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ISSN 2039-2117 (online)
ISSN 2039-9340 (print)
Mediterranean Journal of Social Sciences
MCSER Publishing, Rome-Italy
Vol 6 No 2 S1
March 2015
407
A Systematic Review on Factors Affecting Community Participation towards
Polio Immunization in Nigeria
Shehu Dalhatu
Faculty of Islamic Contemporary Studies, Universiti Sultan Zainal Abidin, 21300, Kuala Terengganu, Malaysia
Norizan Abdul Ghani (PhD)
Faculty of Applied Social Sciences, Universiti Sultan Zainal Abidin, 21300, Kuala Terengganu, Malaysia
Bozkurt, Veysel (PhD)
Faculty of Economic Sociology, Istanbul University, 34452, Beyazid, Istanbul, Turkey
shehudalhatu73@gmail.com
Doi:10.5901/mjss.2015.v6n2s1p407
Abstract
Several publications have been written and reviewed to urge efforts reducing the rate of infant morbidity and mortality
throughout the world. Scientific innovations and research for efficient immunization has been able to reduce the spread of
poliomyelitis across the world and make this vaccine preventable disease a history. However, immunization coverage and
poliomyelitis disease eradication seems to be cost effective and has continued to falter in Nigeria (Nnenna et al, 2013) due to
various factors; attitude, culture, beliefs, religions, politics, economy, conspiracies, boycotts and human suspicions. The main
objectives of this study are; to identify the potential factors affecting immunization coverage in Nigeria and provide
recommendations towards total poliomyelitis eradication. Four electronic databases including Science Direct, Springer Link,
Pub-Med and MedLine were used to access over 52 academic journal articles where detailed inclusion and exclusion criteria
were adopted to select various studies related to polio immunization within the Nigerian context, but only 18 were found to be
related to the topic and met inclusion criteria, using search engines like Freefullpdf, HotBot and Google Scholar. Studies
pertaining polio eradication conducted in Nigeria from 2010-1014 were included in this study. Knowledge, attitude, and practice
(KAP) or community participation in polio immunization had been made priority. The study was carried out from May to
September 2014. Further research should explore the factors affecting community participation in polio immunization
particularly on parents’ beliefs and attitudes towards poliomyelitis disease as well as design possible plans to engage
community leaders achieving total immunization coverage as a whole.
Keywords: community participation, immunization, polio, knowledge and attitude
1. Background
The World Health Assembly (WHA) has concluded that poliomyelitis should be eradicated from the human community
(Globally) by the year 2000 (Donbraye et al, 2011). This program of polio eradication involves halting the incidence of the
disease and worldwide eradication of the virus. Focusing on the African region (AFRO) of the World Health Organization
(WHO), eradication procedures and strategies were accelerated following the supporting resolution by WHO’s Regional
committee for Africa in 1995 and the organization for African Unity (OAU) in 1996. Remarkable efforts and attempts to
reduce high morbidity and mortality rates among infants’ children as an initiative began in 1988 (Donbraye et al, 2011).
Available records indicate that with the absence and rejection of immunization, about 216,000 Nigerian children will
die each year, an average of about 600 per day (Imoh, 2013) and an additional 100,000children are liable to physical
disability. Measles in particular is a major community health problem with an estimate of 3.6 million cases occurring
annually that result in about 108,000 infant mortalities and 54,000 morbidities (UNICEF, 1985). Nigeria is one of the few
countries in the world where the wild polio virus is highly endemic (Imoh, 2013). In an attempt to tackle this, the Nigerian
government embarked upon the Expanded Program on Immunization (EPI) in 1975, with collaboration from the World
Health Organization (WHO) and UNICEF, mainly to achieve 80 percent of the eradication coverage within the target
population by the year 1990. But owing to a lack of human and material resources allocated to the program, political
maneuvers and discontinuity of government policies and unreliable commitments, lack of efficient communication
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between policy makers, implementers and beneficiaries of the program, the objectives were not achieved, (Imoh,1991).
