Abstract
Live measles vaccine induced protective levels of antibody in 70% of children with protein-caloriemalnutrition (PCM) within 21 days and possibly in 90% by 42 days. The development of specific antibody was delayed and symptoms due to the vaccine more frequent (64%) in these children than in healthy children. Administration of measles vaccine may have predisposed to an associated fatal pneumonia in one malnourished child. Human measles hyperimmune globulin can maintain adequate antibody levels in most children with PCM (75%) for at least three to four weeks. Vaccination induced protective levels of measles antibody in 83% of healthy children under 10 months of age, which compared well with 86% of successful immunizations done at 10 months or later. There was wastage of vaccine in 40 to 70% of children who, despite a negative history of measles, had protective levels of antibody when admitted to the study. It is suggested that malnourished children in the community or the very young can be safely and effectively vaccinated against measles. But passive immunization is preferred in children with PCM severe enough to be admitted to hospital and thereby at increased risk of exposure to measles and other infections.
CHAPTER ONE
INTRODUCTION
- Background of the study
Measles is a highly infectious and contagious disease of the respiratory system caused by Morbilivirus which belongs to family Paramyxoviridae (Hashiguchi et al., 2011). The disease is a common cause of childhood morbidity and mortality across the globe, particularly in developing countries and has been characterized by high fever, cough, conjunctivitis, coryza, malaise and maculopapular rash along with erythematous patches throughout the body (Ellison, 1931; Yanagi et al., 2006; Fazlalipour et al., 2008). Measles infection has been controlled by introduction of live attenuated measles vaccine in United States and Europe (Gindler et al., 2004). However, measles is still affecting the developing countries due to insufficient coverage and improper handling of vaccines (Poland and Jocobson, 1994; Muscat et al., 2009). Historically, immunization against vaccine preventable diseases (VPDs) in children has been started by WHO in 1974, and it was initiated in Pakistan during 1978 (Ali, 2000; Bugvi et al., 2014). In general the vaccine coverage against VPDs in Pakistan ranged between 56 to 88 % which significantly varied among various Provinces (Sheikh et al., 2011). Recently, increased number of measles outbreaks with high morbidity and mortality has been observed in various regions of Pakistan during recent years (Khan and Khan, 2012; Khan and Qazi, 2014). These particular episodes of higher incidence of measles were started in Thatta, Mirpurkhas and Jacobabad Districts of Sindh Province by the end of 2012, which later on spread towards Punjab Province (Khan and Khan, 2012; Khan and Qazi, 2014). The spread of measles was reported to be higher in both rural as well as developed cities of Pakistan along with high incidence of mortality and morbidity (Khan and Qazi, 2014). The important factors considered for these outbreaks were associated with vaccination failure due to several reasons i.e. low vaccination coverage, malnutrition and vitamin-A deficiencies, poor vaccination facilities in remote and rural areas, mis-handling of vaccines and lack of immunization awareness among parents due to lower levels of education in various areas of country (Cohen et al., 2009; Khan and Khan, 2012; Khan and Qazi, 2014). To combat the situation extensive supplementary immunization activities have been initiated which targets the chil-dren less than 10 years of age particularly in Punjab, Pakistan under Expanded Program on Immunization (EPI). Therefore, in the current investigation, impact of supplementary vaccination has been estimated in children from Faisalabad and Kogi using enzyme linked Immunosorbent assay (ELISA) as outlined in supplemental material. A total of 871/1053 (82.71 %) children from Faisalabad and 647/813 (79.58 %) children from Kogi were found vaccinated either with single or dual dose of measles vaccination (Table 1). Out of these 264 blood samples from vaccinated and 100 samples from non-vaccinated children were collected randomly and analysed for the presence of anti-measles IgG antibodies. Only 73.48 % of vaccinated children developed humoral immune response as detected through ELISA. This indicated that the protection against measles was not optimum according to WHO standards (Rabenau et al., 2007; Fazlalipour et al., 2008; Lauridan and van Damme, 2007). Sero conversion following vaccination against measles in developing countries has been reported to be lower (75 %) due to certain factors as described previously (Fowotade et al., 2013; Shah et al., 2012). The highest values (95 %) for measles vaccination have been reported in European countries (Tischer and Gerike, 2000).
