A QUALITY ASSESSMENT OF MEASLES VACCINATION AND SEROLOGIC STATUS (SEROCONVERSION) AMONG CHILDREN 9 – 12 MONTHS IN OTUKPO LOCAL GOVERNMENT AREA OF BENUE STATE

A QUALITY ASSESSMENT OF MEASLES VACCINATION AND SEROLOGIC STATUS (SEROCONVERSION) AMONG CHILDREN 9 – 12 MONTHS IN OTUKPO LOCAL GOVERNMENT AREA OF BENUE STATE

Abstract

A cross sectional study of measles vaccination status and a serological study by ELISA was carried out among infants aged 9-12 months in Otukpo Local Government Area of Benue State from 20th July to 30th November 2007.
A cross sectional study using the WHO/EPI recommended 30 X 7 cluster sampling technique for assessing measles vaccination coverage, a total of 230 care givers of children 9-12 months were selected and interviewed. The results showed a measles vaccination status of 69.9%, verified by card or history and which is below the national target to raise measles coverage to above 90% among all children less than one year of age and to reduce case fatality rate to less than 1%. This study was conceived to determine the effectiveness of the measles vaccination programme in Otukpo LGA and thus the country in comparison to the high coverage recorded by the measles eradication programme in the country.
Nigeria has in its inception of EPI in 1979 intensified efforts at establishing vaccination delivery points at health care centers. However, the availability of services does not ensure their full utilization. Among other reasons given for failure to vaccinate children in this study includes vaccine out of stock, fear of side effect of vaccines, long waiting time and lack of motivation to make effort.
The statistically significant factors influencing measles vaccination status identified in this study include; card retention, the age of the children, the knowledge of the immunization center and client’s satisfaction.
Issues of quality in the assessment of measles immunization services include; accessibility, client’s satisfaction, costs of immunization services and time spent in rendering the services. Majority of respondents (68.5%) could access the immunization services in less than 15 minutes. Measurement of access to immunization services as determined by DPT1 coverage was 85.7% and the overall drop out rate (measles drop out rate) was 15.8%.
The serological analysis was carried out to determine the level of measles antibodies before immunization (seroprevalence) and after vaccination(seroconversion) using a cohort of forty three children aged 9-12 months with no previous history of measles infection or vaccination. This study was thus aimed at determining the efficacy of measles vaccines, ascertaining whether the children being vaccinated with measles vaccines
are actually immunized and determining the variables that could influence immunological response.
The result of this study showed a seroprevalence rate of 27.9% which differs slightly from previous studies done in Lagos which showed a measles antibody seropositivity of 30.2%, 21%, 15% and 22% respectively. The differences could be attributed to the choice of serological assay used.
The measles vaccine used in this study was the Schwarz Live hyper attenuated vaccine and the seroconversion rate found with this vaccine among the children aged 9-12 months was 58.1%. Similar serological tests carried out in different areas revealed different results of vaccine seroconversion rates of 95%, 73%, 60% and 56% respectively.
From this study, 41.9 % of children failed to seroconvert after being given the measles vaccination. This therefore signifies that even when measles vaccination coverage is high, which is the case presently in the country Nigeria after the series of measles eradication programme and multiple antigen campaign, the proportion of immunized children will still be low with a high percentage susceptible among the vaccinated children. This challenge occurs in secondary vaccine failure and this could explain the reason for the recent occurrences of measles infection and measles out break among pre-school aged and in previously vaccinated children.
The variables which were correlated with seroconversion rates so as to determine their statistical significant difference include; the age and sex of the child, the state of child’s health, the nutritional status of the child, history of previous contacts with measles infection, routes of administration of measles vaccination, the batch number/expiry date of the vaccines used and the seroprevalence level.
The significant relationship found in this study was the seroprevalence and the routes of measles vaccine administration. It was found that the majority of the children vaccinated through the subcutaneous route seroconverted.It was also found that the presence of measles antibodies before immunization (seropositivity) may inhibit successful seroconversion after measles vaccination. This signifies that wrong administration of the site of measles vaccine lowers the efficacy and the protective capacity of the vaccine.
Therefore, adequate training, retraining and supportive supervision of health workers on true contraindications and correct route of administration of measles vaccine is strongly recommended.

Title Page———i

Certification——–ii

Dedication———iii

Acknowledgement——-iv

Abstract ———vi

Table of Content——–vii

 

Chapter One

1.0 Introduction ——-1

1.1 Statement of Problem——4

1.2 Purpose of the Study——5

1.3 Significance of Study——8

1.4 Limitation——–9

1.5 Scope of Study——-11

 

Chapter Two

2.0 Review of Related Literature —-12

2.6 Summary of Literature Review—- 19

 

Chapter Three

3.0 Research Methodology and Procedure—22

3.1 Population ——–22

3.2 Sample and Sampling Technique—-22

3.3 Validation of the Instrument —-23

3.4 Reliability of the Instrument —–23

3.5 Data Analysis——-23

 

Chapter Four

4.0 Presentation and Discussion of Result—24

4.1 Analysis and interpretaion of Data—25

4.2 Discussion of Results——38

 

Chapter Five

5.0. Summary, Conclusion, and Recommendation  –40

5.1 Summary——–40

5.2 Conclusion——–41

5.3 Recommendation——42

References ———45

Appendix 1——–47

Appendix ———50

A QUALITY ASSESSMENT OF MEASLES VACCINATION AND SEROLOGIC STATUS (SEROCONVERSION) AMONG CHILDREN 9 – 12 MONTHS IN OTUKPO LOCAL GOVERNMENT AREA OF BENUE STATE

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