Project – Caregivers’ Perceptions, Knowledge and Attitudes Towards Childhood Vaccination and Their Effects on Immunization Uptake in Selected Communities in Ikorodu

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Childhood vaccination is one of the most important public health interventions for preventing morbidity, disability and mortality from vaccine-preventable diseases. Vaccines stimulate the immune system to develop protection against specific infectious diseases before exposure occurs. Routine childhood vaccination therefore provides children with protection against diseases such as tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, measles and other vaccine-preventable conditions. The success of vaccination programmes, however, depends not only on the availability of vaccines but also on whether caregivers accept vaccination and consistently utilize immunization services.

Globally, vaccination has contributed substantially to improvements in child survival. Nevertheless, millions of children continue to miss recommended vaccines. The persistence of under-vaccination is particularly concerning in low- and middle-income countries where health-system limitations, socioeconomic inequalities, misinformation, geographical barriers and concerns about vaccine safety may influence uptake. The problem is therefore not simply the availability of effective vaccines, but also the complex interaction between caregivers, families, communities and health systems.

Nigeria remains an important setting for research on childhood vaccination because immunization uptake has historically been characterized by considerable inequalities. Antai (2009), using a multilevel analysis of individual and contextual determinants, demonstrated that childhood immunization uptake in Nigeria is influenced by factors operating at both individual and community levels. The study showed that immunization coverage was far from optimal and that socioeconomic and contextual circumstances contributed to inequalities in vaccination uptake.

The issue of vaccination uptake is closely connected with caregivers’ perceptions. Perception refers to the way individuals understand, interpret and evaluate an issue based on their experiences, information and beliefs. In the context of childhood vaccination, caregivers may perceive vaccines as beneficial, necessary and safe, or they may have concerns about vaccine effectiveness, adverse effects, ingredients, religious implications or the intentions of health authorities. Such perceptions can influence whether caregivers initiate vaccination, return for subsequent doses and recommend vaccination to other members of their communities.

Knowledge is another important component of vaccination behaviour. Caregivers who understand the purpose of vaccines, the diseases they prevent, the recommended vaccination schedule and the consequences of non-vaccination may be more likely to seek immunization services. However, knowledge alone does not necessarily guarantee vaccination. A caregiver may possess adequate knowledge but still fail to vaccinate because of transportation difficulties, competing responsibilities, negative experiences at health facilities, vaccine stock-outs, misinformation or influence from family and community members.

This distinction between knowledge and behaviour is particularly important in Nigeria. Research among Nigerian mothers has demonstrated that knowledge about routine childhood immunization can coexist with practical and attitudinal barriers to completion. Oladepo et al. (2019), for example, examined Nigerian rural mothers’ knowledge of routine childhood immunization and their attitudes toward reminder text messages for promoting timely completion. Their findings highlighted the importance of both caregiver knowledge and communication strategies in improving vaccination behaviour.

Attitude is also an important determinant of vaccination uptake. Attitude encompasses an individual’s favourable or unfavourable feelings, beliefs and disposition toward vaccination. A positive attitude may be expressed through confidence in vaccines, willingness to follow health workers’ recommendations and readiness to complete the vaccination schedule. Conversely, a negative attitude may involve fear of adverse effects, distrust of healthcare providers, suspicion about vaccines or the belief that vaccination is unnecessary when a child appears healthy.

The concept of vaccine hesitancy has become particularly relevant to understanding vaccination behaviour. MacDonald (2015), through the Strategic Advisory Group of Experts on Immunization Working Group on Vaccine Hesitancy, described vaccine hesitancy as delay in acceptance or refusal of vaccination despite the availability of vaccination services. Vaccine hesitancy is influenced by factors involving confidence, complacency and convenience, and its causes vary according to geographical, social and cultural contexts. This makes it important to examine vaccination perceptions within specific communities rather than assuming that the same explanation applies everywhere.

In Nigeria, interpersonal and community relationships can influence caregivers’ vaccination decisions. Limaye et al. (2019) found that vaccination decision-making among Nigerian caregivers was influenced not only by individual factors but also by interpersonal and community influences. Frontline health workers reported that family members, community networks and social relationships could affect caregivers’ decisions regarding childhood vaccination.

