Assessment of an Evaluation on the effect of Immunization on Child Development in Gombe Local Govt. Area Gombe - Nigeria

 This article is published by the Zamfara International Journal of Humanities.

Sani Dayyabu*¹ Muhammad Isma’il ^*2 Balkisu Yayaji Ahmad*³ Umar Yusuf Abdullahi*⁴ Isah Abdullahi*⁵

¹  Department of Geography, Federal University of Kashere, Gombe State

² Department of Geography and Environmental Management, Ahmadu Bello University, Zaria
³ Department of Geography, Gombe State University, Gombe State

⁴  Department of Geography, Federal University of Kashere, Gombe State⁵  Department of Geography, Bayero University Kano

1sdayyabu29@gmail.com   2*migeogjameel@gmail.com          3*bilkisuyayajiahmed68@yahoo.com
3*aumaryusuf@yahoo.com            3*kpokpo99@gmail.com

Abstract: Immunization has made momentous contribution to public wellbeing in the African Region, including eradication, elimination and control of life threatening diseases. Hospitalization due to vaccine preventable diseases has been drastically reduced due to introduction of new effective vaccines. However, optimizing the benefits of immunization by achieving high general coverage has met with many challenges. This research provides accurate information on the Effect of Immunization on Child Development in Gombe Local Government Area of Gombe State, Nigeria. Therefore Level of Immunization uptake was analyzed with over 70%, also effect of the immunization on child development was equally analyzed. Numbers of 400 Mothers/caregivers were randomly interviewed and systematic sampling techniques were used to obtain their housing samples. Inferential and Descriptive statistics were used to analyze data obtained from the field. The result shows that Immunization is no doubt a way of improving Child health and Development in the study Area with 0.000 significant levels (p value ≤ 0.05). The study recommends that: Government should improve awareness campaigns and empowerment of parents especially women/caregivers of the study Area. Additional Health care facilities should be constructed around some Areas of the Political wards for effective Immunizations service delivery to avoid congestion and waste of time to the mothers/caregiver. Government should employ additional manpower for efficient and easy immunization services, easy networking systems should be provided for easy report of monthly, quarterly or annual immunization status to the Federal capital territory Abuja. Available power supply should be ensured to avoid vaccine spoilage in refrigerators. Government should also encourage formal Education to higher levels as it is one of the factors that influences immunization uptake. Lastly, traditional and religious leaders should put hands in encouraging Parents on the Immunization uptake in the Study Area.

 

Keywords: Immunization, Child Development, Effect and Level

Introduction

_C hildren health and, more importantly, the rates of neonatal and under-5 mortality are significant indicators to measure level  of  development  across  countries  and  continents globally (Oyefara, 2014). Children are the future of any country, so their development is as significant as the development of other  assets.  Immunization  is  a  vital  part  for  the  proper development of the children, it plays a fundamental role in the children’s lives as a protective health action because it protects them from most dangerous childhood diseases, its process will become more successful if the child receives all the required doses (Sourabh, 2016).  Over  two  million deaths of infants below five years are averted through immunization every year (Tilottama and Madulekha, 2013). According to World Health Organization (WHO, 2010), an estimated 18.7 million infants globally are still missing out on essential vaccines. In researches from some parts of Africa, vaccine preventable diseases is still a root of childhood mortality, estimated at three million death every year (Ibnouf, Van den Borne and Maarse, 2014).

