Awareness and Acceptance of Malaria Vaccines by Caregivers of Under-five Children in Abia State, Nigeria: A Mixed Methods Study

Globally, under-five mortality rates declined from 93 deaths per 1,000 live births in 1990 to 38 in 2019. Despite the remarkable progress in reducing under-five mortality globally, it is still significantly high in Nigeria with 117 deaths per 1,000 live births, meaning that 1 in 8 children die before the age of 5. The extant literature on the risk factors of under-five mortality in Nigeria have been largely limited to maternal socio-economic characteristics and environmental factors, with little known about the macroeconomic predictors within a spatial context. As a result, this study examines the macroeconomic predictors of under-five mortality in Nigeria. The data were analysed using spatial statistics. Results show that some parts of northern Nigeria are hotspots of under-five mortality. The study also discovers that inflation rate is a risk factor of under-five mortality in southern Nigeria while internally generated revenue is the predictor in the northern region. The study recommends region-specific interventions such as controlling the high rate of inflation and improving internally generated revenue to reduce under-five mortality in the country.

Pneumonia is a severe infection and one of the most common causes of mortality among children under five years of age, when not appropriately managed. Infection of the lungs by bacteria, viruses, or fungi and consequent inflammation may lead to cough and difficult breathing. Some of the key predisposing factors are malnutrition and air pollution. WHO reports that Africa has the highest burden of global child mortality, and 16% of all deaths in pneumonia, were children under five years of age in 2016. This study aimed to explore how health providers perceive pneumonia as a cause of under-five mortality in Nigeria. A qualitative study design with in-depth interviews and focus group discussions was used to explore and understand nurses and pediatricians' views regarding the pneumonia situation, vaccinations, and preventive suggestions to reduce under five pneumonia deaths in Nigeria. Two themes and four categories emerged: participant's anxiety over the situation, their views on impediments, current policies and strategies, and suggestions on addressing severe pneumonia. The results from this study highlight contextual issues playing major roles in pneumonia mortality among children in Nigeria, which will need approaches on several levels to address them.

Malaria infection continues to cause significant morbidity and mortality in Nigeria despite the integration of the R21/Matrix-M malaria vaccine into the National Programme on immunization. Understanding how caregivers of young children perceive this new vaccine is important for successful implementation. To assess the awareness, acceptability and factors affecting uptake of the new R21/Matrix-M malaria vaccine among caregivers of under-fives in Asaba, Southern Nigeria. A cross-sectional study was conducted between January and June 2025, among 358 consenting caregivers of under-5 children who presented at the children's outpatient and immunization clinic in three health facilities in Asaba, Delta State, Nigeria. The study utilized pretested semi-structured, self-administered questionnaires containing information on vaccine awareness, hesitancy and adverse reactions. Data was analyzed using SPSS 26, with a p-value < 0.05 considered significant. Only 36.3% of respondents were aware of the vaccine. However, most (85.8%) were willing to vaccinate their children. Reasons for reluctance to accept the vaccine were fear of adverse reactions (45.1%), lack of interest (19.6%), and spousal disagreement (13.7%). There was a statistically significant association between the type of health facility and knowledge of malaria vaccines (p = 0.038). Occupation (p = 0.018) and gender of caregivers (p = 0.006) were significant factors, female caregivers and civil servants were more willing to accept malaria vaccination for their wards. Despite a strong willingness among caregivers to vaccinate their children, awareness of the malaria vaccine was inadequate. Targeted awareness campaigns, especially addressing safety concerns and spousal engagement, are urgently needed to translate high willingness into actual uptake.

Background: High rate of under-five mortality (UFM) in Nigeria is an impediment to national development. This study examined the influence of family type and ethnicity on UFM. Data Source and Methods: The study was cross-sectional and employed the 2013 Nigeria Demographic and Health Survey dataset. The survey utilised a stratified three-stage cluster sampling procedures in interviewing 31,828 women of childbearing age. Data were analysed using Chi-square test, Brass and Cox-proportional hazard models. Results: UFM rates were 92, 119 and 196 deaths per 1000 live births among Yoruba, Igbo/Ibo and Hausa/Fulani respectively. On overall, single-parent who were Hausa/Fulani women reported the highest deaths (265/'000) and the polygamous Igbo women reported the lowest (2/'000). UFM is lowest among the Igbo/Ibo while single parenting impact on UFM more among Hausa/Fulani than other ethnic groups. Conclussion: Family type and ethnicity were associated with UFM. Measures to reduce UFM should target single-parenting and the Hausa/Fulanis

