FACTORS INFLUENCING THE ATTITUDE OF MOTHERS TOWARDS IMMUNIZATION (A STUDY OF LAPAI LGA, NIGER STATE)

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Immunization remains one of the most cost-effective public health interventions available for reducing childhood morbidity and mortality from vaccine-preventable diseases such as measles, poliomyelitis, tuberculosis, pertussis, diphtheria and tetanus. Despite decades of global and national investment in routine immunization programmes, full immunization coverage in Nigeria continues to fall short of established targets, leaving a substantial proportion of children vulnerable to diseases that are otherwise readily preventable. Because mothers are typically the primary caregivers responsible for presenting children for scheduled vaccinations, their attitude toward immunization, shaped by their knowledge, beliefs, socio-demographic circumstances and lived experience of the health system, plays a decisive role in determining whether a child is fully, partially, or never immunized (Abidoye & Odeyemi, 2013).

A useful theoretical lens for understanding maternal immunization attitudes is the Health Belief Model, first articulated by Rosenstock (1974), which holds that an individual's likelihood of engaging in a health-protective behaviour, such as presenting a child for vaccination, depends on their perception of the disease's severity and their own or their child's susceptibility to it, weighed against their perceived benefits of the behaviour and the barriers standing in its way. This framework has proved useful in explaining the sometimes wide gap between mothers' general awareness of immunization and their actual attitudes and practices. Abidoye and Odeyemi (2013), in a study of mothers in Kosofe Local Government Area of Lagos State, found that although a large majority of mothers were aware of childhood immunization and showed a broadly positive attitude toward it, actual knowledge of the specific diseases prevented by each vaccine was considerably lower, a gap with clear implications for consistent practice.

Subsequent Nigerian studies have continued to probe the specific socio-demographic factors that shape maternal attitudes and practice. Adedire, Ajumobi, Bolu, Nguku and Ajayi (2021), in a household survey conducted in Atakumosa-West Local Government Area of Osun State, found that a majority of mothers demonstrated good knowledge of routine immunization and a positive attitude toward the programme, though the study also identified sociodemographic variation in these outcomes. Asiegbu, Obu, Una, Ezeonu and Asiegbu (2020), examining low childhood immunization uptake in Ebonyi State, similarly found that maternal knowledge and attitude were significant contributing factors to immunization coverage, reinforcing the view that interventions aimed at improving coverage cannot succeed by focusing on health-system factors, such as vaccine supply, alone, but must also address the attitudes, beliefs and circumstances of mothers themselves. It is against this background that the present study investigates the immunization attitude and practice among mothers in Lapai Local Government Area of Niger State, with particular attention to how maternal age and educational level shape both attitude and practice.

1.2 Statement of the Problem

Although routine immunization services are, in principle, freely available across Nigeria, including in Niger State, childhood immunization coverage in many parts of the country remains below the levels required to achieve herd immunity against vaccine-preventable diseases, and outbreaks of diseases such as measles and diphtheria continue to be reported in various parts of the country. While health-system factors, such as vaccine stock-outs, distance to health facilities and staff availability, undoubtedly contribute to this shortfall, a growing body of evidence points to maternal attitude as an equally important, and in some respects more tractable, determinant of whether a child completes the recommended immunization schedule (Asiegbu et al., 2020). What remains less well documented, particularly for Lapai Local Government Area of Niger State, is the precise nature of mothers' attitudes and practices regarding childhood immunization, and the extent to which readily observable socio-demographic characteristics, specifically maternal age and educational level, help explain variation in both attitude and practice. It is this gap that the present study seeks to address.

1.3 Aim and Objectives of the Study

The purpose of the present study was to investigate the immunization attitude and practice among mothers in Lapai LGA of Niger State. Specifically, the study was designed to find out:

• The attitude of mothers towards immunization against childhood killer diseases.

• The immunization practice of mothers against childhood killer diseases.

• The extent to which the mothers' age influence their attitudes towards immunization of their children against childhood killer diseases.

• The extent to which the mothers' educational levels influence their attitudes towards immunization of their children against childhood killer diseases.

• The extent to which the mothers' age influence the practices of immunization against childhood killer diseases.

• The extent to which the mothers' educational level influence the practices of immunization against childhood killer diseases.

1.4 Research Questions

This study seeks to provide answers to the following research questions:

• What is the attitude of mothers in Lapai LGA towards immunization against childhood killer diseases?

