Research proposal

FACTORS INFLUENCING IMMUNIZATION COVERAGE

IN ACUNA VILLAGE, ADOKO SUBCOUNTY

DOKOLO DISTRICT

DEFINITION OF KEY TERMS

IMMUNIZATION: Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease.

Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.

Vaccine : A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins. The agent stimulates the body’s immune system to recognize the agent as foreign, destroy it.

Vaccination policy;   Vaccination policy refers to the health policy a government adopts in relation to vaccination.

Immunization coverage; This refers to the number of people who have access to immunization in a specific area.

ACRONYMS

MoH                                 : Ministry of Health

ORS                                  : Oral Rehydration Solution

ORT                                 : Oral Rehydration Treatment

SPSS                                : Statistical Package for Social Scientist

UDHS                               :  Uganda Demographic and Health Survey

UNICEF                           : United Nations International Children’s Emergency Fund

UNMEB                            :  Uganda Nurses and Midwives Examination Board

WHO                                : World Health Organization

CHAPTER ONE: INTRODUCTION

1.1 Introduction

According to WHO, (2016) 130 of the 194 WHO Member States have achieved and sustained at least 90% coverage for immunization at the national level as one of the targets set out in the Global Vaccine Action Plan. However, an estimated 10 million additional infants need to be vaccinated in 64 countries, if all countries are to achieve at least 90% coverage. Of these children, 7.3 million live in fragile or humanitarian settings, including countries affected by conflict. 4 million of them also live in just three countries, Afghanistan, Nigeria and Pakistan, where access to routine immunization services is critical to achieving and sustaining polio eradication in addition to that In 2016, eight countries had less than 50% coverage with DTP3 in 2016, including Central African Republic, Chad, Equatorial Guinea, Nigeria, Somalia, South Sudan, Syrian Arab Republic and Ukraine.

The immunization coverage in Africa has been low since the 1980s were the coverage was at 20%, however the with the introduction of universal childhood immunization, the coverage increased to 57% in the 1990s this also further increased to an all time high of 76% in 2015, however despite the increase there has been stagnation of immunization coverage in sub-Saharan Africa to around 70% for a long period of time, however some countries in sub-saharan Africa experience low levels of coverage than others this is indicated by the fact that 77% of children aged 12 – 23 months in Nigeria have not received all the routine vaccinations as recommended by the national EPI schedule while 40% of children in this age group did not receive any vaccinations setting the countries far below the 90% national coverage it so desires (WHO & UNICEF, 2015).

According to the Ministry of Health report on immunization promotion for leaders, the proportion of children who are fully immunized in Uganda has been dropping since 1995; from 47% in 1995 to only 37% in 2001, (MOH, 2002). “Fully immunized” is the term used to describe a child less than 12 months old who received one dose of BCG, one dose of Measles, and three doses of DPT/OPV before his/her first birthday. The report also states that most children (84%) received one dose of immunization and only 37% received all the five doses. The report further indicates that as many as 63% of mothers are not aware when their children need their next immunization doses in order to complete the immunization schedule. A nationwide demographic and health survey conducted in 2006 showed that only 46% of the children (12 to 23 months) had received all the recommended vaccines (Kiwanuka,  et al, 2008).).

According to Daily monitor, (Wednesday January 30 2013) with 52 per cent national immunization coverage, Uganda has the lowest number of fully immunized children in East Africa against the 90 per cent target of the global immunization vision and strategy. This makes Uganda the country with the highest infant mortality rate in the region. The report further indicates that at 55 per cent, Uganda has the lowest measles vaccination coverage against Kenya’s 86 per cent. Rwanda’s coverage stands at 82 per cent while that of Tanzania is at 92 per cent. It further shows that Uganda’s immunization coverage for Hepatitis C stands at 60 per cent compared to Kenya’s 83 per cent, while that of Rwanda is at 80 per cent. In Tanzania, the coverage stands at 91 per cent.

According to Rahman, & Obaida-Nasrin, (2010) on average, 54% of children in Uganda were fully immunized, 89% received a full dose of BCG, 24% received DPT, 52% received polio, and 64% received the measles vaccine. The percentage of immunized children increased with maternal education; 63% of children whose mothers had post-secondary education were immunized compared to 53% of children having mothers with no education.