The strategies designed for the achievement of the program included routine immunization, targeted mop-ups,
campaigns for polio eradication in the form of door to door immunization of children in the focal area, and Supplementary
Immunization Days (SIDs) conducted rapidly to boost immunity for all children under 5years of age, regardless of their
immunization records. These objectives had not been achieved because of the communication failure between technical
and operational aspects, and community participation was taken granted (Imoh, 2013).
Scientific researchers had already discovered that poliovirus, an entrovirus in the family of picornaviridae consists
of antigenic serotypes 1 2 3 and all the three cause paralysis (Soji et al,2012). In an attempt to eradicate the wild polio
virus, vaccination with the oral polio vaccine (OPV) was recommended to induce adequate immunity in children, but it is
still endemic in Nigeria. Past evaluators of the (NPI) program were products oriented, rather than process, they based the
program on impact about knowledge and behavior intervention in the target population only, without recourse to the
prevailing socio cultural, organizational and communication variables. Because of the growing importance of
immunization as a global strategy for reducing infant deaths, and the massive human and financial resources allocated to
the program by the federal, state, and local governments and donors agencies like WHO, UNICEF and USAID, it is
compulsory to monitor the process and viability of the communication strategies used in ensuring the involvement and
participation of policy and decision makers, community and community leaders, community scholars, religious leaders,
community groups, stakeholders, media personnel, individuals, and families (Imoh,2013).
The National Program on Immunization (NPI) is a people oriented program with government support. To create
demand for the program, the support, involvement and participation of mothers with children, policy and decision makers,
health workers, professional groups, community leaders, and community groups are all need at the level of
implementation, (Imoh, 2013). In Nigeria, polio eradication and immunization programs are still voluntary, free cost
effective, and its success is still upon voluntary demands and media messages directed to the community audience to
stimulate a proper attitude and awareness of the immunization program. Yet the implementation and utilization level has
been far short of the specific target population, because over half of the Nigerians live in rural habitats where mass media
involvement in promotional activities is minimal because of urban bias in location and reach of mass media institutions.
Polio immunization coverage in Nigeria has to go along with community participation and social mobilization by
integrating social reinforcing factors that can bring differences between intention and performances into proper
achievement,, as stated by (Green, 1984)[5] that in the diffusion of innovation about new ideas, social reinforcing factors
can make the difference between intention and performances, as such there is need for integration of opinions of leaders,
in sociological tradition within the dissemination channels in influencing individual immunization behavior towards polio
eradication (Imoh, 2013).
Immunization gives total protection and adequate immunity to children and humans in general. It has been
detected that active immunization has turn many childhood disease into distant memories among industrialized countries
(Nnenna et al,2013). Immunization needs to be offered at every opportunity with the aim of eliminating vaccine
preventable diseases. In the Nigerian context however, studies have shown that immunization coverage is declining,
because of the failure to access immunization targets of children during visits to facilities and failure to administer all the
needed vaccines simultaneously (Tagbo BN, et al, 2005)[7].
Nigeria is a country in the West African region, blessed with abundant crude oil and other natural resources. It
shares boundaries with Cameroon and Chad in the east, the Republic of Benin in the west, and Niger Republic in the
north with estimated total population of about 150 million people (NPC, 2006).
2. Objectives
The objectives of this study are as follows:
i. To evaluate the contribution of education and awareness on community participation in polio immunization
ii. To evaluate the effect of community attitudes and beliefs towards participation in polio immunization
iv. To evaluate the degree of community participation in polio immunization
v. To recommend the way forward for eradicating polio through efficient sensitization and educational provision
on health seeking behavior
3. Operational Definition
Polio (poliomyelitis) is an infectious disease which is caused by a virus. It can affect the nervous system causing partial or
total and permanent paralysis of body muscles in limbs, and muscles in the respiratory system and swallowing, so it may
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be fatal. Polio virus transmits from person to person with transmission usually through the faeco oral route (Khan S A,
2010). Immunization is the process whereby a person is made immune or resistant to an infectious disease typically by
the administration of a vaccine. Vaccine stimulates the body’s own immune system to protect the person against
subsequent infection or disease. Recent developments and progressive efforts suggest the total eradication of the
disease is possible through joint forces of different bodies, from government to non-governmental organizations,
stakeholders, and community involvement in general. Launch of Global Polio Eradication Initiatives in 1988, and the
intensification of activities like Routine Immunizations (Ris), Supplementary Immunization Days (SIDs), Mop-ups, Acute
Flaccid Paralysis (AFPs) surveillance, (Baba and Ayivor 2012), contribute towards polio eradication in Nigeria.
