria, with regard to polio immunization uptake, is quite challenging principally owing to religious as well as cultural attitudes of the people towards the same. This indicates that the consequences of the influence of religious and cultural values on polio immunization uptake in Northern Nigeria are quite severe. This particular notion can be justified with the help of analysing certain facts that can be attained from numerous literature studies conducted with emphasis to the same issue. As per the report of NPI (2006), by the year 1980, immunization coverage reached 80% in Nigeria. However, in subsequent years, the figures dropped considerably. Researches correspondingly revealed that it was primarily owing to the emergence of religious groups that continuously raised voice against the campaigns of polio immunization on the ground that these have been offered by the western world for depopulating the Muslim community. Furthermore, it is widely observed that polio cases have been quite frequent in Nigeria, which especially includes the Muslim people. NPI (2006) also revealed that the wider prevalence of polio cases within the nation is mainly due to increased extent of religious violence and crime prevailing in the nation. This can be justified with reference to the fact that nine health workers engaged in introducing programs associated with polio immunization have been killed in Nigeria in recent times, further influencing the entire schedule of the immunization process (Otieno, 2013; Yahya, 2007). In subsequence to this particular aspect, Northern Nigeria has shown an immunization coverage rate of only around 1%, which was recorded to be among the least in the world. The report of NPI (2006) also presented facts that showed how lack of proper immunization is leading to numerous health complications, degrading the overall social stability in the long run. Notably, owing to the failure of ensuring appropriate routine immunization contacts, a transmission of wild poliovirus has been identified in this region (UNICEF, 2013). As per the report of NPI (2006), by the end of the year 2006, there were more than 542 cases of wild poliovirus in Northern Nigeria as compared to the 302 cases in the year 2005. Hence, it is quite apparent that the number of the above-discussed cases is increasing with every passing year at quite a brisk pace. Facts provided in NPI (2006) also suggested that the contribution of Nigeria in terms of wild poliovirus is around 97.1%. This can be regarded as one of the major consequences of the influence of religious and cultural values on polio immunization uptake in Northern Nigeria, where 11 states are noted to fall under acute polio risk margin in the present day scenario (NPI, 2006). As per the study conducted by Ozohu-Suleiman (2009), the cultural and religious influences on polio immunization uptake in Northern Nigeria have imposed considerable impacts on the way of thinking of the people, especially the parents who possess the duty to ensure polio immunization for their children. Notably, owing to the false perception of the religious groups concerning the fact that polio vaccine is contaminated with HIV virus, they influenced the people of Northern Nigeria not to uptake polio immunization. Owing to this false knowledge, the parents have been observed to show reluctance towards providing proper and scheduled polio vaccine for their children, further raising the vulnerability of their children concerning the risk of polio disease (Ozohu-Suleiman, 2009). From the overall analysis, it can be determined that various studies have been conducted with regards to the subject matter i.e. polio immunization in Northern Nigeria. Each of these studies provides extensive information relevant to the current state of polio immunization as prevalent in the region. The literature studies and articles that have been reviewed in this study mainly depict about how polio immunization is inappropriately executed in the northern region of Nigeria. The studies also portrayed the consequences of improper conduct of polio immunization campaigns on the lives of the people affecting their health. However, it can be ascertained that the studies will need to be extensively conducted on other factors (apart from culture and religion) that might influence people towards selecting effective treatments of polio immunization for their children. This particular approach will therefore provide a more extensive understanding about the overall factors from which people of Nigeria may get influenced with regard to their choice of vaccination against polio. Comprehensively, these can be regarded as certain gaps of evidence that ought to be overcome while conducting future researches. References Adeyinka, D. & et. al., 2013. Uptake of Childhood Immunization among Mothers of Under-Five in Southwestern Nigeria. Internet Scientific Publications. [Online] Available at: http://ispub.com/IJE/7/2/3255 [Accessed July 16, 2014]. Cooke, J. G. & Tahir, F., 2009. Polio in Nigeria. Home. [Online] Available at: http://csis.org/files/publication/120210_Cooke_PolioNigeria_Web.pdf [Accessed July 16, 2014]. 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The Final Push for Polio Eradication: Addressing the Challenge of Violence in Afghanistan, Pakistan, and Nigeria. PLOS. [Online] Available at: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001529 [Accessed July 16, 2014]. NPI, 2006. Knowledge, Perception and Beliefs about Childhood Immunization and Attitude towards Uptake of Poliomyelitis Immunization in Northern Nigeria. Study Report. [Online] Available at: http://www.comminit.com/files/NPI%20STUDY%20Beliefs%20in%20about%20RI%20in%20N%20Nigeria%20-%20COMPLETEfinal1.pdf [Accessed July 16, 2014]. Ozohu-Suleiman, Y., 2009. Media and Interpersonal Persuasions in the Polio Eradication Campaign in Northern Nigeria. Journal of Public Health in Africa, Vol. 1, No 1. Oshinsky, D. M., 2005. Polio: An American Story: An American Story. Oxford University Press. Ozohu-Suleiman, Y., 2009. Interpersonal Communication and Risk Perception Determinants in the Polio Eradication Campaign in Zaria, Northern Nigeria. 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[Online] Available at: http://polioinfo.org/downloads/reports/2011_Polio_Communication_Summary_Report.pdf [Accessed July 16, 2014]. Vaccin, J. V., 2013. Myths and Misconceptions as Barriers to Uptake of Immunization Services in Nigeria. Vaccines & Vaccination, Vol. 4, No. 7, pp. 1-4. World Health Organization, 2014. Childhood Vaccination in Africa and Asia: The Effects of Parents’ Knowledge and Attitudes. Bulletin of the World Health Organization. [Online] Available at: http://www.who.int/bulletin/volumes/86/6/07-047159/en/ [Accessed July 16, 2014]. Yahya, M., 2007. Polio Vaccines—“No Thank You!” Barriers to Polio Eradication in Northern Nigeria. African Affairs. [Online] Available at: http://afraf.oxfordjournals.org/content/106/423/185.abstract [Accessed July 16, 2014]. Read More