 

Immunization is the administration of antigen in the form of a vaccine, to produce an immune response to the body so as to protect it against future exposure to illness (Medical Dictionary 2012). Around the world, United Nations Children’s Fund (UNICEF) and its partners like World Health Organization (WHO) and Global Alliance for Vaccines and Immunization (GAVI), the United State centers for disease control, the Bill & Melinda Gates foundation and others including numerous non-governmental organizations jointly act to ensure that vaccines protect all children, especially those hardest to reach and most in need (Sourabh, 2016). Before vaccines were available, many children in the United Kingdom (UK) died from diseases such as whooping cough, measles and polio. (WHO Bulletin, 2018). Many developing countries had difficulty in ensuring that children received prescribed course of immunizations and Nigeria inclusive, the United Nations Children’s Fund (UNICEF) has regarded immunization as an important component of child survival programms (WHO Bulletin, 2018). According to Adetukunbo (2007), immunization of children is one of the most cost effective public health interventions. The ultimate goal of immunization is eradication of diseases globally. Tinashe (2015) reiterated that others refused immunization based on religious beliefs. Some groups of parents consider compulsory vaccination as undesirable act of undermining individual rights (Brown, Oluwatosin and Ogundeji, 2015). This is because of poor understanding and provision of immunization services (Regmi, 2015). Nigerian Demographic and Health Survey (NDHS, 2018) report revealed that there is very low coverage of immunization service in the country, and the poor rates recorded are due to some factors mentioned in some studies like Kabir and Ahamadu (2016) found that numerous factors like inadequate knowledge of vaccination, lack of proper locations, lengthy waiting time, conveyance problems, inadequate medical amenities and poor incentive slowed down even acknowledgement of the goals of immunization packages, also Rasheed (2017) exposed that socioeconomic aspects like income status, occupation, poor health amenities and incentives also hindered and caused variations in utilization of immunization services. Similarly, socio demographic factors like mother’s age, child gender, marital and educational conditions of the mother were considered to be the factors influencing immunization services. These influences cut across all states and are mostly found in the northern region of the country (Rasheed, 2017). Data from the 2018 National Demographic and Health Survey (NDHS), revealed that children whose mothers have no education are more likely to die young (170 deaths per 1000 live births) than children whose mothers have more than secondary education (56 deaths per 1,000 live births), also under five mortality is more than 3 times higher among children in the poorest households (173 deaths per 1,000 live births) compared to children in the wealthiest households (53 deaths per 1,000 live births). As children develop they are exposed to many risks, one of these risks being infections most of these will cause mild illnesses, however, despite great medical advances, infection can still cause severe illness, disability and, at times, death (Kabir and Ahamadu 2016). Before the introduction of global immunization, out of estimated 125million children born worldwide every year, approximately 12 million or nearly 10% die before the age of one, 97% of the deaths occurring in the developing countries and Nigeria inclusive. Also over 800,000 newborn babies died from neonatal Tetanus and over 275,000 children in the developing world were affected by paralytic polio every year in most cases before the age of 3years, tuberculosis had as many as 10million victims every year, and most of the affected children are under the age of 5 (WHO Bulletin, 2018). It is estimated that out of every 1000 Nigerian children born, 187 will die before their fifth birthday, measles alone accounting for about 50% pertussis 600,000 deaths annually, neonatal tetanus 800,000 deaths, with a case fatality rate of about 85% occurring every year with few deaths but polio is now reduced drastically (WHO Bulletin, 2018). In Nigeria, the trends in vaccination coverage revealed that children aged 12-23 months with no vaccinations from 1990 were 36%, 2003 27%, 2008 29%, 2013 21%, and in 2018 is 19%, also all basic vaccinations coverage has gradually increased from 29% in 1990 to 31% in 2018 which is inadequate (NDHS, 2018).

 

