MEASLES INFORMATION VACCINE HESITANCY-CASE STUDY OF MOTHERS IN MINNA, NIGER STATE

ABSTRACT

Vaccine hesitancy has been growing in an alarming rate and as a result, innocent children are dying. This study investigated the information behaviour of mothers in Minna, Niger state about information on measles vaccination. Information processing theory was also used as a theoretical framework while grounded theory was used as the methodology. Also, concept mapping and in-depth interview were employed to collect data until saturation level was attained at the fifteenth respondent. The researcher used an analytic inductive process to identify 384 narratives, the narratives were further organized into 28 recurring topics and further collapsed into 8 emergent categories to explain hesitancy to measles vaccination. Findings indicated that hesitant women in Minna, Niger State, were aware of measles vaccination but they did not subscribe to using orthodox medicines in curing measles .The findings also showed that the term “viral” did not exist in the native vocabulary of the women in Minna, Niger state. So they do not believe measles is curable. It is aslo clear that they received conflicting information on vaccination from different sources hence their hesitancy. The research however recommended amongst others that information professionals should swing from the normal informative learning process which has proven ineffective (from the findings) and embrace the transformative learning processes. Also, there is a critical need to understudy the vaccine cognition of parents to determine their cognitive perspectives and then design communicative learning strategies for measles vaccination in the context and situations of Minna.

CHAPTER ONE

1.0       INTRODUCTION

1.1       Background to the Study

The wish of every mother regardless of age, race, literacy level, settlement or religious background is to give birth and bring up a healthy child that is free of diseases. For this reason, a preventive measure to childhood killer diseases was invented. It is called vaccination. Vaccination is the process of stimulating the body’s own immune system to protect a child against infection or disease, typically by the administration of a vaccine. WHO (2019) defined vaccination as the administration of a vaccine to help the immune system develop protection against a disease. Furthermore, the Centre for Diseases Control (2018) defined vaccination as the process of introducing a vaccine into the body to produce immunity to a specific disease.  The term is often used interchangeably with immunization, as immunization is the process by which a person or animal becomes protected against a disease.

The use of vaccines has led to major improvements in children’s health especially at a tender age. Vaccines are basically biological preparations that improve immunity to a particular disease. It typically contains an agent that resembles a disease-causing micro- organism, usually 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, and remember it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters (WHO, 2015). There are several vaccine preventable diseases  but the top 10 according to Expanded Programme on Immunization (EPI) are Tubercle bacillus., Poliovirus, Diphtheria, Tetanus, Pertussis, Measles virus, Hepatitis B virus, Rotavirus,  Haemophilus influenzae

type B (Hib), Streptococcus Pneumoniae (Pneumococcal infection), and  Yellow fever virus. (WHO, 2019).

Globally, vaccines are available for most childhood killer diseases especially the ones mentioned above but myths around them discourage parents from immunizing their children (Bustreo, 2017). For example, Multiple Indicator Cluster MICS (2016-2017) reported that in Nigeria, 77% of children aged 12-23 months did not receive all the routine vaccinations as recommended by national, while 40% of children in this age did not receive any vaccinations. The report also revealed that every day in Nigeria, roughly

2,300 children under 5 years of age die mainly from preventable causes. In addition to this, Shuaib (2019) discovered that one (1) out of every 10 Child in the same age category is a Nigerian and before their 5th birthday, one (1) out of every 8 Nigerian children died. It is in view of these discoveries that parents and particularly mothers are advised to stop vaccine hesitancy for the sake of the lives of their children.

Vaccine hesitancy is a situation where parents do not give consent for their children to be immunized or do not complete the vaccine dose. Vaccine hesitancy is high on an alarming rate and as a result, innocent children are dying from preventable diseases.  Research has shown that there are surplus of studies aimed at finding the determinants of vaccine hesitancy. For instance, Macdonald (2015) in a research categorized the vaccine hesitancy determinants matrix into three, contextual, individual and group, and vaccine specific influence. The author referred to these three factors as responsible for influencing the behavioural decision for the acceptance, delay or outright refusal of vaccines. The World Health Organization (WHO) Euro Vaccine Communications Working Group (EVCWP) (2011) similarly proposed a 3Cs model that confirmed the complexity of vaccine hesitancy and its determinants which include complacency, confidence and convenience. In relation to this, Daniel et al. (2015) opined that the compulsory nature of vaccines,

