A Survey on Attitude of Mothers towards Immunization of Their Children in Nigeria (A Case Study of Zuru Metropolis)

Abstract

Thousands of children are dying and some are disabled because of some common diseases such as measles, polio, tetanus, whooping cough, tuberculosis etc, hence there is need to sensitize parents towards the immunization of their children. In this study, questionnaires were administered to 500 women in Zuru local government area of Kebbi state to elicit relevant information regarding their general attitudes to child’s vaccination. Results from the analyses carried out using SPSS, show that mothers’ locality, place of vaccination, mothers’ educational status, age at vaccination, spouses educational status, mothers’ religious beliefs as well as mothers’ age group at birth of child are all positively associated with attitudes of mothers towards vaccination. Further results finally revealed that donation of gifts items to mothers serve as positive inducement towards improving the attitudes of mothers towards immunization of their children.

Full text

The International Journal of Engineering and Science (IJES)
|| Volume || 8 || Issue || 11 || Series II || Pages || PP 31-38|| 2019 ||
ISSN (e): 2319 – 1813 ISSN (p): 23-19 – 1805
A Survey on Attitude of Mothers towards Immunization of Their
Children in Nigeria (A Case Study of Zuru Metropolis)
1Anas Abubakar Maiwada, 2Shamsudeen Dahiru*, 3Gerald Ikechukwu Onwuka
1,2,3Department of Mathematics, Kebbi State University of Science and Technology, Aliero, Nigeria
*Corresponding Author: Anas Abubakar Maiwada
--------------------------------------------------------ABSTRACT-------------------------------------------------------------
Thousands of children are dying and some are disabled because of some common diseases such as measles,
polio, tetanus, whooping cough, tuberculosis etc, hence there is need to sensitize parents towards the
immunization of their children. In this study, questionnaires were administered to 500 women in Zuru local
government area of Kebbi state to elicit relevant information regarding their general attitudes to child’s
vaccination. Results from the analyses carried out using SPSS, show that mothers’ locality, place of vaccination,
mothers’ educational status, age at vaccination, spouses educational status, mothers’ religious beliefs as well as
mothers’ age group at birth of child are all positively associated with attitudes of mothers towards vaccination.
Further results finally revealed that donation of gifts items to mothers serve as positive inducement towards
improving the attitudes of mothers towards immunization of their children.
KEYWORDS;- Immunization, Questionnaire, Knowledge, Attitude, Survey
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Date of Submission: 03-11-2019 Date Of Acceptance: 20-11-2019
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I. INTRODUCTION
In the presence of effective vaccines in the national schedule, childhood deaths from vaccine
preventable diseases (VPDs), such as pneumonia, diarrhoea, and measles, accounted for about 40% of all deaths
among children under-five in developing countries including Nigeria. Evidence from the National Immunization
Coverage Survey (NICS) indicates that variations exist in routine immunization (RI) performance across the
country’s zones, with the South West (76%) and South East (91%) zones showing higher attitude, and the North
West (60%) and North East (46%) showing lowest attitude. This disparity ultimately impacts on national
immunization coverage.
The low or sub-optimal immunization coverage is mainly due to factors like parents’ locality, parents’
religious beliefs, parents’ educational status, age, place of vaccination and so on (Path and Aihi, 2002). More
importantly, the reported administrative coverage is bedevilled with poor data quality in the face of the large
pool of susceptible under-fives, which could lead to outbreaks of vaccine-preventable diseases (VPDs) at
various administrative levels, i.e., Local Government Area (LGA) and State. Consequently, this could delay or
reverse the gains made through supplemental immunization activities (SIAs) for diseases that are targeted for
eradication and elimination such as Polio and Measles respectively.
According to administrative coverage reports in nationwide survey, routine immunization showed
consistent and increasing trend in Kebbi State, including Zuru Local Government Area (LGA). However,
findings from community-level survey put in doubt the validity of these administrative figures, as there are
disparities between these data sources. Perhaps, reported cases of VPDs, and sometimes outbreaks could be an
indication of immunity gaps suggesting that the administrative coverage often reported may not be correct.