1.2 Problem Statement

Childhood vaccination has contributed to major global reductions in morbidity and mortality and is considered to be the most successful public health intervention in terms of number of deaths averted per year. However, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) estimate that 1.5 million children worldwide continue to die from vaccine-preventable diseases every year because of sub-optimal vaccination coverage. The largest number of these deaths occurs in Sub-Saharan Africa (SSA) and South-East Asia where more than 70% of unvaccinated children worldwide live (WHO, 2015).

According to Denboba, et al., (2014) No district in Uganda has reached the full immunization coverage of 80% for children below one year. This leaves the children exposed to the risk of vaccine preventable diseases. The proportion of children who are fully immunized in dokolo region has been dropping since 1995 from 47% in 1995, to 37% in 2001; rising to 44% in 2006 and finally to 52% in 2011 which is far below the national target of 80% coverage for all vaccines. Currently, there is concern by government and development partners that Uganda is experiencing declining trends in immunization as the gains that had been achieved were reversed by reported cases of high infant mortality rate which was attributed to vaccine preventable diseases, It’s against this Background that this study intends to investigate into the factors influencing immunization coverage in ADOK Sub-county, Dokolo district.

1.3 Purpose of the study

The purpose of the study is to examine the factors influencing immunization coverage in Acuna village, Adok Sub county Dokolo district.

1.4 Specific objectives

1. To establish health facilities factors associated with immunization coverage in Acuna village, Adok Sub county Dokolo district.
2. To analyze the social-economic factors of immunization in Acuna village, Adok Sub county Dokolo district.

• To examine the cultural factors that affect immunization coverage in Acuna village, Adok Sub county Dokolo district.

1.5 Research Questions

1. What are the health facilities factors associated with immunization coverage in Acuna village, Adok Sub county Dokolo district?
2. What are the social-economic factors of immunization in Acuna village, Adok Sub county Dokolo district?

• What are the cultural factors that affect immunization coverage in Acuna village, Adok Sub county Dokolo district?

1.6 Justification

The study is being carried out because of the numerous challenges Uganda is facing in regards to immunization coverage therefore this study may help the government of Uganda is planning better ways of improving the coverage of immunization across the country.

The study may also help the country in closing the gap in immunization coverage across different districts in Uganda this will help in ensuring that all the district in Uganda achieve the world health organization targets of 100% immunization coverage in all districts in Uganda.

The study may also help in improving the livelihood of Ugandans by ensuring that the killer diseases are eliminated in Uganda. Apart from that Uganda immunization challenges are high this is indicated by Denboba, et al., (2014) who states that no district in Uganda has reached the full immunization coverage of 80% for children below one year. This leaves the children exposed to the risk of vaccine preventable diseases. The proportion of children who are fully immunized in dokolo region has been dropping since 1995 from 47% in 1995, to 37% in 2001; rising to 44% in 2006 and finally to 52% in 2011 which is far below the national target of 80% coverage for all vaccines.

CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This study will discuss what various scholars have written about factors influencing immunization coverage in Acuna Village, Adok sub-county, Dokolo district.

2.1 Health facilities factors associated with immunization coverage.

Uganda suffered many challenges to its routine immunization program in recent years, including yellow fever and polio outbreaks in 2010, and measles and hepatitis B outbreaks in 2013. This rash of outbreaks underscores the critical need for continued efforts to increase immunization coverage levels, but in ways that the country can sustain. Within the country, much variation exists across districts, with poorer performance in northern parts of Uganda as recovery from years of conflict continues. Multiple recent assessments such as the 2010 Expanded Program on Immunization (EPI) Review, 2011 Effective Vaccine Management Assessment, and 2012 assessment of immunization and surveillance all point to persistent systems-based problems within the country’s operational components of immunization and surveillance (W HO, & Unicef,  2015).