Gombe state is experiencing influx of people since when it was created, this leads to increase population with diverse societies especially in the Gombe Local Government Area which serve as the capital of the state (GSPHDA, 2019). It was reported by the World Health Organization (WHO,2018) that Gombe state recorded less than 50% coverage of immunization due to numerous factors which include cultural and religious beliefs, poor records keeping, poor outreaches and little awareness to the parents of the 0-23 months children. Furthermore, according to Gombe Local Government Area Primary Healthcare Department (GLGPHCD, 2019) revised report states that in 2018, out of the 506,129 0-23 month’s children, more than 2/3 are not immunized in the area which is below the expected target. Among the principal causes of mortality and morbidity in Gombe Local Government Area are vaccine preventable diseases, pneumonia, tuberculosis, and neonatal tetanus (Gombe State Ministry of Health, 2010). According to Nigerian demographic and health survey (2018), north eastern part of Nigeria is one of the regions in the country with the second highest total fertility rate (TFR) with 6.1 live birth per woman, and Gombe state emerged the second highest with TFR of 6.6 live births per woman in the region, Furthermore, Verbal and Social Autopsy Study (2019) shows that north eastern region emerged second to the last with children reported to have received at least one immunization with 59.5%. Nigerian Demographic and Health Survey (2018) also shows that Gombe state emerged the least in terms of all age appropriate vaccination with just 6.1% in north east and recorded the highest with children with no vaccination of 34.4% in the region. NDHS, (2018), again proved that in the whole country Gombe state emerged the fourth least with children with no vaccination, hence, this will be one of the reasons why the state recorded the highest number of infant and child mortality in north east with 189 deaths per 1000 live births, because immunization is one of the indicators used to monitor progress towards reduction in child morbidity and mortality. Therefore what are the reasons behind high mortality rate in the area, perhaps poor funding by the government regarding immunization services, misperception of immunization by the parents of children or the influences of demographic and socioeconomic statuses of the parents like education, income, occupation, religion, age, ethnicity, contributed on the setback of child development in the study area while the child development through immunization is a key fundamental element of public health and prerequisite to social and economic development, and a crucial element that enables every child to reach his or her full physical and intellectual potential (Oyefara, 2014). Ahmed (2016) studied the spatial analysis of tuberculosis spread in Gombe Local Government Area of Gombe state, the study applied GPS in collecting the coordinates of the Health centers and used nearest neighbor analysis to examine the TB spread in the area, the study revealed that lack of access to healthcare centers, public education on TB, are the major causes of Tuberculosis disease in Gombe Local Government area. Muhammad (2016) studied spatio temporal analysis of polio cases in Kaduna central senatorial zone both primary and secondary data were used, his results shows that polio cases have been declining within the study area from 2006-2014 due to the wider immunization coverage. Mihigo et al., (2017), studied challenges of immunization in the African region and used both primary and secondary data, their result showed that issues of sustainable funding and resources for immunization, vaccine stock outs and logistics, data issues and laboratory infrastructure, are the major problems of immunization in the African region. Meleko et al., (2017), studied child immunization coverage and associated factors with full vaccination among 12-23 months children of Bench Maji zone, south west Ethiopia, the study design was community-based cross-sectional survey, data was collected by using pretested structured questionnaire their results shows that mothers and fathers educational level, place of delivery, maternal health status, mothers knowledge about vaccine and vaccine preventable diseases showed significant relationship with full child immunization. Also Adebiyi (2013) studied determinants of full child immunization among aged 12-23 months children in Nigeria, both primary and secondary data were used, and the results shows that demographic and socioeconomic features like religion, culture, income, education plays significant role on immunization uptake.

 

However, most of the above reviewed literatures shows less attention was paid to Gombe and any study on population characteristics in relation to immunization in Gombe is paramount important due to the current changes that are taking place in the area. Furthermore, most of the reviewed literatures focused on either some vaccine preventable diseases like tuberculosis, polio, Measles etc, as an entity but this study looked at the immunization in general perspective in Gombe. The study further investigates both the spatial distribution pattern and factors affecting immunization in Gombe L.G.A. the study does not focused on salary earners only but to all women that engage in various Occupations. In view of the above challenges of Immunization services in Nigeria and Gombe in specific, research of this kind is very important in order to investigate spatial distribution pattern and Demographic and socioeconomic economic factors affecting immunization in Gombe Local Government Area.