Community is a social group of any size whose members reside in a specific locality, share government and upon
have a common cultural and historical heritage. Participation is a joint consultation in decision making, goal setting profit
sharing, team work and other measures. It is also a condition of sharing with others in the activities of a group or society.
4. Methods and Materials
The article focused mainly on researches conducted on polio immunization in Nigeria and the factors affecting the
immunization coverage from social, political, cultural, religious and economic influences (Theeten et al, 2007).
Study Selection: All studies carried out from 2010-2014 were selected because they were the most recent
publications and will reveal the current situation of what is obtainable in the country (Nigeria) about polio immunization.
Data Sources: Four electronic data sources were included, these are Science Direct, Springer link, PubMed, and
MEDLINE; to obtain 52 academic journal articles on mothers attitude, beliefs, perception, and knowledge of households
towards childhoodimmunization, using Freefullpdf, Google scholar, and HOTBOT as search engines. The search terms
were community participation, polio immunization, factors affecting polio immunization in Nigeria, mothers knowledge,
attitude and participation, parental perception, and parental decision making on childhood immunization.
Inclusion Criteria: Only studies carried out from 2010-2014 were selected, and knowledge, attitude, and
participation of community or specifically nursing mothers were include.
Excluded Criteria: All studies conducted before 2010 and studies on general public KAP were excluded. Studies on
professional pediatrics, emergency and treatment of paralysis were also excluded; studies not carried out in Nigeria were
also discarded. All the references of the initial articles that met the inclusion criteria were cross checked and more
relevant articles were retrieved for inclusion.
Data Extraction: Researches from different parts of Nigeria were selected and finally 18 academic journal articles
were chosen to be examined, analyzed and reviewed based on inclusion and exclusion criteria.
5. Results
Description of the Articles Included and Reviewed: A total of 18 articles obtained from different sources that met the
inclusion criteria were reviewed and analyzed. Three of the studies (Antai D, 2010; Baba and Ayivor, 2012; Antai D,
2012) are retrospectives with secondary data (readymade), in which the first assessed the effect of individual and
community level participation, the second evaluate the good, the bad and the ugly aspects of polio in Nigeria, and
assessed the association between multiple dimensions of gender inequalities and full childhood immunization. The
remaining fifteen articles (Alfred and Alfred, 2012; Nnenna et al, 2013; Iliayasu Z, et al, 2014; Itimi et al, 2012; Ogwumike
et al, 2012; Ekure et al, 2013; Tagbo B N, et al, 2012; Oyefara J L, 2014; Awodele O. et al, 2010; Oladejo O P et al,
2013; Abdulraheemetet al, 2011; Singh et al, 2013; Rahji and Ndikom, 2013; Ita et al, 2012; Olawepo and Fashagba,
2014) were purely cross sectional descriptive studies. Two (Iliayasu Z, et al, 2010; Oladejo O P et al, 2013)of the studies
were conducted to assess the serological response of OPV to trivalent formulation in order to observe the seroconversion
rate among the OPV recipients and the other was a seroprevalence survey of neonates and infants children.
A majority of the studies were conducted to assess the knowledge, attitude, and perception of the nursing mothers
and to assess the degree of their participation in polio immunization programs. All the studies were also conducted in
Nigeria; fourteen out of eighteen articles were surveys of professionals in medicine, pharmacology, and pediatrics
department in different University Teaching Hospitals in Nigeria. Only one article was written by a professor in geography.
