Project – Assessment of Factors Influencing Childhood Immunization Uptake among Mothers of Under-Five Children in Selected Primary Health Centres in Jos North LGA, Plateau State

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Immunization is one of the most important public health interventions for protecting children against vaccine-preventable diseases. It involves the administration of vaccines to stimulate the body’s immune system to develop protection against specific infectious diseases. Childhood immunization protects individual children while also contributing to population-level protection when sufficiently high proportions of eligible children are vaccinated. The World Health Organization (WHO) identifies immunization as a fundamental component of primary health care and an essential investment in reducing childhood morbidity and mortality. Through vaccination, millions of deaths and severe illnesses from diseases such as measles, poliomyelitis, diphtheria, pertussis, tetanus and hepatitis B can be prevented (World Health Organization [WHO], 2024).

The importance of childhood immunization extends beyond the prevention of individual infections. Vaccine-preventable diseases can result in hospitalization, disability, nutritional deterioration, long-term complications and death, particularly among young children. High immunization coverage also reduces the circulation of infectious agents within communities and protects children who cannot receive certain vaccines for medical reasons. Consequently, immunization is considered both an individual health intervention and a population-level disease-control strategy. The continued global emphasis on immunization reflects its contribution to child survival and the achievement of universal health coverage and Sustainable Development Goal targets relating to child health (WHO, 2024).

Despite the established benefits of immunization, millions of children worldwide remain unvaccinated or incompletely vaccinated. The persistence of zero-dose and under-immunized children demonstrates that vaccine availability alone does not guarantee vaccine uptake. UNICEF identifies Nigeria as one of the countries carrying a disproportionately large share of the global burden of zero-dose children. The organization’s 2025 analysis of immunization in Nigeria reported that, according to the 2021 Multiple Indicator Cluster Survey/National Immunization Coverage Survey, 18% of Nigerian children aged 12–23 months had received no routine immunization, while only 36% had received all recommended routine immunizations.

Nigeria’s immunization challenge is particularly important because of the country’s large population and substantial burden of childhood morbidity and mortality. UNICEF has identified routine immunization as a major priority within Nigeria’s child-health agenda, noting that only about one in three children were fully vaccinated in the period informing its country programme and that Nigeria had millions of zero-dose children. The organization has consequently emphasized the need to increase immunization coverage, reduce inequalities, strengthen vaccine logistics and improve primary healthcare systems (UNICEF, 2023).

Nigeria has implemented routine immunization through the primary healthcare system for several decades. The national routine immunization programme provides vaccines against a range of childhood diseases at specified ages. The schedule begins at birth with vaccines such as Bacille Calmette-Guérin (BCG), oral polio vaccine and hepatitis B vaccine, followed by additional doses during the first months of life and measles-containing and other vaccines later in infancy. The Nigerian immunization schedule is designed to ensure that children receive vaccines at ages when they are most vulnerable to vaccine-preventable diseases and when vaccination can produce appropriate protection (UNICEF Nigeria, 2024).

The success of routine immunization therefore depends substantially on mothers and other caregivers taking their children to health facilities or outreach points at the appropriate times. Mothers are particularly important because they frequently serve as the primary caregivers and are often responsible for decisions concerning children’s preventive and curative healthcare. UNICEF’s 2025 gender and behavioural analysis of immunization in Nigeria observed that women traditionally bear substantial responsibility for children’s healthcare, placing mothers at the forefront of immunization decisions. However, women may encounter educational, economic, social and health-system barriers that affect their ability to obtain immunization services for their children.

The concept of immunization uptake is therefore broader than simply whether a child has ever received a vaccine. It includes the initiation of vaccination, timely receipt of recommended doses and completion of the age-appropriate immunization schedule. A child may receive the first dose of a vaccine but fail to return for subsequent doses. Such a child is partially immunized and may remain inadequately protected against vaccine-preventable diseases. Aheto et al. (2022), using Nigerian data, examined separate indicators for receiving the first pentavalent dose, completing the pentavalent series and receiving measles vaccine, demonstrating that initiation and completion of vaccination can be influenced by different factors.

One of the major factors influencing childhood immunization is the mother’s level of education. Education can improve a mother’s ability to understand health information, interpret immunization schedules, recognize the benefits of vaccination and communicate effectively with healthcare workers. Educated mothers may also be more likely to seek information about childhood diseases and preventive healthcare. Burroway and Hargrove (2018) found that maternal education had a robust relationship with child immunization in Nigeria, both at the individual and community levels. Their findings suggest that the educational environment of communities can influence immunization beyond the educational attainment of individual mothers.

