View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Kyoto University Research Information Repository Promotional Model: A New Direction for National Program in Title Immunization (NPI) and Oral Rehydration Therapy (ORT) in Nigeria Author(s) P.EKERETE, Paulinus Citation African Study Monographs (2000), 21(1): 1-17 Issue Date 2000-01 URL http://dx.doi.org/10.14989/68191 Right Type Departmental Bulletin Paper Textversion publisher Kyoto University 21-1/1 03.4.4 3:07 PM ページ1 African Study Monographs, 21(1): 1-17, January 2000 1 PROMOTIONAL MODEL: A NEW DIRECTION FOR NATIONAL PROGRAMME IN IMMUNIZATION (NPI) AND ORAL REHY- DRATION THERAPY (ORT) IN NIGERIA Paulinus P. EKERETE Department of Business Administration Faculty of Management Sciences Rivers State University of Science and Technology ABSTRACT The National Programme on Immunization (NPI), formerly known as the Expanded Programme on Immunization (EPI) and Oral Rehydration Therapy (ORT), were relaunched in 1984 after the problems of vaccine supply have been corrected. The NPI aimed to protect children against six childhood killer diseases and ORT, to remedy dehydration. In order to achieve these objectives, Partner-in-Health strategy was set up to educate, convince and motivate mothers, pregnant women and community to accept the programme. To assess the effect of the promotional strategy, the government conduct National Immunization Coverage survey. The survey found lack of information and motivation as key components of immunization failure. After an evaluation of promotional strategy set up by the Government, a pilot survey was conducted from which nine promotional elements were selected. These promotional elements were regarded of sources of information and motivation. Based on these, a promotional model was set up which stated that promotion depends of consumer information which in turn depends on the extent of interaction between consumer and promotional elements. The implication of the model is the need for formation of Public Health Organization from Public Health Committee at all levels of Government. Key Words: Immunization; Therapy; Rehydration; Dehydration Public Health. BACKGROUND OF THE STUDY In 1984 Nigeria relaunched two programmes to protect our children from danger- ous childhood diseases. One of the two programmes was Expanded Programme on Immunization (EPI), renamed National Programme on Immunization (NPI). The aim of the programme was to immunize at least 80% of all children aged 0-2 years before 1990, and 80% of pregnant women to be vaccinated against tetanus. The killer diseases are measles, poliomyelitis, tetanus, whooping cough, tuberculosis and diphtheria (Federal Government of Nigeria/UNICEF, 1984a). The other programme was Oral Rehydration Therapy (ORT) which was designed to teach at least 50% of parents with children aged 0-5 years, how to prevent death from diarrhoea by using a simple, cheap, home-made salt-sugar solution to rehy- drate children with diarrhoea. In order to achieve these objectives, “Partners-in-Health”, strategy was set up to educate, convince and motivate mothers, pregnant women and the community at large to utilize the service (Federal Government of Nigeria/UNICEF, 1984b). 21-1/1 03.4.4 3:07 PM ページ2 2 P.P. EKERETE According to the Ministry of Health the main task of Partner in Health is to edu- cate and convince mothers of the value of NPI/ORT in preventing the six childhood killer diseases and in control of diarrhoea so that they: 1. Decide it is worthwhile to invest (time, money, and energy) in repeated trip to the vacci- nation centre to complete all the doses. 2. Can prepare salt-sugar-solution at home. 3. Can recognize the early sings of dehydration. 4. Have enough faith in efficacy of ORT, to prepare and use it when diarrhoea strikes. 