Aim and Objectives

 

The aim of this research is to provide empirical information on the effect of immunization on child development in Gombe Local Government Area of Gombe state, Nigeria, this can be achieve through the following objectives:

 

1.      To determine the level of children immunization in Gombe Local Government Area.

 

2.      To assess the effect of immunization on child development in Gombe L.G.A.

 

Conceptual Frame Work

 

The conceptual frame work of the study is adapted from Verissimo (2015) and is shown below with a view to address the impact of immunization on child development. It came up with the explanation of two major issues thus: Getting better quality of life (development) of a child through quick motor skills, strength, and language abilities, also acquisition of movements like sitting, crawling, walking, running, language skills, activity and better general health conditions at the age of two years, when he receives recommended vaccines. Figure 2.1 Frame work of the study.

 

Figure 1.2: Conceptual Framework of Immunization and Child Development in Gombe Local Government. Source: Adapted from Verissimo, 2015.

 

On the other hand, it further described that children whose development is inadequate, they are vulnerable to variety of illness and it will definitely affect their future life, because when the child is experiencing poor health conditions, it will definitely affect his expected growth stages of sitting, crawling, walking, talking and running and he might also be vulnerable to variety of illness as the cell organs will be weak to enable any disease to come in to his/her body easily.

Immunization and Child Development

 

Immunization and child development are linked together because immunization prevents children from becoming ill with unpleasant and serious infectious diseases, which have a risk of complications and long term side effects, until these diseases are eradicated every child that is not immunized is at risk of complications (Public Health England, 2015). Immunization help protect all children in the population, the more people who are immunized, the less the infectious diseases. Immunization improves the living standard of people as its trying to wipe out many infectious diseases around the globe (Public Health England, 2015).

 

Routine Immunization against vaccine preventable diseases is proven to be one of the most cost effective interventions for reducing childhood illness and mortality. In Nigeria, the Immunization coverage is in the richest fifth 76% and in the poorest 8.2% and over 2 million children still die yearly from vaccine preventable diseases (WHO Bulletin, 2018). It is estimated that out of every 1000 Nigerian children born, 187 will die before their fifth birthday, Measles alone accounting for about 50% Pertussis 600,000 deaths annually, neonatal tetanus 800,000 deaths, with a case fatality rate of about 85% occurring every year with few deaths but polio is now reduced drastically (WHO Bulletin, 2018).

 

Routine Immunization schedule is the actual recommended process of arranging vaccines that should be administered to children from day one to two years or above, (WHO Bulletin, 2018). Below table shows the recommended vaccines to be taken by the under-five children.

 

Table 2.1 Routine Immunization Schedule

Source: Pentavalent Vaccine by World Health Organization (WHO, 2012).

Note:                       BCG=Baccillus         Calmette-Guerin,       OPV= Oral    Polio

 

Vaccine, HBV= Hepatitis B Vaccine, Penta-1 (Hib+DPT+HepB) = Haemophillus Influenza, Diphthria, Tetanus, Pertussis, and HepatitisB Vaccines, PCV = Pneumococcal Conjugate vaccine, Measles and Yellow fever.

 

Note: The following shows the immunization positions in the body of 0-23months of age.

1.      Intra-dermal== In to the Skin (BCG)

 

2.      Intra-Muscular== In to the Muscles (Pentavalents 123, IPV, HBV, PCV, Men A)

 

3.      Subcutaneous== Under Skin (Measles and Yellow fever)

 

4.      Oral========= (OPV and Vitamin A)

 

Methodology

 

