Project – Assessment of socio economics determinants of immunization uptake among children under 5 years in keffi local government area, Nasarawa state, Nigeria

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Immunization is universally recognized as one of the most cost-effective and successful public health interventions for reducing childhood morbidity and mortality. It serves as a critical strategy for the prevention of infectious diseases that once posed serious threats to child survival worldwide. According to the World Health Organization (WHO, 2022), immunization prevents an estimated 2 to 3 million deaths annually from vaccine-preventable diseases such as measles, diphtheria, tetanus, and pertussis. By stimulating the immune system to resist infections, vaccines not only protect individuals but also contribute to herd immunity, reducing disease transmission within communities. The global commitment to immunization has been instrumental in eradicating smallpox and significantly lowering the incidence of diseases like poliomyelitis.

Despite the proven benefits of immunization, the challenge of low coverage persists in many developing countries, including Nigeria. Although the Expanded Programme on Immunization (EPI) was introduced in Nigeria in 1979 to ensure that every child receives essential vaccines, the country continues to struggle with achieving optimal coverage (UNICEF, 2023). The 2021 Nigeria Demographic and Health Survey (NDHS) reported that only about 57% of children aged 12–23 months had received all basic vaccinations, far below the 90% coverage recommended by WHO. This low coverage contributes to recurring outbreaks of preventable diseases, indicating that national immunization programs are still hindered by socio-economic, infrastructural, and cultural barriers.

Socio-economic determinants play a significant role in influencing immunization uptake among children under five years. Factors such as parental education, household income, occupation, and accessibility to healthcare services directly affect parents’ willingness and ability to ensure their children are fully vaccinated (Adenike & Olayinka, 2020). Parents with higher levels of education tend to possess better health literacy, enabling them to understand the importance of vaccines and adhere to immunization schedules. Conversely, parents with little or no formal education may hold misconceptions about vaccines or rely on traditional beliefs that discourage immunization (Olorunsaiye & Degge, 2016).

Income and occupation also have notable effects on immunization behavior. Families with low income are often unable to afford the transportation costs associated with accessing health centers, particularly in rural or semi-urban areas. Parents engaged in informal or unstable occupations may also lack the time or flexibility to attend immunization sessions (Obasohan et al., 2021). Furthermore, children from low-income households are more likely to live in areas with inadequate healthcare infrastructure, poor road networks, and limited access to reliable information about vaccination schedules. These barriers collectively contribute to the inequities in immunization coverage observed across socio-economic groups in Nigeria.

In addition to economic and educational disparities, cultural and religious beliefs also influence immunization uptake. In some communities, traditional norms and mistrust of Western medicine discourage parents from allowing their children to be vaccinated. Past controversies, such as the polio vaccine boycott in Northern Nigeria in the early 2000s, demonstrate how misinformation and cultural resistance can hinder immunization programs (Adebayo et al., 2020). Moreover, gender dynamics may play a role, as decision-making regarding child health is sometimes dominated by fathers who may not prioritize vaccination, especially when health awareness is low.

Nigeria’s immunization coverage also reflects strong regional and urban–rural disparities. While urban areas generally record higher immunization rates due to better access to health services and public awareness, rural and semi-urban areas such as Keffi Local Government Area (LGA) in Nasarawa State often face challenges including limited healthcare infrastructure, low literacy levels, and entrenched cultural beliefs (National Population Commission [NPC] & ICF, 2021). Keffi, being a semi-urban community with a mix of educated and less educated populations, provides a suitable context for assessing how socio-economic characteristics shape immunization behavior among caregivers of children under five.

Government and non-governmental organizations have implemented numerous interventions aimed at improving immunization coverage, including the National Primary Health Care Development Agency’s (NPHCDA) campaigns and community outreach programs. However, the effectiveness of these interventions depends largely on the socio-economic realities of the communities they serve. Without a clear understanding of these determinants, immunization programs risk being less efficient and equitable (Ene-Obong, Okoro, & Umeh, 2020). Thus, identifying the factors that influence parents’ decisions regarding vaccination is essential for developing targeted and context-specific strategies to boost immunization uptake.

Assessing the socio-economic determinants of immunization uptake among children under five years in Keffi LGA is therefore vital for public health planning and policy formulation. The findings will provide insights into how education, income, occupation, and healthcare accessibility interact to influence vaccination behavior in semi-urban Nigerian communities. Ultimately, understanding these determinants will contribute to designing interventions that promote equity in immunization coverage and help Nigeria progress toward achieving Sustainable Development Goal (SDG) 3, which aims to ensure healthy lives and promote well-being for all at all ages (United Nations, 2015).

1.2 Statement of the Problem

Despite continuous government and donor-driven immunization programs, Nigeria remains one of the countries with the highest number of unvaccinated children globally (WHO, 2023). According to the Multiple Indicator Cluster Survey (MICS, 2021), only about 57% of Nigerian children aged 12–23 months received all basic vaccinations. This situation exposes children to preventable diseases and contributes to high child morbidity and mortality rates.

In Keffi Local Government Area, the immunization coverage rate remains below the national target, even with the presence of several primary healthcare centers. Many children under five are either partially immunized or not immunized at all. Several socio-economic factors such as parents’ education level, income, employment status, cultural beliefs, and accessibility to health facilities have been linked to poor immunization uptake (Ene-Obong et al., 2020).

