A Systematic Review on Factors Affecting Community Participation towards Polio Immunization in Nigeria

Noting that poliomyelitis disease eradication has continued to falter in Nigeria, this paper examines research conducted on the factors affecting immunisation coverage in the country from social, political, cultural, religious, and economic angles. The main objectives of this study are to: evaluate the contribution of education and awareness on community participation in polio immunisation; evaluate the effect of community attitudes and beliefs towards participation in polio immunisation; evaluate the degree of community participation in polio immunisation; and recommend the way forward for eradicating polio through efficient sensitisation and educational provision on health seeking behaviour. Four electronic databases, including Science Direct, Springer Link, Pub-Med, and MedLine, were used to access over 52 academic journal articles where detailed inclusion and exclusion criteria were adopted to select 18 studies conducted in Nigeria from 2010-2014. Knowledge, attitudes, and practices (KAP) or community participation in polio immunisation had been made priority.

The researchers found that parents' educational level plays a vital role in decision- making regarding immunisation. It can be deduced that mothers with a high education level are more likely to immunise their children than those mothers with primary or non-formal education. Similarly some surveys conclude that women who were more educated than their spouses were more likely to give full immunisation to their children. Awareness plays another key role: In the surveys conducted, a majority of the mothers were aware of the vaccines and reasons for immunisation. Almost all the women in the rural communities were aware of the polio immunisation programme. With regard to attitudes, mothers whose children suffered from polio, resulting in partial or total paralysis, did not believe that the physical deformity was a result of spiritual witches or evil. It is also encouraging that any adverse effects from or reaction to the vaccine are not regarded as an illness worse than poliomyelitis. Some mothers continued taking their children for vaccination even if the side effects persisted. According to various study outcomes, mothers' participation in polio immunisation was far beyond expectation. Parents need not be forced to immunise their children, and children were immunised irrespective of their gender. Geographical location also helps to determine the level of community participation in polio eradication: There is higher immunisation coverage in urban areas than rural, and the speed of immunisation coverage is highly associated with access roads, hospitals, and other health facilities.

The researchers conclude that future surveys should focus on assessing the opinions and behaviour of parents "with respect to socio-economic characteristics in direct proportional relation to the high rate of paralytic poliomyelitis victims in the society. Adult education programs in the rural areas should be implemented to reduce the rate of illiteracy, misguidance, lack of awareness, and conservative attitudes from different communities in Nigeria. The government at all levels should review the curriculum in education and include professional social and psychological knowledge that will help health workers to effectively deliver modern services and practices to the patients. In the community context, health seeking education, [and] health living education [should be undertaken] so as to improve the individual and community health status."