This research paper employs the use of qualitative and quantitative techniques that were sourced from both primary and secondary data. The primary data were collected through field observations and interviews from mothers/care givers of children 0-23 months of age, while the secondary data were obtained from existing literatures which include records from: Gombe state Ministry of Health, Gombe Local Government Primary Healthcare Development Agency (GSPHDA), Independent National Electoral Commission manual, Gombe Local Government Primary Healthcare Department, and other published and non published materials. This study also involves the use of 506,129 0-23 months children as sampling frame in the study Area according to Rew micro plan records of Gombe Local Government Area, Primary Health care Department (2018), in which 400 was used as sampling size which was derived through the use of Yamane (1967) formula. Data collection was obtained through the use of both simple random and systematic sampling techniques. Simple random was used to obtain the streets samples and the first house in each sampled street, while systematic sampling technique was used to obtain the remaining sample houses in each sampled street by the use of dice to determine the sequence of intervals of houses to be skipped in each sampled street. However, numbering was used in counting houses and streets from which the samples were derived. Lastly, this research employed the used of Inferential and descriptive statistics like: Chi-square, cross tabulations, frequency tables and percentages to analyzed data obtained from the field.

 

Study Area

Location and Ariel Extent

 

The Geographical coordinates of the study area ranges between Latitude 10^°14’ 30’’N and 10^°19’ 30’’N and Longitudes 11^°7’ 0’’ E and 11^° 13’ 30’’ E (Satellite images of Gombe, 2015). It occupies an area of about 45Km² (ministry of land and survey Gombe, 2008). Gombe local government area is located approximately at the center of Gombe state. It is bounded by Kwami L.G.A in the north and almost surrounded by Akko Local Government Area in the south east and south west; Gombe town is well linked by road to other regional centers like Biu/Maiduguri, Potiskum/Damaturu, Bauch/Jos, Kari/Kano, and Kumo/Yola (Adam Modu Abbas et; al 2017).

 

Climate

 

The climate of Gombe state is part of tropical continental climate characterized by distinctive rainy and dry seasons. The wet season start around April to October with an average annual rainfall of 650-1000mm, while dry season commences around November to April with the coldest months in January and February. Relative humidity in pattern has been 94% in August and drops to less than 10% during Hamatan period (Gombe state diary, 2008). The dry season become distinctly severe when the north East trade wind over the region becomes established. The wind originating from the Sahara belt that is high pressure area at that period, this dry and dust laden wind produces the harsh conditions of the season. Temperature becomes lower at 75⁰F (25⁰C) particularly during the period from December to February due to the harmattan. Average relative humidity is also lowest at about 15% during the harmattan period of the dry season; this shows that climatic conditions hinders most parents in Gombe local government area to engage in the immunization of their children, because of marketing in the dry season and farming in the rainy season (Abdullahi 2017).

 

Topography and Hydrology

 

Gombe town is largely at the foot of Akko escarpment in the west of the town. Developments are taking up sites on the escarpment and on Tumfure plains as well as southwards and up the higher grounds to the east beyond the newer Liji area. The highest point on the landscape is on the Liji hills, and the sandstone hills dotting the southern parts of the town site. The highest part of the buildup area of the town is located at the western gateway of about 1850ft (610.5m) above the sea level and the lowest part at the BCGA areas with about 1250ft (412.5m) above the sea level. The study area in conclusion shows low grounds in BCGA, Yelon Guruza area, and high grounds located in Tunfure and Liji hills, many rivers truncate the older part of the town with all flowing eastwards from their source at the Akko escarpment. The rivers and streams, some of which have tributaries with active gullies have truncated the town, particularly at the north east parts, creating east striations on the landscape so this also affect the immunization coverage in the area due to the high level of obstacles and flowing of rivers during the rainy season (Gombe state diary, 2018).

 

Soils and Vegetation type

 

The soil is a tropical ferruginous type, dark grey in colour and has PH value ranging from 4-6, depending on the location (Layarank, 1990). The vegetation of Gombe is typically ‘a high close canopy, with sprinkling of under shrubs and a sparse growth of grass to a more open grass of less height more spreading and stunted shrubs and dense growth of grass’’. It can also be described as Sudan savanna with open grassland which dries up during dry season. The anthropogenic activities affected and modified the natural vegetation through deforestation, overgrazing, bush burning, constructions and Agriculture, all these activities causes low patronage of immunization because of flooding, windstorm and other natural disasters especially in the rainy season (Abdullahi, 2017). 