However, limited local studies have examined how these socio-economic factors specifically influence immunization behavior in Keffi. Understanding these determinants will guide policymakers, healthcare workers, and stakeholders in developing effective community-based strategies to increase immunization coverage and reduce child mortality in Nasarawa State and Nigeria at large.

1.3 Objectives of the Study

The main objective of this study is to assess the socio-economic determinants of immunization uptake among children under five years in Keffi Local Government Area, Nasarawa State, Nigeria.

The specific objectives are to:

1. Examine the relationship between parental education level and immunization uptake among children under five.
2. Assess the influence of household income on immunization uptake.
3. Determine how accessibility to healthcare facilities affects immunization uptake.
4. Investigate the role of parental occupation and awareness on immunization completion rates.

1.4 Research Questions

This study seeks to answer the following research questions:

1. What is the relationship between parents’ education levels and immunization uptake among children under five in Keffi LGA?
2. How does household income influence immunization uptake?
3. In what ways does access to healthcare facilities affect the completion of immunization schedules?
4. What role do parents’ occupations and awareness levels play in determining immunization uptake?

1.5 Research Hypothesis

The following hypothesis was formulated to guide the study:

H₀: There is no significant relationship between socio-economic factors (education, income, occupation, and accessibility) and immunization uptake among children under five years in Keffi Local Government Area.

H₁: There is a significant relationship between socio-economic factors (education, income, occupation, and accessibility) and immunization uptake among children under five years in Keffi Local Government Area.

1.6 Significance of the Study

This study is significant because it provides a deeper understanding of how socio-economic factors affect immunization uptake among children under five years in Keffi Local Government Area. By examining the influence of education, income, occupation, and accessibility on immunization behavior, the study generates empirical evidence that highlights the real-life challenges caregivers face in ensuring their children receive complete vaccinations. This knowledge is particularly valuable in a semi-urban setting like Keffi, where diverse socio-economic conditions coexist. The findings will contribute to filling the existing gap in research on localized determinants of immunization uptake in Nigeria.

Secondly, the study has practical significance for policymakers at both the state and national levels. Understanding the socio-economic barriers to immunization will enable health authorities to formulate more context-specific policies and strategies aimed at increasing vaccine coverage. For instance, government agencies such as the National Primary Health Care Development Agency (NPHCDA) can use the findings to improve immunization programs by integrating social and economic support mechanisms for low-income households. Policy interventions that are informed by such empirical evidence are more likely to be effective and sustainable in promoting child health and reducing preventable diseases.

Thirdly, the study will be beneficial to public health officials and local government administrators responsible for health service delivery in Keffi LGA. The insights from this research will help them design targeted community outreach programs that address specific socio-economic barriers identified in the area. Health workers can use the findings to plan immunization schedules and outreach campaigns that consider the work patterns, income levels, and educational backgrounds of caregivers. Such tailored approaches will enhance vaccine accessibility and improve compliance with immunization schedules among parents and guardians.

Furthermore, the study will help healthcare professionals, especially those working in primary healthcare centers, to understand the social and economic realities influencing caregivers’ decisions. With this understanding, they can adopt more empathetic communication strategies and dispel myths or misconceptions surrounding vaccination. It will also help strengthen collaboration between healthcare providers and community leaders, which is crucial for building trust and encouraging higher participation in immunization programs. In the long term, this will contribute to improving child health outcomes and reducing vaccine-preventable diseases in Keffi and beyond.

Additionally, the study has educational significance for researchers, students, and scholars in public health, sociology, and development studies. It provides a valuable resource and reference material for future studies focusing on child health, preventive healthcare, and socio-economic determinants of health behavior in Nigeria. By identifying key variables and relationships, this research can guide the design of subsequent studies, stimulate further academic inquiry, and contribute to theory building in the field of public health and social development.

Finally, the study’s findings have broader social implications. By highlighting how socio-economic inequalities impact immunization uptake, the research underscores the need for equity-driven health policies that leave no child behind. It advocates for improved access to healthcare services, health education, and financial empowerment for vulnerable populations. Ultimately, the study contributes to the global goal of promoting child survival and achieving universal immunization coverage, which aligns with national and international efforts to ensure healthy lives and well-being for all.

1.7 Scope of the Study

The study focuses on assessing socio-economic determinants influencing immunization uptake among children under five years in Keffi Local Government Area of Nasarawa State, Nigeria. The socio-economic variables covered include education level, household income, parental occupation, and access to healthcare services. The population of interest comprises parents or caregivers of children aged 0–59 months residing within Keffi LGA. The study does not extend to other Local Government Areas or cover clinical determinants of immunization.

1.8 Operational Definition of Terms

• Immunization Uptake: The degree to which children receive and complete recommended vaccinations within the first five years of life.
• Socio-Economic Determinants: Social and economic conditions that influence individuals’ behaviors and access to health services, such as education, income, occupation, and location.
• Children Under Five: Refers to all children aged between 0 and 59 months.
• Accessibility: The ease with which caregivers can reach healthcare facilities providing immunization services, considering distance, cost, and transportation.
• Parental Education: The level of formal education attained by the child’s primary caregivers.

Project – Assessment of socio economics determinants of immunization uptake among children under 5 years in keffi local government area, Nasarawa state, Nigeria