Similarly, Oku et al. (2017) examined perceptions and experiences of childhood vaccination communication among caregivers and health workers in Nigeria. Their study emphasized the importance of effective communication between healthcare providers and parents in overcoming barriers to childhood vaccination and addressing vaccine hesitancy. The quality of information provided to caregivers and the manner in which vaccination information is communicated may therefore affect caregivers’ confidence and willingness to vaccinate their children.

The relationship between caregivers’ knowledge, attitudes and vaccination uptake has also been demonstrated in Lagos State. Oluwadamilola et al. (2024) investigated knowledge, attitude and uptake of childhood immunization among caregivers in Lagos Island Local Government Area. The study focused specifically on the relationship between what caregivers know about immunization, their attitudes towards it and actual uptake. Its relevance to the present study is considerable because both studies are situated within Lagos State and address caregiver-level determinants of childhood vaccination.

Lagos State provides an important environment for studying childhood vaccination because of its large and heterogeneous population. The state contains densely populated urban communities with considerable differences in socioeconomic status, educational attainment, occupation, access to healthcare and living conditions. These differences may influence how caregivers receive health information, perceive vaccination and utilize primary healthcare services.

Olaniyan, Isiguzo and Hawk (2021) used the Socioecological Model to explore factors influencing childhood immunization uptake in Lagos State. Their qualitative study involved mothers and caregivers, community leaders and healthcare workers. The researchers identified factors at multiple levels, including caregivers’ knowledge and welfare, interpersonal relationships and social networks, geographical and financial access to facilities, health-facility characteristics, health-worker attributes, community outreach and policy-level factors.

The findings of Olaniyan et al. (2021) demonstrate that childhood vaccination behaviour cannot be adequately explained by caregiver knowledge alone. At the individual level, caregivers’ knowledge and perceptions matter; at the interpersonal level, family and social networks can influence decisions; at the organizational level, the accessibility and characteristics of health facilities are relevant; and at the community level, outreach activities and community resources may shape uptake. This multidimensional nature of vaccination behaviour supports the need for localized studies.

The availability and accessibility of immunization services are also important. Even where caregivers have positive attitudes towards vaccination, they may encounter barriers such as long distance to health facilities, transportation costs, inconvenient clinic hours, long waiting times, absence of health workers or vaccine stock-outs. Olaniyan et al. (2021) identified geographical and financial access, health-facility characteristics and staff coverage among the organizational factors influencing immunization uptake in Lagos State.

Communication between healthcare workers and caregivers may determine whether caregivers develop confidence in vaccination. When health workers provide clear information about vaccine benefits, expected minor reactions and the importance of completing the schedule, caregivers may be better positioned to make informed decisions. Conversely, inadequate communication may leave caregivers dependent on informal sources of information, some of which may contain inaccurate or misleading claims.

Misinformation is particularly important in contemporary vaccination programmes because caregivers can obtain health information from family members, social media, religious networks, friends and other informal sources. Although not all informal information is inaccurate, conflicting messages can create uncertainty. Consequently, caregivers may have difficulty distinguishing reliable scientific information from rumours and anecdotal claims.

The social environment can also influence perceptions of vaccination. A caregiver whose family and community strongly support immunization may be encouraged to vaccinate a child even when the caregiver has personal concerns. Conversely, a caregiver living within a community where negative opinions about vaccination are widespread may become hesitant. Limaye et al. (2019) emphasized the role of interpersonal and community influences in Nigerian vaccination decision-making, reinforcing the importance of examining the social context surrounding caregivers.

Educational attainment may influence the way caregivers understand and evaluate vaccination information. However, higher educational attainment does not automatically result in positive vaccination attitudes. Vaccine decisions can be shaped by trust, personal experiences, social relationships and perceptions of risk. Consequently, research should examine education alongside other demographic, attitudinal and contextual variables rather than assuming that education alone determines vaccine uptake.

