ASSESSMENT OF IMMUNIZATION COVERAGE AND BARRIERS AMONG MOTHERS IN ZAMFARA RURAL COMMUNITIES

ASSESSMENT OF IMMUNIZATION COVERAGE AND BARRIERS AMONG MOTHERS IN ZAMFARA RURAL COMMUNITIES

CHAPTER ONE: INTRODUCTION

1.1 Background of the Study

Immunization is one of the most cost-effective public health interventions, significantly reducing the incidence of vaccine-preventable diseases (VPDs) and childhood mortality worldwide. According to the World Health Organization (2022), immunization prevents an estimated 2–3 million deaths globally each year. However, despite substantial global progress, many developing countries, including Nigeria, still face significant challenges in achieving universal immunization coverage, particularly in rural and underserved regions. In Nigeria, the National Demographic and Health Survey (NDHS, 2018) reported that only 31% of children aged 12–23 months were fully immunized, with rural states like Zamfara recording some of the lowest rates in the country.

Zamfara State, located in Nigeria's North-West geopolitical zone, is predominantly rural and has struggled with low immunization uptake, resulting in frequent outbreaks of vaccine-preventable diseases such as measles, polio, and diphtheria. Numerous socio-cultural, economic, and systemic barriers contribute to this problem. These include inadequate access to healthcare facilities, poor maternal education, religious and traditional beliefs, vaccine hesitancy, and logistical challenges related to vaccine cold chain management and distribution (Aliyu & Salihu, 2021). These barriers not only threaten child survival but also undermine public health achievements.

Mothers play a critical role in the immunization process, as they are primarily responsible for making decisions concerning their children's health. Thus, understanding maternal knowledge, attitudes, and practices is essential for addressing immunization gaps. Community health programs, including the National Primary Health Care Development Agency’s (NPHCDA) Expanded Programme on Immunization (EPI), have made concerted efforts to increase immunization rates in rural areas. However, coverage remains uneven, and the effectiveness of these interventions has not been fully assessed in Zamfara’s rural communities.

This study, therefore, seeks to assess the level of immunization coverage among mothers in Zamfara rural communities and identify the key barriers that hinder full immunization of children. It aims to provide evidence-based insights that can inform local and national strategies for improving vaccine uptake and public health outcomes.

 

1.2 Statement of the Problem

Despite numerous policy interventions and immunization campaigns in Nigeria, rural areas such as those in Zamfara State continue to experience low immunization coverage. This situation poses a significant public health risk by increasing the vulnerability of children to preventable diseases. Data from the Nigeria Immunization Coverage Survey (2021) indicate that Zamfara State remains below the national average, with full immunization coverage in rural areas at less than 20%. This troubling statistic reflects systemic gaps in health service delivery and highlights the importance of understanding the unique challenges faced by rural mothers.

Multiple factors contribute to this public health challenge. These include poor healthcare infrastructure, vaccine stock-outs, inadequate healthcare worker training, and cultural resistance. In some communities, traditional and religious beliefs actively discourage immunization. In others, long distances to health centers and lack of awareness about immunization schedules limit participation. Mothers in these settings often lack accurate health information, resulting in poor decision-making and incomplete immunization for their children (Adebayo et al., 2020).

Although previous studies have examined general immunization trends in Nigeria, few have explored the specific socio-cultural and logistical barriers faced by mothers in Zamfara’s rural communities. Without this critical understanding, interventions are likely to be poorly targeted and ineffective. This study is therefore necessary to uncover the real-life experiences and challenges mothers face, assess the current level of immunization coverage, and provide practical recommendations to bridge the gap between policy and practice.

1.3 Objectives of the Study

To assess the level of immunization coverage among mothers in Zamfara rural communities.

To identify the key barriers that hinder full immunization of children in these communities.

To evaluate the relationship between maternal socio-demographic characteristics and immunization compliance.

1.4 Research Questions

What is the level of immunization coverage among children in Zamfara rural communities?

What are the major barriers to full immunization compliance among mothers?

How do maternal socio-demographic factors influence immunization coverage?

1.5 Research Hypotheses

H₀₁: There is no significant relationship between maternal socio-demographic characteristics and immunization compliance.

H₀₂: Barriers such as distance, cultural beliefs, and healthcare access do not significantly affect immunization coverage.

1.6 Significance of the Study

This study will be useful to public health practitioners, local government health departments, and national immunization program stakeholders. By identifying the barriers to immunization uptake in rural Zamfara, it offers actionable insights that can help redesign community-based health initiatives. Health education campaigns, resource allocation, and policy implementation can be better tailored to the realities of rural communities. Furthermore, the findings will contribute to the growing body of literature on maternal and child health in northern Nigeria, providing a foundation for future research and intervention planning.

1.7 Scope and Limitation of the Study

The study is limited to selected rural communities in Zamfara State and focuses specifically on mothers with children aged 0–23 months. It assesses immunization coverage based on the National Immunization Schedule and considers both routine and supplementary immunization activities. Limitations include potential recall bias in mothers' responses, limited access to accurate health records, and variations in the implementation of immunization programs across local government areas.

1.8 Operational Definition of Terms

Immunization Coverage: The proportion of children who have received the recommended vaccinations according to national health guidelines.

Barriers: Factors that hinder or prevent mothers from completing their children’s immunization schedule, including logistical, cultural, and informational obstacles.

Rural Communities: Geographically isolated areas in Zamfara State with limited access to health infrastructure and services.

Mothers: Women of reproductive age who have at least one child within the immunization age group.

1.9 Structure of the Study

The study is organized into five chapters. Chapter One provides the introduction, problem statement, objectives, research questions, hypotheses, and significance of the study. Chapter Two presents a review of existing literature and theoretical frameworks. Chapter Three outlines the research methodology. Chapter Four contains data analysis and interpretation. Chapter Five concludes the study with a summary, findings, and recommendations.

 

References

Adebayo, A. M., Bamidele, J. O., & Omotola, B. D. (2020). Barriers to routine immunization in rural Nigeria: A qualitative study of mothers and health workers. African Journal of Reproductive Health, 24(3), 78–89.

Aliyu, A. A., & Salihu, H. M. (2021). Immunization in Nigeria: Current status and future directions. Public Health Review, 42(2), 211–225.

National Population Commission (NPC) & ICF International. (2018). Nigeria Demographic and Health Survey 2018. Abuja: NPC and ICF.

World Health Organization (WHO). (2022). Immunization coverage fact sheet. Geneva: WHO.