Further, the surveillance and outbreak response reports in the state corroborated these findings. Similarly,
national survey results following measles follow-up campaign in 2015 also revealed a great discrepancy
between the reported administrative coverage and coverage surveys (104% versus 80.4%). Likewise,
observations from community surveys during immunization supervision by senior supervisors from the state
(government and partners) showed huge difference among fully immunized children compared to the high
reported administrative coverage in the same catchment health facility providing services to same settlement
where surveys were conducted.
In the light of the above, World Health Organization recommended consistent survey on the awareness
and sensitization, knowledge, practice and attitude of mothers towards immunization of their children at
different locations. Consequently, partners are making efforts to support the government to address this issue.
For instance, in Kebbi State, the attention of programme managers and relevant stakeholders has been drawn to
mothers’ attitudes during the routine technical review meetings and supportive supervision by partner agencies.
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A Survey on Attitude of Mothers towards Immunization of Their Children…
Sadly, there was no formal assessment to specifically investigate the basis of the discrepancies and proffer
possible remedies.
Universal immunization of children against six preventable diseases (tuberculosis, diphtheria, pertussis
(whooping cough), tetanus, polio and measles) is vital to reduce childhood mortality and morbidity across the
world and a major public health concern in Zuru local government area. Recent statistics, however, findings
reveal that there is still much work to do in these sectors. An estimated 40 percent of the country’s population
live below the poverty line (UNAIDS, 2001), with an estimated literacy rate of 29 percent for women and 47. 6
percent for men (MoEYS, 2000). The 1998 National Health Survey (NHS) reported an infant (under 1 year)
mortality rate of 89.4 per 1000 live births – compared to a regional average of 38, and child (under 5 years)
mortality of 115 per 1000 live births – compared to a regional average of 50. The 2000 Demographic and
Health Survey (DHS) reported that approximately only one third of children were fully immunized by 12
months, and this was similar to the NHS results. The World Health Organization (WHO) considers a child fully
immunized when they have received one dose of BCG (against tuberculosis); three doses each of diphtheria,
tetanus and pertussis vaccine (DTP) and oral polio vaccine (OPV); and one dose of measles vaccine, preferably
by age 12 months. In 1978, the Nigerian government with support from UNICEF officially launched the
Expanded Programme on Immunization (EPI). EPI activities were extended to all provinces by the end of 1987,
and by early 1999 tetanus toxoid (TT) immunization was included for pregnant women. In 1995, an
independent Polio Eradication Unit (PEU) was established to accelerate polio eradication activities and Nigeria
was certified polio free in November 2000. Hence the need to pilot a study seeking to understand the attitude of
mothers towards immunization of their children and to identify the root cause(s) as well as recommends action
points towards improving the positive attitude. This study will also form a foundation for a more robust study,
perhaps a state-wide assessment on this subject.
The programme “immunization” is described as the process by which disease carrying organisms that
is part not infected with disease is purposely introduced into human body system for it to produce anti-bodies
and protect itself from the real version of the disease. However, in 20 th century, in developing world, it does not
only prevent about three million children deaths annually, but also has the potential to prevent additional two
million deaths if coverage improves. Immunization coverage has remained low in Nigeria, although the
government provides vaccines freely (Onuzulike, 2008).
Moreover, the attitude of mothers towards immunization services is positive and relies on the efficiency
of the vaccine to protect against disease, among respondents who believe that it contains anti-fertility agents,
decision making of vaccination of a child lies predominantly on the father and was rejected because of rumours,
non-payment or charges and priority accorded to it. Because of the attitude of mothers toward vaccination,
thousands of children were dying and some become disabled as a result of common childhood diseases such as
measles, polio, tetanus, whooping cough, tuberculosis and so on (Osakwe, 2010).
These as a result brought about the introduction of immunization programme by united nation children
fund (UNICEF). The programme “immunization” which can be described as the process in which a disease
carrying organisms’ part which is not infected with disease is purposely put into system so that your body
produce anti-bodies and protect itself from the real version of the disease. The word immunity refers to the
body’s ability to defend itself against a particular disease, vaccines stimulate the body’s defence mechanism to
provide the receipt with immunity to specify disease diseases organism (WHO, 2001).