Gombe Local Government Area, Gombe State, Nigeria.

Source: Adapted from Administrative Map of Gombe (2021).

Health Sector

 

There are 21 (9-Maternity, 12-Dispensaries) primary health care facilities, 2 secondary healthcare facilities (general hospital and specialist hospital) and 1 tertiary which is the federal teaching hospital. There are 32 Private clinics and laboratory services and 7 TB Centers, health personnel workers are 157. The L.G.A has a school of health technology, 1 school of nursing and midwifery and a proposed college of medical sciences at the Gombe state university. International development partners (IDPs) in the health sector are World Health Organization, United Nations Children Fund, World Bank and MTN foundation. The Millennium Development Goals (MDGs) office in the presidency and the National Health Insurance Scheme (NHIS) are partnering with the Gombe L.G.A in achieving the sustainable development goals 4, 5, and 6, but still immunization is not well practiced as a result of different perception of the masses (Gombe state ministry of health, 2010).

 

Population and People

 

According to National Population and Housing Census (2006), priority table, Gombe town has population of 266,844 people with males having 146,721, and Females having 120, 123 people, (National Bureau of Statistics, 2012). While according to population projection of 2021 by the united nation world population prospect, Gombe local government area has the total projected population of 529, 000 people at 3.93% growth rate. The people of Gombe could be said to be diverse in terms of different languages spoken, the customs and the traditions being adhered to. According to Joseph Greenberg’s (Undated) in Abba et al (2000), linguistic classification, the most dominant linguistic to be found in this area to the Afro-asiatic and Niger-Congo family of languages. Thus the ethno-linguistic composition of Gombe state include, among others, the Fulbe (Fulanis), Bolewa, Tera, Tangale, Tula, Waja, Wurkun, Jara, Dadiya, Cham, Awak, Pero, Kamo, Kushi and Bangunji. There are also more recent migrants such as Kanuri, the Hausa language, does serve the purposes of commerce, interaction, and of education at the lower levels of school systems. The English language remains the official language as obtains all over Nigeria and as a result of cultural diversity, immunization service in the area is affected (Abba, et al 2000).

 

Socio-economic Activities

 

Gombe state is abundant with physical, human and economic resources, it is the center of economic activities; it serves as the meeting point of investors from surrounding states which are: Borno and Yobe to the north and east, Taraba and Adamawa to the south and Bauchi to the west. This advantage triggers the state to be vibrant in all aspects. Again, the state is blessed with natural resources like coal, limestone, abundant land and so forth. There within the short period of time in existence, it encountered tremendous progress. In addition to that, the state is located in the sub-Saharan savannah thus it is a productive farming area cultivating crops like maize, millet, rice, guinea corn, sorghum, soybean, beans et.c, and vegetables like tomatoes, pepper, water melon, cabbage and so on. Gombe is the collection and distribution center for the cereals, which are transported by road and sold at many northern states and exported in to the Niger republic. The area is also beneficial in animal husbandry were hide and skin are produced for leather and the products are supplied to the southern states of Nigeria and Abuja, therefore these activities strengthen the economic base of Gombe. The occupational pattern of Gombe people is dominated by public service, Farming and business, and these activities tend to causes under utilization of immunization in the area because of the massive engagements day by day (Gombe state diary, 2018).

 

Results And Discussion

 

This section devoted to the analysis and discussion of results from the data collected in 11 wards in the Gombe Local Government Area. All the data are formed in to tables and charts which shows frequencies and percentages of the variables used in the study Area.

 

Level of Immunization

 

In order to understand the parental perception of immunization services, it is very important to know the Level of Immunization which is the extent at which the immunization service is accepted or not in the study Area. Table 1 shows the level of immunization in the study area.

