Work

1. BARRIERS TO IMMUNIZATION COVERAGE
AWARENESS AND CHALLENGES AMONG
MOTHERS OF UNDER-ONE CHILDREN IN
EZIANI PRIMARY HEALTH CENTRE IHIALA
ANAMBRA STATE
ABUGU CHINONYELUM LYNDA
REG NO: CONI/BM/2022B/004
SUPERVISOR: MRS EZENECHE FRANCISCA

2. BACKGROUND INFORMATION
Immunization is one of the most effective and widely implemented public
health interventions, significantly reducing morbidity and mortality caused by
vaccine-preventable diseases (VPDs) globally (World Health Organization
[WHO], 2023). Since the introduction of vaccines, the burden of deadly diseases
such as polio, measles, and diphtheria has been significantly reduced, saving
millions of lives annually. Despite the success of immunization programs
worldwide, disparities in vaccine coverage persist, particularly in low- and
middle-income countries, where healthcare access, socio-economic barriers,
and cultural beliefs influence vaccine uptake (Gavi, the Vaccine Alliance,
2022).The United Nations Children's Fund (UNICEF, 2022) reports that Nigeria
has one of the highest rates of under-five mortality, with vaccine-preventable
diseases contributing significantly to these deaths.
Nigeria, as the most populous country in Africa, has made significant progress in
immunization coverage through the implementation of the Expanded
Programme on Immunization (EPI), introduced in 1978 and revitalized in the
early 2000s to address coverage gaps (National Primary Health Care
Development Agency [NPHCDA], 2021). The Nigerian government, in
collaboration with global health organizations, has invested in immunization
campaigns and outreach services to improve vaccine accessibility. However,
routine immunization coverage remains suboptimal, with the National

3. STATEMENT OF THE PROBLEM
Immunization is one of the most cost-effective public health interventions for preventing
childhood diseases and reducing infant mortality. Despite global efforts to improve vaccine
coverage, many children in developing countries, including Nigeria, remain under-immunized
due to various challenges (WHO, 2023). The World Health Organization (WHO) and the
United Nations Children’s Fund (UNICEF) report that Nigeria has one of the highest numbers
of unimmunized children globally, with multiple barriers preventing access to vaccines
(UNICEF, 2022).
At Eziani Primary Health Centre, Anambra State, the immunization coverage rate among
mothers of under-one children is not well documented. However, anecdotal evidence
suggests that factors such as lack of awareness, misinformation, cultural beliefs, financial
constraints, and healthcare accessibility issues may hinder vaccine uptake. Studies have
shown that inadequate maternal knowledge about immunization schedules and vaccine-

4. ECTIVES OF THE STUDY
study is guided by the following objectives;
o assess the level of awareness of immunization and its benefits among
hers of under-one children in Eziani.
o examine the major challenges faced by mothers in accessing and
pleting their children's immunization.
o determine strategies to improve immunization awareness and coverage
ziani Primary Health Centre.

5. SCOPE OF THE STUDY
This study focuses on investigating the
barriers to immunization coverage
awareness and challenges among mothers
of under-one children in Eziani Primary
Health Centre, Anambra State.

6. SIGNIFICANCE
The study will provide valuable insights into the barriers affecting
immunization uptake, enabling policymakers and healthcare agencies
to develop targeted interventions to improve vaccine coverage.
The study will help raise awareness about the importance of
immunization, dispel myths, and encourage caregivers to complete
their children’s vaccination schedules.
The findings will contribute to existing literature on immunization
coverage in rural communities, serving as a reference for future
research and policy formulation.
The study will provide evidence-based recommendations to
government bodies and health organizations, assisting in policy
formulation and implementation of strategies to improve
immunization coverage in Anambra State and Nigeria as a whole.

7. CONCEPTS/THEORY/OPERATIONALISATION
Literature review was reviewed under the following
subheadings;
• Conceptual review: Concept of Immunization
• Theoretical review: Health Belief Model Theory
was used
• Empirical review: In relations to barriers to
immunization coverage awareness and
challenges

8. STUDY DESIGN AND AREA OF STUDY
• Research Design: This study employed a descriptive cross-
sectional design to investigate the barriers to immunization
coverage awareness and challenges among mothers of
under-one children in Eziani Primary Health Centre
• Area of Study: The study was conducted in Eziani primary
health, located in Ihiala Local Government Area (LGA) of
Anambra State, Nigeria.

9. POPULATION OF STUDY
The target population for this study comprised
mothers of under-one children attending Eziani
Primary Health Centre for immunization
services. These mothers were selected because
they were the primary caregivers responsible for
ensuring their children receive routine
vaccinations.