Household socioeconomic conditions may similarly influence immunization. Although routine childhood vaccination is generally provided through public health services without direct vaccine charges, caregivers may still incur indirect costs such as transportation expenses and lost income or time. These costs can become significant for caregivers who work daily, operate small businesses or have several household responsibilities.

The relationship between service availability and caregiver attitudes can also be reciprocal. A caregiver who repeatedly visits a facility and finds vaccines unavailable may eventually lose confidence in the immunization programme. Similarly, a caregiver who experiences long waiting times or unfriendly treatment may become less willing to return. Therefore, negative vaccination attitudes may sometimes develop from experiences with the health system rather than from misinformation alone.

The problem is especially important because vaccination uptake is ultimately reflected in whether children receive the recommended vaccines. Recent evidence from Nigeria continues to show substantial variation in routine childhood vaccination coverage. A recent analysis of Global Burden of Disease Study 2023 estimates reported improvements in several vaccine indicators over time but also demonstrated that national vaccination coverage has remained incomplete, with considerable room for improvement.

Studies conducted specifically in Lagos provide evidence that caregiver-related factors deserve attention. The study by Oluwadamilola et al. (2024) among caregivers in Lagos Island examined knowledge, attitudes and immunization uptake, demonstrating the continued relevance of caregiver perspectives to childhood vaccination in Lagos State. However, findings from Lagos Island cannot automatically be generalized to communities in Ikorodu because differences in population characteristics, socioeconomic conditions, community structures and healthcare access may produce different patterns.

Ikorodu is therefore a relevant setting for investigating caregivers’ perceptions, knowledge and attitudes toward childhood vaccination. The communities within the area include caregivers with different educational backgrounds, occupations, household circumstances and sources of health information. These differences may result in variations in how caregivers understand vaccination, assess its benefits and risks, interact with healthcare workers and ultimately decide whether to vaccinate their children.

The importance of studying Ikorodu is further strengthened by evidence that vaccination behaviour in Lagos operates through multiple interconnected levels. Olaniyan et al. (2021) found that factors influencing immunization uptake in Lagos included caregiver knowledge, social relationships, geographical and financial access, healthcare-worker characteristics, community resources and policy-related factors. Therefore, examining caregivers’ perceptions, knowledge and attitudes within selected Ikorodu communities can contribute to a more localized understanding of the determinants of vaccination uptake.

Understanding caregivers’ perceptions is also important for designing appropriate health education interventions. If caregivers’ concerns are primarily related to adverse effects, interventions may need to focus on explaining expected vaccine reactions and the benefits of vaccination. If lack of knowledge of the immunization schedule is the dominant problem, health workers may need to strengthen appointment reminders and individualized counselling. If negative attitudes are associated with distrust or poor healthcare experiences, improving communication and the quality of interaction between caregivers and health workers may be necessary.

The study is consequently anchored on the recognition that childhood vaccination uptake is a behavioural outcome influenced by knowledge, perceptions, attitudes and contextual circumstances. While vaccines are scientifically established tools for preventing infectious diseases, caregivers ultimately make many of the decisions concerning whether and when young children receive routine vaccines. Their understanding and interpretation of vaccination therefore remain central to successful immunization programmes.

It is against this background that this study seeks to examine caregivers’ perceptions, knowledge and attitudes towards childhood vaccination and their effects on immunization uptake in selected communities in Ikorodu, Lagos State. The study is expected to provide localized evidence that can assist healthcare providers, community stakeholders and public health authorities in developing interventions that address the specific concerns and information needs of caregivers and ultimately improve childhood vaccination uptake.

1.2 Statement of the Problem

Childhood vaccination remains one of the most effective strategies for preventing vaccine-preventable diseases and reducing childhood morbidity and mortality. However, the availability of effective vaccines does not automatically translate into high vaccination uptake. Caregivers must be willing and able to present their children for vaccination, complete the recommended schedule and maintain confidence in the immunization programme.