5. Know when to seek additional medical aid in cases of severe diarrhoea. (Federal Government of Nigeria/UNICEF, 1984c). THE NATIONAL IMMUNIZATION COVERAGE SURVEY REPORT OF 1991 To assess the effect of the promotional strategy, the Federal Government of Nigeria decided to conduct National Immunization Coverage survey. The objectives Table 1. Immunization Covergage by Antigen of 12-13 Month Cohort on Crude Data Up to 2 Years of Age, by State, February 1991. STATE BCG BCG DPT1/ DPT3/ MEASLES FULL CARD SCAR OPV1 OPV3 VACC RETENTION AKWA IBOM 97.6 90.0 974.0 89.0 93.8 88.5 93.8 ANAMBRA 99.5 93.2 99.8 94.7 93.7 89.8 99.0 BENUE 95.7 90.0 93.6 74.0 78.5 67.0 86.1 CROSS RIVER 99.0 96.2 97.6 85.2 86.1 80.4 93.3 IMO 90.1 79.7 88.1 78.2 76.2 69.8 76.7 RIVERS 96.7 91.4 94.5 83.5 86.1 79.4 90.0 ZONE A 95.9 90.1 94.8 84.4 85.6 79.1 89.8 BENDEL 79.0 68.8 73.7 52.7 53.7 46.8 56.6 LAGOS 96.7 77.5 95.0 86.1 77.5 73.2 84.2 OGUN 98.5 85.5 98.5 87.5 88.0 85.0 93.0 ONDO 99.5 85.1 98.6 90.9 92.3 87.5 89.4 OYO 99.0 93.8 98.5 89.2 89.7 84.8 96.2 ZONE B 95.2 82.1 93.7 82.5 81.9 76.9 83.9 ABUJA 100.0 97.7 100.0 100.0 100.0 100.0 99.6 KADUNA 100.0 97.5 100.0 94.1 94.1 91.6 97.5 KATSINA 89.6 83.4 88.4 65.4 75.8 61.6 74.4 KWARA 100.0 90.6 100.0 100.0 100.0 100.0 99.9 NIGER 99.0 85.6 97.4 83.0 92.3 82.7 86.7 SOKOTO 99.0 86.5 98.4 91.1 92.3 88.9 89.4 ZONE C 97.3 90.2 96.7 86.8 90.3 84.7 91.3 BAUCHI 99.0 93.2 97.6 32.5 89.8 80.1 89.8 BORNO 98.1 91.5 98.3 81.4 95.1 85.9 97.1 GONGOLA 97.1 91.3 96.2 81.7 87.5 80.3 86.5 KANO 89.9 79.7 89.4 58.0 73.9 51.7 79.7 PLATEAU 89.7 81.4 85.8 63.7 73.0 58.3 76.5 ZONE D 94.0 87.4 93.0 72.5 82.5 68.1 85.9 NIGERIA 95.5 87.5 94.4 81.1 84.7 76.6 87.7 Criteria: Measles 36 weeks; DPT1/OPV1 6 weeks; Intervals between repeat doses 21 days. 21-1/1 03.4.4 3:07 PM ページ3 Promotional Model: A New Direction 3 of the survey were: (a) To assess antigen by antigen coverage of BCG; and polio Oral Polio Vaccine, (OPV), Diphtheria Pertusis Tetanus (DPT), and measle vaccines administered to children up to 2 years. (b) To assess the tetanus toxoid coverage in mothers of children under one year of age. (c) To assess the dropout rates, missed opportunities, reasons for immunization default, immunization coverage of children before their first birthday, BCG, scar status, and card retention rate. (Federal Government of Nigeria/UNICEF, 1991) The national task force was appointed by the Federal Government to organize and manage the planning and implementation of the survey. The WHO 30-cluster sam- pling technique was selected (Federal Government of Nigeria/UNICEF, 1991). One cluster coverage survey was conducted in each state. A total of 600 inter- views were made, supervised by 165 team leaders. A total of 660 clusters were com- pleted and 5000 interviews were conducted per cohort, (Federal Government of Table 2. Immunization Covergage by Antigen of 12-13 Month Cohort on Crude Data Up to 1 Year of Age, by State, February 1991. STATE DPT3 OPV3 MEASLES FULLY IMMINIZED AKWA IBOM 69.9 69.9 82.8 66.0 ANAMBRA 88.4 88.4 87.4 78.2 BENUE 61.2 61.2 61.7 49.8 CROSS RIVER 67.0 67.0 74.2 61.7 IMO *55.0 *55.0 61.9 48.5 RIVERS 53.6 53.6 68.9 46.4 ZONE A 65.9 65.9 72.8 58.4 BENDEL 32.7 32.7 32.7 25.9 LAGOS 63.6 763.6 56.9 47.9 OGUN 75.5 75.5 75.0 67.0 ONDO 72.1 72.1 74.5 62.5 OYO 78.6 78.6 81.9 70.0 ZONE B 64.5 64.5 64.2 54.7 ABUJA 95.0 95.0 87.8 84.1 KADUNA 74.4 74.4 61.9 61.6 KATSINA 47.9 47.9 55.6 40.8 KWARA 90.1 90.1 92.5 82.2 NIGER 57.5 57.5 67.6 46.8 SOKOTO 76.0 76.0 75.6 67.3 ZONE C 73.5 73.5 73.5 63.8 BAUCHI 58.7 58.7 66.5 48.5 BORNO 75.6 75.6 84.6 66.2 GONGOLA 59.1 59.1 64.9 50.5 KANO 43.5 43.5 55.6 34.8 PLATEAU 38.7 38.7 53.9 30.4 ZONE D 55.1 55.1 65.1 47.7 NIGERIA 65.2 65.2 70.0 56.2 Figures produced by COSA3 “Coverage with Exact Cl” Criteria: Measles 36 weeks; DPT1/OPV1 6 weeks; Intervals between repeat doses 21 days. 21-1/1 03.4.4 3:07 PM ページ4 4 P.P.