The need for more pragmatic approaches to achieve sustainable development goal on childhood mortality reduction necessitated this study. Simultaneous study of the influence of where the children live and the censoring nature of children survival data is scarce. We identified the compositional and contextual factors associated with under-five (U5M) and infant (INM) mortality in Nigeria from 5 MCMC Bayesian hierarchical Poisson regression models as approximations of the Cox survival regression model. The 2018 DHS data of 33,924 under-five children were used. Life table techniques and the Mlwin 3.05 module for the analysis of hierarchical data were implemented in Stata Version 16. The overall INM rate (INMR) was 70 per 1000 livebirths compared with U5M rate (U5MR) of 131 per 1000 livebirth. The INMR was lowest in Ogun (17 per 1000 live births) and highest in Kaduna (106), Gombe (112) and Kebbi (116) while the lowest U5MR was found in Ogun (29) and highest in Jigawa (212) and Kebbi (248). The risks of INM and U5M were highest among children with none/low maternal education, multiple births, low birthweight, short birth interval, poorer households, when spouses decide on healthcare access, having a big problem getting to a healthcare facility, high community illiteracy level, and from states with a high proportion of the rural population in the fully adjusted model. Compared with the null model, 81% vs 13% and 59% vs 35% of the total variation in INM and U5M were explained by the state- and neighbourhood-level factors respectively. Infant- and under-five mortality in Nigeria is influenced by compositional and contextual factors. The Bayesian hierarchical Poisson regression model used in estimating the factors associated with childhood deaths in Nigeria fitted the survival data.

The death of children under-five years is one of the critical issues in public health and the need for improving child survival continues to be a matter of urgent concern. In this study, we develop a predictive model in order to examine the risk factors of under-five mortality in Nigeria. The study utilized data from 2018 Nigeria Demographic and Health survey. The demographic and mortality data of 127,545 children were extracted and univariate and multivariate logistic regression models were employed. The results revealed that under-five mortality was 143 deaths per 1,000 live births in Nigeria. The likelihood of death was higher among males compared to females children (OR = 1.893, P&lt;0.05). First and second birth order have a lower chances of decreasing odds of under-five children (OR = 0.737, P&lt;0.05) and (OR = 1.888, P&lt;0.05).The under-five mortality was higher among children born to mothers who belong to other religions compared to Christians. Islam (OR = 1.689, P&lt;0.05) and traditionalist (OR = 2.705, P&lt;0.05) respectively. Public servant (OR = 1.881, P&lt;0.05) and unmarried mother (OR = 1.896, P&lt;0.05) were increased the odds of dying chances of under-five mortality in Nigeria. Children of mothers without education experienced more death compared to mothers who attended post-secondary education (OR = 3.372, P&lt;0.05). Sex of child, birth order, religion, marital status, maternal occupation and maternal education were significant factors associated with under-five mortality in Nigeria. Thus, planning and implementing relevant strategies that focus on those identified risks factors of under-five mortality is required for improvement of child survival in Nigeria.

Nigeria still showcases unacceptably high under-five mortality despite all efforts to reduce the menace. Investigating the significant predictors of this occurrence is paramount. To examine the interplay between family setting, domestic violence and under-five death in Nigeria. Cross-sectional secondary data, the 2013 Nigeria Demographic and Health Survey, (NDHS) women dataset was utilized. Subset of 26,997 ever married and ever had childbirth experience respondents were extracted from the nationally representative women dataset. Dependent and Independent variables were recoded to suit the statistical analysis for the study. The study revealed that 33.7% of the respondents were in polygyny family setting; one-quarter of the ever married women reported ever experiencing one form of domestic violence or the other. The results of the logistic regressions indicate that family type and domestic violence were significant predictors of under-five children mortality in Nigeria. The study concludes that women who belong to polygyny family setting and who ever experienced sexual domestic violence are highly susceptible to experience under-five children mortality than their counterparts. The study recommends that strategies and policies aimed at improving child survival should strengthen women empowerment initiatives, discourage multiple wives and campaign against domestic violence in Nigeria.