Evidence from more recent Nigerian analyses continues to support the importance of maternal education. A 2024 multilevel analysis of Nigerian vaccination data identified maternal educational level as significantly associated with multiple indicators of childhood vaccination. The study also identified health-card ownership, socioeconomic status, skilled birth attendance, travel time to health facilities, problems seeking healthcare and other maternal and household factors as important determinants of vaccination outcomes (Aheto et al., 2022).

Socioeconomic status is another important determinant of immunization uptake. Although routine immunization vaccines are generally provided through government health services without direct vaccine charges, mothers may incur indirect costs associated with transportation, lost working time, childcare for other children and other expenses involved in visiting health facilities. Poor households may therefore experience difficulties maintaining regular attendance at immunization clinics. Oleribe et al. (2017), using the 2013 Nigeria Demographic and Health Survey, found significant relationships between immunization coverage and socioeconomic characteristics, including household wealth, maternal education and occupation.

Maternal employment can also influence immunization uptake. Mothers who work outside the home may have difficulties attending health facilities on designated immunization days, especially where services operate only during conventional working hours. Conversely, employment and income may provide mothers with resources to overcome transportation and other access barriers. The direction of this relationship can therefore depend on the type of employment, working conditions, family support and accessibility of immunization services.

Maternal age may similarly influence childhood immunization. Younger mothers may have less experience with child health services and may require additional support concerning immunization schedules and vaccine safety. Older mothers may have greater experience navigating health services, although age alone does not guarantee appropriate vaccine uptake. The 2024 scoping review of routine immunization in Nigeria identified maternal age as one of the caregiver-related factors reported in existing Nigerian studies, alongside maternal education, socioeconomic status and healthcare utilization (Mohammed et al., 2024).

Knowledge about immunization is another important factor. Mothers need to understand which vaccines their children should receive, the appropriate timing of doses, the diseases prevented and the importance of completing the schedule. Lack of awareness can result in missed appointments, delayed vaccination and incomplete vaccination. A national analysis of reasons for non- and partial vaccination found that lack of awareness of the need for immunization was one of the leading reasons caregivers gave for children not being vaccinated. Among partially vaccinated children, some caregivers incorrectly believed that their children had already received all necessary vaccines (Adebowale et al., 2019).

Awareness of immunization is closely related to health literacy. Health literacy involves the ability to obtain, understand and use health information to make appropriate health decisions. A mother may know that vaccines are important but still lack sufficient knowledge concerning the timing of individual doses. Health workers therefore have an important role in explaining immunization schedules and reminding mothers about subsequent appointments. Mohammed et al. (2024) identified health literacy as an important facilitator of routine immunization in Nigeria and lack of awareness of immunization schedules as a major barrier.

Maternal attitudes and perceptions toward vaccines can also influence uptake. Mothers who believe vaccines are effective and necessary are more likely to take their children for vaccination. Conversely, mothers who perceive vaccines as dangerous, unnecessary or ineffective may delay or refuse vaccination. Vaccine hesitancy can arise from concerns about adverse reactions, misinformation, religious or cultural beliefs, distrust of health institutions or previous negative experiences. Mohammed et al. (2024) identified fear of vaccine side effects and misinformation among the prominent caregiver-related barriers to routine immunization in Nigeria.

Fear of adverse events following immunization is particularly important. Mild fever, pain at the injection site and temporary discomfort may occur after some vaccines, and mothers may interpret these events as evidence that the vaccine is harmful. If healthcare workers do not provide appropriate counselling before and after vaccination, mothers may become reluctant to return for subsequent doses. In the Jos study conducted by Yiltok et al. (2022), experience of vaccine side effects was significantly associated with immunization status among children aged 1–5 years attending the Emergency Paediatric Unit of Jos University Teaching Hospital.

Trust in healthcare workers and health institutions is also an important determinant of immunization behaviour. Mothers are more likely to accept vaccination when healthcare providers communicate respectfully, answer questions and demonstrate competence. Poor communication, unfriendly attitudes and inadequate explanations can discourage mothers from returning. Mohammed et al. (2024) found trust in healthcare providers to be among the factors influencing routine immunization in Nigeria, while the Jos study by Yiltok et al. (2022) found healthcare workers’ attitude to be significantly associated with immunization status.

Accessibility of healthcare facilities represents another important factor. A mother may understand the benefits of vaccination and intend to immunize her child but fail to do so when the health facility is too far away or difficult to reach. Distance becomes particularly important where mothers must walk long distances, spend considerable amounts on transportation or travel with multiple children. In a national Nigerian analysis, longer distance to the nearest health facility was associated with lower vaccine uptake and delayed vaccination (Okwaraji et al., 2019). Specifically, an additional kilometre of distance from the nearest clinic was associated with a reduction in the likelihood of receiving vaccination.