According to (Steinglass et al, 2014) in a study in northern Nigeria unavailability of vaccines is a big hindrance to the levels of immunization in most parts of nigeria ; this has also led to the low levels of immunization because most of the health facilities do not have the required vaccines, in most of the rural parts of Africa there are no vaccines for the immunization so most mothers do not go to health facilities because of lack of facilities.

According to report in Chad most of the health workers in the country have been found to verbally and physically abuse parents who bring their children to immunization this has thus led to low levels of immunization in the country there by affecting the country’s ability to achieve the target of 90% immunization  (Scott, Wonodi, Moïsi, Deloria-Knoll, M., DeLuca, Karron,… & O’Brien,2012).

According to a study in guinea Bissau there is shortage of health professional in the country to fully enable the country offer the service of immunization to the masses this has thus led to the serious challenges to the development partners and the government in trying to enable the country elimination Vaccine preventable diseases in the country, (UNICEF,  2008).

A study in Sub-Saharan Africa discovered that most countries especially south Sudan do not have the necessary funds to fully immunize the children this has therefore made it difficult to fully implement the program in these area  most of the health facilities do not have enough facilities needed for the provision of health services, this has hindered the implementation of immunization programs in these areas especially in rural areas in Uganda, apart from that Nigeria is one of few in Africa countries that bear the cost of its traditional RI vaccines as opposed to donor-funded. At the national level, the timely release of adequate funding to UNICEF for vaccine procurement is very crucial to avoid any delay in the vaccine supply chain (Shehu, 2015).

According to a study by Scolding, et al, (2015) Poor road network in northern Nigeria has made it difficult to administer, when an area lacks proper roads this limits the ability of the Health team to be able to access the areas which need immunization to be able to access. WHO reported that, in 2011,22.4 million children globally were not completely vaccinated at 12 months of age and remained at risk for vaccine-preventable morbidity and mortality (Selvaraj, Sarkar & Daya, 2014).

2.2 Social-economic factors of immunization

The recurrent vaccination preventable diseases in Nigeria are public health challenge despite all attempts to address the situation, Poor immunization coverage especially in rural community in South Western Nigeria has been mainly accelerated because of Illiteracy . most of the women in rural areas who did not attend school do not understand the benefits of immunization Adebayo, Oladokun & Akinbami (2012). In the another study by Kapoor & Vyas, (2010) in northern somalia illiterates parents were very hesitant to take their children for immunization because poor perception of immunization by low class families, trusting the efficacy of vaccines seems can be a major factor in parents’ decision to go to the trouble to have their children vaccinated. In a study in Punjab Province, Pakistan, 34% of mothers said they doubted the effectiveness of vaccination. People in various countries also talked about children who got the disease (particularly measles) despite being vaccinated. Both mothers and health workers in Somalia believed that the protection from immunization was of limited value because it lasted only for a limited time.

According to Rahji & Ndikom, (2013) in  a study in Liberia it was discovered that Fear side effects of immunization this has made them to fear immunization, Mild side effects, such as fever, redness or rash, are common and normally clear up on their own within a day or two. In many of the studies reviewed, parents mention fear of side effects as a reason for not vaccinating their children.

According to Nelson, Bloom, & Shankland, (2018) In  a study in northern Nigeria in Kano state the findings indicated that, Public trust is essential in promoting public health, Such trust plays an important role in the public’s compliance with public health interventions, especially compliance with vaccination programs, which target mainly healthy people. Where public trust is eroded, rumours can spread and this can lead to rejection of health interventions. In northern Nigeria in 2009, the political and religious leaders of Kano, Zamfara, and Kaduna states brought the immunization campaign to a halt by calling on parents not to allow their children to be immunized. These leaders argued that the vaccine could be contaminated with anti-fertility agents (estradiol hormone), HIV, and cancerous agents.

According Awosika, (2012) Poor families is south sudan were less likely to take their children to immunization centres because of lack of transport to immunization centers since they are located in trading centres this has led to conflicting priorities appear to be a significant factor affecting families with non-vaccinated or partially vaccinated children; e.g. 31% mothers of children with no immunizations and 14% of those with partial 21 immunizations in urban Indonesia cited this factor. It is difficult for poor parents to travel long distance, wait for long hours and get one of their children vaccinated, when they should be earning money or growing food to be able to provide food for the entire family at the end of the day. In some countries, weddings and funerals last up to a week and lead to mothers missing the vaccinations appointments.