BackgroundNigeria ranks second globally only behind India in under-five mortality prevalence. In Nigeria, 108.8 children die per 1000 live births before their 5th birthday. It is of note that diarrhoea (15.3% prevalence) is the second leading cause of under-five mortality in Nigeria after pneumonia. General poor hygiene and nutritional status are contributory factors to diarrhea.MethodsData was collected for severe acute malnutrition (SAM) using the weight for height z-value (WHZ) and/or oedema criteria. In addition, data on diarrhoea prevalence, oral rehydration salt therapy (ORST), improved source of drinking water and improved sanitation were collected. These were obtained for 36 states and federal capital territory (FCT) from the National Bureau of Statistics headquarters in FCT, Abuja for 2015. Correlation analysis was first carried out to determine relationships followed by geographically weighted regression analysis (GWR). GWR was used to predict under-five mortality pattern and accuracy mapped.ResultsObserved correlation coefficients to diarrhoea prevalence were 0.59,–0.49, −0.35 and −0.63 for SAM, ORST, improved drinking water access, and improved sanitation, respectively. R2 varied across states, though positive, from 0.29 in Akwa Ibom to 0.95 in Kebbi states. Standard deviation of residuals in the regression model ranged from −3.89 to 3.33 in Borno and Gombe states respectively, while Sokoto and Bauchi had 0.006 and 0.024 respectively, thus having the best accuracy in predictions across all states in the country. Both correlation and GWR were at p&lt;0.05.ConclusionThe results obtained support literature, confirming the inverse relationship between ORST prevalence, improved drinking water access and improved sanitation to diarrhea prevalence. It also supports the already confirmed positive relationship between poor nutrition of children and susceptibility to diarrhoea. The study however expanded knowledge by incorporating geocomputation to predict diarrhoea prevalence.

Nigeria’s under-five mortality rate is the eighth highest in the world. Identifying the causes of under-five deaths is crucial to achieving Sustainable Development Goal 3 by 2030 and improving child survival. National and international bodies collaborated in this study to provide the first ever direct estimates of the causes of under-five mortality in Nigeria. Verbal autopsy interviews were conducted of a representative sample of 986 neonatal and 2,268 1–59 month old deaths from 2008 to 2013 identified by the 2013 Nigeria Demographic and Health Survey. Cause of death was assigned by physician coding and computerized expert algorithms arranged in a hierarchy. National and regional estimates of age distributions, mortality rates and cause proportions, and zonal- and age-specific mortality fractions and rates for leading causes of death were evaluated. More under-fives and 1–59 month olds in the South, respectively, died as neonates (N = 24.1%, S = 32.5%, p<0.001) and at younger ages (p<0.001) than in the North. The leading causes of neonatal and 1–59 month mortality, respectively, were sepsis, birth injury/asphyxia and neonatal pneumonia, and malaria, diarrhea and pneumonia. The preterm delivery (N = 1.2%, S = 3.7%, p = 0.042), pneumonia (N = 15.0%, S = 21.6%, p = 0.004) and malaria (N = 34.7%, S = 42.2%, p = 0.009) fractions were higher in the South, with pneumonia and malaria focused in the South East and South South; while the diarrhea fraction was elevated in the North (N = 24.8%, S = 13.2%, p<0.001). However, the diarrhea, pneumonia and malaria mortality rates were all higher in the North, respectively, by 222.9% (Z = -10.9, p = 0.000), 27.6% (Z = -2.3, p = 0.020) and 50.6% (Z = -5.7, p = 0.000), with the greatest excesses in older children. The findings support that there is an epidemiological transition ongoing in southern Nigeria, suggest the way forward to a similar transition in the North, and can help guide maternal, neonatal and child health programming and their regional and zonal foci within the country.