Distance and accessibility are especially relevant to Jos North Local Government Area because mothers may live in communities with varying degrees of access to primary healthcare facilities. Although urban and peri-urban communities may have several health facilities, physical proximity alone does not guarantee convenient access. Factors such as road conditions, transportation costs, waiting time, clinic schedules, household responsibilities and security may determine whether mothers can actually use available services.

The importance of physical access is strongly supported by evidence from Jos itself. Yiltok et al. (2022) investigated immunization status among children aged 1–5 years seen at the Emergency Paediatric Unit of Jos University Teaching Hospital. Of the 191 children studied, 76.4% were fully immunized for age. Distance to the health facility was significantly associated with immunization status and was identified as an independent predictor of complete immunization. The researchers also found that SMS reminders were the most frequently suggested strategy for improving immunization uptake.

The Jos-specific evidence is particularly important for the present study because it demonstrates that accessibility and service-related factors have measurable relationships with childhood immunization within Plateau State. However, the previous study was conducted among children presenting at a tertiary teaching hospital rather than among mothers attending selected primary health centres. The population, healthcare setting and purpose of service utilization therefore differ from the population targeted by the present study.

The quality and reliability of immunization services may also affect uptake. Mothers may be discouraged when vaccines are unavailable during scheduled visits, when health workers are absent or when clinic sessions are cancelled. A mother who repeatedly visits a facility without receiving the required vaccine may lose confidence in the programme. A systematic review and meta-analysis of childhood immunization determinants in Nigeria identified vaccine unavailability among factors associated with low coverage (Babalola & Lawan, 2009; see also Mohammed et al., 2024). More recent Nigerian evidence continues to identify supply-side and health-system deficiencies as important barriers.

Vaccine availability is closely connected to health-system logistics. Immunization requires functioning cold-chain systems, reliable vaccine supplies, trained healthcare workers, appropriate records and effective supervision. UNICEF’s 2025 annual report noted substantial investment in vaccine logistics in Nigeria, including the delivery of essential vaccines to the last mile, solarization of health facilities, installation of cold-chain units and distribution of vaccine carriers and cold boxes. These investments illustrate the importance of health-system capacity in ensuring that vaccines reach eligible children.

Clinic waiting time may also influence mothers’ decisions to use immunization services. Mothers with other children, employment or household responsibilities may find prolonged waiting periods inconvenient. If immunization sessions are poorly organized, mothers may postpone attendance or miss the scheduled appointment altogether. Health facility organization, staff availability, appointment systems and the integration of immunization with other child-health services can therefore influence the practical convenience of vaccination.

The availability of reminder systems can help mothers remember vaccination appointments. Immunization schedules involve multiple visits during the first year of life, and mothers may forget subsequent appointments, particularly when they do not receive reminders. Yiltok et al. (2022) found SMS to be the most preferred suggested strategy for improving immunization uptake among caregivers in their Jos-based study. Digital reminders, community health-worker follow-up, immunization cards and telephone communication may therefore complement conventional health education.

The possession and proper use of an immunization card are also important. Health cards provide a record of vaccines already administered and indicate the next doses due. They assist mothers and healthcare workers in determining whether a child is fully, partially or inadequately immunized. Aheto et al. (2022) found health-card or vaccination-document ownership to be significantly associated with several childhood vaccination outcomes in Nigeria.

Antenatal care and place of delivery may indirectly influence immunization uptake. Mothers who attend antenatal services are more likely to receive information about child health, preventive services and vaccination. Mothers who deliver in health facilities may also receive immediate information concerning birth-dose vaccines and subsequent immunization appointments. The 2024 scoping review of Nigerian routine immunization identified skilled facility delivery and antenatal-care-related factors among important facilitators of immunization uptake (Mohammed et al., 2024).

Household decision-making and maternal autonomy may further influence immunization. In some households, mothers may require the permission, financial support or physical assistance of spouses or other family members before accessing healthcare. Where mothers have limited autonomy, even a strong personal intention to vaccinate may not translate into actual uptake. UNICEF’s 2025 analysis specifically highlighted gender-related barriers, including women’s education, employment and broader social circumstances, as relevant to immunization utilization in Nigeria.

Religious and cultural beliefs can also shape perceptions of vaccination. Religious leaders, traditional leaders, family members and community networks can either support or discourage vaccination. The evidence reviewed by Mohammed et al. (2024) indicates that cultural and religious factors are prominent influences on routine immunization in different parts of Nigeria. The nature and strength of these influences vary geographically, which makes location-specific research particularly important.