According to Mojoyinola & Olaleye, (2013) in a study in south Sudan Every child in the country is supposed to be vaccinated against tuberculosis, polio, diphtheria, tetanus, whooping cough and measles by its first birthday. Kirbak said that only happens for about 65 percent of the country’s children due to a scant health infrastructure, poor roads and cyclical violence in some areas of the country. The level of poor infrastructure has made it difficult to reach all the children in south Sudan in immunization.

2.3 Cultural factors that affect immunization coverage

Vaccines, though administered worldwide, are manufactured dominantly by a small number of manufacturers which are based in industrialized countries. Up to late 1900’s, the big manufacturer’s were supplying large volumes traditional vaccines recommended by WHO, EPI to Pan American Health Organization (PAHO) and United Nations Children’s Fund (UNICEF) at low prices to be used in developing countries. This was possible as the suppliers sold the same vaccine at higher process to the industrialized countries and thus recouped their production cost (Antai, 2009).

Some cultures are against immunization, especially in the Asia were they have negative attitude towards immunization , these people they feel immunization harms their reproductive organ, specifically they think if they immunize they won’t be able to give birth (Cooper et al., 2010).

According to a study in Peshawar , Pakistan most of the parents who were moslems were shunning immunization as they found it against their religious beliefs, this has therefore had serious impacts on the number of people who receive immunization in this area and led to the serious challenges with children in the area (Mojoyinola & Olaleye, 2013) on the same view in a study in Karachi Pakistan Everist, (2015) stated that around 350,000 children were denied polio and a World Health Organization doctor was nearly killed on the 17th of July in 2012 in Karachi while participating in the polio eradication campaign. In the North Waziristan region, over 160,000 children were denied polio vaccinations in 2012 all these were mainly due to the fact that the religious leaders of Taliban have negative effects on immunization.

During the period (2007-2009), an estimated number of 590,000 children were unimmunized against DPT3 and 652,711 children were unimmunized against measles. In 2009, the total number of unimmunized children (DPT3) was 223,218 nationally, increasing from 210,361 reported in 2008. This scenario together with other vaccine preventable diseases that are still occurring have made Uganda to be ranked among the top five countries with the largest number of unimmunized children in Eastern and Southern Africa (Ziraba et al., 2010).

According Satekge, (2012) a study in Pakistan indicated that parents’ perception of importance of vaccination for their child’s health was important since most parents viewed immunization in the city of Karachi they therefore did not take their children for immunization.

Lost or forgotten health cards, Most of the parent do not remember where they placed their immunization cards for their children this has therefore made many not to complete immunization. Health cards were created to help the health workers and parents keep a track of individuals’ service history and to serve as a reminder for people to return for essential and timely health care services (Woldesenbet, et al., 2015).

CHAPTER THREE:  METHODOLOGY

3.1 Introduction

This chapter presents the description of the study design, study area, study population, sample size determination, sampling techniques, data collection procedures, study variable, data collection tool, data presentation, data analysis, ethical considerations and quality assurance.

3.2 Study Design and rationale

This will be a cross sectional descriptive study design employing both qualitative and quantitative methods in which a questionnaire will be used to collect data. The   Participants will be recruited once in the study and interviewed once during the study to allow completion of the study within the academic schedule.

3.3 Study setting and rationale

The study will be conducted at Acuna Village, Adoko Sub County, Dokolo district.

3.4 Study population

The study will focus specifically focus both men and women in Acuna Village, Adok sub county, dokolo district.

3.4.1 Sample Size Determination

The study will consist of 30 respondents in Acuna Village, Adok Sub County, Dokolo district as per UNMEB guideline.

3.4.2 Sampling Procedure

The study will employ simple random sampling, which will be used in selecting respondents at Acuna village, Adoko Sub County, Dokolo District.

Using this technique the researcher will write pieces of paper and puts them in a box and then will give the respondents an opportunity to choose. The papers will be written with numbers one and two with number one meaning No and number two meaning Yes. Therefore those who choose number two will be chosen to participate in the study.

