INTRODUCTION
Two to three million child
fatalities from diseases that can be prevented by vaccines each year are
prevented due to vaccination, which is a cost-effective public health strategy
for child survival. Sub-Saharan Africa is where many of these deaths occur 1,2. Ten low- and middle-income countries,
including Angola, Brazil, the Democratic Republic of the Congo, Ethiopia,
India, Indonesia, Myanmar, Nigeria, Pakistan, and the Philippines, are home to
more than 60% of these newborns 3.
The third dose of diphtheria, tetanus toxoid, and pertussis-containing
antigens (DTP3) was also reportedly missed by an estimated 187 million kids,
while the measles vaccine was reportedly missed by roughly 201 million children
4.
According
to the 2018 National Demographic and Health Survey (NDHS) in Nigeria, 31% of
children had received all the recommended vaccines, while 19% had not.
Information on the maternal and child
attributes that are linked to children's immunization status in remote Rivers
State communities is limited. Therefore, the purpose of this research was to
assess maternal and child variables related to children's immunization status
in a rural Rivers State community.
METHODOLOGY
Study Areas. The study was carried
out in Rumuji in Emohua Local Government Area, which is one of the rural local
government areas of Rivers State. Rivers State is one of the thirty-six (36)
states of the Federal Republic of Nigeria located in the south-south
geopolitical region of the country.
Research Design. Between October and
December 2022, a descriptive cross-sectional study of women in Rumuji who had
children between the ages of 9 and 23 months was carried out.
Sample size: The study’s minimum sample size
"n" was calculated using Fisher's formula for sample size determination
for cross-sectional studies5, n = z2pq/d2. The
confidence interval (C.I.) was set at 95% normal deviation z = 1.96, d = 0.05,
p = prevalence (coverage) of 39.2% 6. Q = 1-p. With a 10%
non-responder rate, the calculated minimum sample size was 407, but 410 was
used.
Sampling Method: A multi-stage
sampling technique was used to select the participants. The community was
divided into five zones using a sketch map of the community. 82 mothers were
selected from each zone. The sampling started from the household of the leader
in charge of each zone, which was purposefully selected. Thereafter, every
fourth household to the right of the household of the leader was selected. If
the selected household did not have any eligible child, the immediate household
to its right was selected. This was done until the sample size of 410 was
obtained.
Data
collection instrument. The tool for data collection was a pre-tested,
interviewer-administered semi-structured questionnaire with open-and
closed-ended questions adapted from another study7. The immunization
cards of the children were used to determine their immunization status.
Data Management: Manual sorting of the data was done, and the
data were validated by checking for inconsistencies and inaccuracies and asking
questions in more than one way. The data were then entered into Microsoft
Excel 2019 (Microsoft, Redmond, Washington, DC, USA), cleaned, and transferred
to IBM SPSS Version 25.0 (IBM, Armonk, New York, USA), where they were
revalidated with the in-built validation functions of IBM SPSS Version 25. Using
another study, a child was fully immunized if he or she had taken a dosage of
the BCG, hepatitis B, measles, and yellow fever vaccines, as well as four doses
of the oral polio vaccine and three doses of the pentavalent vaccine. This
gives a total of eleven doses8. A child who had taken one or more
vaccination doses but fewer than eleven doses was considered partially
immunized, and any child who had not yet received any of the eleven doses was
considered unvaccinated 8.
The data were analyzed with IBM SPSS Statistics Version 25. Univariate
analysis was performed, and the data were presented as frequency tables.
Categorical variables were expressed in percentages, while continuous variables
were expressed as the mean and standard deviation. The Pearson Chi-square (χ2)
test was used for the test of associations between the independent and
dependent variables. A p-value less than 0.05 was considered statistically
significant at a 95% confidence interval.
Ethical
approval: Ethical approval was obtained from the Rivers State Primary HealthCare
Management Board, Port Harcourt. Permission was obtained from the chiefs, heads
of households, and other community opinion leaders. Informed consent was
obtained from the mothers. Verbal consent was obtained where written consent
was not possible.
RESULTS
Sociodemographic
characteristics of the respondents
Table 1 shows the sociodemographic
characteristics of the respondents.
Many mothers, 238 (54.4%), were aged 21 to 30 years with a mean
age of 28.2 6.9 years; Christians, 324 (83.7%); married, 204 (54.9%); and had
secondary education, 205 (50.0%).
DISCUSSION
The study showed that children who
had up-to-date vaccinations were 295 (72.0%), partially vaccinated were 84
(20.5%), and not vaccinated were 31 (7.6%). The 72% up-to-date vaccination was
similar to that of infants who were fully immunized in an urban area in Nigeria9
and also a community-based study in Karachi, which is also a low-income,
low-literacy setting in Pakistan 10. The up-to-date coverage was not
too different from the coverage of 69.4% in a study in the Demographic Republic
of Congo11. The partial immunization coverage reported in this study
(20.5%) was slightly lower than the reported 27.9% coverage in Ludhiana, India,
while those that were unvaccinated (7.6%) in this study were slightly higher
than the 3.3% reported in Ludhiana, India, in another study12.
