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Effect of Child Immunization Education on Routine Immunization Uptake among Mothers of Under-Five Children in Nigeria

Abstract

Routine childhood immunization is one of the most effective public health interventions for preventing vaccine-preventable diseases, reducing childhood morbidity and mortality, and promoting healthy child development. Mothers and other primary caregivers play an important role in ensuring that children receive recommended vaccines at the appropriate ages and complete the routine immunization schedule. Child immunization education provides mothers with information about vaccine-preventable diseases, the benefits and safety of vaccination, recommended childhood immunization schedules, vaccine doses and timing, possible minor reactions, contraindications and precautions, the importance of completing vaccination schedules, and the location of available immunization services. Routine immunization uptake refers to the extent to which eligible children receive recommended routine vaccines according to the national immunization schedule. In Nigeria, incomplete or delayed routine immunization may be associated with inadequate knowledge, misconceptions about vaccines, fear of adverse reactions, misinformation, concerns about vaccine safety, limited awareness of immunization schedules, transportation difficulties, financial constraints, geographical barriers, and limited access to immunization services. Effective child immunization education may improve mothers' knowledge, confidence, awareness of immunization schedules, and willingness to utilize routine immunization services for their children. Against this background, this study investigates the effect of child immunization education on routine immunization uptake among mothers of under-five children in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Knowledge-Attitude-Practice framework. The Health Belief Model provides a framework for understanding mothers' vaccination decisions through perceived susceptibility, perceived severity of vaccine-preventable diseases, perceived benefits of immunization, perceived barriers, and cues to action. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, and environmental conditions in shaping immunization-related behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how child immunization education may improve maternal knowledge and attitudes and influence routine immunization uptake. Collectively, these theoretical perspectives provide a suitable framework for explaining how child immunization education may influence routine immunization uptake among mothers of under-five children in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from mothers of under-five children attending selected public and private healthcare facilities, immunization clinics, primary healthcare centres, and community-based maternal and child health programmes in Nigeria using a structured interviewer-administered questionnaire and a routine immunization uptake assessment tool. A multistage sampling technique will be employed to select states, local government areas, communities, healthcare facilities, and eligible mothers. Where feasible, selected healthcare facilities or participant groups will be assigned to intervention and comparison groups. Mothers in the intervention group will receive structured child immunization education covering vaccine-preventable diseases, benefits and safety of vaccination, recommended childhood immunization schedules, vaccine doses and timing, common minor reactions, contraindications and precautions, the importance of completing the vaccination schedule, management of common concerns, and available immunization services. Routine immunization uptake will be assessed using indicators such as receipt of age-appropriate vaccines, timeliness of vaccination, completion of recommended vaccine doses, and vaccination status verified through child health cards, immunization records, or facility documentation where available. Descriptive statistics will be used to summarize participants' sociodemographic and maternal characteristics, number and age of children, previous immunization education, immunization knowledge, and routine immunization uptake. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic regression analysis, will be used to determine the effect of child immunization education on routine immunization uptake. Where appropriate, vaccination uptake before and after the intervention will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that child immunization education has a significant positive effect on routine immunization uptake among mothers of under-five children in Nigeria. Mothers exposed to structured immunization education are expected to demonstrate improved knowledge of vaccine-preventable diseases, recommended vaccination schedules, vaccine safety, and the importance of completing all recommended doses. Education may improve mothers' confidence in routine vaccination and reduce misconceptions, fear, and misinformation regarding childhood vaccines. Reminders and practical information about immunization schedules and service locations may further improve timely attendance at immunization clinics. However, education alone may not guarantee complete immunization because mothers may continue to experience barriers such as vaccine stock-outs, transportation difficulties, long distances to healthcare facilities, inconvenient clinic schedules, inadequate healthcare staffing, misinformation, and other health-system challenges. Consequently, child immunization education is expected to be most effective when supported by reliable vaccine availability, accessible immunization services, trained healthcare providers, effective reminder systems, community mobilization, and appropriate follow-up of children who miss scheduled vaccinations. The study is expected to contribute to the literature on childhood immunization, maternal health education, vaccine uptake, child health, preventive healthcare, community health, maternal and child health, and public health in Nigeria by providing empirical evidence on the effect of child immunization education on routine immunization uptake among mothers of under-five children. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, National Primary Health Care Development Agency and state primary healthcare agencies, hospitals, primary healthcare centres, immunization programmes, nurses, midwives, community health workers, development partners, and policymakers regarding strategies for improving childhood vaccination coverage. The study will also provide evidence-based recommendations for strengthening maternal immunization education, integrating vaccine education into antenatal, postnatal, and child-welfare services, improving community-based immunization awareness, strengthening vaccination reminders and follow-up systems, addressing vaccine misinformation, improving access to reliable immunization services, and promoting timely completion of routine childhood immunization schedules in Nigeria.

Keywords: Child immunization education, routine immunization uptake, mothers of under-five children, Nigeria, childhood vaccination, vaccine uptake, maternal health education, immunization schedule, child health, preventive healthcare, community health, maternal and child health, vaccination coverage, public health, Nigeria.