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A SURVEY OF DISEASE PREVALENCE AND IMMUNIZATION COVERAGE AMONG CHILDREN OF AGES 0-5 YEARS IN INTERNALLY DISPLACED PERSONS CAMPS IN LAFIA, NIGERIA. AUTHORS: EGBERE, O.J1, A’KADIR, T2 OYERO, S. K3, HENRY, U.I4 AND OGBONNA, C.I.C5 1 Department of Microbiology, University of Jos, Nigeria. 2 Department of Chemical Pathology college of Health Technology, Zawan, Nigeria. 3 Department of Histopathology, Jos University Teaching Hospital, Nigeria. 4 Federal college of Forestry. Jos, Nigeria. 5 Centre for Genetic Engineering and Biotechnology, University of Jos, Nigeria. ABSTRACT A survey of the disease prevalence and immunization coverage among children of age 0-5 years was carried out in Dunama and shinge camp of the internally displaced persons from the shendam/Yelwa crisis of 2004, after due approval from the Nassarawa state government. Structure questionnaire were issued to mothers of the children for their response. Relevant health records of the children were also obtained from Nassarawa state ministry of the Health. The disease among the children surveyed within the period of their camping were malaria (44%), diarrhea (31.5%), cough/catarrh/fever (18.3%), and measles (12.0) in order of their prevalence, with malaria being the most prevalent and persistent, followed by diarrhoea. The total number of the internally displaced persons vaccinated was 24,818 with 1,357 (5.47%) children vaccinated with calmette-Guerine (BCG), 5,124 (20.65%) with measles vaccine, 4,115 (16.58%) with Oral Polio vaccine (OPV), and 2,227 (8.97%) with Diptheria Pertusis Tetanus vaccine (DPT). Persons (adults and children) vaccinated with Anti- Tetanus Toxoid (ATT) vaccine were 3379 (13.62%) while 8616 (32.73%) persons received Bacile cerebrospinal meningitis vaccine (CSM). it could be concluded from this study that the prevalent rates for malaria and diarrhea were particularly higher than the values reported from the normal population of Nigeria by UNICEF while the data on immunization intervention by the state Government tends to imply that the coverage was adequate. INTRODUCTION The most widely used definition of internally displaced persons (IDPS) is one presented in a 1992 report of the secretary-General of the United Nations, which identifies them as “person who have been forced to flee their homes suddenly or unexpectedly in large numbers, as a result of armed conflict, internal strife, systematic violation of human rights or natural or unexpectedly in large numbers, as a result of armed conflict, internal strife, systematic violation of human rights or natural or man-made disasters and who are within the territories of their own” (UNHCR 1992). Presently, there are about 26 million idps scattered all over the world with a population of 2.4 million being in Africa (ef) Nigeria has witnessed not lee than 30 ethno-religious crises since independence, leaving a total of about 500,000 displaced person as refuses in their own homes. Among the many harrowing effects of wars and arm-conflicts are in lingering nutritional and health crisis of the survivors. (Van Damme1998); statistic has it that 75% of refugees or displaced person are vulnerable group, which are normally women and children of which children alone form 50% of any refugee population. Ethnic-religion hostilities which started in February 2004 in shimkar and Kelwa in Plateau state, with the conflict spreading to neigbouring communities of Zomo, Doka and Lopidi, Laraba and Unguwar Adamu. Many people were wounded and houses burnt. On 13 May 2004, a total of 735 internally-displaced families were sheltered in school compounds, markets and mosques in Lafia town of Nassarawa state. This figure includes 1,543 displaced children (The Federation’s Mission, 2004). Malaria, diarrhea, measles, pneumonia, tuberculoses, meningitis and enteric parasitic infections are the most common infection diseases in many refuges or idps camps in Africa. Factors that enhance transmission of these diseases in the camps include high population density and lock of sanitation and clear water. Epidemics of these diseases resulting in loss of the thousands of lives are a common phenomenon in most camps (Van-Damme 1998). Report by the WHO health update (WHO 2004) IN Dafur region of Sudan showed that the main health cancers facing displaced people in Dafur and their host communities include: Malnutrition, acute respiratory infections, diarrhoeal disease, malaria, hepatitis E and conflictreated tarauma. The possibility of outbreaks of communicable diseases is particularly elevated, low standards of environmental hygiene, declining nutritional states, and low vaccination coverage. The essence of this field survey was to assess the adverse health implication on displaced persons, specially on the most vulnerable group (children of ages 0-5 years) and also to determine the effectiveness of intervention programmed particularly in the area of immunization. MATERIALS AND METHODS STUDY AREA: The Research was carried out in Lafia, the capital of Nassarawa state, North central region of Nigeria, between March and August, 2004. The two sites where the study was conducted were Dunama primary school camp, in the heart of the town, and shinge camp in the western outskirt of Lafia town. AUTHORIZATION A letter of permission to carry out the survey was obtained from the Nassarawa state Government and Dalhata att specialist Hospital lagi. The Red cross society of Nigeria assisted with the administration of the questionnaire SURVEY Structured questionnaires were administered to 200 randomly sampled mothers of the displaced children in order to obtain data on incidences prevalence rates of the diseases suffered by children within the five-month period of their camping in Lafia while Immunization coverage data were also obtained from Nassarawa state ministry of health. RESULTS The results generally shows that males had more incidences of diseases with the exception of mesten) than the female counterparts (table 1) malaria was found to be most the most prevalent followed by Diarrhoeas, cough/catarrh/fever and measles in descending order of both incidences and prevalence rate The result in table 2 showed that a total of 24,818 were vaccinated against six different disease (tuberculosis, Tetanus, cerebrospinal meningitis, poliomyelitis, measles and Diphtheria) with the vaccines against cerebrospinal meningitis (CSM) and measles being the most administered. The result in table 3 showed immunization coverage as assessed by the questionnaire method indicate that the total 65.5% of the children were actually vaccinated, with only 8% of the mother agreeing that their children received all of the 5 vaccines against the communicable