Project – Factors Influencing Uptake of Routine Immunisation among Caregivers of Children Under Five Years: A Study of Selected Primary Healthcare Centres in Umuahia, Abia State.

CHAPTER ONE

INTRODUCTION

Topic: Factors Influencing Uptake of Routine Immunisation among Caregivers of Children Under Five Years: A Study of Selected Primary Healthcare Centres in Umuahia, Abia State

1.1 Background to the Study

Routine immunisation is one of the most important public health interventions for protecting children against vaccine-preventable diseases. It involves administering recommended vaccines to children at specified ages to stimulate immunity against illnesses such as tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, measles, and other vaccine-preventable infections. The World Health Organization (WHO, 2024) identifies immunisation as a core component of primary healthcare and an essential strategy for reducing illness and death associated with infectious diseases. Through routine immunisation, children can develop protection before they are exposed to diseases that may cause serious complications, disability, or death. The importance of immunisation is particularly pronounced during the first years of life, when children are vulnerable to infections and depend largely on caregivers and health workers for preventive healthcare. Consequently, the uptake of routine immunisation among children under five years is an important indicator of access to preventive health services and the ability of health systems to protect vulnerable populations.

The uptake of routine immunisation depends not only on the availability of vaccines but also on whether caregivers understand, accept, and complete the recommended vaccination schedule. Caregivers are responsible for presenting children for vaccination, keeping immunisation cards, remembering appointment dates, and seeking information when they have concerns about vaccine safety or eligibility. The WHO (2022) explains that behavioural and social factors, including what people think and feel, social influences, motivation, and practical barriers, can affect the acceptance and use of vaccination services. A caregiver may believe that vaccines protect children but still fail to complete the schedule because of transportation difficulties, competing household responsibilities, long waiting times, or a lack of information about the next appointment. Similarly, misinformation or fear of adverse events may cause a caregiver to delay or reject a vaccine. Understanding these individual, social, and practical influences is therefore necessary for designing interventions that improve routine immunisation uptake among caregivers of children under five years.

At the national level, Nigeria continues to face challenges in achieving universal childhood immunisation. The National Bureau of Statistics (NBS) and UNICEF reported in the 2021 Multiple Indicator Cluster Survey and National Immunization Coverage Survey that childhood vaccination coverage remained inadequate, with substantial differences between children who received all recommended vaccines and those who received none (NBS & UNICEF, 2022). More recent evidence from the 2024 Nigeria Demographic and Health Survey indicates that only 39% of children aged 12–23 months were fully vaccinated against the basic antigens used in the survey, while 31% had received no vaccinations (National Population Commission [NPC] & ICF, 2025). These figures demonstrate that the challenge is not simply the existence of immunisation programmes but whether children are reached and receive the vaccines required for protection. Low uptake can arise from a combination of caregiver-related factors, service-delivery difficulties, geographical barriers, and wider socioeconomic conditions. Investigating these influences is important for understanding why some caregivers consistently use routine immunisation services while others initiate vaccination late, miss appointments, or discontinue the recommended schedule.

Caregivers’ knowledge and awareness of routine immunisation may influence their decisions to present children for vaccination. Knowledge includes understanding the benefits of vaccines, the diseases they prevent, the recommended vaccination timetable, and the importance of receiving subsequent doses. Caregivers who have accurate information may be more likely to recognise immunisation as a preventive measure rather than a service needed only when a child is ill. In contrast, inadequate knowledge may lead to missed appointments, misconceptions about the number of doses required, or the belief that a child who appears healthy does not need further vaccination. The WHO (2022) behavioural and social drivers framework emphasises that people’s thoughts, feelings, social influences, and practical experiences can affect vaccination behaviour. In Nigeria, UNICEF’s analysis of gender barriers and behavioural and social drivers of immunisation also highlights the role of education, access to information, and social circumstances in shaping childhood vaccination outcomes (UNICEF, 2024). It is therefore necessary to examine whether caregivers’ knowledge and awareness are associated with routine immunisation uptake at selected primary healthcare centres in Umuahia.