1.2 STATEMENT OF THE PROBLEM
In order to attain the health for all, it is very important that an attempt has to be made to address diseases burdens and other health problems that significantly contribute to the poor health status of Nigeria. Base on this, there is need to mount urgent and appropriate health interventions capable of achieving this prime goal. The main goal of the policy is to develop and promote immunization programmes geared toward reduction of childhood morbidity and mortality through adequate immunization coverage of all at-risk population. In view of this, we have to provide the guideline and framework for proper implementation of an immunization schedule for the target and at-risk population. To established a comprehensive guidelines to assure compliance with the plans to detect, control or eliminate the occurrence of vaccine preventable diseases (VPDS).
National programme on immunization (NPI) has the primary mandate to protect children and adult alike, as the case may be against vaccine presentation diseases (VPD).
Namely: Diphtheria, Pertusis (Whooping Cough) Poliomyelitis, Tuberculosis, Teltanus, hepatitis Measles, Yellow Fever and Cerebrospinal Meningitis.
National programme on immunization (NPI) is a policy of the Federal Government of Nigeria to provide immunization services and potent vaccine free to all population at-risk of vaccine preventable diseases.
- AIMS AND OBJECTIVE OF THE STUDY
- To examine the effect of measles on the wellbeing of children in Kogi state.
- To examine the relationship between measles immunization program and children wellbeing in the study area
- To determine the trend on the level of immunization against measles in Kogi State.
- To proffer suggested solution to the identified problem
1.4 RESEARCH QUESTIONS
The following research questions were formulated by the researcher to aid the completion of the study
- Does measles immunization have any effect on the wellbeing of children in Kogi state?
- Is there any significant relationship between measles immunization program and children wellbeing in the study area?
- How adequate is the trend on the level of immunization against measles in Kogi State?
- RESEARCH HYPOTHESES
The following research hypotheses were formulated by the researcher to aid the completion of the study
H0: There is no significant relationship between measles immunization program and children wellbeing in the study area
H1: There is a significant relationship between measles immunization program and children wellbeing in the study area
H0: Measles immunization does not have any effect on the wellbeing of children in Kogi state
H2: Measles immunization does have an effect on the wellbeing of children in Kogi state
1.6 SIGNIFICANCE OF STUDY
This research will aids in policy making and increase knowledge
on routine immunization in Kogi State. It will also be useful in evaluating the performance of existing population policies and programme aim at promoting immunization programme.
1.7 SCOPE AND LIMITATION OF STUDY
This research work is limited to the out break of communicable disease (Measles) in Kogi State, considering the 21 Local Areas, due to conveniences and financial constraints on the part of the researcher. This constraints and limitation should be look into as the data will be use for the generalization about the general populace;
- a) AVAILABILITY OF RESEARCH MATERIAL: The research material available to the researcher is insufficient, thereby limiting the study
- b) TIME: The time frame allocated to the study does not enhance wider coverage as the researcher has to combine other academic activities and examinations with the study.
- c) Organizational privacy: Limited Access to the selected auditing firm makes it difficult to get all the necessary and required information concerning the activities.
1.8 DEFINITION OF TERMS
Immunization
Is the act of introducing a particular antigen into the body to fight against a specific disease e.g. Bacteria and Measles.
Measles
Is a very infectious diseases, illness cause by a virus (paramyxo virus).
Vaccines
Are antigen use for prevention of specific communicable diseases.
1.9 ORGANIZATION OF THE STUDY
This research work is organized in five chapters, for easy understanding, as follows
Chapter one is concern with the introduction, which consist of the (overview, of the study), statement of problem, objectives of the study, research question, significance or the study, research methodology, definition of terms and historical background of the study. Chapter two highlight the theoretical framework on which the study its based, thus the review of related literature. Chapter three deals on the research design and methodology adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding. Chapter five gives summary, conclusion, and recommendations made of the study.