Nigeria continues to experience substantial inequalities in childhood immunization uptake. Antai (2009) demonstrated that childhood immunization in Nigeria is influenced by both individual and contextual determinants and that coverage is inequitable. This suggests that improving vaccination uptake requires more than simply increasing vaccine availability; it also requires an understanding of the social and behavioural factors affecting caregivers’ decisions.

One major concern is that caregivers may possess inadequate knowledge about the purpose, benefits and schedule of childhood vaccination. When caregivers do not know which vaccines their children require or when particular doses are due, they may miss vaccination appointments or fail to complete the recommended schedule. Oladepo et al. (2019) highlighted knowledge gaps among Nigerian rural mothers and examined the potential of reminder messages to support timely immunization.

Another concern is caregivers’ perceptions of vaccine safety and effectiveness. Some caregivers may fear adverse reactions or believe that vaccination can cause illness. Others may perceive certain vaccine-preventable diseases as unlikely to affect their children and consequently consider vaccination less important. Such perceptions can reduce the perceived need for routine vaccination.

Attitudes toward vaccination may also affect uptake. A caregiver who has confidence in vaccines and healthcare providers is more likely to accept recommended vaccines, whereas a caregiver who distrusts vaccination may delay or refuse immunization. Vaccine hesitancy is therefore a significant behavioural challenge. MacDonald (2015) emphasized that vaccine hesitancy involves delay in acceptance or refusal despite the availability of vaccination services and is influenced by context-specific factors.

In addition, caregivers’ vaccination decisions are influenced by people around them. Family members, friends, community leaders and other social networks can either reinforce positive attitudes toward vaccination or encourage hesitation. Limaye et al. (2019) found that interpersonal and community influences were important in childhood vaccination decision-making among Nigerian caregivers.

Communication between healthcare workers and caregivers may further influence the problem. Where caregivers receive inadequate explanations or have limited opportunities to ask questions, uncertainty about vaccination may persist. Oku et al. (2017) demonstrated the importance of vaccination communication in Nigeria and emphasized effective communication as an important component of addressing barriers to childhood vaccination.

The problem is also connected with access to immunization services. Caregivers may have positive attitudes and adequate knowledge but still experience geographical, financial or organizational barriers. Evidence from Lagos State identified geographical and financial access, health-facility characteristics and healthcare-worker factors as important influences on childhood immunization uptake.

Although research has examined childhood immunization in Lagos State, there remains a need for community-specific evidence from Ikorodu. Findings from Lagos Island, for example, cannot necessarily be generalized to Ikorodu because the two areas may differ in population characteristics, community structures, socioeconomic conditions, health-service utilization and sources of vaccination information. The Lagos Island study by Oluwadamilola et al. (2024) confirms the relevance of knowledge, attitude and uptake as interconnected issues but also highlights the need for additional local studies.

The lack of sufficiently localized evidence may make it difficult for health workers and programme managers to determine whether low uptake is primarily associated with knowledge deficiencies, negative perceptions, unfavourable attitudes, social influence, access barriers or a combination of these factors. Without understanding the specific reasons for vaccine acceptance or hesitancy within selected Ikorodu communities, interventions may not adequately address caregivers’ actual concerns.

The problem, therefore, is not merely that some children may remain unvaccinated; it is that the underlying perceptions, knowledge and attitudes that shape caregivers’ vaccination decisions may not be sufficiently understood within the selected communities in Ikorodu. Identifying these factors is essential for developing evidence-based health education, communication and community engagement strategies.

Consequently, this study will assess caregivers’ perceptions, knowledge and attitudes towards childhood vaccination and determine how these factors affect immunization uptake in selected communities in Ikorodu, Lagos State. The findings are expected to provide useful evidence for improving caregiver education, strengthening vaccination communication and supporting strategies aimed at increasing childhood immunization uptake.

1.3 Objectives of the Study

1.3.1 General Objective

The general objective of this study is to assess caregivers’ perceptions, knowledge and attitudes towards childhood vaccination and determine their effects on immunization uptake in selected communities in Ikorodu, Lagos State.

