Factors Associated with Low Uptake of Vaccines among Mothers and Pregnant Women in Western Nigeria - Literature review Example

Literature Review: Factors Associated with Low Uptake of Vaccines among Mothers and Pregnant Women, in North-Western Nigeria. A Cross-Sectional StudyName: Institution: Literature Review: Factors Associated with Low Uptake of Vaccines among Mothers and Pregnant Women, in North-Western Nigeria. A Cross-Sectional Study Introduction Vaccination among mothers and pregnant women plays an important role in preventing and controlling diseases in newborn infants. Uptake of vaccines by mothers and pregnant women for serious diseases such as tetanus and rubella is vital for preventing the transmission of these diseases from the mother to the unborn child during pregnancy. Nigeria is one of the worst performing countries in terms of child mortality due to poor immunisation tendencies (Black, et al., 2010). The North-western region of the country represents one of the worst performing regions in Nigeria with regard to effective immunisation and mitigation of child mortality from vaccination-related illnesses (Black, et al., 2010). The FBA immunisation review in 2005 indicated that full immunisation coverage in children in the North-western region was below 4%; with some states in the region having less than 1% immunisation coverage (FBA Analysts, 2005). In spite of the importance of optimal vaccine uptake in mothers and pregnant women, this aspect of immunisation has attracted limited scholarly interest especially for individual regions in Nigeria. Numerous studies and researches have focused on immunisation activities on infants ignoring the vital issue of vaccination in mothers and pregnant women. Several studies have ventured into this issue; although it is usually included among antenatal care programs and maternal health studies. The North-western region of Nigeria was found to be the worst performing in terms of antenatal care utilization with a utilization level of only 24.7% which was far behind the second worst performing North-eastern region which had 48% utilization (Adamu, 2011). The following literature reviews various case studies on factors affecting vaccine uptake by mothers and pregnant mothers in Northwestern Nigeria. The review is based on the logical assumption that women who do not utilize MHCS or access antenatal care do not uptake vaccines. The review reflects on the factors attributed to low vaccination levels among women in the northwestern region of Nigeria. Discussion The most insightful study regarding women vaccination in North-western Nigeria was conducted to assess the patterns and determinants of MHCS utilization in various geopolitical regions in Nigeria (Adamu, 2011). The researcher used a quantitative methodology to ecologically analyze secondary data with respect to seven independent variables associated with MHCS across six geopolitical zones in Nigeria. By adopting an epistemological approach, the researcher assumed that the analysis of data retrieved regarding the utilization of MHCS in the different regions of Nigeria offered an observable reality on the factors evaluated. The researcher used information from the 2008 Nigerian National Demographic and Health Survey (NDHS). The researcher analysed both predisposing factors and enabling factors associated with MHCS usage. The predisposing factors included: mother’s age, employment, birth order, education level and religion while the enabling factors included: place of residence and family wealth index. Finally the researcher applied descriptive statistics and logistic regression to evaluate the patterns of MHCS use and ascertain the factors affecting MHCS use in respective regions in Nigeria. The results of this research offered varying factors for various geopolitical regions. The researcher used statistical analysis tools to manipulate the dependent variables with the independent variables and drew conclusions regarding the factors affecting MHCS use in Northern Nigeria. Another relevant study that helps to draw inference on the factors affecting low uptake of vaccines among women in North-western Nigeria was conducted by FBA Health Systems and Analysts in 2005 (FBA Analysts, 2005). Although this study mainly focuses on vaccine uptake in children, it also acknowledges and appreciates the vaccination of mothers and pregnant women. This study considered different perspectives from various stakeholders in the Nigerian immunisation endevour including: clients, donors, service providers, decision makers and managers. The FBA health consultants used data from the Nigeria Immunisation Coverage Survey (NICS) 2003. The reviewers considered this data to be credible and the information to be viable. This is because the NICS survey has a large sample size and its information is not altered, tampered or suppressed by the State and the local government authorities. The NICS 2003 conducted interviews and analysed data from immunisation stakeholders giving a detailed report on the issue. This research inferred several factors that affected the uptake of vaccines among mothers and pregnant women in the North-western region of Nigeria. The International Vaccine Access Center conducted a landscape analysis routine immunization in Nigeria in 2011 (Stokes-Prindle, et al., 2012). The researchers used a multi-component qualitative methodology to collect and analyse data from relevant stakeholders from various geopolitical regions in Nigeria. Information was collected using several qualitative designs including; facility-based participant observation and exit interviews, facility and community-based focus group discussions, key informant interviews