Abstract

Immunization is one of the major cost-effective healthcare interventions in promoting health . Globally, immunization prevents 2–3 million deaths every year, an additional 2 million deaths can be prevented annually with appropriate use of currently available vaccines .Vaccines used in National Immunization Programs are considered safe and effective when used correctly . Immunization quality and safety surveillance has become as important as the efficacy of vaccines in VPD Programs. The purpose of this study was to assess health care workers  knowledge, attitude and practice on immunization among children 0-59 months in the BHD.

A cross sectional facility-based study conducted between March and June2022, among health care workers  in BHD. Health personnel involved in the immunization process were recruited into the study and data was collected using a well structured questionnaire. Data was entered, cleansed and sent into Microsoft Excel 2013, and and then exported  to Statistical Package for Social Sciences version 24 software for analysis. A p-value <0.05 was considered to be statistically significant.

A total of 395 participants were enrolled in the study from 6 health areas in BHD. Majority of the health care workers were in the age group 20-30 years and the mean age was 32±7.43 and 65.8% of the study participants had good knowledge on immunization of children between 0-59 month of age. Participants had good attitudes (67.1%) and good practices (93.2%)  towards immunization of children between 0-59 months of age. Knowledge on immunization of children was found to be independently associated with profession age. Attitudes and practices towards immunization of children was significantly associated with age, marital status and type of health facility.

The knowledge attitudes and practices on immunization of children among health care workers in the BHD was good. Age, marital status, profession, type of health facility were independently associated with the knowledge, attitude and practices of health care workers on immunization of children.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Immunization is one of the major cost-effective healthcare interventions in promoting health [1, 2]. Globally, immunization prevents 2–3 million deaths every year, an additional 2 million deaths can be prevented annually with appropriate use of currently available vaccines [3, 4]. Vaccines used in National Immunization Programs are considered safe and effective when used correctly [4]. Immunization quality and safety surveillance has become as important as the efficacy of vaccines in vaccine preventable disease (VPD) Programs [2, 4]. Quality use of vaccines can be described as the utilization of properly maintained vaccines for immunizing at appropriate ages for maximal benefit with minimal risk. Safe and quality use of vaccines at the immunization center includes activities such as safe transport of vaccines; maintaining proper storage conditions for vaccines; safe administration practices; educating parents about the vaccination coverage; possible adverse events following immunization (AEFIs) and the importance and process of reporting AEFIs; adequate safety monitoring by the health care team in the hospital and communication of reported AEFIs to the National Regulatory Authority (NRA); maintenance of immunization records in electronic for; and the timely, routine reporting of immunizations to local or national registries as appropriate [5, 6].

Vaccination is one of the most powerful and cost-effective of all health interventions [7]. Vaccines are expensive products that save millions of children’s lives each year [8]. The introduction of a new vaccine can have a significant impact on a country’s health system [9] and require new strategies and additional cold storage capacity [10].

Vaccines are sensitive biological products that can easily be destroyed if handled incorrectly [8]. Exposure to inappropriate conditions can affect the potency of refrigerated vaccine [11]. The loss of vaccine potency may also cause the vaccine to become more reactogenic. Vaccines require more complex handling and storage requirements due to increased temperature sensitivity and complicated immunization schedules. This urges adequate training and supervision [12].

In the United States of America (USA), health professionals’ median knowledge on vaccine program score was 47.6% [13]. In India, the overall knowledge regarding cold chain practices was satisfactory [14, 15]. A review of evidence in Europe showed gaps in knowledge and poor communication among healthcare workers [16]. Knowledge of health care workers (HCWs) on the cold chain was not as per required levels to support effective cold chain management in Mozambique [17]. A study conducted in Nigeria showed an inadequate implementation of vaccine management guidelines [18] and about 43.0% health workers in Nigeria had good knowledge of vaccine management, while 66.1% of health workers in Nigeria had good vaccine management practices [19]. Another study in the health care facilities of Southern Nigeria showed that knowledge on appropriate management of the cold chain in two districts was poor [20]. Also, in other previous studies, 272 (64.0%) personnel in Nigeria were found to have poor knowledge [21] and 7 (28.3%) personnels in a study carried out in Cameroon did not know the correct vaccine storage temperature [22]. About 124 (67.8%) vaccine providers in South Ethiopia responded correctly to the recommended range of temperature for storage vaccine [23] and 84% of health workers in Nigeria had good knowledge of vaccine vial monitor (VVM) [24].