When the programme on immunization was launched in 1978, less than five percent of world’s
children were immunized in the first year of campaign against the killer diseases. Today, a certain percentage of
children who received this life saving vaccines, and increasing number are protected by new and under used
vaccines (Babalola, 2005).
The attitude of most mothers towards immunization service is positive and relies on the efficacy of the
vaccine to protect against disease, there was a poor attitude towards polio immunization among respondent who
believe that it contains anti-fertility chemicals. Decision-making on immunization of a child lies predominantly
on the father, and if vaccination was rejected because of the rumour and the priority accorded to parents’
preference to more severe disease. Mothers’ knowledge, attitude and practice play an important role in achieving
complete immunization before first birthday of the child, the previous parent factors are also contributing to
success or failure of immunization program (Adewuyi, 2007).
Ahonkhai (2008) stated immunization remains one of the most important public health interventions
and a cost effective strategy to reduce both the morbidity and mortality associated with infections disease. They
asserted that over two million deaths are delayed through immunization each year worldwide. The researchers
further explained that despite the above assertion, vaccine mortality within an estimated three million death.
Mukherjee (1988) defined attitude to one’s feelings, thoughts, and predisposition to behave in some
particular manner towards some aspect of one’s environment.
According to him, attitudes are best expressed when individuals make statement about their feelings or option
about certain objects, issues or things.
II. OBJECTIVE OF THE STUDY
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A Survey on Attitude of Mothers towards Immunization of Their Children…
This study aims at assessing knowledge, attitude and practice of mothers towards children’s obligatory
immunization in Zuru Metropolis, Kebbi state of Nigeria. The objectives are to find out the;
i. Attitude of mothers towards immunization against childhood killer diseases.
ii. Immunization practice of mothers against childhood killer diseases.
iii. The extent to which the mothers educational level influence the practice of immunization against
childhood killer diseases.
iv. The extent to which the mothers age influence the practice of immunization against childhood killer
diseases.
III. METHODOLOGY
The sampling elements of the study area are women (mothers). Simple random sampling scheme was
used in selecting the sample size of five hundred (500) respondents from different parts of Zuru local
government area of Kebbi state. The respondents were to respond to the questionnaires for the purpose of this
study. Since the study is more of software-based, all the analysis and computations are carried out using SPSS
statistical software.
Methodology
Zuru Metropolis is one of the twenty one (21) local government areas of Kebbi state. The area is
located at the extreme southeastern part of kebbi state and covers an area of approximately 32,626 square
kilometers. The area is bordered in the Northwest by Fakai local government area, in the east by Danko-Wasagu
local government area, in the southeast by Sakaba local government area, and in the south by Rijau local
government area of Niger State (KBSG, 2003). The estimated population of the area is one hundred and sixty
five thousand, five hundred and forty seven (165, 547) people as at 2006 population census (NPC, 2006).
IV. DATA COLLECTION
The study was conducted using a primary data. A semi-structured questionnaire was used to collect
primary data from the respondents (mothers), which contain questions relating to personal data, geographical
and immunization data of each respondents as well as questions relating to age, number of children, sex of the
child, immunization of children and so on. The questionnaires were made short and succinct with limited
number of questions needed for this study.
V. DATA ANALYSIS
The data analysis in this study was analyzed using chi-square statistic with p-values recorded to test
whether the attitudes of mothers towards immunization is independent of the factors under study. The primary
data from all sources were summarized, analyzed and presented in tables and graphs while comparisons and
conclusions made from summaries. Data analysis was made after developing thematic framework using
responses, coded, compiled and summarized manually, then complemented with the quantitative results of
primary data sources. Finally, the findings from the data were presented in narrations and tables.
The p-value will be compared with 5% level of significance. The formula for the chi-square statistic used in the
chi square test is given as;
 
2
2
c
O E
XE


�
The subscript ‘c’ is the degrees of freedom while ‘O’ is the observed values and ‘E’ is the expected values.
Ethical Consideration
We obtained consent from all the mothers and their spouses (where necessary), and some districts heads at LGA
level who participated in the study, after explaining the purpose of the study to them. We also got ethical
clearance from the Research and Ethical Committee of the Kebbi State Ministry of Health.
