ABSTRACT
The study assessed information dissemination and use to post-natal mothers on immunisation as prevention to childhood killer diseases by librarians in Federal Medical Centres, North-central, Nigeria. The study was guided by eight research objectives, six research questions and two research hypotheses. The objectives of the study were to: identify the available information resources and services in federal medical centre libraries in North-central, Nigeria, investigate the level of library use by post-natal mothers in federal medical centres in North-central Nigeria, determine ways librarians disseminate information on immunisation, find out how information on immunisation is used by post-natal mothers, ascertain which killer diseases are prevented as a result of information disseminated by librarians and to find out the factors affecting information dissemination and use to post-natal mothers on immunisation against childhood killer diseases. Survey research design was adopted for the study. The total population for the study was seven thousand, seven hundred and sixty-four (7,764) librarians working in Federal Medical Centre Libraries and post-natal mothers attending federal medical centres in North-central Nigeria. A sample size of four hundred and nine (409) was used based on the Krejcie and Morgan (1970) Table for determining sample size from a given population. Observation checklist and questionnaire were used as the instruments for data collection; where 0.75 and 0.79 were obtained as the results for reliability test of the two sets of questionnaire. Four hundred and nine (409) copies of questionnaire were distributed, out of which three hundred and two (302) were filled, returned and used for the analysis. The analysis was presented using statistical tools such as frequency counts and percentages, mean and standard deviation. Pearson Product Moment Correlation (PPMC) was used for analysing research hypotheses. The study revealed among others that the information resources available were textbooks on medical lines, professional journals, newspapers, magazines, newsletters, manuals and guides on immunisation, medical standards and guidelines, dictionaries, posters/handbills, while library services available were reference services, current awareness services, selective dissemination of information, intra and inter-library loan services, library orientation services in the medical centre libraries studied. The study equally revealed that medical librarians mostly disseminate information on immunisation to post-natal mothers through radio/television messages, workshops/seminars and outreach services/programmes. The major factors identified as affecting the information dissemination and use on immunisation to post-natal mothers as revealed in the study are inadequate fund to sponsor library immunisation programmes, erratic power supply for effective dissemination of information on immunisation, others include: inadequate fund to acquire the ICT equipment to disseminate the needed information to post-natal mothers, post-natal mothers lack of interest of seeking information on immunisation and lack of government intervention towards the awareness of information on immunisation to post-natal mothers. The study, therefore, recommended among others, that the Federal Government of Nigeria in conjunction with the management of federal medical centres should as a matter of urgency finance the purchase of health information resources in order to carry out effective services particularly on immunisation programmes to post-natal mothers as well as the general public.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background to the Study
Prevention as popularly said is better than cure. Good health is indeed the foundation upon which individuals and families build long, healthy lives especially when unburdened by sickness and diseases. This occurs mainly when there is proper immunisation. Immunisation is the key to healthier childhood and it is one of the safest and most effective precautions to prevent disease and early childhood death. World Health Organisation (WHO) (2018) stated that good health of people in the community could not be only as a reflection of mental and social well-being but also absence of disease. However, to obtain the (WHO) goal of providing health for all, improvement in a community should aim not merely mental ill health and tension but also to reduce diseases to a worthy or moderate level. According to Global Vaccine Action Plan (GVP) (2018) immunisation is a central pillar of universal health coverage, providing an infrastructure on which effective and equitable health systems can be constructed and effective national immunisation system requires ongoing nurturing, political commitment as well as public support and there will never come a point at which immunisation is no longer required because every year more than 130 million new babies are born and each equally deserve protection against vaccine-preventable diseases.
Immunisation is simply the process of introducing weakened or killed germs (vaccines) into the body, which increases body immunity to protect one from a particular disease. These weakened or killed germs stimulate the body to produce antibodies that will fight or weaken any disease organism that attempts to enter the body. Immunisation is given against infectious diseases that cause much illness, death and which if not given could make a child to become disabled permanently.