Cold chain management, training, supervision, a higher level of education, and year of service were significant determinants of the practice of vaccine management [19, 20, 25]. Besides, vaccine supply chain performance and logistics in the health facilities were sub-

optimal [26]. The inefficient vaccine management systems, including poor stock management, poor quality of vaccine handling and storage, contribute to high wastage of vaccines [10].

Vaccine wastage could be expected in all programs and some level of wastage is unavoidable [27]. Due to the increasing vaccine costs, countries are looking more closely than before at vaccine wastage [9]. Effective management of vaccine at all levels is one of the crucial factors for maintaining vaccine potency [8], which narrows the gap between vaccinated and immunized [14]. It saves program costs, prevents high wastage rates and stock-outs, and improves the safety of immunizations [28]. Significant improvements can also be made in cold chain management, resulting in considerable savings in vaccine and children’s life [29].

Global vaccination coverage dropped from 86% in 2019 to 83% in 2020. An estimated 23 million children under the age of one year did not receive basic vaccines, which is the highest number since 2009. In 2020, the number of completely unvaccinated children increased by 3.4 million. Only 19 vaccine introductions were reported in 2020, less than half of any year in the past two decades [30].

In Sub-Saharan Africa, 56.5% of children received full vaccination, 35.1%  had incomplete vaccination, while 8.4% of children remained unvaccinated. Full vaccination coverage across the 25 sub-Saharan African countries ranged from 24% in Guinea to 93% in Rwanda. We found pro-rich inequality in full vaccination coverage in 23 countries, except for Gambia and Namibia, where we found pro-poor vaccination coverage [31].

Based on the world head organization (WHO) definition, only 53 % of children aged between 12 and 23 months in Cameroon were completely vaccinated, 5 % did not receive any antigen of the EPI, 42 % were only partially vaccinated and 5 out of the 9 antigens had national coverage rates lower than 80 %, far below the national targets [32]

1.2 Statement Of The Problem

The Expanded Program on Immunization (EPI) was introduced in Cameroon in 1976 [33]. Since 2010, the national targets have been to achieve a national coverage of 90%, and 80 % at the level of health districts [34]. To achieve these objectives, several vaccination strategies have been adopted, and recommended to be used in health facilities. These strategies includes; organizing vaccination at fixed posts, outreach vaccinations, mobile and supplementary vaccination activities [35].

Despite adoption of these strategies, in an attempt to achieve a universal coverage in the EPI, access of populations to vaccination services remains low. In fact, based on the world head organization (WHO) definition, only 53 % of children aged between 12 and 23 months were completely vaccinated, 5 % did not receive any antigen of the EPI, 42 % were only partially vaccinated and 5 out of the 9 antigens had national coverage rates lower than 80 %, far below the national targets [32].

Several health districts in the South West Region of Cameroon recorded new cases of measles epidemic in the last few years, including the isolation of a wild poliovirus (WPV) type 1 from two acute flaccid paralysis (AFP) cases in October 2013 [36], representing the first polio-outbreak reported in the country since 2009. While it was important for the populations to collaborate with health providers by accepting vaccines to their children, the knowledge of health care workers and quality of vaccination services provided by them was indispensable for the success of the immunization and vaccination programs.

1.3 Research Questions

1. What proportion of health care workers have good knowledge on immunization of children 0-59 months in Buea Health District?
2. What are the attitudes of healthcare workers on immunization of children 0-59 months in Buea Health District?
3. What are the practices of health care workers on immunization of children 0-59 months in Buea Health District?
4. What are the factors influencing knowledge attitude and practice on immunization of children 0-59 months in the Buea Health District?

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