with opinion leaders and qualitative analysis to highlight barriers to vaccination. Acquired data was coded, categorized and indexed under various domains regarding the issues addressed. The northwestern region was considered under states with persistently low vaccination coverage. The researchers uncovered several hindrances to vaccine uptake in the northwestern states that were studied. Another relevant research conducted an assessment of the attitude, knowledge and practice of stakeholders towards vaccination in a state in Northwestern Nigeria (Omotara, et al., 2012). The researchers used guide questions to conduct focus group discussions with stakeholders in the Borno state. The researchers discussed the results and highlighted several factors that relate to the low uptake of vaccines among mothers and pregnant women in the north-western region. Factors Affecting Vaccination among Women in North-Western Nigeria Cultural beliefs and practices Adamu (2011) concluded that cultural beliefs and practices were the reason that the data analysis showed an association between the mother’s age at child birth and use of MHCS. The relationship between a mother’s age at birth and the use of antenatal care has been ascertained by previous studies in Nigeria and abroad (Adeoye, et al., 2005; Ikeako, et al., 200)). In his study, Adamu (2011) considered the age of mother at the time of giving birth and the access to antenatal care. The results indicated that young adults or women between the age of twenty and thirty four were more likely to use antenatal care with 43% turnout level. Women below the age of twenty or adolescents represented the lowest level of antenatal care use with only 26.2% utilization level while the older women came second with 36.2% attending antenatal care. The researcher concluded that these findings reflected the strong cultural beliefs and practices in the Northern region regarding childbirth and pregnancy. According to Adamu (2011) early marriages and pregnancies are cultural norms and hence are very common in this region. The young mothers are forbidden from accessing MHCS because this would draw attention to their condition and age and hence expose the vile practice supported by prejudiced customary laws. Social and domestic issues Adamu (2011) found that higher order births enjoyed a higher chance of antenatal care as compared to subsequent births. These findings collude with previous studies on similar associations (Chakraborty, et al., 2003; Nigussie, Mariam and Mitike, 2004; Kamal, 2009). The first order births had 46.6% antenatal care usage compared to 35.6% for fifth order births and below. In this context linear declination occurred in MHCS use for subsequent births. The researcher attributed this trend to the increase in physical and material responsibilities of mothers with every subsequent birth. This allowed the women very limited resources in terms of time and resources to consider personal health issues such as vaccination and antenatal care. This trend is attributed to high child bearing practices in the North due to social and cultural ideologies; for example, to discourage polygamy or divorce (Izugbara and Ezeh, 2010). Educational level Adamu (2011) coded mother’s education level under four categories. The lowest level was no education, then primary, secondary and more than secondary. The study ascertained that the lowest level of education presented the highest antenatal users with a linear declination for subsequent levels of education. However, the researcher concluded that these findings were affected by the fact that education levels were very low in the North with over 65% of women being totally illiterate in the north. He cited previous studies on this factor and made key observations. Educated women were more empowered to overlook traditional practices and to make enlightened and informed decisions about using MHCS (Furuta and Salway, 2006; Babalola and Fatusi, 2009). He also stated that educated women were mentally equipped and rational enough to exploit available health resources such as MHCS (Gabrysch and Campbell, 2009). Employment, earning ability and poverty index In Adamu’s study, employed women received lower antenatal care with 39.7% as compared to their unemployed counterparts who achieved 41% (Adamu, 2011). This translates into lower vaccine uptake among employed mothers and pregnant women than among unemployed ones. According to Adamu, the lower levels of employment in the north, caused by poor education, account for the low utilization of MHCS. The researcher indicates that the earning ability of mothers and pregnant women determines their usage of MHCS as ascertained by previous studies concerning the same (Furuta and Salway, 2006; Babalola and Fatusi, 2009). Due to low education resulting in low employment among women in the north, the poverty levels are very high with states showing a poverty index of between 75% and 95% (Mohammed, 2010). In Adamu’s research, the correlation between these factors (employment, earning ability and poverty index) and utilization of MHCS was also researched under another independent variable; family wealth index (Adamu, 2011). Previous studies have shown an association between economic status and antenatal utilization (Say and Raine, 2007; Koenig, et al., 2007). The poorest women accounted for the lowest antenatal care use with 38.5%. The wealthy women accounted for the highest levels of antenatal use with 41.8% indicating that women in higher wealth levels utilized MHCS more in the north. The Nigerian health system charges mothers for antenatal services (FBA Analysts, 2005; Adamu, 2011). The cost of antenatal care is further exacerbated by