The National Programme on Immunisation (NPI) was introduced in Nigeria in 1979. From 1979-1997, the programmme was known and called Expanded Programme on Immunisation (EPI). To give a national outlook and show federal government commitment, the federal government established an agency called NPI under Decree 12 in August 1997 (NPI/UNICEF Security Report, 2003). This is to effectively control the occurrence of all vaccine preventable diseases through immunisation and provision of vaccine and other consumables. Focus was on prevention, control & eradication of the following vaccine preventable diseases in Nigeria. The diseases include: tuberculosis, measles, diphtheria, pertussis, neonatal tetanus, cerebrospinal meningitis, yellow fever and polio to mention but a few. These diseases are targeted through immunisation service delivery and this is done by administration of vaccine to susceptible target. NPI aims at the following group of people for immunisation: Children of age ≤ 11months, all pregnant women and women of reproducing age group.
To corroborate this position, Adedokun et al. (2017) in their study on ‗‗Incomplete Childhood Immunisation in Nigeria: a multilevel analysis of individual contextual factors,‘‘ asserted that more than three-quarters of the children (76.3%) were not completely immunised, about 83% of the children of young mothers 15–24 years and 94% of those whose mothers are illiterate did not receive full immunisation. In the fully adjusted model, the chances of not being fully immunised reduced for children whose mothers attended antenatal clinic. It was therefore concluded that the risk of children being incompletely immunised in Nigeria was influenced by not only individual factors but also community and state-level factors.
Similarly, according to (NPI/UNICEF Security Report, 2003) the National Programme on routine immunisation of children in Nigeria is carried out using the following vaccines: BCG (BacilliCalmette Guerin)—at birth or as soon as possible after birth; OPV (Oral Polio Vaccine)—at birth and at 6, 10, and 14 weeks of age; DPT (diphtheria, pertusis, tetanus)—at 6, 10, and 14 weeks of age; hepatitis B—at birth, 6 and 14 weeks; measles—at 9 months of age; yellow fever—at 9 months of age; and vitamin A—at 9 months and 15 months of age.
In the same vein, the Nigerian Federal Ministry of Health definition (2011) stated that a child is considered fully vaccinated if he or she has received a Bacilli Calmette Guerin (BCG) vaccination against tuberculosis; three doses of Diphtheria, pertusis, tetanus (DPT) to prevent diphtheria, pertussis (whooping cough), and tetanus; at least three doses of polio vaccine; and one dose of measles vaccine. All these vaccinations should be received during the first year of life, over the course of five visits, including the doses delivered at birth. According to this schedule, children aged 12–23 months would have completed their immunisations and be fully immunised. To keep track of the delivery of these immunisations, Nigeria also provides parents or guardians with a health card on which each dose is recorded.
Immunisation according to GVAP (2012) is and should be recognised as a core component of the human right to health and an individual, community and governmental responsibility because vaccination prevents an estimated 2.5 million deaths each year. When protected from the threats of vaccine-preventable diseases, immunising children have the opportunity to thrive and have a better chance of realising their full potential. The Global Vaccine Action plan (2012) stated further that immunisation is an essential investment in a country because it is a comprehensive package for disease prevention and control.
Similarly, Illinois Immunisation Programme (IIP)(2018) opined that immunisation protects against the following serious diseases which can cause disability and death. These diseases do strike thousands of children each year because some babies are not immunised thus, they cause serious health problems in young children. These diseases are varicella (chicken pox), tetanus (lockjaw), whooping cough (pertussis), polio (poliomyelitics), measles (rubeola), mumps (rubella hepatitis B) pneumonia and meningitis.
Furthermore, Mediclook.info (2018) stated that vaccination or immunisation gives a small amount of weak virus in a person, invoke an immune response that will prevent or reduce future infection by the same virus/bacteria. This means that antibodies produced in the body will enhance the person‘s immunity against those diseases because future exposure will be fought quickly by the body due to the vaccine which therefore reduces the severity or prevent the onset of the diseases. In a similar vein, to prevent oneself and the general public from getting sick, vaccinations are recommended for everyone because it is easier to prevent than treat a disease once an individual have it. Ophori et al. (2014) explained that immunisation against childhood diseases such as diphtheria, pertussis, tetanus, polio and measles is one of the most important means of preventing childhood mobility and mortality. Therefore, achieving and maintaining high levels of immunisation of post-natal mothers coverage should be a priority for all health workers including the information professionals.