VI. RESULTS
Table 1: Data Presentation and Analysis
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A Survey on Attitude of Mothers towards Immunization of Their Children…
FACTORS EVER VACCINATED TOTAL P-VALUE
NO YES
Marital status
Single 50 75 125 0.001
Married 35 105 140
Divorced 65 68 133
Widowed 48 54 102
Mother’s age group
15 years or less 24 45 69 0.010
16-30 years 98 100 198
31-50 years 77 101 178
51 years and above 35 20 55
Spouse age group
15 years or less 24 45 69 0.008
16-30 years 98 100 198
31-50 years 77 101 178
51 years and above 35 20 55
Mother’s educational status
Not educated 70 25 95 0.001
Primary 91 105 196
Secondary 42 68 110
Higher level 13 33 46
Islamic School 40 13 53
Spouse educational status
Not educated 70 25 95 0.001
Primary 91 65 156
Secondary 20 100 120
Higher level 13 87 100
Islamic School 16 13 29
Mother’s religion
Muslim 100 225 325 0.001
Christian 50 85 135
Tradition 35 5 40
Others - - -
Spouse religion
Muslim 100 200 300 0.003
Christian 40 95 135
Tradition 35 30 65
Others - - -
Mother’s locality Rural area 250 80 330 0.001
Urban area 70 100 170
Spouse locality Rural area 200 125 325 0.001
Urban area 65 110 175
Mother’s occupational
status
Civil servant 33 167 200 0.001
Self employed 47 53 100
Private worker 50 50 100
Unemployed 70 30 100
Spouse occupational status
Civil servant 43 157 200 0.001
Self employed 57 64 121
Private worker 66 73 139
Unemployed 25 15 40
Total number of children 321 179 500
Child’s age
0-1 year 25 100 125 0.057
2-3 years 23 77 100
3-4 years 59 166 225
More than 5 years 20 30 50
Age at vaccination
0-1 year 20 85 105 0.001
2-3 years 25 100 125
3-4 years 70 110 180
6 years and above 80 10 90
Presented last child Yes 27 223 250 0.001
No 223 27 250
Received full vaccine for Yes 30 270 300 0.001
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last child No 150 50 200
Sex of last child Male 150 205 355 0.001
Female 180 65 245
Frequency of vaccination
1-2 times 70 22 92 0.001
2-3 times 55 36 91
3-4 times 44 90 134
6 or more times 53 130 183
Place of vaccination
Home 105 35 140 0.001
Hospital 41 225 266
Market 34 12 46
Road 40 8 48
Do you receive gifts Yes 225 105 330 0.001
No 70 100 170
A total of 500 mothers with infants participated in this study. One hundred and forty (28%) of the study
participants were married, one hundred and thirty three (26.6%) were divorced, one hundred and two (20.4%)
were widowed and one hundred and twenty five (25%) were single. Regarding mothers’ age group, of this, 69
(13.8%) are of the age 0-15, 198 (39.6%) are of the age 16–30, 178 (35.6%) of them are of age 31-50, and only
55 (11%) are between the age of 51 and above.
Literate mothers who attend Islamic school 53 (10.6%), primary school 196 (39.2%), secondary school
110 (22%), and higher education 46 (9.2%) are more likely to be knowledgeable than illiterate respondents.
Literate respondents who attend primary school were more than two times (39.2%) and whereas mothers who
achieved secondary education were almost two times (22%) had positive attitude towards infant immunization
than illiterate respondents (19%).
Regarding mothers’ religious beliefs, Muslim mothers were more than eight times (39.2%) and whereas
Christian mothers who are Christians were almost four times (27%) had positive attitude towards infant
immunization than mothers with traditional beliefs (8%).
Regarding mothers’ locality, urban mothers are more likely to have positive attitudes than rural
respondents. This might be as a result of their low exposure to civilization compared to their urban counterparts
who are more civilized and exposed but in this study; the result we obtained revealed the opposite, where the
rural mothers were almost two times (66%) had positive attitude towards their children’s immunization than the
urban respondents having only 34%.
On mothers’ occupational status, 40% of mothers were civil servants, who were two times more in
showing positive attitude towards their infants immunization than the self-employed mothers (20%), private-
workers mothers (20%), and house wives (20%) equally.