3.4.3 Inclusion Criteria.

The study will consider only adult men and women.

3.5 Definition of Variables

According to this study the independent variable is factors influencing this refer to the factors that affect a give variable.

And the dependent variable is immunization coverage; This refers to the number of people who have access to immunization in a specific area.

3.6 Research Instruments

The researcher will also use researcher administered questionnaire. The purpose of the study will be comprehensively explained to the respondents using the consent form.

3.7 Data Collection Procedure

The researcher will inform the chairman LC I of areas were the research will be carried out for security purposes. The study will take like 5 days since the area is big.

3.7.1 Data Management

Raw data will be processed into meaningful information. The process will involve editing, tabulation and analysis with a view of checking the completeness and accuracy of the information.

3.7.1 Editing

This is intended to detect and eliminate errors that could occur. Only relevant, correct and crucial information will be identified and used to draw conclusion.

3.7.2 Tabulation

Some data will be presented in table to enable analysis and identification of relationship between variables.

3.7.3 Analysis

The findings of the research will be written down and worked out, edited and analyzed using comparison and percentage approaches with the help of computer program known as statistical package for social scientist and Excel program to draw conclusions and recommendations.

3.8 Ethical Considerations.

Upon completion of proposal, an introductory letter is offered for research by Mulago School of nursing and midwifery, to go to the field to collect data. It will then be presented to the LC I officials of Acuna Village, Adoko sub county.

3.9 Limitations of the study

The research may be hampered by the following challenges.

Non responses

The researcher will also experience a problem of non-response from respondents who will be given the questionnaires to fill. However, the researcher will assure the respondents that any information given will be treated with maximum confidentiality.

Cost

The researcher will experience a problem of limited finances with respect to this study. Costs regarding this limitation included transport, printing and photocopying of relevant materials. However, the researcher has to borrow some money from relatives, friends and use it sparingly so as to overcome the cost constraint.

Time

The researcher will experience time constraint in data collection, analyzing of data and in final presentation of the report. However, the researcher will overcome this problem by ensuring that the time element will be put into consideration and that all appointments agreed upon with respondents shall be fully met.

3.10 Dissemination of Results

A report on findings of this study will be compiled and copies of the report will be produced and distributed as follows;

• Mulago School of Nursing and Midwifery
• Uganda Nurses and Midwives Examination Board
• Researcher
• Research supervisor
• Health centre

REFERENCES

Adebayo BE, Oladokun RE, Akinbami FO (2012) Immunization Coverage in A Rural Community in Southwestern Nigeria. J Vaccines Vaccin 3:143. doi:10.4172/2157-7560.1000143

Adebiyi Joseph, A., & Ajani Taiwo, A. (2017). Childhood immunization in Nigeria: factors influencing noncompliance. Educational Research (ISSN: 2141-5161), 8(3), 034-038.

Antai D (2009) Inequitable Childhood Immunization Uptake in Nigeria: A Multilevel Analysis of Individual and Contextual Determinants, BMC infectious diseases 9: 181.

Awosika, D. M. D. (2012). ACCESS TO IMMUNIZATION AND OTHER PUBLIC HEALTH INTERVENTIONS THROUGH THE PHARMACIST. West African Journal of Pharmacy, 23(1).
Kiwanuka, S. N., Ekirapa, E. K., Peterson, S., Okui, O., Rahman, M. H., Peters, D., & Pariyo, G. W. (2008). Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. Transactions of the Royal Society of Tropical Medicine and Hygiene, 102(11), 1067-1074.

Bhola N, Singh JV, Shally A, Vidya B, Vishwajeet K et al. (2008) KAP Study on Immunization of Children in a City of North India – A 30 Cluster Survey. Online J Health Allied Scs 7: 1.

Bosch‐Capblanch, X., Banerjee, K., & Burton, A. (2012). Unvaccinated children in years of increasing coverage: how many and who are they? Evidence from 96 low‐and middle‐income countries. Tropical Medicine & International Health, 17(6), 697-710.