Socioeconomic and demographic characteristics may also influence caregivers’ ability to access immunisation services. Factors such as educational attainment, occupation, household income, age, family size, and the number of children requiring care can affect how easily caregivers obtain health information and attend scheduled appointments. For instance, caregivers whose work requires long or inflexible hours may find it difficult to visit a health facility during designated immunisation sessions. Transportation expenses and the loss of daily income may also discourage repeated visits, particularly when multiple doses are required. The 2021 Nigerian Multiple Indicator Cluster Survey and National Immunization Coverage Survey showed substantial differences in vaccination coverage according to mothers’ educational attainment, with children of more highly educated mothers generally more likely to be fully vaccinated than children of mothers with no formal education (NBS & UNICEF, 2022). Such differences suggest that immunisation uptake should be understood in relation to the social and economic circumstances in which caregiving takes place. Examining these factors in Umuahia may help identify groups of caregivers who require more accessible information, flexible service arrangements, or additional support to complete their children’s immunisation schedules.

Cultural beliefs, family influence, community attitudes, and confidence in healthcare providers may further shape routine immunisation behaviour. Caregivers often make health decisions within families and communities where opinions from spouses, relatives, religious leaders, traditional leaders, and other trusted individuals can influence their perceptions of vaccines. Positive community experiences may encourage caregivers to attend immunisation sessions, whereas rumours, fear of infertility, concerns about vaccine safety, or beliefs that vaccination is unnecessary may contribute to hesitancy. The WHO (2022) explains that social norms, trust, and motivation are important considerations in understanding vaccination behaviour. UNICEF (2024) also identifies gender-related and social barriers that can affect caregivers’ ability to access and use immunisation services in Nigeria. Such barriers may interact with individual concerns: for example, a caregiver who has limited information and little opportunity to consult a trusted health worker may be more susceptible to misinformation. Consequently, examining the influence of cultural beliefs, family support, community perceptions, and trust in healthcare workers can provide a broader understanding of the factors affecting routine immunisation uptake.

The quality and accessibility of services provided by primary healthcare centres are also important in determining whether caregivers initiate and complete routine immunisation. Relevant service-related factors include the distance to a facility, the availability of vaccines, the regularity of immunisation sessions, waiting time, staff attitude, health education, and the clarity of appointment instructions. Even caregivers who support vaccination may miss scheduled visits if a facility is difficult to reach, vaccines are unavailable when they arrive, or the service is delivered at an inconvenient time. The WHO (2024) emphasises the need for accessible, reliable immunisation services as part of efforts to close vaccination gaps and reach children who have missed doses. Nigeria’s vaccination coverage data similarly show that substantial numbers of children remain unvaccinated, indicating the need to address both demand-side barriers and weaknesses in service delivery (NPC & ICF, 2025). Against this background, the present study examines factors influencing routine immunisation uptake among caregivers of children under five years attending selected primary healthcare centres in Umuahia, Abia State, with particular attention to caregiver knowledge, socioeconomic characteristics, cultural and social influences, and the accessibility and quality of healthcare services.

1.2 Statement of the Problem

Routine immunisation is intended to protect children against vaccine-preventable diseases, reduce avoidable childhood illness and death, and strengthen public health. However, the continued presence of children who receive none of the recommended vaccines or fail to complete their vaccination schedules indicates that access to immunisation programmes does not automatically translate into adequate uptake. The 2024 Nigeria Demographic and Health Survey reported that 39% of children aged 12–23 months were fully vaccinated against the basic antigens measured, while 31% had received no vaccinations (NPC & ICF, 2025). These national figures reveal a substantial gap between the availability of immunisation as a public health intervention and the proportion of children who receive the intended protection. When children miss routine vaccinations, they may remain susceptible to preventable diseases and contribute to continuing transmission within their communities. It is therefore important to investigate the factors that influence caregivers’ decisions and ability to present their children for routine immunisation.

One problem that may contribute to incomplete immunisation is inadequate knowledge, limited awareness, and uncertainty about the benefits and schedule of childhood vaccines. Caregivers may not know the appropriate ages for particular doses, may forget subsequent appointments, or may believe that one or two visits are sufficient to protect a child fully. Concerns about fever or other reactions after vaccination may also discourage caregivers from returning for subsequent doses, particularly when they have not received adequate explanations from healthcare workers. The WHO (2022) behavioural and social drivers framework recognises that thoughts and feelings about vaccines, social influences, motivation, and practical barriers can shape vaccination decisions. UNICEF (2024) likewise identifies information-related and social barriers as relevant to immunisation uptake in Nigeria. However, the extent to which these factors influence caregivers attending selected primary healthcare centres in Umuahia needs to be established through a focused local investigation rather than assumed from national findings alone.