Social support can facilitate immunization. Mothers who receive encouragement from spouses, relatives, friends, community health workers and other mothers may be more likely to maintain vaccination schedules. Conversely, misinformation circulating within social networks may produce vaccine hesitancy. Community-level interventions that involve trusted leaders and peer networks can therefore complement facility-based health education.

The geographical distribution of immunization coverage in Nigeria demonstrates that national averages can hide important regional inequalities. Oleribe et al. (2017) identified substantial associations between immunization and maternal, household and socioeconomic factors. Aheto et al. (2022) similarly found significant community-level variation in vaccination outcomes after accounting for individual and household characteristics. These findings demonstrate that immunization uptake is influenced by multiple levels of the social and health environment.

Recent evidence indicates that maternal education and household wealth continue to be important predictors of full immunization. A recent analysis using Nigerian survey data found substantial differences in full immunization according to maternal education and household wealth, with higher educational attainment and greater household wealth associated with higher immunization coverage. The study also found associations involving distance to health facilities, employment and religious affiliation. These findings reinforce the need to consider socioeconomic and demographic factors when assessing immunization uptake.

The national picture has shown some improvement, but progress remains uneven. UNICEF’s 2024 situation analysis reported gains in childhood immunization coverage in Nigeria while simultaneously emphasizing persistent challenges affecting children’s health and survival. Improvements at national level should therefore not obscure continuing gaps among specific communities and population groups.

Recent immunization activities in Nigeria have also demonstrated the potential of targeted interventions. UNICEF’s 2025 annual report documented the introduction of the measles-rubella vaccine across hundreds of LGAs and efforts to reach zero-dose children through integrated campaigns and maternal, neonatal and child-health activities. These efforts show that substantial gains are possible when immunization programmes combine vaccines, community mobilization, logistics and targeted identification of missed children.

Nevertheless, routine immunization remains distinct from campaign-based vaccination. Campaigns can reach large numbers of children within a short period, but routine immunization requires mothers to repeatedly attend health facilities according to the national schedule. Sustainable improvement in immunization coverage therefore requires understanding the everyday factors that affect mothers’ ability and willingness to use primary health-care immunization services.

Primary Health Centres are particularly important in this regard because they constitute a major point of contact between mothers and the routine immunization programme. They provide opportunities for vaccination, health education, growth monitoring, antenatal and postnatal services, and other preventive interventions. Understanding why mothers use or fail to use immunization services at this level can therefore provide practical information for strengthening primary healthcare delivery.

Jos North Local Government Area provides an important setting for investigating these issues. Previous research in Jos has already demonstrated suboptimal immunization among children and identified distance to facilities, vaccine side effects and healthcare workers’ attitudes as significant factors. However, the continuing existence of immunization gaps and the changing context of healthcare delivery justify further investigation among mothers attending primary health centres in the LGA.

The present study therefore focuses on mothers of under-five children because maternal characteristics, knowledge, attitudes, perceptions, socioeconomic circumstances and interaction with healthcare services can substantially influence children’s vaccination status. Rather than examining immunization coverage alone, the study seeks to identify the factors that explain why some mothers successfully obtain recommended vaccines for their children while others delay, partially complete or fail to obtain them.

The study will particularly examine maternal sociodemographic factors, knowledge and awareness, perceptions of vaccine benefits and adverse effects, accessibility of health facilities, transportation and financial considerations, health-worker attitudes, vaccine availability, waiting time, immunization reminders, social and cultural influences and other relevant health-service factors. Examining these dimensions together is important because barriers to immunization rarely operate independently.

The evidence from Nigeria suggests that immunization uptake is influenced by a combination of caregiver-related, socioeconomic, geographical, cultural and health-system factors. Mohammed et al. (2024), in a comprehensive scoping review, identified logistical challenges, maternal education, socioeconomic conditions, misinformation, fear of adverse effects, cultural and religious beliefs, health literacy, healthcare accessibility, vaccine availability and trust in healthcare providers among the factors affecting routine immunization.

Therefore, improving immunization uptake in Jos North LGA requires more than making vaccines available. It requires understanding the circumstances of mothers who use primary health centres, identifying barriers that prevent timely attendance and developing interventions that respond to those barriers. Evidence generated from the selected primary health centres can support health education, reminder systems, community mobilization, improved service organization and other interventions tailored to local needs.

It is against this background that this study seeks to assess the factors influencing childhood immunization uptake among mothers of under-five children in selected Primary Health Centres in Jos North Local Government Area, Plateau State. By examining maternal, socioeconomic, cultural, accessibility and health-system factors, the study intends to provide evidence that can assist healthcare providers, public health practitioners and policymakers in improving routine childhood immunization uptake in the study area.