their coincidental temporal relationships to adverse health outcomes, unfamiliarity with vaccine-preventable diseases and lack of trust in corporations and public health agencies are some of the reasons for parent’s refusal or reluctance to vaccinate their children. In a related discovery, Bowes, (2016) disclosed that lots of parents’ still believe that combination of vaccinations is hazardous and may amplify the likelihood of an adverse reaction when the contents of one vaccine react with another. The author further observed that the defective study that linked autism to vaccinations is another concern of parents. Based on the above discoveries, it is reasonable to argue that there is the urgent need to discard vaccine hesitancy.

So many efforts have been made in reducing vaccine hesitancy. For example, in Nigeria, the National Primary Healthcare Development Agency (NPHCDA) collaborates with the WHO and other civil society organizations to sensitize parents on the importance of vaccinating their children. The Executive Director of the National Primary Healthcare Development Agency (NPHCDA) Shuaib (2019) stated that all avenues of media including the social media, traditional and religious influencers like the Catholic Bishop of Abuja and the Sultan of Sokoto have helped to sustain and encourage immunization efforts and best health practices at the community and state level. Furthermore, NPHCDA and its partners have also developed a ‘Demand Creation Package’, which uses community influencers such as Quranic teachers for mobilization and health camps to provide free health services (WHO, 2019). All efforts made to reduce vaccine hesitancy have not worked according to expectations especially for the dreaded measles.

Measles is an aerosol-borne disease caused by one of the most contagious pathogenic viruses known with no specific antiviral treatment (Holzman et al., 2016). The case for global eradication of measles was first made in 1982. Since then, technical aspects of measles  eradication  have  concluded  that  measles  satisfied  all  criteria  required  for

eradication. To date, only smallpox, among human diseases, has been eradicated, with polio, the next eradication candidate (Robert et al., 2017). WHO launched a programme to eliminate measles by a worldwide vaccination strategy in 2001 (WHO, 2011). Though the prevalence of wild-type measles infection has decreased by 90 % in Europe, measles is still not eliminated and has even re-emerged with recurrent outbreaks in developed countries, in which effective vaccination programmes have been installed for decades. In Nigeria for example,  measles has been  a burden especially on  the northern region (Ibrahim et al., 2019). Also, among the childhood vaccine-preventable diseases, measles causes the most deaths in children, (Kabra & Lodha, 2013) furthermore, Ibrahim et al. (2016) in his research discovered that measles is an endemic disease in Nigeria, with recurrent outbreaks occurring at irregular intervals. With the above example, it is obvious that measles is still far from being eradicated as many parents are still hesitant about its vaccine.

To succeed in reducing to the bearest minimum, vaccine hesitancy, there is need to have a fresh perspective. A potentially useful approach is the use of scientific information approach known as, human information behaviour perspective. Human information behaviour has been utilized to investigate issues relating to health and wellbeing. For instance, St. Jean, (2012) conducted a longitudinal investigation into the information behaviour of people with type 2 diabetes. The findings proved that information behaviour plays  a very important  role in  enabling participants  to  physically,  cognitively,  and affectively cope with having diabetes. Similarly, Meadowbrooke et al. (2014) used the Theory of Planned Behaviour (TPB) to predict intentions to seek HIV testing among Young Men who have Sex with Men (YMSM).  The results suggested that information behaviours may be more important predictors of health behaviour intentions.

Human behaviour research approach has been classified into human computer interaction and information processing approach. Due to the nature of research problem, information processing approach will be adopted for this study. The information processing approach focuses on how the mind operates (David, 2015). The approach is classified into cognitive, social and socio-cognitive dimensions.  The cognitive dimension deals with mental processing of information while social dimension examines the influence of environment on human reasoning and the third which is socio-cognitive hybridized the earlier mentioned approaches. (Sage publication, 2018).