According to Charlotte et al. (2006) the postpartum also known as post-natal period of a mother is defined as the first six weeks after birth and it is very critical to the health and survival of a mother and her newborn. The most vulnerable time for both mother and child is during the hours and days after birth. This simply means that lack of care in this time period may result into death or disability as well as missed opportunities to promote healthy behaviors, affecting women, newborns, and children.
Post-natal mothers are regarded as those women who visit federal medical centres and other health institutions like hospitals, clinics, maternities which are usually owned by federal and state government or private individuals after a child is born for regular check-up. WHO (2014) described the post-natal period of a mother as the most critical and yet the most neglected phase in the lives of mothers and babies; most maternal and newborn deaths occur during the post-natal period. In addition, Kansky (2016) stated that postpartum (or post-natal) period begins immediately after the birth of a child as the mother’s body, including hormone levels and uterus size, returns to a non-pregnant state. Similarly, Romano et al (2010) stated that postpartum period can be divided into three distinct stages; the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts 2–6 weeks, and the delayed postpartum period, which can last up to six months.
For effective immunisation services to be achieved among post-natal mothers, some variables such as information dissemination and use need to be in place as well as the federal medical centre libraries. Information dissemination according to Isibor and Fidella (2018) involves strategic efforts to reach out to individuals, organisations and communities with the right information, in the right format, using the right medium and at the right time. Therefore, the role of the federal medical centre library in information dissemination is fundamentally critical in health education and the provision of balanced perspectives to medical issues. They argued further that information dissemination in the context of healthcare provision is the careful collection, analysis, matching and delivery of a message for a desired outcome by the medical librarians working in the federal medical centre libraries. The matching process is usually facilitated through a systematic approach, an appropriate media and using the right language. Information disseminated to post-natal mothers particularly on childhood killer diseases helps to clarify the rights and privileges of patients‘ thus promoting self- esteem and dignity of mothers.
Information dissemination is normally one of the services performed in various libraries including federal medical centre libraries in Nigeria. This service is usually provided to medical students, medical practitioners, pregnant and post-natal mothers. This is to enable them be aware of the medical libraries existence as well as provide them resources and information services to enhance and better their conditions. This service is necessary in every information centre because _Information‘‘ as popularly said is _Power‘‘
Various ways of disseminating information particularly in information centres exist with each targeting a specific accomplishment to serve clienteles in the best possible ways presupposes that the services be focused on the needs of the customer and federal medical centres (FMC) is not an exception. However, the dissemination of information particularly in this contemporary period has taken a unique dimension, which could be either through the use of telecommunication systems or social media platforms such as Facebook, Instagram, Twitter, WhatsApp, Telegram through your smartphones, laptops, computers and palmtop etcetera. Dissemination of information could also be through interpersonal communication such as: face-to-face communication with persons involved through television, radio programmes, newspapers, magazines and pamphlets and these are all found to be useful in terms of dissemination of information to post- natal mothers by librarians.
Another important variable for better immunisation process to be achieved among post- natal mothers is through information use. IGI Global Dissemination of knowledge (2019) defined information use from the user or cognitive perspective as the modification of the user‘s knowledge structure. Information use is concerned with understanding what information sources people choose and ways in which people apply information to make sense of their lives and situations (Encyclopedia.com, 2019).