 

Table 1 Level of Immunization

 

Source: Field Survey (2021)

The results of the analysis shown in Table 1 shows that about 70% of the parents of children 0-23 months of age carry their children to immunization which is more than half of the population in the study area, therefore, the level of immunization uptake in Gombe is high, and this is true because Gombe Local Government Area is the city center that comprises People with varied social background in terms of Education, Politics, and ideology. Therefore, there is high proportion of people that carries their children to immunization which is agreed with the current situation in the Area as it is the most developed Area in the whole Gombe state (Gombe state diary, 2018).

 

Similarly, According to the Gombe Local Government Primary Health Care Development Agency (GSPHCDA), regarding the level of acceptance of immunization in Gombe, it was confirmed that Gombe Local Government Area reached about 80% in its uptake being the state capital and gathered highly educated people with different social background (GSPHCDA, 2021).

 

Table 2 Chi-Square showing Effect of Immunization on Child Development

 

Source: Field Survey (2021)

As regards to the Effect of Immunization on Child Development, the above table 4.6 shows inferential statistics of chi-square and the result shows significant influence of Immunization on Child Development as the p value ≤ 0.05 significant level, therefore, Immunization significantly increases Child Development in Gombe Local Government Area. This result is real as it was observed from the records in Health Centers, from the Gombe Local Government Primary Health Care Development Agency, that Immunization increases Child Development due to the recent wider coverage in the state (Gombe State Ministry of Health, 2020). Also this finding is in conformity with that of Oyefara (2014) who states that immunization is a key fundamental element of public health and prerequisite to social and economic development, and a crucial element that enables every child to reach his or her full physical and intellectual potential.

 

CONCLUSION

 

This study analyzed the effect of immunization on child development in Gombe Local Government Area of Gombe State, Nigeria. Inferential and Descriptive statistics (chi-square and cross tabulation) containing tables and charts were employed in analyzing data on the effect of immunization on child development in Gombe Local Government Area of Gombe state, Nigeria.

 

Results of the study revealed that Immunization is no doubt a way of improving Child health and Development in the study Area with 0.000 significant level (p value ≤ 0.05); This is in contrary to the World Health Organization report of (WHO, 2015) which states that Gombe state experiences low immunization uptake with less than 50% coverage, and the Nigerian Demographic and Health Survey (2019) that said that Gombe state emerged the least in terms of all age appropriate vaccination with just 6.1% in the north east and recorded the highest with children with no vaccination of 34.4% in the region, also with high level of children morbidity and mortality in Nigeria.

Recommendations

 

In line with the findings of this work, the following recommendations are made:

 

^ü        Government should improve awareness campaigns and empowerment of parents especially women/caregivers of the study Area.

 

^ü        Additional Health care facilities should be constructed around some Areas of the Political wards like Bajoga, Pantami, Nasarawo, Jekadafari, Herwagana, and Bolari West, for effective Immunization service delivery to avoid congestion and waste of time to the mothers/caregivers.

 

^ü        Government should also encourage formal education to higher levels in the study Area as higher qualification is one of the key factors that influences immunization uptake.

 

^ü        Traditional and religious leaders should put hands in encouraging parents on the immunization uptake in the study Area.

 

^ü        Further researches should look at the impact of other childhood diseases on the development of children in the study Area.

 

^ü        Women in the study Area should be empowered to have variety of knowledge through awareness programmes.

 

^ü        Results from interview with the relevant immunization authorities revealed that there is little effort of government intervention on the immunization services in the study area; therefore, government should put more effort as the contribution from partners is not guaranteed forever.

 

^ü        The masses in the local government Area should be enlightened on the present situation of immunization and to be encouraged on its compliance so that level of its uptake will be made available for future investigations.

 

^ü        Government should employ additional manpower for efficient and easy immunization services, easy networking systems should be provided for easy report of monthly, quarterly or annual immunization status to the Federal capital territory Abuja.

 

^ü        Available power supply should be ensured to avoid vaccine spoilage in refrigerators

 

ü      Further researches on Vaccine preventable diseases and other child killer diseases are encouraged so seek their impact on people of Gombe local Government Area of Gombe state.

 

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