Citation

Ekunwe EO, Taylor P, Macauley R, Ayodele O. World Health Forum 1994; 15(4): 340-344.

Affiliation

Institute of Child Health and Primary Care, College of Medicine, University of Lagos, Nigeria.

Copyright

(Copyright © 1994, World Health Organization)

DOI

unavailable

PMID

7999218

Abstract

After a preliminary assessment in 1991 showed that immunization services in Lagos were among the worst in Nigeria, Resources for Child Health (REACH) started a multi-component demonstration project in the city. The communications component consisted of focus groups with users and interviews with providers to determine beliefs and practices in order to assess the support for the immunization service and discover ways of strengthening it. Based on data from the 1991 survey, questions were designed to discover why opportunities for immunization were missed and why health workers were giving mothers misinformation. The 15 focus groups consisted of 15 people each (3 with fully immunized children) from each socioeconomic group. The interviews were conducted in the same 4 localities as the focus groups with 11 physicians, 25 nurses, and 12 community health workers. In the focus groups, users blamed incomplete immunization on attributes of the health services and on factors which they themselves controlled. The former included negative staff attitudes, long waiting times, missed opportunities (including refusal to immunize even mildly sick children), and reduced potential contact hours. The latter included fear of side effects, lack of motivation, misinformation, pressures of work, and the laziness or carelessness of the mother (in the view of fathers). The nurses and health workers blamed lack of coverage on the mothers working or traveling, ignorance or carelessness on the part of the mothers, illness in the children, side effects, a preference for native methods, and staff attitudes. It was found that 84% of the nurses and 81.8% of the health workers provided completely accurate counseling information. After analyzing the suggestions of the health workers for improving services and the perception of the physicians about areas in which staff training could improve, REACH recommended that possible contact hours between the mother and the health services be increased, that staff attitudes be improved, and that the knowledge of health workers be updated and improved. Each immunization district in Lagos State now has its own plan to implement these recommendations.

Language: en