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Availability And Storage Of Vaccines In Community Pharmacies
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Rejection of Routine Immunization
Another
problem and challenges facing immunization programmes in Nigeria is the
rejection of selected vaccines/vaccination by parents or religious
bodies more especially in the northern part of this country (Jegede,
2007; Ankarah, 2005). The reasons for such rejection are outlined below;
Fear and Confusion
Many
decision-makers and caregivers reject routine immunization due to
rumours, incorrect information, and fear. Attempts to increase coverage
must include awareness of people’s attitudes and the influence of these
on behaviour. Fears regarding routine immunization are expressed in many
parts of Nigeria. Fathers of partially immunised children in Muslim
rural communities in Lagos State see hidden motives linked with attempts
by nongovernmental organisations (NGOs) sponsored by unknown enemies in
developed countries to reduce the local population and increase
mortality rates among Nigerians. Belief in a secret immunization agenda
is prevalent in Jigawa, Kano and Yobe States, where many believe
activities are fuelled by Western countries determined to impose
population control on local Muslim communities (Feildein, 2005; Yola,
2003)
Low Confidence and Lack of Trust
Lack of confidence and
trust in routine immunization as effective health interventions appears
to be relatively common in many parts of Nigeria (Babalola, 2005). A
2003 study in Kano State found that 9.2% of respondents (mothers aged
15–49) evinced ‘no faith in immunization’, while 6.7% expressed ‘fear of
side effects’. For many, immunization is seen to provide at best only
partial immunity, e.g. in Kano and Enugu (Brieger, 2004; Fieldein,2005).
The widespread misconception that immunization can prevent all
childhood illnesses reduces trust because when, as it must, immunization
fails to give such protection, faith is lost in immunization as an
intervention, for any and all diseases.
Religious Factors
Nigeria
is a very religious country with religion and spirituality permeating
all aspects of life. Matters around health, including immunization, are
not excluded from this infiltration (Anyene, 2009). Some of the ways in
which religion has impacted uptake of routine immunization are described
below. Conspiracy theories linking vaccination and fertility control
and/or sterilization have been propounded and promoted by religious
leaders, particularly in the North including in States with the least
immunization coverage rates. One such theory is that polio vaccination
and other vaccines are a part of a western plot to sterilize young girls
and eliminate the Muslim population (Jegede, 2007). Generally, the
Muslim north has the low immunization coverage, the least being 6%
(northwest) and the highest being 44.6% (southeast). In Ekiti state
(southwest), for example, the northeast and west of Ekiti, with a
stronger Islamic influence, has low immunization coverage and also poor
educational attainment (Ophori, et al., 2014). Christians have 24.2%
immunization coverage as compared to only 8.8% for Muslims (Ankrah, et
al., 2005).
Cultural Practices
Cultural practices, like religion
and politics, play a key role in uptake of routine immunization.
Immunization directly affects the issue of childrearing and child care
and these are issues that have a cultural foundation. Certain cultural
practices though acceptable for many years, have however, been found to
be detrimental to immunization uptake, child survival and development.
While this has been recognized and efforts to counter detrimental
cultural practices are undertaken in different parts of the country,
they have not always been successful, partly because these cultural
practices are sometimes deeply entrenched and other times because there
is insufficient engagement with the community and therefore inadequate
sensitivity to the issues and education on their harms.
One such
cultural practice which occurs in Yobe State is that a woman should
remain indoors for 40 days after giving birth. This prevents her from
accessing both postnatal-care for herself and immunization services for
her newborn (Rafau, 2004). In some communities, having babies at home is
still the norm. In such situations, the opportunities for immunization,
especially the early ones such as BCG and OPV1, given right after birth
and six weeks after respectively, may be missed (Ubajaka, et al.,
2012).
In some communities, a husband’s permission is required in
order for a woman, typically the primary caregiver, to leave the house
as well as to give any form of medical treatment or obtain any health
services for the child (Mongono, 2013). Cultural practices and beliefs
may be responsible for some of the disparities in immunization uptake.
For instance, males are more likely to receive full immunization
compared to girls, emphasizing cultural attitudes to gender, where male
children are often more highly regarded and desired than females.
However, it has been stated that the disparity is generally not
significant. These gender disparities also affect education. Males in
some areas are more likely to have had the opportunity of education than
females. Studies have shown that the more educated a mother is the
higher the chances that her children would be immunized (Babaloloa,
2006). Confusion remains significant in Katsina and in other Northern
States regarding the need for immunization. There is uncertainty as to
the reasons why a perfectly healthy looking infant should receive an
injection. This raises suspicion and closes minds to what immunization
truly has to offer. The same sensitivity and consistency applied to
addressing the effect of religion on vaccine-related matters should be
applied to cultural issues. It is very important to understand the
cultural beliefs and practices and develop and implement the right kind
of engagement, education and other strategies.
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