transport costs to health centers. The low uptake of vaccines in Northwestern Nigeria can be attributed to low employment levels in this region accounting for low incomes and thereby inhibiting affordability among mothers and pregnant women (Amin, Shah and Becker, 2010). Service Delivery All the studies show an association between service delivery and vaccine uptake. The researchers highlighted various instances which illustrated the effects of poor service delivery on vaccine uptake by mothers and children in various regions including the northwestern region. Service delivery covers various issues including; health and safety, availability and accessibility of vaccines, leadership and governance and inadequate resources. Health and safety When conducting an assessment on the attitudes of various stakeholders in the Borno state regarding immunization, the researchers noted that provision of free drugs, improved sanitation, renovation of health care facilities and creation of more public awareness would encourage the use of antenatal care by women in the northwestern region (Omotara, et al., 2012). This means that health and safety, service delivery and influential campaigns were factors affecting the uptake of vaccines among mothers and pregnant women in the northwestern region. Availability and accessibility of maternal health care (MHC) facilities Various studies have reported that urban residence has a positive impact on MHCS usage (Raghupathy, 1996; Mekonnen and Mekonnen, 2002). Adamu’s study findings indicated that urban women were higher in antenatal utilization than the rural women (Adamu, 2011). The researcher observed that MHC facilities are not distributed proportionately in Nigeria and most of them are situated in the urban regions. This means that mothers and pregnant women living in urban centers are more likely to uptake vaccines than those in rural areas. This is because antenatal care is more readily available and easily accessible in urban centers. Women in the northern region are less likely to live in urban centers due to social, cultural and economic factors (Amin, Shah and Becker, 2010). This accounts for the low uptake of vaccine among women in the North-western region of Nigeria because antenatal care is not readily available and easily accessible in rural areas. The FBA review of full immunisation trends in Nigeria revealed that limited availability of vaccines was cited as the most rampant reason for low vaccine uptake in the north (FBA Analysts, 2005). The researchers considered the supply, storage and handling of vaccines, syringes, cold chain equipment and other necessary accompaniments. The study found that there was a chronic shortage for the various vaccination materials in many parts of the country and this was partly attributed to a biased concentration on the polio virus. This means that mothers and pregnant women vaccines were not significantly prioritised accounting for the low uptake of vaccines among women in the north. Lack of access to health facilities was the second most cited reason for not up taking full immunisation in the northern region. Accessibility of health facilities is attributed to political factors. Political interests lead to the construction of expensive urban health facilities in favor of rural primary care centers for high political visibility. The IVAC study outlined several service delivery barriers that were affecting the immunisation program in various regions in Nigeria (Stokes-Prindle, et al., 2012). These include supply chain management, transport problems for vaccines and health workers and inadequate cold chain capacity. Leadership and governance The FBA review observed that inappropriate and outdated institutional management regarding immunization accounted for ineffective immunization programs in the country (FBA Analysts, 2005). Lack of capacity to implement full immunization, political interests and undefined roles in state and local government institutions paralyses the vaccination program in the country. The IVAC study identified low commitment and the abdication of responsibility in various hierarchical arrangements between the state and federal governments as factors that hindered effective immunisation in various northwestern states (Stokes-Prindle, et al., 2012). These negative influences were tagged under leadership and governance hindrances and the researchers observed that they undermined accountability affecting vaccine administration in many regions including the north-west region. All these practices have led to poor vaccine administration by underperforming and unaccountable staff causing low vaccine uptake among women and pregnant women in many regions including the Northwestern Nigeria. Inadequate resources (financial and human) The immunisation program in Nigeria is understaffed and suffers from financial resource constraints (FBA Analysts, 2005; Stokes-Prindle, et al., 2012). The IVAC landscape analysis indentified financial and human resource constraints in Nigeria’s immunisation program (Stokes-Prindle, et al., 2012). The study listed lack of sustainability, political feasibility, inadequate capacity and supply as the main causes of this hindrance to vaccine uptake. These factors inhibit vaccine dispensation in the northwestern region thereby accounting for the low vaccine uptake by mothers and pregnant women in the region. According to the FBA NPI review, one of the main reasons for resource constraints in various regional immunisation programs is the Polio Eradicative Initiative (PEI) (FBA Analysts, 2005). The PEI has consumed nearly all the vaccination resources in the immunization program in Nigeria. The FBA analysts observed that