Chimah and Nwokocha (2013) asserted that the efficacy of the principle of information utilisation is anchored on its ability to satisfy the needs of all seekers including the post- natal mothers. Similarly, Uhegbu (2007) simply described information use as the act of putting into appropriate use the information acquired. Post-natal mothers just like other women counterparts use information for life-long learning, solve their daily problems, to forge social relationships as well as use this information to better their health matters. The ultimate goal of information dissemination is its utilisation and for proper decisions to be made. The process of examining, searching and making good use out of a piece of information is regarded as information use or utilisation. Therefore, it is expected that when the librarians disseminate information on the importance or benefits of immunisation on children, the age brackets of those to be immunised, the period or immunisation routine of each vaccine and the consequences of incomplete immunisation on children, their mothers should adhere as well as comply and properly use the information disseminated.
Therefore, with regards to this study, information use refers to the process by which post-natal mothers make adequate and proper use of information provided to them against infectious childhood killer diseases; and one of the most effective ways to increase utilisation and to improve on the quality and relevance of health information to post-natal mothers particularly on immunisation is through proactive, regular dissemination of information by the librarians. This is why information dissemination and use as regards to immunisation becomes paramount to post-natal mothers to guide against childhood killer diseases.
1.2 Statement of the Problem
Immunisation of children has remained an outstanding preventive measure against vaccine preventable diseases (VPDs) all over the world, Nigeria inclusive. Access to quality information on immunisation by post-natal mothers is considered the most important factor for healthier childhood. Information on routine immunisation received by post-natal mothers may make or mar its successes. Proper communication and dissemination of information on immunisation to post-natal mothers as well as their use of information cannot be over emphasised.
The researcher, after some preliminary investigation, discovered that even with the recent advancement in technology in terms of information dissemination, some post- natal m others still have little or no information on immunisation, which deprived them the opportunity of explaining the benefits of immunising children against childhood killer diseases. Furthermore, the researcher through the information gathered from daily newspapers, one on one interaction with post-natal mothers in the study area and other literature has learnt the adverse effects of improper immunisation of children in Nigeria. For instance, according to the Nigerian Networks of NGOs (NNGOs) (2018), a survey conducted in Lagos 2017, using a Multi Indicator Cluster Survey (MICS) showed that only about 23% of children in Nigeria were fully immunised in the last one year leaving out 77%. This means that there is still a lot more work to be done to achieve 100% coverage in immunisation with the intention of leaving no child behind in Nigeria. This present situation is worrisome considering the fact that the rate of child mortality in Nigeria may be on the increase, if nothing is done fast.
In order to improve and achieve proper routine immunisation among the post-natal mothers in Nigeria, the information professionals particularly the librarians are expected to disseminate the right information at the right time to post-natal mothers on the dangers of not immunising their children against diseases. Such knowledge is necessary in order to take appropriate steps in increasing the levels of use of information disseminated on immunisation by post-natal mothers in the overall interest of the children, mothers, the federal medical centres in North-central, Nigeria and Nigeria as a whole.
This, therefore, necessitates the need to assess the information dissemination and use to post-natal mothers on immunisation as prevention to childhood killer diseases by librarians in FMCs North- central Nigeria.
1.3 Objectives of the Study
The aim of the study is to assess the information dissemination and use to post-natal mothers on immunisation as prevention to childhood killer diseases by librarians in FMCs North-central, Nigeria. The specific objectives were to:
1. identify the available information resources and services in federal medical centre libraries in North-central, Nigeria;
2. investigate the level of library use by post-natal mothers in federal medical centres in North-central, Nigeria;
3. determine the ways librarians disseminate information on immunisation to post- natal mothers in federal medical centres in North-central, Nigeria;
4. find out how information disseminated on immunisation is used by post-natal mothers in North-central, Nigeria;
5. ascertain which killer diseases are prevented as a result of the information disseminated on immunisation to post-natal mothers in North-central, Nigeria;
6. find out if there is any relationship between information disseminated to post- natal mothers and information use on immunisation as prevention to childhood killer diseases;
7. ascertain if there is any relationship between information use by post-natal mothers and diseases prevented as a result of information dissemination on immunisation against childhood killer diseases and
8. find out the factors affecting information dissemination and use on immunisation to post-natal mothers in North-central, Nigeria.
