Managerial and client - related problems associated with immunization in the Adansi East District of Ashanti - Ghana

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Immunization is administering a substance, which is capable of inducing a protective immunity against a specific infection or disease without itself producing that disease. The purpose of these immunizations is to ensure that all the children in the communities receive adequate and lasting protection against the six vaccine preventable diseases, namely: Diphtheria, Pertussis, Tetanus, Measles, Tuberculosis and Poliomyelitis. Achieving this aim will involve ensuring that potent vaccines are readily available at point of delivery. In all countries, provision is made to immunize children against the six vaccine preventable diseases to reduce infant and child mortality rates. In Ghana, there is a Draft Document on Policies and Priorities for the Health Sector (1994-95) on immunizable disease, which focuses on making available daily immunization services at all delivery points including hospitals. Globally, it has been observed that not all the children who start an immunization schedule finish it. The number reduces towards the end of the schedule. The Adansi East District has an estimated population of 174,254 (1999), with the largest forest cover to total land ratio in the region. Educational and Health facilities are inadequate; most health facilities are MCH centers. The D.H.M.T. has found that for the past three (3) years, the number of mothers who do not complete their children’s immunization schedule has not seen any appreciable change. This study was therefore carried out, to find the number of women with children aged 0 - 2 years in the community who have not completed their children’s immunization and the reasons for non-compliance. Methods employed for the study included Direct Observation of an immunization clinic, interview of mothers with children 0 - 2 years using interview guide, and interview of health staff using self-administered questionnaire. In all, two out of five sub-districts were randomly selected for the study. Eight communities from each sub-district were also selected by random (i.e. total of sixteen communities). Twenty-five (25) mothers were interviewed in each village given the total of (200) two hundred mothers. Community leaders (one per village) were also interviewed using interview guide. Over (5 0%) percent of the respondents were between 20 - 29 years, and (46%) percent had no formal education. Fourteen and half percent (14.5%) could not even mention their age. Most of the respondents and their husbands were farmers. From the study the major key findings accounting for the dropout were related to lack of education and knowledge, varying perceptions, inadequate logistic and manpower support misconception, laziness and ignorance among others. The major broad areas of interventions that have been recommended include: • Improving female education • More human and vehicular support • Intensification of health education • Training for health staff • Presenting vaccines in smaller dose vials The findings and recommendations would be disseminated to all stakeholders to assist them in reducing dropout rate.
A thesis submitted to the Department of Community Health, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, in partial fulfilment of the requirements for the award of Master of Science degree in Health Services Planning and Management, 2001