1.2 Statement of the Problem

Childhood immunization is one of the most effective ways of preventing deaths and disabilities caused by vaccine-preventable diseases. Nevertheless, Nigeria continues to experience substantial numbers of zero-dose and under-immunized children. UNICEF/NPHCDA reported from the 2021 MICS/NICS that 18% of Nigerian children aged 12–23 months had received no routine immunization and only 36% had received all recommended routine immunizations. This situation represents a major public health concern because children who are not adequately vaccinated remain vulnerable to preventable diseases.

The persistence of low or incomplete immunization is particularly problematic because Nigeria has a functioning national routine immunization programme and vaccines are delivered through the primary healthcare system. The continuing gap therefore suggests that the problem cannot be explained solely by the absence of vaccines. A combination of maternal, household, community, geographical and health-system factors may influence whether mothers take their children to health facilities and complete the recommended vaccination schedule.

Maternal factors constitute an important part of the problem. Mothers differ in education, age, occupation, knowledge, income, autonomy and previous experience with health services. These differences may influence their ability to understand vaccination schedules, recognize the importance of completing immunization and respond appropriately to concerns about adverse effects. Research in Nigeria has consistently identified maternal education and other maternal characteristics as important determinants of childhood immunization (Oleribe et al., 2017; Burroway & Hargrove, 2018).

Lack of adequate knowledge may result in delayed or incomplete immunization. Some mothers may understand that vaccination is beneficial but may not know the exact dates when subsequent doses are due. Others may not understand why multiple doses of the same vaccine are necessary. The problem can be compounded where mothers lose immunization cards, receive inadequate counselling or do not receive reminders from health workers. National evidence has identified lack of awareness of the need for immunization as one of the major reasons for non-vaccination among Nigerian children (Adebowale et al., 2019).

Vaccine hesitancy constitutes another problem. Some mothers may fear fever, pain, swelling or other perceived adverse effects following vaccination. Others may have heard misinformation concerning vaccine safety or effectiveness. Such concerns can cause mothers to delay subsequent doses or refuse vaccination altogether. Mohammed et al. (2024) identified fear of side effects and misinformation among the most prominent caregiver-related barriers reported across Nigerian immunization studies.

The problem of vaccine hesitancy is particularly important because mothers who have previously observed an adverse event may develop a negative perception of vaccination. Without adequate counselling by healthcare workers, an experience that could have been managed through reassurance and appropriate clinical advice may result in permanent reluctance to vaccinate. The Jos-based study by Yiltok et al. (2022) found that experience of vaccine side effects was significantly associated with immunization status among children aged 1–5 years.

Accessibility presents another challenge. A mother may be willing to vaccinate her child but face difficulties reaching the health centre because of distance, transportation costs, poor roads, competing household responsibilities or lack of convenient clinic schedules. National evidence indicates that greater distance to health facilities is associated with lower vaccination uptake and delayed receipt of vaccines.

The accessibility problem has particular relevance in Jos North LGA because mothers attending different primary health centres may reside at varying distances from facilities. Even within an urban or semi-urban environment, the practical cost and time required to reach a health facility can vary considerably. The fact that Jos-specific research identified distance to a health facility as an independent predictor of complete immunization demonstrates that physical accessibility should not be overlooked in the study area.

Transportation costs can further discourage attendance. Although childhood vaccines may be provided without direct payment, a mother may need to pay for public transportation or other means of reaching the health centre. For low-income households, repeated transportation expenses can become a significant barrier, particularly when several immunization visits are required during infancy.

The socioeconomic circumstances of mothers may also affect uptake. Mothers who are financially constrained may prioritize immediate household needs over preventive healthcare. Mothers engaged in informal employment may lose income when they leave their businesses or workplaces to attend immunization sessions. The relationship between socioeconomic status and vaccination has been demonstrated in Nigerian studies, including the work of Oleribe et al. (2017), which found wealth and other socioeconomic variables to be significantly associated with immunization coverage.

Another problem concerns the attitude and behaviour of health workers. Healthcare providers are often the main source of information about vaccination for mothers. When providers are respectful, patient and willing to explain the benefits and possible side effects of vaccines, mothers may develop greater confidence in immunization. However, unfriendly attitudes, poor communication, inadequate counselling or perceived discrimination may discourage mothers from returning to the health centre.

This issue is supported by evidence from Jos. Yiltok et al. (2022) found that healthcare workers’ attitude was significantly associated with children’s immunization status. This finding suggests that improving vaccine supply alone may not be sufficient if mothers experience poor-quality interactions with health personnel.