AIM: This study looked at the contribution of the health expenditure by the government on under-five mortality in Nigeria. METHODS: The autoregressive distribution lag technique was employed in this study in examining the long-run effect of public health expenditure on under-five mortality in Nigeria. Data were sourced from the World Development Indicators for the period 1985–2017. RESULTS: Results from the study showed that though public health expenditure is statistically significant, it showed a positive relationship with the under-five mortality. CONCLUSION: The implication of this result is that 1 unit increase in public health expenditure would improve increase under-five mortality rate by 1.56 units. However, in the Nigerian context, this can be better explained by the lack of proper health-fund coordination and other factors such as maternal education. Therefore, the study concluded by recommending that proper health-fund coordination should be put in place to ensure that budget allocated to the health sector is being spent properly.

Background: Estimates of Under-Five mortality (U5M) have taken advantage of indirect methods but U5M risk factors have been identified using fixed statistical models with little considerations for the potentials of mixture models. Mixture models such as Poisson-Mixture models exhibit flexibility tendency, which is an attribute of robustness lacking in fixed models. Objective: To examine the robustness of Poisson-Mixture models in identifying reliable determinants of U5M. Methods: The data on 18,855 women used in this study were obtained from the 2008 Nigeria Demographic and Health Survey (NDHS). Six different Poisson-Mixture models namely: Poisson (PO), Zero-Inflated Poisson (ZIP), Poisson Hurdle (PH), Negative Binomial (NBI), Zero-Inflated Negative Binomial (ZINBI) and Negative Binomial Hurdle (NBIH) were fitted separately to the data. The Akaike Information Criteria (AIC) and diagnostic check for normality were used to select robust models. All tests were conducted at p = 0.05. Results: The models and AIC values for U5M were: 38763.47 (PO), 38654.55 (ZIP), 44270.77 (PH), 38526.26 (NBI), 38513.71 (ZINBI) and 44269.30 (NBIH). The PO, ZIP, PH and NBIH met normality test criteria, and the ZIP model was of best fit. The model identified breastfeeding, paternal education, toilet type, maternal education, place of delivery, birth-order and antenatal-visits as significant determinants of U5M at the national level. Conclusion: The Zero-Inflated Poisson model provided the best robust estimates of Under-five Mortality in Nigeria, while maternal education and birth-order were identified as the most important determinants. The Poisson-mixture models are recommended for modelling Under-five Mortality in Nigeria.

The R21 malaria vaccine has recently been rolled out in Uganda and other endemic settings across sub-Saharan Africa. Its implementation, faces many potential challenges. We assessed caregivers' awareness, knowledge, attitude, and perceptions towards the vaccine in northern Uganda. A sequential explanatory mixed methods study was conducted in Kole and Kwania districts, Northern Uganda. Quantitative data were collected through a structured survey of 574 randomly selected caregivers of age-eligible children. Qualitative data were gathered through follow-up focus group discussions with caregivers. Descriptive statistics and exploratory factor analysis were used to assess knowledge and latent dimensions of attitudes and perceptions. Qualitative data were transcribed verbatim, anonymized, organized within ATLAS.ti version 25, and analysed using deductive thematic analysis. Among the 574 caregivers 90.1%, (95% CI 87.3-92.4) were aware of malaria vaccine. However, only 13.9% (95% CI 11.2-17.0) demonstrated factual knowledge regarding key aspects of malaria vaccine including; number of doses required (16.4%), dosing intervals (21.0%), and age eligibility (34.2%). Overall, 57.4% of the caregivers expressed positive attitudes and 57.5% reported positive perceptions towards the vaccine. Common factor analysis (CFA) revealed two key dimensions of vaccine attitudes: caregiver confidence (54.9%) and safety concerns (49.7%). Regarding perceptions, three factors emerged: vaccine confidence (56.5%), trust in delivery (54.9%), and safety concerns. While most caregivers stated confidence and trust, nearly half reported lingering concerns. Qualitative data reinforced these results and revealed five central themes: caregivers' knowledge and awareness of the malaria vaccine; enduring community misconceptions; mixed attitudes reflecting trust, and fear; and perceptions related to vaccine's safety, effectiveness, and value for child-health. Although, factual knowledge was limited, caregivers reported high awareness of malaria vaccine, alongside positive attitudes and perceptions tempered by safety concerns. The Ministry of Health needs to implement regular, nationwide community education campaigns anchored in locally tailored communication strategies.