Cooper Robbins, S. C., Bernard, D., McCaffery, K., Brotherton, J. M., & Skinner, S. R. (2010). “I just signed”: Factors influencing decision-making for school-based HPV vaccination of adolescent girls. Health Psychology, 29(6), 618.

Denboba, A. D., Sayre, R. K., Wodon, Q. T., Elder, L. K., Rawlings, L. B., & Lombardi, J. (2014). Stepping up early childhood development: investing in young children for high returns.

Everist, L. (2015). The Impact of Vaccine Hesitancy on the Polio Vaccine in South Asia.

Kapoor, R., & Vyas, S. (2010). Awareness and knowledge of mothers of under five children regarding immunization in Ahmedabad. Editorial Board, 16.

LaFond, A., Kanagat, N., Steinglass, R., Fields, R., Sequeira, J., & Mookherji, S. (2014). Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies. Health policy and planning, 30(3), 298-308.

Nelson, E., Bloom, G., & Shankland, A. (2018). Accountability for Health Equity: Galvanising a Movement for Universal Health Coverage.

Progress and challenges with achieving universal immunization coverage: 2016 estimates of immunization coverage (WHO/UNICEF, July 2017).

Rahji, F. R., & Ndikom, C. M. (2013). Factors influencing compliance with immunization regimen among mothers in Ibadan, Nigeria. IOSR Journal of Nursing and Health Science, 2(2), 1-9.

Rahman, M., & Obaida-Nasrin, S. (2010). Factors affecting acceptance of complete immunization coverage of children under five years in rural Bangladesh. Salud pública de méxico, 52(2), 134-140.

Satekge, M. M. (2012). Knowledge, Attitudes and Practices regarding the Prevention of Hepatitis B Viurs Infections, in Final Year College Student Nurses in Gauteng Province.

Scolding, N., Barnes, D., Cader, S., Chataway, J., Chaudhuri, A., Coles, A., … & Shehu, A. (2015). Association of British Neurologists: revised (2015) guidelines for prescribing disease-modifying treatments in multiple sclerosis. Practical neurology, 15(4), 273-279.

Scott, J. A. G., Wonodi, C., Moïsi, J. C., Deloria-Knoll, M., DeLuca, A. N., Karron, R. A., … & O’Brien, K. L. (2012). The definition of pneumonia, the assessment of severity, and clinical standardization in the Pneumonia Etiology Research for Child Health study. Clinical infectious diseases, 54(suppl_2), S109-S116.

Selvaraj, K., Sarkar, S., & Daya, A. P. (2015). Knowledge on routine pentavalent vaccines and socioeconomic correlates among mothers of children aged younger than 5 years in Urban Puducherry. Int J Med Sci Public Health, 4(2), 199-207.

UNICEF. (2008). The state of the world’s children 2008: Child survival (Vol. 8). Unicef.

Woldesenbet, S., Jackson, D., Lombard, C., Dinh, T. H., Puren, A., Sherman, G., … & Chopra, M. (2015). Missed opportunities along the prevention of mother-to-child transmission services cascade in South Africa: uptake, determinants, and attributable risk (the SAPMTCTE). PLoS One, 10(7), e0132425.

World Health Organization, & Unicef. (2015). Trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.

World Health Organization, & Unicef. (2015). Trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.

World Health Organization. (2016). The World Health Report 2016: Make every mother and child count. World Health Organization.

Ziraba, A. K., Bwogi, J., Namale, A., Wainaina, C. W., & Mayanja-Kizza, H. (2010). Sero-prevalence and risk factors for hepatitis B virus infection among health care workers in a tertiary hospital in Uganda. BMC infectious diseases, 10(1), 191.

APPENDIX I: PARTICIPANTS INFORMED CONSENT FORM

TOPIC: FACTORS INFLUENCING IMMUNIZATION COVERAGE IN ACUNA VILLAGE, ADOK SUBCOUNTY, DOKOLO DISTRICT.

Dear Respondent,

I, Owiny James a student at Mulago School of Nursing and Midwifery carrying out a research study on the above mentioned topic request you to kindly participate in this study by answering the questionnaire provided to you. Your participation in this study is voluntary and you are free to withdraw from it at any time you so wish.