Socioeconomic conditions, cultural beliefs, and the practical challenges of attending healthcare facilities may create additional barriers to routine immunisation. Caregivers may face transport costs, work commitments, childcare responsibilities, long waiting periods, or difficulty obtaining permission and support from other household members. Others may encounter negative community perceptions, misinformation, or insufficient confidence in the safety and effectiveness of vaccines. National survey evidence indicates that childhood vaccination outcomes vary with maternal education and other background characteristics, suggesting that caregivers do not all experience the same opportunities to access immunisation services (NBS & UNICEF, 2022). In addition, the WHO (2022) framework demonstrates that social influences and practical constraints can affect whether positive attitudes towards vaccination translate into actual behaviour. Without understanding the relative importance of these barriers in the selected healthcare centres, immunisation providers may find it difficult to design health education and service-delivery strategies that respond to caregivers’ specific needs.

Furthermore, the accessibility and quality of primary healthcare services may influence whether caregivers initiate vaccination and complete all required doses. Irregular immunisation sessions, vaccine stock interruptions, unfriendly staff attitudes, inadequate counselling, and inconvenient opening times can discourage caregivers from returning even when they recognise the benefits of vaccination. Although national reports document significant immunisation gaps, they do not by themselves establish which caregiver-related and facility-related factors are most influential among clients of the selected primary healthcare centres in Umuahia. The WHO (2024) identifies the need to improve access to immunisation and reach children who remain unvaccinated or incompletely vaccinated, while NPC and ICF (2025) document the continuing national challenge of childhood vaccine coverage. The problem this study seeks to address is therefore the lack of sufficiently focused evidence on the factors influencing routine immunisation uptake among caregivers of children under five years in the selected primary healthcare centres in Umuahia, Abia State. The study will investigate these factors to provide evidence that may inform health education, caregiver support, and improvements in immunisation service delivery.

1.3 Objectives of the Study

The general objective of this study is to examine the factors influencing uptake of routine immunisation among caregivers of children under five years attending selected primary healthcare centres in Umuahia, Abia State.

The specific objectives are to:

1. Assess the influence of caregivers’ knowledge and awareness on the uptake of routine immunisation among children under five years in selected primary healthcare centres in Umuahia, Abia State.

2. Examine the influence of socioeconomic and demographic factors on routine immunisation uptake among caregivers of children under five years.

3. Determine the influence of cultural beliefs, family support, and community perceptions on routine immunisation uptake among caregivers of children under five years.

4. Assess the influence of healthcare service-related factors, including accessibility, waiting time, staff attitude, and vaccine availability, on routine immunisation uptake among caregivers of children under five years.

1.4 Research Questions

The following research questions will guide the study:

1. How do caregivers’ knowledge and awareness influence the uptake of routine immunisation among children under five years in selected primary healthcare centres in Umuahia, Abia State?

2. How do socioeconomic and demographic factors influence routine immunisation uptake among caregivers of children under five years?

3. How do cultural beliefs, family support, and community perceptions influence routine immunisation uptake among caregivers of children under five years?

4. How do healthcare service-related factors influence routine immunisation uptake among caregivers of children under five years?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no statistically significant relationship between caregiver-related and healthcare service-related factors and the uptake of routine immunisation among caregivers of children under five years attending selected primary healthcare centres in Umuahia, Abia State.

1.6 Significance of the Study

The findings of this study are expected to be beneficial to caregivers, healthcare workers, primary healthcare administrators, government agencies, public health practitioners, and future researchers.

Caregivers of children under five years: The study may improve caregivers’ understanding of the factors that influence routine immunisation and the importance of adhering to recommended vaccination schedules. By identifying common barriers, the findings may encourage caregivers to seek accurate information, keep immunisation appointments, and consult healthcare workers when they have concerns about vaccine safety or adverse reactions.

Healthcare workers: Nurses, community health extension workers, immunisation officers, and other primary healthcare personnel may benefit from the findings by gaining a clearer understanding of caregivers’ concerns, knowledge gaps, and practical difficulties. This information may help them improve health education, provide clearer appointment instructions, respond respectfully to questions, and develop communication strategies that encourage caregivers to complete immunisation schedules.

Primary healthcare centre administrators: The findings may assist administrators in identifying service-related challenges that discourage attendance, such as long waiting times, inconvenient session schedules, inadequate communication, and interruptions in vaccine availability. The results may guide improvements in service organisation, appointment reminders, client flow, and the overall experience of caregivers visiting immunisation clinics.

Abia State Ministry of Health and relevant government agencies: The study may provide locally relevant information that can support the planning and improvement of childhood immunisation programmes. Findings concerning knowledge, socioeconomic circumstances, community attitudes, and service accessibility may help policymakers and programme managers develop more targeted interventions to improve vaccination coverage.