Background Nigeria suffers from one of the world’s highest child mortality rates, with about 900,000 deaths in a single year, despite being classified as a middle-income country. Over the past few years, substantial efforts have been made to reduce child mortality, with under-five mortality declining by 31.6% between 1990 and 2018. However, this decline is slower than needed to reduce child mortality significantly. This study presents the social autopsy component of the 2019 verbal and social autopsy (VASA) survey to provide an in-depth understanding of the social determinants of under-five mortality in Nigeria. Methods The study was a cross-sectional inquiry into the social determinants of neonatal and 1-59 months child deaths from the 2018 Nigeria Demographic and Health Survey (NDHS) weighted to represent the Nigerian population. The social autopsy survey asked about maternal care for neonates and 1-59 months children during the final illness. Results Child mortality in Nigeria in children aged 1-59 months is strongly associated with levels of wealth, place of residence, and maternal education. The association of these same socio-economic factors with neonatal mortality is weaker. While there were significant associations with wealth quintiles and geopolitical zones, higher maternal education was not significantly associated with lower neonatal death rates. Maternal complications in pregnancy and/or labour and delivery were common and strongly associated with stillbirths and deaths in the first two days. Severity scores at the inception of the illnesses did not show differences between children who only received informal care versus those who went to formal care providers. The main barriers to care were distance, cost, transport, and the need to travel at night, and these barriers were interlinked. More distant facilities usually required vehicle transport, which was expensive for low-income families. Travelling for an emergency at night was even more difficult in terms of finding and paying for transport and involving problems with insecurity and bad roads. Conclusions The family, community, and health system factors related to neonatal and 1-59 months child deaths in Nigeria were highlighted in this study. Deaths were commonly associated with numerous factors, each of which could contribute to the sequence of events resulting in a preventable death.

Despite global decline in childhood mortality, under-5 mortality remains high in Nigeria. While many studies have reported individual level factors as important determinants of under-five mortality in Nigeria, similar studies on the effects of neighbourhood contexts have been minimal. Hence, this study examines the effects of neighbourhood contexts on under-5 mortality in Nigeria. Using 2003 and 2008 Nigeria Demographic and Health Survey (NDHS) data, multilevel Cox regression analysis was performed on a nationally representative sample of 6,028 children (2003 NDHS) and 28,647 children (2008 NDHS). Results indicated neighbourhood context as important factor for child survival.For instance, findings showed that being born or raised in poor neighbourhoods (HR:1.54,p&lt;0.05), rural communities (HR:1.25,p&lt;0.05), and North-eastern region of Nigeria (HR:1.56,p&lt;0.05) was associated with elevated hazards of death before age 5. Findings of this study suggest that achieving improved neighbourhood contexts holds great potentials for acceleration of under-five mortality reduction in Nigeria.

Malaria is a disease of public health concern and in endemic areas, pregnant women and children under-five years are vulnerable to the disease. The introduction of the pilot program of a malaria vaccine for children under-five years in Ghana is an intervention to further reduce the burden of the disease. However, the availability of the vaccine does not necessarily mean it will be accepted by the public. This is why the perceptions and acceptance of the vaccine among mothers of these children are worth exploring. A descriptive qualitative study, with the aid of a semi-structured interview guide, was utilized in collecting data from ten (10) purposively sampled mothers whose children were taking the malaria vaccine in a municipality in Ghana. Written informed consent was obtained from all participants. The audiotaped interviews were transcribed verbatim and inductively analyzed into themes describing their perceptions and acceptance. Participants were aged between 22 and 40 years with eight (8) of them married. Three themes emerged from the study. "Awareness of malaria and the malaria vaccine" (1), "Insight into the malaria vaccine" (2), where participants communicated the beliefs and judgments formed on the vaccine, its benefits, and the need for vaccinating their children. With the third theme "Reaction to vaccine" (3), participants communicated their motivation to vaccinate their children and their concerns about the administration of the vaccine. The caregivers had positive perceptions about the malaria vaccine for children, with fewer hospital admissions and saving money as some benefits. Healthworkers played a significant role in influencing the acceptance of the vaccine. However, the fear of the unknown concerning the side effects of the vaccine serve as a possible barrier to recommending the vaccine to other caregivers. Health education must also address the fears of caregivers in order to enhance recommending the malaria vaccine to other caregivers and promote uptake of the vaccination.