Mothers who had infants aged from 3-4 years were two times or more 225 (45%) significantly
associated with positive attitude about infant immunization program than mothers having infants in the age
group less than 3-4 years and mothers having infants in the age group more than 3-4 years respectively.
Regarding their last Child, 245 (49%) were females and 355 (71%) were males. Age of infants ranged
from 1 year to 6 years and above. More than one third, 180 (36%) infants found in the ‘age at vaccination’ group
of 3-4. 250 (50%) mothers presented their last Childs for vaccinations and same thing happened in the case of
mothers who didn’t present their last Childs. 300 (60%) mothers received full vaccine for their last Childs while
200 (40%) didn’t received full vaccine for their last Childs.
Regarding place of vaccination, 266 (53.3%) mothers were always bringing their infants for
immunization according to the schedule given by health professionals in hospitals, followed by 140 (28%)
mothers who received vaccination for their infants at home while 46 (9.2%) and 48 (9.6%) mothers received
vaccination for their children at market and road respectively.
Out of the total of 500 mothers with infants who participated in this study, 330 (66%) mothers receive
gifts while 170 (34%) mothers have not received any gift. Mothers who receive gifts are more likely to practice
infant immunization than mothers that did not receive any gifts.
VII. DISCUSSION
This dissertation has tried to identify the Attitude and Practice of mothers about immunization of their
infants in Zuru municipal, Kebbi state, Nigeria. Over all, in this study 110(22%) of mothers had good
knowledge and this is lower than the study finding from Nnamdi Azikiwe University hospital, Nigeria which
revealed that, 215(70.0%) of mothers had good knowledge (Okafor et al, 2012). The inconsistency may be due
to sample size difference or educational back grounds of the participants.
Moreover, immunization practice in the present study (53.13%) is also a bit greater than EDHS 2011
and Ethiopia ministry of health 2011 annual health and health related indicator reports (which are both similar
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A Survey on Attitude of Mothers towards Immunization of Their Children…
studies with different case studies) which represent 49% and 44.4% of infants were fully vaccinated,
respectively. The variation is due to a study design difference (institution in this study and national based survey
in comparison studies). Nearly 266 (53.3%) of respondents in this study always bring their infants for
immunization according to the scheduled time. From the total of 225 infants aged 3-4 years, 26.8% of them
received vaccines appropriate to their age where as from 275 infants aged less than 3-4 years and above, were
not fully vaccinated. This is consistent with a cross sectional study done in India, that 98% and 93% of children
completely immunized and had been immunized on the schedule, time, respectively (Andarabi et al, 2012). In
the contrary, inconsistencies had been seen with other findings. For example, in Congo, mothers’ immunization
practice based on immunization card showed about 37% (Mapatamo, 2008) and in Ambo, Ethiopia only 35.6%
of infants completed all the recommended vaccines (Etana and Deressa, 2012). The discrepancy may be due to
social or cultural reasons, and study setting differences.
The present study also tried to identify predictors of maternal attitude and practice towards infant
immunizations, literate mothers attended primary schools were more than two times (39.2%) more likely to have
good knowledge of immunization than illiterate mothers. Similarly, other study findings conducted in Enugu
(Nigeria) mothers attending secondary or higher educational status was significantly associated with good
knowledge and acceptance of immunization (Tagbo et al, 2012). In addition to literacy status, mothers who had
infants aged from 3-4 years were two times or more 225 (45%) significantly associated with positive attitude
about infant immunization program and more likely to have good knowledge of immunization than mothers
having infants in the age group less than 3-4 years. This might be due to the fact that mothers could get
information from health professionals and add knowledge of immunization with repeated vaccination visits than
mothers who couldn’t visit immunization clinics repeatedly. Mothers who gave births two times and above were
also about two times more likely to have good knowledge of infant immunization than respondents who
delivered only once. Similarly, a study conducted in Kinshasa (Democratic Republic of Congo), showed that
mother’s experience of an EPI-targeted disease emerged as significant predictors of knowledge of immunization
(Mapatamo, 2008). Inconsistencies regarding birth order of infants were also seen between this study and other
study findings which were conducted in Arab Emirates, (Bernsen et al., 2011). The inconsistency might be due
to differences in study design, sample size or study participants’ educational status.