The purpose of the study is to examine the factors influencing immunization coverage in adok sub county dokolo district.

Your participation in this study will be a 30 minutes session while filling the questionnaire. In addition, your participation is completely confidential and your identity will not be revealed in the findings of this study.

I have clearly explained the purpose and objectives of the study to you and you have consented to participate

Researcher’s Signature: ………………………………….                Date: ………

I have been clearly explained to the purpose and objectives of the study and I willingly consent to participate.

Respondent’s Signature: ………………………………….               Date: ………

APPENDIX II: QUESTIONNAIRE

Introduction and Purpose

My name is Owiny James a student from Mulago School of Nursing and Midwifery conducting a research as a requirement for the award of a diploma in nursing.

Tick (√) against the answer of your choice or fill in the blank spaces where applicable.

SECTION A: Social demographic characteristics of respondents

1. Sex of the respondents
2. a) Male b) Female
3. Age
4. a) 20-25
5. b) 26-30
6. c) 31-35
7. d) 36-40
8. Religion?
9. Muslim
10. Christian
11. Pagan
12. Other specify ;………………….

4. Tribe …………………
5. Level of education that you have attained?
6. No formal education
7. Primary education
8. Secondary education
9. Tertiary education
10. Marital status?
11. Single
13. Divorce
14. Widow
15. Separated
16. Occupation?
17. House wife
18. Peasant
19. Pastoralist
20. Self employed
21. Employed by Government
22. None
23. What is your husband’s Occupation?
24. Peasant
25. Pastoralist
26. Self employed
27. Employed by Government

8 (i) What is your wife’s occupation?

(a) House wife

(b) Farmer

(c) Formerly employed

(d) Others please explain

SECTION B: HEALTH FACILITIES FACTORS FOR THE LOW LEVELS OF IMMUNIZATION.

9 (i) Have you ever had of immunization?

1. Yes
2. No
3. (ii) If yes what is it all about?

………………………………………………………………………………………………………………………………………………………………………………………………….

10. Do you have a health facility nearby?
11. Yes
12. No

11. If yes, what is the distance from your home to the health facility?
12. Less than one 1km
13. 2km -3km
14. 4Km-5Km
15. Above 6 Km
16. Does the health facility have immunization services?
17. Yes
18. No
19. Have you taken your children for immunization?
20. Yes
21. No

SECTION D: Social-economic factors that affect levels of immunization.

14. Do you pay for immunization services?
15. Yes
16. No
17. If yes how much is immunization services?
18. less than 5,000
19. 6000-10,000
20. Morethan 11,000
21. Others (specify);…………………………………………

14 If you pay for immunization services do you feel satisfied?

1. Yes
2. No
3. Are immunization service expensive?
4. Yes
5. No
6. Do you feel at your economic level immunization is necessary?
7. Yes
8. No

17. Are there enough health centers in this area to provide the immunization services needed?
18. Yes
19. No

18) Do all the people in this area take their children for immunization?

1. Yes
2. No

19) Can you afford the transport costs for immunization services?

1. Yes
2. No

SECTION C: Cultural factors that determines the levels of immunization

20. Does your culture allow immunization?
21. Yes
22. No
23. I don’t know
24. If no, explain why?

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

22. If yes explain how your culture views immunization?

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

23. Do you take your children for immunization?
24. Yes
25. No
26. ii) If no why

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

24. Do you feel immunization is important for your children?
25. Yes
26. No
27. If yes explain how?

………………………………………………………………………………………………………………………………………………………………………………………………………………

26. What are the challenges to immunization in this community?

1. a) Community members’ do not approve of it.

1. b) People are ignorant of the benefits

1. c) There are immunization services offered here

27. What are the benefits of immunization to this community?

1. a) Fighting six killer diseases

1. b) Elimination of unwanted diseases in the community

1. d) Others explain

THANK YOU FOR YOUR ACTIVE PARTICIPATION

APPENDIX III: BUDGET ESTIMATES

APPENDIX IV: WORK PLAN