Vaccine availability is another potential health-system problem. A mother who makes the effort to attend a health centre but finds that a required vaccine is unavailable may have to return another day. Repeated unsuccessful visits may result in frustration, increased costs and eventual discontinuation of the vaccination schedule. The Nigerian literature identifies vaccine shortages and other supply-side problems as contributors to incomplete immunization.

Waiting time and inconvenient clinic arrangements may also affect mothers’ willingness to use immunization services. Long queues, inadequate staffing, limited clinic days and delays in service delivery can make immunization burdensome for mothers with employment, household and childcare responsibilities. Such organizational barriers may be especially important for mothers who need to travel considerable distances to reach the facility.

Another concern is poor continuity of immunization. Some children receive initial vaccines but fail to complete the subsequent doses. This is significant because receiving one vaccine dose does not necessarily provide the same level of protection as completing the recommended series. Aheto et al. (2022) showed that the factors associated with initiation of vaccination can differ from those associated with completion of the vaccination series.

There may also be inadequate follow-up of children who miss appointments. Primary healthcare facilities need effective systems for identifying children who have missed vaccination appointments and reconnecting them with their caregivers. Reminder systems, community health-worker follow-up, immunization registers and electronic communication may help reduce missed opportunities. In the Jos study, SMS reminders were identified by caregivers as the most preferred strategy for improving immunization uptake.

Cultural and religious beliefs may further complicate immunization uptake. Mothers may receive conflicting information from family members, religious leaders, traditional leaders, peers and social media. Where negative beliefs about vaccines are widespread, individual mothers may find it difficult to make independent decisions. Conversely, supportive religious and community leaders can encourage vaccination and increase trust in health services. Mohammed et al. (2024) found cultural and religious influences to be important determinants of routine immunization in Nigeria.

The issue of maternal autonomy is also important. In some households, mothers may not have complete control over decisions concerning children’s healthcare or the financial resources required to attend health facilities. UNICEF’s 2025 analysis of gender-related immunization barriers highlighted the ways in which women’s social and economic circumstances can affect access to and utilization of vaccination services.

The existence of these multiple potential barriers means that a single explanation for low immunization uptake would be inadequate. A mother may have adequate knowledge but face transportation difficulties; another may have easy access to a health centre but fear vaccine side effects; another may trust vaccines but experience vaccine stock-outs or unfriendly healthcare workers. Consequently, assessment of multiple interacting factors is necessary to understand the actual determinants of immunization uptake among mothers in the study setting.

Although several Nigerian studies have investigated childhood immunization, important gaps remain. Many studies rely on national datasets, making it difficult to determine how factors operate in specific local primary healthcare settings. Other studies have focused on children attending hospitals rather than mothers accessing routine immunization services at Primary Health Centres. The Jos study by Yiltok et al. (2022), for example, provides valuable evidence on immunization status among children seen at JUTH, but it does not specifically examine mothers attending selected PHCs in Jos North LGA.

There is therefore a need for a study that directly examines mothers’ experiences within the primary healthcare environment. Understanding what mothers know, believe, experience and encounter when seeking immunization services can help identify practical barriers that may not be captured adequately by national surveys.

The problem is further strengthened by evidence that immunization determinants differ geographically. Mohammed et al. (2024) found substantial regional variation in the barriers and facilitators of routine immunization across Nigeria’s geopolitical zones. The review concluded that region-specific interventions are required because factors that influence immunization in one area may not have the same importance in another.

Jos North LGA is located within North-Central Nigeria, a region in which immunization outcomes have historically lagged behind desirable coverage levels. Previous Jos evidence reported suboptimal immunization and identified maternal, accessibility and service-related factors. More recent national analyses also continue to demonstrate inequalities in vaccination coverage based on socioeconomic circumstances, maternal education, access to healthcare and other characteristics.

If the factors responsible for missed or incomplete immunization are not identified and addressed, children in the affected communities may remain unnecessarily vulnerable to vaccine-preventable diseases. Low uptake can also undermine herd protection and increase the possibility of disease outbreaks. The consequences extend beyond individual children to families, health facilities and the wider community.

The central problem, therefore, is that despite the availability of a national routine immunization programme and the existence of primary healthcare facilities in Jos North LGA, some mothers may still fail to initiate or complete recommended childhood immunization for their under-five children. The specific combination and relative importance of maternal, socioeconomic, knowledge-related, cultural, accessibility and health-system factors influencing this situation among mothers attending selected Primary Health Centres in Jos North LGA are not sufficiently established.