the PEI had taken up a vast amount of the human and financial resources available for full immunisation in the country. Monopolizing immunisation resources on a single disease has crippled the immunisation program for other sectors and also created patronage opportunities. Religion Adamu assessed the religion factor in MHCS utilization to verify previous findings on the issue (Kamal, 2009; Adamu, 2011). The researcher recognized three types of religion types, namely; Christians, Muslims and Traditionalists. The researcher found that Muslim women scored the highest in using antenatal care in the north with 41.8% while traditionalist came second with 36% using antenatal care. 34.9% of the Christian women in the north used antenatal care. Considering that the majority of the population in the north is Muslim, the researcher concluded that these findings happened because of the limited representation of the Christian minority religious types. Because the uptake of antenatal care among the Muslim women is below half, religion appears as an inhibitor to effective use of antenatal care. The FBA review also noted that Muslim women in the northwestern state of Kano were reluctant to uptake vaccines because they believed they contained family planning drugs which were opposed by Islam (FBA Analysts, 2005). Other Barriers The FBA review identified other barriers to vaccine uptake in the northwestern region such as fear and confusion (FBA Analysts, 2005). Vaccine uptake was rejected in the northwestern states of Kano, Yobe and Jigawa because many residents believed there were secret agendas to the immunisation program such as population control. Low confidence and lack of trust in vaccines was cited as one reason why women refused to uptake vaccines in Kano. The women also expressed fear of side effects while failing to acknowledge the effectiveness of vaccines in diseases control. Summary The low uptake of vaccines among mothers and pregnant women in the North-western region of Nigeria is evident from the studies discussed. These studies have inferred several factors that contribute to the low uptake of vaccines by women in this region. Adamu (2011) identified the factors affecting low uptake of antenatal care in this region to include: cultural beliefs and practices, social and domestic concerns, religion and educational level. He also identified the following factors; employment, earning ability and poverty index, availability and accessibility of maternal health care (MHC) facilities. This study offers useful and insightful findings and analysis whose credibility and realism is supported by the use of population-based data in the research. However, the research suffered a major limitation because it depended on a single source of data (DFDS 2008) for analysis. Although this study generated an observable reality regarding the factors affecting vaccine uptake among women in the northwestern region, it undermines its credibility by using only one source of data. The FBA consultants used several data sources including secondary data from several approved sources in the NPI review (FBA Analysts, 2005). This study offered a multi-dimensional perspective to the study topic. The researchers inferred several factors that affect vaccine uptake among women in the northwestern region. These include: poverty index, religion, availability and accessibility of maternal health care (MHC) facilities institutional management and resource constraints. The research also identified other barriers to this process such as fear and confusion and trust issues about vaccination. A major limitation of this study was the overreliance on secondary data sources which could contain errors or whose data could be manipulated. Despite these impediments, this study offers convincing deductions which complement previous research findings on the study topic. The IVAC landscape analysis used a highly effective data collection and analysis framework (Stokes-Prindle, et al., 2012). Although the study focuses on some states in Northwestern Nigeria, it offers only a generalized scope in relation to the study topic. The analysis complements the other studies by adding deeper insights on the issue of service delivery in relation to low vaccine uptake in this region. This study was very effective in its findings although its applicability in this context was limited. The assessment of the attitudes of stakeholders in the northwestern state of Borno towards immunization was an invaluable source of hard evidence on the specific region of interest (Omotara, et al., 2012). This study identified specific service delivery considerations from stakeholders on the ground. The study added several factors that were not identified by other studies including: health and safety and public awareness to the list of issues affecting vaccine uptake among women in the northwestern region. This study focused on a single state in the vast northwestern region thereby limiting its findings geographically. The study also indexed very few data codes which accounts to its limited results in this context. Despite the occurrence of design and application issues in these studies, the individual findings complement each other making the overall review informative and credible. The low uptake of vaccines among women in the northwestern region of Nigeria is affected by the following factors: cultural practices, religion, service delivery, education, employment, poverty and other barriers. These factors should be addressed conclusively to enhance vaccination among mothers and pregnant women in the North-western region of Nigeria. References Adamu, H. S., 2011. 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