In respect to respondents’ attitude on immunization, literate respondents who attend elementary school
or higher education were about two times more likely to have positive attitude towards infant immunization than
illiterate mothers. This is consistent with results of different articles reviewed by global immunization division
centers for disease control and prevention from 1999-2009 (WHO, 2009). The possible explanation might be,
literate mothers may have more opportunities to understand about vaccination and its importance than illiterate
mothers and this may create favorable attitude towards infant immunization than illiterates. On the other hand,
study conducted from Oromia zone of Amhara region of Ethiopia which showed no association between
maternal education and favorable attitude towards immunization (Ashene, 2006). The discrepancy may be due
to educational back ground difference between the two study respondents since only 19% of mothers in the
present study and the majority 80% of the study participants in Oromia zone, Amhara region were illiterates,
respectively. It may be also due to study period difference and could be associated with the efforts of health
extension workers since the comparison study was conducted six years ago. Similar to knowledge association
with infants’ age, mothers who had infants aged from 3-4 years were two times more likely to develop positive
attitude about infant immunization program than mothers who had infants aged 0-1 year. This may be due to
frequent contact of immunization sessions.
Moreover, place of delivery and vaccination was also significantly associated with infant immunization
practices. In the present study, 266 (53.3%) mothers were always bringing their infants for immunization
according to the schedule given by health professionals in hospitals, followed by 140 (28%) mothers who
received vaccination for their infants at home while 46 (9.2%) and 48 (9.6%) mothers received vaccination for
their children at market and road respectively.
Regarding the objectives of this study, from the analysis we have seen that the results in tables above,
the p – values (0.010) and (0.001) are less than α value (0.05) hence; we accept the null hypothesis and conclude
that there is no significant difference in the mother’s age group with respect to vaccination and there is no
significant difference in mother’s educational status with respect to vaccination, respectively.
VIII. SUMMARY
In this study, only 53.0% of respondents had good practice and attitude towards immunization of
infants. Despite inadequate knowledge and attitude of mothers towards infant immunization, the majority 84.0%
of mothers had good practice of infant immunization. From this point of view, it is possible to conclude that
mothers’ immunization practice was not really based on their knowledge and attitude regarding immunization of
infants. Maternal education and birth order were significantly associated with good knowledge. Similarly,
Mothers’ education, infants’ aged from 3-4 years was significantly associated with favorable attitude towards
immunization of infants. Good infant immunization practice was significantly associated with mothers
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A Survey on Attitude of Mothers towards Immunization of Their Children…
education who have ever heard information about vaccination, who know correctly the time when infants should
begin immunization, who know correctly the number of sessions needed, who know the time when infants
should complete immunization and place of delivery.
IX. CONCLUSION
The analysis of the study revealed that there is significance relationship between mothers’ locality,
mothers’ religious group, place of vaccination, mothers’ educational status, age at vaccination, frequency of
vaccination, spouse educational status as well as giving gifts to mothers. It shows that the factors mentioned
above are the main factors that contributed to the attitude of mothers towards immunization. This gives an
indication that those factors should be considered and maintained as early as possible in Kebbi state of Nigeria.
X. RECOMMENDATION
This study found that the developed questionnaire was a reliable and valid tool for assessing the
attitudes of mothers towards immunization of their children in Zuru metropolis. This questionnaire should be
used in future researches on immunization for better understanding of the association between the immunization
of mothers and their children vaccination status.
In conclusion the results of the present survey showed that parents had good knowledge and positive
attitudes on some aspects related childhood immunization. However, gaps in both studied domains were
identified. Educational interventions are needed to upgrade parents’ knowledge with special emphasis on less
educated and residents of rural areas.
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DOI:10.9790/1813-0811023138 www.theijes.com Page 38
Yousuo Digieneni Anas Abubakar Maiwada "A Survey on Attitude of Mothers towards
Immunization of Their Children in Nigeria (A Case Study Zuru Metropolis)" The International
Journal of Engineering and Science (IJES), 8.11 (2019): 31-38