It is against this background that the present study is designed to assess the factors influencing childhood immunization uptake among mothers of under-five children in selected Primary Health Centres in Jos North Local Government Area, Plateau State. The findings are expected to provide evidence that can assist healthcare providers, primary healthcare managers, community health workers and policymakers in developing interventions capable of improving immunization uptake and reducing the number of incompletely immunized children in the study area.

1.3 Purpose of the Study

The general purpose of this study is to assess the factors influencing childhood immunization uptake among mothers of under-five children in selected Primary Health Centres in Jos North Local Government Area, Plateau State.

Specifically, the study seeks to:

1. assess the level of childhood immunization uptake among under-five children whose mothers attend the selected Primary Health Centres;
2. determine the level of mothers’ knowledge regarding childhood immunization;
3. examine the influence of maternal sociodemographic characteristics on childhood immunization uptake;
4. determine the influence of mothers’ perceptions and attitudes toward childhood vaccines on immunization uptake

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of childhood immunization uptake among under-five children whose mothers attend the selected Primary Health Centres in Jos North LGA?
2. What is the level of mothers’ knowledge regarding childhood immunization?
3. To what extent do maternal sociodemographic characteristics influence childhood immunization uptake?
4. How do mothers’ perceptions and attitudes toward childhood vaccines influence immunization uptake?

1.5 Research Hypothesis

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

H₀: There is no significant relationship between the identified maternal, socioeconomic, accessibility, sociocultural and health-system factors and childhood immunization uptake among mothers of under-five children in selected Primary Health Centres in Jos North LGA, Plateau State.

1.6 Significance of the Study

The study will be significant to mothers of under-five children because it will provide information concerning factors that can affect childhood immunization. Findings may improve mothers’ awareness of the importance of timely and complete vaccination and help them recognize the consequences of delaying or missing scheduled doses.

The study will be beneficial to under-five children because improved understanding of the factors affecting immunization may contribute to interventions that increase vaccination coverage. Higher uptake can reduce children’s vulnerability to vaccine-preventable diseases and contribute to improved child survival.

The study will be useful to primary healthcare workers. By identifying the factors that influence mothers’ immunization decisions, health workers can improve health education, counselling, communication and follow-up. The findings may also encourage healthcare providers to pay greater attention to vaccine concerns, adverse events and mothers’ questions.

The study will benefit Primary Health Centre managers because the findings may identify facility-level problems such as vaccine availability, waiting time, inconvenient service arrangements, staff attitude and inadequate reminder systems. Such information can support improvements in service organization.

The study will be useful to community health workers because it may identify social and community factors that contribute to missed immunization. Community health workers can use such information to strengthen household mobilization, defaulter tracing, immunization reminders and community education.

The study will be significant to the Plateau State Ministry of Health and relevant immunization programme managers. The findings may provide local evidence for planning interventions aimed at increasing routine immunization uptake. Such interventions can be designed around the specific barriers experienced by mothers in Jos North LGA rather than relying exclusively on generalized national strategies.

The study will also be useful to the National Primary Health Care Development Agency (NPHCDA) and other organizations involved in immunization programming. Nigeria’s immunization strategy increasingly emphasizes reaching zero-dose and under-immunized children and addressing inequalities in vaccination access. Evidence from the study area can contribute to this broader objective. UNICEF/NPHCDA’s 2025 analysis specifically recommends targeted approaches to address behavioural, social and gender-related barriers to immunization.

The study will be useful to public health practitioners because it will provide evidence regarding the interaction of individual, household and health-system determinants of immunization. Such evidence can support more comprehensive immunization interventions.

The study will also be valuable to health policymakers because the findings may contribute to evidence-based policy decisions concerning vaccine availability, primary healthcare accessibility, health-worker training, maternal health education and community mobilization.

Finally, the study will contribute to academic and research knowledge by providing empirical evidence on childhood immunization uptake among mothers attending Primary Health Centres in Jos North LGA. It may serve as a reference for future researchers in public health, nursing, community health, epidemiology, maternal and child health and related disciplines.

1.7 Scope of the Study

The study focuses on the assessment of factors influencing childhood immunization uptake among mothers of under-five children in selected Primary Health Centres in Jos North Local Government Area, Plateau State.

The study will focus on mothers who have at least one child below five years of age and who attend the selected Primary Health Centres. The dependent variable is childhood immunization uptake, while the explanatory factors will include:

• maternal knowledge of immunization;
• maternal age;
• maternal educational level;
• maternal occupation;
• household socioeconomic circumstances;
• maternal perceptions and attitudes toward vaccines;
• knowledge of immunization schedules;
• fear of vaccine side effects;
• accessibility and distance to health facilities;
• transportation factors;
• waiting time;
• vaccine availability;
• healthcare workers’ attitudes;
• quality of counselling and communication;
• immunization reminders;
• social support;
• cultural and religious beliefs; and
• other relevant health-service factors.