1.4 Research Questions
Based on the objectives of the study, the following research questions were answered:
1. What are the information resources and services available in federal medical centre libraries in North-central, Nigeria?
2. What is the level of library use by post-natal mothers in federal medical centres in North- central, Nigeria?
3. What ways do librarians disseminate information on immunisation to post-natal mothers in North-central, Nigeria?
4. How do post-natal mothers use information disseminated on immunisation in North-central, Nigeria?
5. What killer diseases are prevented as a result of the information disseminated on immunisation to post-natal mothers in North-central, Nigeria?
6. What are the factors affecting information dissemination and use on immunisation to post- natal mothers in North-central, Nigeria?
1.5 Research Hypotheses
The following null hypotheses were tested in the study at 0.05 level of significance:
1. There is no significant relationship between information dissemination to post- natal mothers and information use on immunisation as prevention to childhood killer diseases.
2. There is no significant relationship between information use by post-natal mothers and diseases prevented as a result of information dissemination on immunisation against childhood killer diseases.
1.6 Scope of the Study
The study covered Bida, Keffi, Lokoja and Makurdi Federal Medical Centres all in North-central, Nigeria as well as the medical librarians and post-natal mothers found in the Bida, Keffi, Lokoja and Makurdi federal medical centres. It also determined the extent to which medical librarians dissminate information on immunisation to help the well-being of both post-natal mothers and their children and how information on immunisation is being used by post-natal mothers against childhood killer diseases in federal medical centres in North-central, Nigeria.
1.7 Significance of the Study
The study will be of benefit to the following people: medical practitioners, post-natal mothers, policy makers in government, federal medical centres and Medical librarians.
The study will be significant to medical practitioners in the federal medical centres as they will know the extent post-natal mothers are educated or informed on the importance of immunisation thereby make their work easy and better. It will also be of immense significance to post-natal mothers as they will adequately be informed on why their children should be immunised as well as the consequences or implications of improper immunisation and will therefore reduce childhood killer disease cases in the future. The study also will be of benefit to policy makers in government as it will assist them to develop policy suitable for all in terms of making available both the human and material resources necessary for adequate service delivery especially to post-natal mothers against the killer diseases.
Medical librarians will also benefit in the sense that they will identify their roles as information professionals and thereby protect childrens‘ lives. They will equally have unique opportunity to help overcome health literacy challenges by developing new and effective communication strategies for disseminating relevant information to audience with differing levels of health literacy. This is of particular importance to the post-natal mothers in Bida, Keffi, Lokoja and Makurdi federal medical centres in North-central, Nigeria.
1.8 Operational Definition of Terms
The following terms were defined as used in the context of the study:
Assessment is the evaluation of information dissemination and use to post-natal mothers on immunisation against childhood killer diseases in federal medical centres North-central, Nigeria.
Childhood killer diseases are diseases such as diphtheria, pertussis, tetanus, polio, whooping cough, pneumonia and measles that affect children in four federal medical centres in North-central, Nigeria.
Immunisation is a service provided by nurses to post-natal mothers and their children for a good health care in federal medical centres in North-central, Nigeria.
Information dissemination is the method used by medical librarians in federal medical centres in conveying information to post-natal mothers on immunisation as prevention to childhood killer diseases in bida, keffi, lokoja and makurdi federal medical centres
Information use is the ability of post-natal mothers to use the information provided to them on immunisation by librarians to help prevent child mortality in the federal medical centres.
Medical Librarians are medical librarians in charge of making available the needed information resources and services as regards to immunisation to post-natal mothers in federal medical centres in North-central, Nigeria.
Post-natal mothers refer to those women who visit federal medical centres after a child is born for regular check-up.
This material content is developed to serve as a GUIDE for students to conduct academic research
ASSESSMENT OF INFORMATION DISSEMINATION AND USE TO POST- NATAL MOTHERS ON IMMUNISATION AS PREVENTION TO CHILDHOOD KILLER DISEASES BY LIBRARIANS IN FMCs NORTH- CENTRAL, NIGERIA
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