Community leaders and public health advocates: Traditional leaders, religious leaders, community-based organisations, and health educators may use the findings to identify misconceptions and social barriers affecting vaccination. Their involvement may support community education, strengthen trust in health services, and encourage families to participate in routine immunisation.

Researchers and students: The study may contribute to literature on childhood immunisation and primary healthcare utilisation in Nigeria. It may serve as a reference for further research on vaccine acceptance, immunisation completion, healthcare access, caregiver behaviour, and interventions aimed at improving child health.

1.7 Scope of the Study

The geographical scope of the study is Umuahia, Abia State, Nigeria. The study will be conducted in selected primary healthcare centres within the study area, with caregivers of children under five years serving as the principal respondents.

The content scope focuses on factors influencing routine immunisation uptake. These factors will be examined under four main areas: caregivers’ knowledge and awareness; socioeconomic and demographic characteristics; cultural beliefs, family support, and community perceptions; and healthcare service-related factors, including accessibility, waiting time, staff attitude, and vaccine availability.

Routine immunisation uptake will be assessed in relation to caregivers’ reported attendance, adherence to scheduled vaccinations, and whether their children have received the recommended doses appropriate to their ages. Where available and with appropriate consent, immunisation cards or clinic records may be used to support the information provided by respondents.

The study will focus on routine childhood immunisation and will not treat every specialised vaccination campaign as equivalent to routine immunisation. The findings will be interpreted within the context of the selected primary healthcare centres and should not automatically be generalised to all caregivers in Abia State or Nigeria.

1.8 Limitations of the Study

The study may encounter some limitations that could affect the collection and interpretation of data.

Recall bias: Some caregivers may have difficulty remembering their children’s previous immunisation visits, missed appointments, or the reasons for delays. Where possible, the researcher may use immunisation cards or available clinic records to support respondents’ accounts.

Social desirability bias: Some respondents may provide answers they believe healthcare workers or researchers expect, particularly on sensitive issues such as vaccine hesitancy or missed appointments. The researcher will explain the purpose of the study and encourage honest responses while protecting participants’ confidentiality.

Time and financial constraints: Limited time and research funds may affect the number of healthcare centres and caregivers that can be included. An appropriate sampling procedure and a well-organised data collection plan will be used to make the best use of available resources.

Limited geographical coverage: Since the research will focus on selected primary healthcare centres in Umuahia, its findings may not represent the experiences of caregivers in every community in Abia State. Differences in facility resources, transportation, community beliefs, and socioeconomic conditions may influence immunisation uptake elsewhere.

Access to immunisation records: Some caregivers may not have their children’s immunisation cards available, while some facility records may be incomplete. The researcher will use the available sources of information responsibly and acknowledge any resulting limitations when interpreting the findings.

1.9 Operational Definition of Terms

Routine immunisation: The scheduled administration of recommended vaccines to children at specified ages to protect them against vaccine-preventable diseases.

Uptake of routine immunisation: The extent to which caregivers present their children for scheduled vaccinations and ensure that the children receive the required doses appropriate to their ages.

Caregiver: A parent, guardian, or other responsible adult who provides care for a child under five years and makes or participates in decisions concerning the child’s immunisation.

Children under five years: Children from birth up to, but not including, their fifth birthday.

Knowledge and awareness: The caregiver’s understanding of the purpose, benefits, timing, recommended doses, and importance of completing routine childhood immunisation.

Socioeconomic and demographic factors: Characteristics such as age, educational attainment, occupation, income, household responsibilities, and family size that may influence a caregiver’s ability to access immunisation services.

Cultural beliefs and community perceptions: Values, traditional beliefs, shared opinions, rumours, and social expectations that may influence caregivers’ attitudes towards childhood vaccination.

Family support: The practical, financial, or emotional assistance caregivers receive from spouses, relatives, or other household members in obtaining immunisation services for children.

Healthcare service-related factors: Characteristics of immunisation services that may affect uptake, including distance to the facility, waiting time, staff attitude, availability of vaccines, convenience of clinic sessions, and the quality of health education.

Primary healthcare centre (PHC): A health facility that provides essential first-contact health services, including preventive healthcare, health education, and routine immunisation.

Umuahia, Abia State: The geographical area in southeastern Nigeria in which the selected primary healthcare centres for this study are located.

Project – Factors Influencing Uptake of Routine Immunisation among Caregivers of Children Under Five Years: A Study of Selected Primary Healthcare Centres in Umuahia, Abia State.