The study is concerned primarily with routine childhood immunization rather than vaccination received solely through mass campaigns.

1.8 Delimitation of the Study

Geographically, the study is delimited to selected Primary Health Centres in Jos North Local Government Area of Plateau State. It will not cover all Primary Health Centres in Plateau State or all LGAs within the state.

Population-wise, the study is delimited to mothers of under-five children who meet the study’s inclusion criteria and attend the selected Primary Health Centres.

Conceptually, the study is delimited to factors influencing routine childhood immunization uptake. It will not comprehensively examine all determinants of childhood health or all causes of under-five morbidity and mortality.

The study will primarily examine maternal, socioeconomic, sociocultural, accessibility and health-system factors. It will not attempt to conduct laboratory investigations of vaccine-preventable diseases or independently verify every vaccination event through laboratory or serological testing.

1.9 Operational Definition of Terms

Childhood Immunization: The administration of recommended vaccines to children at specified ages to protect them against vaccine-preventable diseases.

Immunization Uptake: The extent to which an eligible child receives recommended routine vaccines according to the national immunization schedule. In this study, uptake will be assessed based on vaccination records, immunization cards and/or mothers’ reports according to the study’s measurement procedure.

Mother: A biological or legally recognized female caregiver who has responsibility for the care of an under-five child and who meets the study’s inclusion criteria.

Under-Five Child: A child who is below five completed years of age.

Routine Immunization: Regular vaccination services provided through health facilities, outreach services and other routine delivery mechanisms according to the national immunization schedule.

Primary Health Centre: A primary-level health facility that provides basic preventive, promotive and curative healthcare services, including routine childhood immunization.

Zero-Dose Child: A child who has not received any dose of the specified routine childhood vaccines. The concept is commonly used in immunization programmes to identify children who have not been reached by routine vaccination services.

Fully Immunized Child: A child who has received all vaccines and doses required for the child’s age according to the applicable national immunization schedule.

Partially Immunized Child: A child who has received some recommended vaccines but has not completed the vaccines and doses expected for the child’s age.

Maternal Knowledge: The mother’s understanding of childhood immunization, including vaccine benefits, vaccine-preventable diseases, recommended schedules, possible side effects and the importance of completing vaccination.

Maternal Attitude: The mother’s positive or negative disposition toward childhood vaccination, including her level of acceptance, confidence, concerns and willingness to vaccinate her child.

Accessibility: The ease with which mothers can reach and utilize immunization services, including distance, transportation, cost, clinic schedules and other geographical or logistical considerations.

Health-System Factors: Characteristics of immunization services that may influence uptake, including vaccine availability, staffing, healthcare workers’ attitudes, waiting time, service organization, counselling, record keeping and reminder systems.

Sociocultural Factors: Social, cultural, religious, family and community influences that may affect mothers’ decisions concerning childhood immunization.

Vaccine Hesitancy: Delay in acceptance or refusal of recommended vaccination despite availability of vaccination services, often influenced by confidence, convenience, concerns about vaccine safety or other contextual factors.

1.10 Organization of the Study

The study will be organized into five chapters.

Chapter One presents the introduction to the study. It contains the background of the study, statement of the problem, purpose of the study, research questions, research hypothesis, significance of the study, scope of the study, delimitation, operational definitions and organization of the study.

Chapter Two will present the review of related literature. It will examine the concepts of childhood immunization, routine immunization, immunization uptake, vaccine hesitancy, maternal knowledge and attitudes, socioeconomic factors, accessibility, health-system factors, sociocultural influences and other relevant concepts. The chapter will also present relevant theoretical perspectives and empirical studies on factors influencing childhood immunization.

Chapter Three will discuss the research methodology. It will include the research design, study area, population of the study, sample size, sampling technique, inclusion and exclusion criteria, research instrument, validity and reliability of the instrument, procedure for data collection, method of data analysis and ethical considerations.

Chapter Four will present and analyse the data obtained from the respondents. Demographic characteristics will be presented, research questions will be answered and the research hypothesis will be tested using appropriate statistical procedures.

Chapter Five will present the summary of findings, conclusion and recommendations. The chapter will also discuss implications of the findings and suggest areas for further research.

Project – Assessment of Factors Influencing Childhood Immunization Uptake among Mothers of Under-Five Children in Selected Primary Health Centres in Jos North LGA, Plateau State