10. SAMPLING METHODOLOGY
• SAMPLING TECHNIQUE: This study adopted systematic
random sampling technique to select mothers of under-
one children attending Eziani Primary Health Centre for
immunization services. This technique ensured that each
eligible mother was selected while maintaining
randomness and reducing selection bias.
• SAMPLE SIZE: The sample size for this study was 154
mothers of under-one attending immunization in Eziani
Primary Health Centre, Ihiala LGA, Anambra State.The
sample size was determined using the Taro yamane's
formula

11. STUDY INSTRUMENT/TOOL -1
A structured questionnaire was used as the
primary instrument for data collection. The
questionnaire consist of 19 items divided into
four sections:
• Section A: Socio-demographic characteristics
• Section B: Awareness of immunization
• Section C: Challenges to immunization
• Section D: Strategies to improve immunization
awareness and coverage

12. DATA MANAGEMENT
•VALIDITY PLAN: To ensure that the questionnaire that was used for
data collection accurately measured the intended variables, face and
content validity was established.
•RELIABILITY OF INSTRUMENT: To ensure the reliability of the
research instrument, a pilot study was conducted involving
10 mothers from different health center ,with similar socio-
demographic characteristics to Eziani Primary Health Centre
•DATA ANALYSIS : Descriptive statistics such as frequencies and
percentages was used to summarize the socio-demographic
characteristics of the respondents and their responses to key
questions. The results were presented using tables for clarity and
ease of interpretation.

13. RESULT
• This chapter discussed in details the data
collected using questionnaire from the
respondents. Each item in the questionnaire
was analyzed using frequency and percentage
which were presented in tables.

14. DISCUSSION OF FINDINGS
• This chapter deals with the discussion of the findings, conclusion, recommendation, implication to
Nursing and Midwifery limitation of the study, summary, recommendation and suggestion for other
studies.
• Objective 1: Level of awareness of immunization among mothers of under-one children in Eziani
• The study revealed that a significant majority (89.6%) of mothers had heard about child
immunization, mainly from health workers (46.8%). . This aligns with findings by Smith et al. (2020),
who noted that frontline health workers remain the most effective source of immunization
information in rural communities. Similarly, UNICEF (2019) emphasized the critical role of
community-based communication in enhancing maternal knowledge and vaccine uptake.
• (84.4%) of mothers knew that immunization helps prevent childhood diseases, and many correctly
identified vaccine-preventable diseases such as polio, measles, and tuberculosis. This is in line with
Ezeama and Okafor (2018), who reported that maternal knowledge of vaccine-preventable diseases
contributes significantly to immunization adherence. However, the (15.6%) of mothers who lacked
this knowledge highlight a persistent information gap, a trend also reported by WHO (2020), which
observed disparities in awareness across geographic and educational lines.
• (62.3%) were aware of the recommended immunization schedule for children under one year. This
supports Babalola (2017), who found that while general awareness of immunization is often high,
detailed knowledge about schedules and completion remains relatively low among rural mothers.

15. RECOMMENDATIONS
Based on the findings of this study, the following recommendations are made:
Organize regular community sensitization campaigns led by nurses and community health
educators.
Extend immunization service hours to evenings and weekends.
Deploy mobile health teams to hard-to-reach areas.
Provide transport incentives or partner with local groups for immunization day support.
Train health workers on respectful, client-friendly service delivery.
Engage traditional and religious leaders in health promotion.
Implement SMS or phone call reminder systems to reduce missed appointments.

16. REFERENCES
• Adebayo, A. M., Oladokun, R. E., & Olorunlana, A. O. (2019). Barriers to childhood immunization in Nigeria: Perceptions of
caregivers and healthcare providers. Vaccine and Public Health Journal, 5(2), 45-53.
• United Nations Children's Fund (UNICEF). (2022). The state of the world’s children: Immunization update. Retrieved from
www.unicef.org
• World Health Organization (WHO). (2021). Global immunization coverage: Progress and challenges. Retrieved from www.who.int
• Eze, C. I., Okonkwo, A. U., & Nwafor, I. O. (2020). Barriers to childhood immunization uptake in rural Nigeria: A qualitative study.
Journal of Public Health Research, 9(2), 45-56.
• Olorunfemi, O. B., Adepoju, S. O., & Oladimeji, A. A. (2021). Maternal knowledge and immunization coverage in Nigeria: A cross-
sectional study. African Journal of Health Sciences, 18(3), 112-127.
• National Primary Health Care Development Agency (NPHCDA). (2021). Routine immunization performance in Nigeria. Retrieved
from https://nphcda.gov.ng
• World Health Organization (WHO). (2020). Immunization coverage. Retrieved from https://www.who.int/news-room/fact-
sheets/detail/immunization-coverage
• Odusanya, O. O., Alufohai, E. F., Meurice, F. P., & Ahonkhai, V. I. (2008). Determinants of vaccination coverage in rural Nigeria.
BMC Public Health, 8(1), 381. https://doi.org/10.1186/1471-2458-8-381
• Brown, V. B., Oluwatosin, O. A., Ogundeji, M. O., & Adeyemo, A. A. (2015). Influence of mothers’ education on immunization
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mothers of under-five in Southwestern Nigeria. The Internet Journal of Epidemiology, 7(2).
• Adokiya, M. N., Baguune, B., & Ndago, J. (2017). Evaluation of immunization coverage and its determinants among children in
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