Abstract
BackgroundNigeria is one of the ten countries globally that account for 62% of under- and unvaccinated children worldwide. Despite several governmental and non-governmental agencies’ interventions, Nigeria has yet to achieve significant gains in childhood immunization coverage. This study identifies intrapersonal, interpersonal, organizational, community, and policy-level factors that influence childhood immunization uptake from various stakeholders’ perspectives using the Socioecological Model (SEM).MethodsUsing the Socioecological Model as a guiding framework, we conducted ten focus group sessions with mothers/caregivers and community leaders residing in Lagos state and nine semi-structured interviews with healthcare workers who provide routine immunization services in Lagos state primary healthcare facilities. We performed a qualitative analysis of focus groups and semi-structured interviews using deductive coding methods.ResultsThe study sample included 44 mothers/caregivers and 24 community leaders residing in Lagos State, Nigeria, and 19 healthcare workers (routine immunization focal persons) working in the primary healthcare setting in Lagos state. Study participants discussed factors at each level of the SEM that influence childhood immunization uptake, including intrapersonal (caregivers’ immunization knowledge, caregivers’ welfare and love of child/ren), interpersonal (role of individual relationships and social networks), organizational (geographical and financial access to health facilities, health facilities attributes, staff coverage, and healthcare worker attributes), community (community outreaches and community resources), and policy-level (free immunization services and provision of child immunization cards). Several factors were intertwined, such as healthcare workers’ education of caregivers on immunization and caregivers’ knowledge of vaccination.ConclusionsThe reciprocity of the findings across the Socioecological Model levels emphasizes the importance of developing multi-pronged interventions that operate at multiple levels of the SEM. Our results can inform the design of culturally appropriate and effective interventions to address Nigeria’s suboptimal immunization coverage.
Highlights
Nigeria is one of the ten countries globally that account for 62% of under- and unvaccinated children worldwide
Caregivers, community leaders, and healthcare workers in our study described the importance of leveraging community resources such as community leaders, including traditional and religious leaders, and those in formal community leadership positions such as members of the Ward Development Committee to encourage caregivers’ immunization uptake
To our knowledge, no study has explored Nigerian childhood immunization uptake for all vaccines guided by the Socioecological Model (SEM) from the perspective of various immunization stakeholders, including mothers/caregivers, community leaders, and healthcare workers
Summary
Nigeria is one of the ten countries globally that account for 62% of under- and unvaccinated children worldwide. Childhood immunization programs prevent two to three million deaths every year by decreasing the incidence of diseases such as diphtheria, pertussis, tetanus, measles, and tuberculosis [2]. They protect the unimmunized by conferring herd immunity achieved with high rates of timely immunization [3]. From 2000 to 2016, global coverage rates for the childhood Diphtheriatetanus-pertussis (DTP3) vaccine increased from 72 to 86% percent, while in the same years, childhood immunizations for measles increased from 72 to 85% [4] Despite these improvements, a significant need remains; in 2016, approximately million children did not receive the required three-dose regimen of DTP3, and more than million children missed their first measles vaccine [4]. According to the Multiple Indicator Cluster Survey, in 2017, Nigeria achieved full immunization coverage of only 23% of its children by their first birthday [6]
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