Cognitive psychologists explain how human brain processes information and because of their varying nature, classified them into principles. According to Lutz and Huitt (2003) the first principle is the ‘assumption of a limited capacity of the mental system’. The second, is that a ‘control mechanism is required to oversee the encoding, transformation, processing, storage, retrieval, and utilization of information. Furthermore, Owlgen (2018) added that there is a ‘two way flow of information’ as the third principle while human organism has been ‘genetically prepared to process and organize information in specific ways’. For the purpose of this study, the third of these principles which deals with the two ways flow of information will be adopted.  This is because it focuses on the interaction between new information and stored information (prior knowledge) which is demonstrated with either a top-down approach (from general to specific) or bottom-up approach (from specific to general). This is analogous to a situation of using information derived from the sensor and imagination.

The third principle states that there are two way flow of information. The two ways are prior knowledge and sensory information. Prior knowledge refers to facts or information learned or gained through previous experience or before meeting new information  (Lee,

2016). There are two types of prior /background knowledge; declarative knowledge and

procedural knowledge. Declarative knowledge is the “knowledge about’ or answers to “WH- questions” (Airth, 2018), such as what is today’s date? What colour is this? Primarily, declarative knowledge comprises of the knowledge of facts and knowledge of meaning. It is also explicit in nature. That is, it is the knowledge an individual is confident that he knows. This type of knowledge comes to surface by recognition, reproduction, recalling, and definition. Procedural knowledge on the other hand is the knowledge of knowing how to do something (Airth, 2018). For example, knowing how to use the library? Knowing how to cook? It is usually implicit in nature, that is to say an individual is no longer consciously aware of the knowledge. It comes in surface through integration of knowledge and the application of knowledge. Sensory information on the other hand refers to meanings that the brain collects from the senses that define the world around us. The primary types of sensory information are visual information, auditory information, sense of touch, heptic perception, balance, taste, and smell (Spacey, 2017). The results of this study taking the prior knowledge of parents and the sensory information they acquired as the primary concern will enable the researcher unravel the reasons why women are hesitant to vaccination.

1.2       Statement of the Research Problem

To bring up a healthy child and ensure a generation free of vaccine preventable diseases, UNICEF and WHO, work with partners in government, NGOs, other UN agencies and the private sector to provide immunization for the children who need it most. To achieve this objective, funds are also allocated from all angles into the health sector so as to help in child vaccination and improve the general wellbeing of all.

Unfortunately however, with all the effort made by the various agencies to ensure that every child is vaccinated, not much seems to be recorded in terms of positive result in Nigeria, especially in the North. For instance, Olugbenga-Bello et al. (2017) corroborated

this view when the author ascertained that routine immunization coverage in Nigeria ranks lowest in terms of national coverage rates in the world. Further, the new Multiple Indicators Cluster Survey (MICS) carried out between 2016 – 2017which was organized by UNICEF, shows that only eight percent (8%) of children from North-western part of Nigeria were fully vaccinated and seventeen point-five (17.5%) from North-eastern part of the country, compared to that of the South-west which had over forty-seven percent (47.9%) of children that were fully vaccinated.

This recent vaccine hesitancy has led to a resurgence of diseases such as measles in countries that were close to eliminating them. This is happening because vaccination rates is allowed to slip backward (Chodosh, 2019). A survey from the northern part of Nigeria also revealed that the incidence of measles among children under the age of five increased more than two-fold (UNICEF, 2017).  Similarly, Shuaib (2017) said a surveillance data shows that measles incidence among children under five years increased in the northern part of Nigeria from 190 million in 2014 to 527 million in 2016, and in 2019, the National Center for Disease Control reported almost 6, 000 cases of measles and 15 deaths since the beginning of 2019,  twice as  much as  that  of 2018  for the same  period.  Most disturbingly, in its 2019 New Year message, WHO named vaccine hesitancy as one of the world’s top 10 global health threats. This is seriously worrisome and one wonders what might have led the situation to degenerate to that level. The knowledge of what might have led to this horrible situation is a gap.

This study was carried out to investigate the information behaviour of mothers in Minna, Niger state about information on measles vaccination. Specifically, what they know about measles, measles immunization, measles vaccination and how the make sense of information on measles vaccination.in Minna, Niger State. So as to fill the gap of knowledge so created in that area.