The findings of this
study did not agree with those of another study in Cross Rivers State, Nigeria,
which reported an up-to-date vaccination coverage of 52%, 48% partially
vaccinated, and 5% unvaccinated13. The study findings did not agree with
those of other similar study7. The study findings were also higher
than the findings reported in other studies14,15. Generally, this
study showed an improvement in the immunization status of children in rural
communities of Rivers State from 39.2% of all basic vaccines to 72.0%, as
reported in other similar studies6,9,12.
Maternal age had
a positive association with up-to-date immunization status. Many mothers in
this study were in the age group 21–30 years, which was statistically
significant with the up-to-date immunization status as reported in other
similar studies16,17. This might be because older mothers are more
familiar with the effect and significance of immunization on children than
younger mothers. This finding was different from that of another study, which
reported that incomplete immunization status of children was significantly
associated with young mothers18, and from another study, which
reported that children whose mothers were between the ages of 35 and 49 years
had 0.64 times lower odds of being fully vaccinated19.
The
study showed a significant association between married mothers and the
up-to-date immunization of children, like the findings of other similar studies19,20.
This may be because married mothers were more stable financially and more
likely to address their children's health issues, including immunization20.
Additionally, stigma, psychological trauma, and financial difficulties
associated with being a single mother have a negative impact on access to
healthcare and immunization20. This is, however, not in line with
the findings of other study 21. The study also showed a positive
association between the educational status of the mothers and complete
immunization. Many of the mothers had secondary education, which was also
reported in other studies 22,23.
Education helps parents be more informed,
particularly on health-related issues, and makes it easier for people to get
immunization services, information, and the ability to communicate with health
personnel and receive medical care 8,16,24,25. However, a study
reported that education was not significantly associated with full immunization21,
while another study reported a negative influence on secondary education26.
Most of the mothers were unemployed. However, this was significantly associated
with the child's up-to-date immunization. This may be due to the increased
sensitization of the communities to immunization during immunization campaigns using
town announcers, community leaders, the mass media, and other resource persons.
There is also the rumor that the immunization card might be needed for school
enrollment. The findings of this study do not agree with those of other studies
24,27. A study reported that children with working mothers were 0.85
times more likely to have received all recommended vaccinations than those with
jobless mothers18. Another indicator of complete immunization is the
number of siblings per household. The study found that many of the mothers had 1-3
children, which was significantly associated with up-to-date immunization, as
was also reported in other studies 25. Compared to mothers with
fewer than three children, mothers with more than four children were twice as
likely to refuse to fully immunize their offspring. This has been seen as a
reflection of the financial burden and the practical difficulty of having
additional children at home to enable mothers to take up immunization services
for the current child 28. Most of the mothers had antenatal clinic
(ANC) follow-ups in a healthcare facility, which was associated with up-to-date
immunization. This agrees with the findings of other studies 22,24,25.
Mothers who had four or more ANC visits during pregnancy were 2.01 times more
likely to fully immunize their children than mothers who did not have ANC
visits during pregnancy 18,23-29. The place of a child's birth was
found to be one of the factors that influenced full immunization. Many mothers
in this study delivered at home, which was significantly associated with
up-to-date immunization. This finding is not in agreement with that of other
studies that reported that a child born in a healthcare facility had a higher
chance of receiving all recommended vaccinations than one born at home18,22,24,25,27,28,30.
The high rate of delivery at home was also observed in another study, which
reported that more children from rural areas were seen to be born at home and
in traditional birth attendant (TBA) facilities than in healthcare facilities 31.
This finding is consistent with a previous study, which showed that pregnant
women in rural areas continue to prefer TBAs to deliver their babies at home 32.
Pregnant women are predicted to deliver at home 40 to 45% of the time,
according to a study on factors influencing birth location decisions in the
Russian village of Jos North, Nigeria 33. The most common
justification for choosing home birth with a TBA was poverty 34.
Many of the children are in birth order 1st and 2nd, which was associated with
completion of immunization. This is similar to the strong link found between a
child's birth order and the completion of childhood immunization in a
cross-sectional community survey conducted in the Sinana district of Southeast
Ethiopia to evaluate child immunization coverage and its determinants35.
Compared to children with the third birth order, children with the first birth
order had a lower likelihood of finishing their immunizations—less than 30% 35.
Most of the children with up-to-date immunizations were female, and this was
statistically significant. The finding does not agree with that of another
study, which reported that male children were found to be more likely to be
fully immunized than female children 36. A study, however, reported
that the sex of the child was not significantly associated with full
immunization 21.
CONCLUSION
Many of the children had up-to-date
immunizations. The maternal and child factors associated with up-to-date
immunization in the study were: mothers aged 21 to 30 years, married, had
secondary education, were unemployed, had 1 to 3 children, attended an antenatal
clinic in a health facility, delivered at home, had a childbirth order of 1st
and 2nd, and had female children.
Acknowledgements
The
authors appreciate the chiefs, opinion leaders, and other community members who
assisted in the study. Special thanks to the mothers who participated in the
study.
Funding
There
was no external funding for the study.
Conflict
of interest: The authors declare no conflict of interest.
Authors
contributions
NCTB
conceptualized and designed the study, supervised the data collection and
collation, analyzed, and interpreted the data, and wrote the initial
manuscript.
IAA
developed the study instrument, conducted the literature review, and data
entry, supervised the data collection and collation, and reviewed the manuscript.
All the
authors read and approved the final manuscript.
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