disease One reason that could be adduced to this is that the male children are naturally more active, agile and stronger than their female counterparts and would normally be found playing around playing around in the open field. This could predispose them more to mosquito bite and contact the dirt. The unhygienic condition of such place could very easily expose them to disease. The prevalence of malaria (44.0%) recorded was comparable to 44.8% rate reported by Ejezie and Ezedinachi (1992) for the non-displaced residents in a malaria endemic location in calabar, south Eastern state, Nigeria, (Mara and Arma 2001). The prevalence of malaria among the children in the idp comps in however higher than the documented UNICEF’s prevalence rate of 34% for the under-fives with malaria fever in Nigeria for the period between 1999 and 2005 (UNICEF, 2007). The absence of ant-malarial measures such as the use of mosquito nets in the camp. The period of camping (March and May) being a rainy season, coupled with the location of the camp, poor sanitation and drainage system could all encourage the breeding of mosquitoes (the malaria vector). The diarrhoea prevalence rate of 31.5% is equally higher than the value reported for the normal population of Nigeria (being 28%) (UNICEF, 2005). Diarrhoea is a major killer of children per annum the poor sanitary condition and unsafe water sources may be responsible for the observed higher prevalence of Diarrhoeas. This justified the oral Dehydration intervention programme that was being run by the medicines same frontiers (Doctors without border) and the Nigeria red cross society, in the internally displaced people camps, at the high prevalence of cough/catarrh/fever at 18.3% could be attributed to a number of reasons; foremost among these could be exposure of the children to cold particularly that the doors and windows of the classrooms in which they were sleeping ware all broken. Overcrowdings, poor ventilation, unhygienic and very dusty environmental were other possible contributory factors to the high incidence of cough/catarrh/fever amongst the children. The need for the distribution of Ascorbic acid (V.T.C) in such camps cannot be overemphasized as this help in accelerating healing and boosting the immure system of campers. The prevalence rate of measles (12%) can be considered high especially in view of its contagion nature that could be favored by crowding, low level of herd immunity, malnutrition and inadequate medical care. Occasional outbreaks of meat have been inked to the lack of immunization in children or the failure of single dose of vaccine in many children. Measles has been regarded as the most frequent cause of death worldwide (Talaro, 2005) Measles vaccination coupled with administration of vitamin A have been found most reliable in curbing the infection with, and spread of, measles. IMMUNIZATION COVERAGE AMONG CHILDREN Immunization coverage has been regarded an one of the parameters for measuring the effe ctiveness of the health programme of organization to the plight of the displaced persons, particularly, children. It could be observed from the table (Table 2) that immunization coverage was substantial for meningitis (34.72%) followed by measles (20.65). Lafia town is naturally both humid and hot and so, the relatively high level of immunization with cerebrospinal meningitis antigen is a justifiable preventive action by the state government. This must have been responsible for the little or no record of incidence of meningitis among the displaced person. However, the results on the questionnaires assessment showed that about 34.5% of the children received no immunization and hence, only 65.5% could be taken as the actual immunization coverage for children. The reasons for the non-complete coverage of immunization coverage for children. The reasons for the non-complete coverage of immunization could be many. One of them could be the dynamic nature of the population of the idps as they move in and out of the caps. It is also possible that many have come into the camps as at July and August when this assessment was taken. It is also possible that some idps, for religious or personal reasons including ignorance may have chosen to refuse immunizing their children. The immunization coverage of 64.5% in these camps is however, far higher that those coverage by governments and health workers in guinea and Liberia where immunization coverage in the respective refuge camps were 27.4% and 46.9% (Hirnscahll, 199) CONCLUSIONS AND RECOMMENDATIONS It could be concluded from this study that the disease incidence and prevalence fate amongst children of displaced person were generally high with malaria and diarrhea the most prevalent and persistent. The fact that the internally displaced persons camps in Lafia were overcrowded, had poor sanitary conition, unsafe water sources, inadequate food supply could be the reasons for this, aside ignorance and beliefs of the people. The Nasarawa stat Government immunization intervention programme was substantial and commendable having a total of 24,818 idps vaccinated, however only 65.5% of the mothers interviewed claimed their children receive immunization in the camps. Recommendations The issue of intervention of the internally displaced person should, as a matter of importance, be reconsidered by the united Nation. This is in view of the fact that the united Nation High commission for Refuges (UNHCR) only extends protection or assistance to idps when the UN secretary general or the UN general assembly has requested the agency to do so. The idps indeed fall between the cracks of current humanitarian law and assistance, unlike the refugees who are solely the burden of UNHCR. The role of the national refuges commission of the Nigeria government should be restructure to cater adequately for idps to as much as they do for refugees who in most case are not Nigerians. The government of Nigeria will do well to, once and for all, address the root causes of most ethno-religious, crises in Nigeria which are basically rooted in issue of indigenization and resource distribution, because most these socalled ethno-religious conflicts are not necessarily religious but a yearning for economic emancipation. REFERENCES Ejezie, C. G. and Ezedinachi E.N.U , Malaria Prevalence in Calabar, Tropical and Geographical Medicine: 1992,44 (1&2), 97-100 Final Report; Centre for Disease Control, Washington D.C. International Community of Red Cross (ICRC)(2007), ICTC in Africa: A long term commitment. Available at http://icrc.org Hirnschhall, G. O. Review of Health and Nutrition Situation of Liberian Refugees in the Forest Region in Guinea, May 5-23, 1990. 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