• What is the immunization practice of mothers in Lapai LGA against childhood killer diseases?

• To what extent does mothers' age influence their attitude towards immunization of their children?

• To what extent does mothers' educational level influence their attitude towards immunization of their children?

• To what extent does mothers' age influence their practice of immunization of their children?

• To what extent does mothers' educational level influence their practice of immunization of their children?

1.5 Significance of the Study

This study is significant to health policymakers and programme managers responsible for routine immunization in Niger State, as its findings will help identify which socio-demographic groups of mothers, by age or educational level, may require more targeted health education and outreach in order to improve immunization uptake. To primary healthcare workers and community health extension workers, the study offers evidence-based insight into the attitudinal barriers that may need to be addressed during antenatal and postnatal counselling sessions.

For the academic community, the study extends the existing body of Nigerian literature on maternal knowledge, attitude and practice regarding childhood immunization, including the work of Abidoye and Odeyemi (2013), Adedire et al. (2021) and Asiegbu et al. (2020), into the specific context of Lapai Local Government Area of Niger State, a setting that has received comparatively limited direct empirical attention. Finally, the study will serve as a useful reference for future researchers, students and public health practitioners interested in maternal immunization attitudes and practice in Nigeria.

1.6 Scope of the Study

This study is focused on mothers of children eligible for routine childhood immunization who reside in Lapai Local Government Area of Niger State. The scope of the study covers an examination of mothers' attitudes toward immunization against childhood killer diseases, their actual immunization practices, and the extent to which maternal age and educational level influence both attitude and practice. The study does not extend to health-system-side determinants of immunization coverage, such as vaccine supply chain management or health facility staffing, except as they may be referenced by respondents in relation to their own attitudes and practices.

1.7 Limitations of the Study

This study is subject to a number of limitations common to survey-based health research. Because attitude and practice are largely assessed through mothers' self-reports, the data gathered may be subject to social-desirability bias, with respondents potentially over-reporting positive attitudes or favourable immunization practices. The cross-sectional design of the study means that it captures attitudes and practices at a single point in time and cannot establish the direction of causality between maternal characteristics and immunization outcomes with certainty. The study is also confined to Lapai Local Government Area, which may limit the extent to which its findings can be generalized to other parts of Niger State or to Nigeria more broadly. Time and resource constraints associated with the research further limited the sample size and depth of investigation that could be undertaken. Notwithstanding these limitations, the study was designed to yield as reliable and representative a picture as possible within the given constraints.

1.8 Definition of Terms

Immunization: The process by which a person is made resistant to an infectious disease, typically through the administration of a vaccine.

Attitude: A settled way of thinking or feeling about something, in this context, mothers' predisposition toward childhood immunization, which may be favourable or unfavourable.

Immunization Practice: The actual behaviour of mothers in presenting their children for scheduled vaccinations, as distinct from their stated attitude or knowledge.

Childhood Killer Diseases: Vaccine-preventable diseases, such as measles, poliomyelitis, tuberculosis, pertussis, diphtheria and tetanus, that pose a significant risk of death or serious illness among young children.

Health Belief Model: A theoretical framework used to explain and predict health-related behaviours based on an individual's perceived susceptibility to, and severity of, a health threat, weighed against the perceived benefits and barriers of taking protective action.

Educational Level: The highest stage of formal education attained by an individual, ranging from no formal education through primary, secondary and tertiary education.

REFERENCES

Abidoye, A. O., & Odeyemi, K. A. (2013). Knowledge, attitude and practice of mothers to childhood immunization in Kosofe Local Government Area of Lagos State, Nigeria. International Journal of Basic, Applied and Innovative Research, 2(4), 66–72.

Adedire, E. B., Ajumobi, O., Bolu, O., Nguku, P., & Ajayi, I. (2021). Maternal knowledge, attitude, and perception about childhood routine immunization program in Atakumosa-west Local Government Area, Osun State, Southwestern Nigeria. Pan African Medical Journal, 40(1), 8. https://doi.org/10.11604/pamj.supp.2021.40.1.30876

Asiegbu, U. V., Obu, D. C., Una, A. F. I., Ezeonu, C. T., & Asiegbu, O. K. (2020). Evaluating mothers' knowledge and attitude as a contributing factor to the low childhood immunization uptake in Ebonyi State, Nigeria. African Journal of Medical and Health Sciences, 19(8), 127–135.

Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403