1.3       Aim and Objectives of the study

The aim of this study is to investigate measles information vaccine hesitancy in Minna, Niger State.  The specific objectives are to:

1.    Determine the prior knowledge of hesitant women  about measles

2.    Determine hesitant women prior knowledge about measles immunization

3.    Determine the prior knowledge of hesitant women about measles vaccination

4.    Determine the information given  to hesitant women  about measles vaccination

5.   Determine the sources and type of information hesitant women receive about measles.

6.    Determine how the information communicated to parents by orthodox health workers contradict the information given to them by family and friends?

1.4       Research Questions

The following research questions were postulated to guide the study.

1.   What is the prior knowledge of hesitant women on measles?

2.   What   is   the   prior   knowledge   of   hesitant   women   about   measles   using immunization?

3.   What is the prior knowledge of hesitant women about measles vaccination?

4.    What kind of information is given to hesitant women about measles vaccination?

5.   What are the sources and types of information parents receive about measles?

6.   How does the information communicated to parents by orthodox health workers contradict the information given to them by family and friends?

1.5       Significance of the study

The findings of this study will be of significance to information professionals, primary health care practitioners, policy makers, government officials, community volunteers, others involved in information management and immunization agencies, post graduate, students and lecturers in Library and Information Science and other related fields.

It will enable the government and policy makers to develop vaccine hesitancy information programmes and other vital policies necessary in fighting the hesitancy, especially in Niger state. It will also achieve the milestone of ensuring that the country is free from the thorn of early childhood mortality. It will enable primary health care practitioners and immunization agencies (UNICEF, WHO, CDC, SDGs, SAGE working group, GAVI) achieve their aim of ensuring that every child is fully immunized and thus no child dies from vaccine preventable diseases.

Information professionals will get to develop communication strategies via this study. This will show them how and when attitude and beliefs about vaccines are formed, how people make decisions  about immunization, how best to present  information about vaccines to hesitant women, and how to identify communities at risk of vaccine- preventable disease outbreaks. The results could also permit repackaging of new information on vaccination that will result in behavioural modification of parents against hesitancy. The findings of this research will also be beneficial to parents. This is because the findings will be used to design evidence based context specific immunization information and communication programmes that will hopefully change the negative parental attitudes on vaccines and vaccination. It will also serve as a guide to lecturers and students while teaching and carrying out related research. Consequently, it will add to the literature of Library and Information Science.

1.6       Scope and Limitations of the Study

The main scope of the study is to sought out the information behaviour of mothers in Minna, Niger state about information on measles vaccination. Specifically, what they know about measles, measles immunization, measles vaccination and how the make sense of information on measles vaccination.in Minna, Niger State.

The study covered hesitant women in Minna, Niger State, Nigeria. However, due to the methodology adopted for the study by the researcher, the population  could  not  be estimated as the researcher was expected to collect code and analyze data until saturation level was reached. Thomsom (2011) in relation to this position opined that the sample size for grounded theory relies on the point of theoretical saturation which normally occurs between 10 and 30 interviews. Although saturation might occur after the tenth interview, it is good practice to test the level of saturation by conducting a few more interviews.

1.7       Operational Definition of Terms

Approach: a way of dealing with a situation or problem.

Behaviour: refers to how people respond to certain situations or stimulus

Eradication:  is  the reduction  to  zero of the incidence  of a  given disease  and  the elimination of the etiologic agent, so that fresh transmission is impossible.

Grounded theory: is a research methodology for the construction or development of theories.

Health professionals: are individuals that study, diagnose, conduct research, and improve or develop concepts or theories and operational methods to advance evidence- based healthcare

Immunization: is the process of making an individual become immuned or resistant to contagious diseases usually via vaccination

Measles: is a highly contagious childhood disease that is spread by a virus.

Information: can be defined as processed data

Investigation: means to closely examine or observe something

Prior knowledge: refers to the information individual already has before he meets new information

Vaccination: is the process of administering a vaccine to help the immune system become resistant to diseases.

Vaccine hesitancy: this refers to delay in acceptance or outright refusal of vaccine despite its availability or refusing to complete vaccine doses.

Vaccine: is a biological preparation that provides active acquired immunity to a particular disease.

Hesitant women:   female mothers that have a children below 5 years who do not complete the vaccine dose for their children or have never in their lives vaccinated their children.

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