1.3.2 Specific Objectives

The specific objectives are to:

1. assess the level of caregivers’ knowledge regarding childhood vaccination in selected communities in Ikorodu;
2. determine caregivers’ perceptions towards childhood vaccination;
3. assess caregivers’ attitudes towards childhood vaccination;
4. determine the level of childhood immunization uptake among children under five in the selected communities; and

1.4 Research Questions

1. What is the level of caregivers’ knowledge regarding childhood vaccination in selected communities in Ikorodu?
2. What are caregivers’ perceptions towards childhood vaccination in the selected communities?
3. What are caregivers’ attitudes towards childhood vaccination?
4. What is the level of childhood immunization uptake among children under five in the selected communities?

1.5 Research Hypothesis

H₀: There is no significant relationship between caregivers’ perceptions, knowledge and attitudes towards childhood vaccination and immunization uptake among children under five in selected communities in Ikorodu, Lagos State.

1.6 Significance of the Study

The study will be significant to the Lagos State Ministry of Health and immunization programme managers because it will provide localized evidence regarding behavioural factors associated with childhood vaccination uptake. The findings may assist policymakers in developing interventions that address the specific concerns of caregivers in Ikorodu.

The study will benefit healthcare workers, particularly those providing routine immunization services in primary healthcare facilities. Understanding caregivers’ perceptions and attitudes may help health workers improve counselling, communication and health education during immunization sessions.

The study will also benefit parents and caregivers by identifying knowledge gaps and misconceptions that may affect vaccination decisions. Findings may encourage caregivers to seek reliable information and make informed decisions concerning their children’s immunization.

Community and religious leaders may benefit from the findings because they can use the evidence to support community mobilization and promote accurate information about childhood vaccination.

The study may also be useful to non-governmental organizations and development partners involved in maternal and child health. The findings may guide the development of community-specific communication strategies, reminder systems and interventions aimed at reducing vaccine hesitancy.

Finally, the study will contribute to academic knowledge by providing evidence on the relationship between caregivers’ perceptions, knowledge, attitudes and immunization uptake in selected communities in Ikorodu. It may serve as a reference for future studies on childhood vaccination in Lagos State and other urban Nigerian communities.

1.7 Scope of the Study

The study will focus on caregivers of children under five years in selected communities in Ikorodu, Lagos State. It will examine caregivers’ knowledge, perceptions and attitudes toward childhood vaccination and determine how these factors relate to immunization uptake.

The study will specifically consider caregivers’ understanding of vaccine-preventable diseases, vaccination benefits and schedules; perceptions of vaccine safety and effectiveness; attitudes toward routine childhood vaccination; and the extent to which children have received recommended routine vaccines.

The study will be limited geographically to selected communities in Ikorodu and will not represent all communities in Lagos State. The findings will therefore be interpreted within the context of the selected study communities.

1.8 Operational Definition of Terms

Attitude: The favourable or unfavourable disposition of a caregiver toward childhood vaccination, reflected in willingness or reluctance to have a child vaccinated.

Caregiver: A parent, guardian or other adult responsible for the care, health and wellbeing of a child under five years.

Childhood Vaccination: Administration of recommended vaccines to children to protect them against vaccine-preventable diseases.

Immunization Uptake: The extent to which eligible children receive recommended routine vaccines within the immunization programme.

Knowledge: The caregiver’s understanding of childhood vaccines, vaccine-preventable diseases, vaccination benefits, schedules and the importance of completing recommended doses.

Perception: The way caregivers interpret, understand and form opinions about childhood vaccination, including their beliefs regarding vaccine benefits, safety, effectiveness and risks.

Routine Immunization: The regular provision of recommended vaccines to children according to the national childhood immunization schedule.

Vaccine Hesitancy: Delay in acceptance or refusal of vaccination despite vaccination services being available.

Vaccine-Preventable Diseases: Infectious diseases that can be prevented through vaccination, including measles, poliomyelitis, tuberculosis, diphtheria, pertussis and tetanus.

Project – Caregivers’ Perceptions, Knowledge and Attitudes Towards Childhood Vaccination and Their Effects on Immunization Uptake in Selected Communities in Ikorodu