QUALITY ASSESSMENT OF CHILDHOOD IMMUNIZATION SERVICES IN PRIMARY HEALTH CENTRES IN CALABAR, CROSS RIVER STATE

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QUALITY ASSESSMENT OF CHILDHOOD IMMUNIZATION SERVICES IN PRIMARY HEALTH CENTRES IN CALABAR, CROSS RIVER STATE

Abstract

Introduction: With 20% of the African population, low routine immunization coverage and a wild polio virus reservoir, Nigeria contributes significantly to the overall regional burden of vaccine preventable diseases. Since the introduction of the EPI in 1974 (which later became the National Programme on Immunisation), Nigeria’s immunization program has suffered declining coverage. Poor quality affects service utilization, even where the services are provided free, just as immunization services are. Quality assessment will give an indication of the degree of satisfaction of clients with services as well as provide a framework for review of programme priorities, strategies and components.
Objective: To assess the quality of childhood immunization services at Primary Health Centres in Calabar, Cross River State.
Study design: This was a descriptive cross-sectional study involving the 12 Primary Health Centres in Calabar.
Materials and Methods: A semi-structured questionnaire was administered on four hundred and two caregivers who were selected using systematic random sampling. Another semi-structured questionnaire was administered on all the one hundred and fifty-two healthcare providers who render immunization services at the primary health centres. Facility assessment was also carried out using a checklist. Personal observation of
the facilities and the immunization processes in them were also performed. The client flow through the facilities was also observed. Four Focus Group Discussions were conducted with 12 caregivers in each group. The caregivers were selected using systematic random sampling from four primary health centres. The four centres were randomly selected from the 12 centres that participated in the study using the table of random numbers.
Data obtained from the study was analysed using Epi –Info software version 2002.
Results: This study found that the quality of immunization services rendered in the Primary Health Centres in Calabar was poor with the result that clients became dissatisfied with these services. The study identified some of the causes of client dissatisfaction. Two hundred and five (51%) caregivers were not satisfied with the waiting time which they complained of as being too long. Waiting time was found to be longer than 30 minutes in 9 (75%) facilities. Two hundred and fifty (62.2%) caregivers were not satisfied with the attitude of the healthcare providers. Ninety-two (59%) of the 156 caregivers who were aware that they are entitled to certain rights as clients were not satisfied with the way the health care providers respected their right to information, especially information regarding adverse events following immunization. One hundred and four (63.7%) of the 156 caregivers were not satisfied with the way the providers respected
their right to dignity while 95 (60.9%) were not satisfied with respect for their right to comfort. Six (50%) facilities had neither a deep freezer nor a fridge for vaccine storage while 4 (33.3%) did not have a cold box. Tickler’s box was not available in 10 (83%) facilities. All the facilities complained of unavailability of vaccines for periods ranging from two to four weeks. Only one facility (8.3%) had a functional source of alternative power supply. Nine (75%) facilities did not have well defined schedule for continuous professional development.
Conclusion and Recommendations: The study concluded that the quality of childhood immunization services offered at the Primary Health Centres in Calabar was poor leading to client dissatisfaction and low vaccine utilisation. It recommended continuous training of healthcare providers, adequate supply of vaccines and other equipment, improved attitude of providers towards their clients as well as education and re-orientation of caregivers so as to dispel rumours and misconceptions about immunization.

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

QUALITY ASSESSMENT OF CHILDHOOD IMMUNIZATION SERVICES IN PRIMARY HEALTH CENTRES IN CALABAR, CROSS RIVER STATE

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