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Influence of Healthcare Facility Accessibility on Childhood Immunization Uptake in Rural Nigeria

Abstract

Childhood immunization is one of the most effective public health interventions for preventing vaccine-preventable diseases, reducing childhood morbidity and mortality, and improving child survival. Despite the availability of routine immunization programmes in Nigeria, children in rural communities may experience incomplete or delayed vaccination because of geographical, financial, transportation, organizational, and other barriers to accessing healthcare facilities. Healthcare facility accessibility refers to the extent to which individuals and households can physically and financially reach and obtain services from healthcare facilities when needed. Accessibility may be influenced by distance to healthcare facilities, travel time, transportation availability, road conditions, healthcare costs, facility operating hours, and the availability of immunization services. Childhood immunization uptake refers to the extent to which eligible children receive recommended routine vaccines according to the national immunization schedule within the appropriate period. In rural Nigeria, long distances to healthcare facilities, poor transportation networks, limited household resources, and irregular access to healthcare services may reduce parents' ability to obtain routine childhood immunization. Improving accessibility to healthcare facilities may therefore increase opportunities for children to receive vaccines and improve completion of recommended immunization schedules. Against this background, this study investigates the influence of healthcare facility accessibility on childhood immunization uptake in rural Nigeria. The study is anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and the Three Delays Model. Andersen's Behavioral Model explains healthcare utilization through predisposing characteristics, enabling resources, and healthcare needs, with geographical and financial accessibility representing important enabling resources. The Health Belief Model explains parental decisions regarding childhood immunization through perceived susceptibility to vaccine-preventable diseases, perceived severity, perceived benefits of vaccination, perceived barriers, and cues to action. The Three Delays Model provides a framework for understanding delays in seeking and reaching appropriate healthcare, particularly where transportation, distance, and geographical barriers affect access to services. Collectively, these theoretical perspectives provide a suitable framework for explaining how healthcare facility accessibility may influence childhood immunization uptake in rural Nigeria. The study will adopt a quantitative cross-sectional research design. Primary data will be collected from mothers or primary caregivers of eligible children in selected rural communities in Nigeria using a structured interviewer-administered questionnaire and child immunization records or vaccination cards where available. A multistage sampling technique will be employed to select states, local government areas, rural communities, households, and eligible caregivers and children. Healthcare facility accessibility will be assessed using indicators such as distance to the nearest healthcare facility providing immunization services, travel time, availability and cost of transportation, road conditions, frequency of facility operation, facility opening hours, financial cost of accessing services, and ease of reaching immunization services. Childhood immunization uptake will be assessed using indicators such as receipt of age-appropriate vaccines, vaccination completion, timeliness of immunization, number of recommended doses received, and proportion of children who are fully immunized according to the applicable national schedule. Where available, vaccination cards and facility immunization registers will be used to verify reported vaccination status. Additional information will be collected on caregivers' age, education, household socioeconomic status, number of children, knowledge of immunization, previous healthcare experiences, and availability of outreach immunization services. Descriptive statistics will be used to summarize household characteristics, healthcare accessibility, vaccination status, and immunization patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the influence of healthcare facility accessibility on childhood immunization uptake. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that better healthcare facility accessibility has a significant positive influence on childhood immunization uptake in rural Nigeria. Children whose caregivers live closer to healthcare facilities and have easier access to affordable transportation are expected to have higher rates of timely and complete immunization. Reduced travel distance and shorter travel times are expected to lower the practical barriers associated with repeated visits required for routine childhood vaccination. Accessible facility operating hours and consistent availability of immunization services are also expected to improve caregivers' ability to complete recommended vaccination schedules. Conversely, long distances, poor roads, high transportation costs, limited facility operating hours, and irregular availability of immunization services are expected to contribute to missed or delayed vaccination appointments. However, accessibility alone may not fully determine immunization uptake because caregiver knowledge, attitudes, perceptions of vaccine safety, household socioeconomic conditions, availability of vaccines, healthcare worker practices, and community-level factors may also influence vaccination behaviour. Consequently, improvements in physical and financial accessibility should be accompanied by effective immunization education, reliable vaccine supply, outreach services, and appropriate follow-up. The study is expected to contribute to the literature on healthcare accessibility, childhood immunization uptake, rural health, maternal and child health, vaccination coverage, primary healthcare, health-services utilization, and public health in Nigeria by providing empirical evidence on how access to healthcare facilities affects childhood vaccination. 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 immunization programmes, state ministries of health, state primary healthcare development agencies, local government health authorities, healthcare facilities, immunization programme managers, community health workers, development partners, and policymakers regarding strategies for improving vaccination coverage in rural communities. The study will also provide evidence-based recommendations for expanding accessible immunization services, strengthening mobile and outreach vaccination programmes, improving rural transportation and referral systems, extending convenient immunization service hours, ensuring consistent vaccine availability, and reducing geographical and financial barriers to childhood immunization in rural Nigeria.

Keywords: Healthcare facility accessibility, childhood immunization uptake, rural Nigeria, routine immunization, vaccination coverage, maternal and child health, primary healthcare, healthcare access, immunization services, rural health, vaccine uptake, child health, public health.