Five surveys from pharmacists, pediatricians and doctors were conducted at practice settings which included teaching
hospitals, general hospitals and laboratories (Nnenna et al, 2013; Iliayasu Z et al, 2014; Ogwumike et al, 2012; Tagbo B
N et al, 2012; Awodele O et al, 2010), while thirteen conducted the research within the community settings (Antai D,
2010; Alfred and Alfred, 2012; Baba and Ayivor, 2012; Itimi et al. 2012; Ekure et al, 2013; Oyefara J L, 2014; Oladejo O
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P, 2013; Antai D, 2012; Abdulraheem et al,2011 Singh et al, 2013; Rahji and Ndikom, 2013; Ita et al, 2012; Olawepo and
Fashagba,2014). Two of the articles focused on rural households’ perception and rural women childhood immunization
(Alfred and Alfred, 2012; Olawepo Fashagba, 2014). (Nnenna et al, 2013; Ekure et al, 2013; Tagbo B N et al 2012;
Oyefara J L, 2014; Awodele O, et al, 2010; Singh et al, 2013; Rahji and Ndikom, 2013)have discussed about the
knowledge, attitude, perception and practice of mothers towards polio immunization. Two papers (Iliayasu Z et al, 2014;
Oladejo O P et al, 2013) discussed the seroprevalence and neutralization of antibodies, children with paralytic
poliomyelitis (Ogwumike et al, 2012), gender inequalities (Antai D, 2012), reasons for incomplete vaccination
(Abdulraheem I S et al, 2011), immunization coverage (Ita et al, 2012), polio vaccination in Nigeria the good, the bad, and
the ugly (Baba and Ayivor, 20212), and community participation in childhood immunization in Nigeria (Itimi et al, 2012).
Fourteen surveys had a response rate of over 50% for community participation in polio immunization program
(Antai D, 2010; Alfred and Alfred, 2012; Nnenna et al, 2013; Baba and Ayivor, 2012; Iliayasu Z et al, 2014;Ogwumike et
al, 2012; Oyefara J L, 2014; Awodele O,2010;Oladejo O P, 2013; Antai D, 2012; Singh et al, 2013; Rahji and Ndiko,
2013; Ita et al, 2012; Olawepo and Fashagba,2014).
6. Parents (Mothers) Participation Towards Polio Immunization
Four main themes were identified with respects to the factors affecting community participation in polio immunization in
Nigeria; these are the level of participation, geographical location, demographic status, and reasons for acceptance and
rejection.
Level of Participation: There was little consistency within and among the study surveys in the context and content
of polio eradication factors that hampered the immunization coverage in Nigeria, especially considering the general level
of parent and community participation. In one of the studies conducted, it was found that the majority of the respondents
(98%) were self employed implying their timely availability for the program, (Alfred and Alfred, 2012), 56%of the
households had high participation, it could be inferred that the households in the study area embraced the expanded
program of immunization, this might however be unconnected with the door to door approach (Alfred and Alfred,
2012).There is also a positive finding that proved the encouraging level of participation of mothers in polio immunization
carried out in Nigeria, 95.2%took their children for immunization (Tagbo et al,2012), 91.7%(Oyefara, 2012), 75.4%
(Tagbo et al, 2012), 57.7% (Alfred and Alfred, 2012),[13] 80.4%(Raji and Ndikom, 2013), of mothers immunized their
children completely. In another study, 93.9% of the children had been immunized (Ekure et al, 2013), 90% of the
immunization services is covered of Deptheria Petusis Tetanus Injection (DPT1) and Bacillus Calmette Guerin or
BCG(Ekure et al, 2013). Another study found that 65.2% of the children were fully immunized (Ita et al, 2012), also
positive findings have shown that 52.5% of the children were immunized irrespective of gender (Oladejo et al, 2013). In
contrast, some studies indicated low participation towards polio immunization as the DPT dropout rate was 77.34% (Itimi
et al, 2012) and 27% (Olawepo and Fashagba, 2014), of the total respondents were partially immunized and did not
complete their immunization package. There is also a likelyhood of not receiving full participation in immunization from
the children of women lacking decision making autonomy, odd ratio 0.74 (Antai, 2012).
Geographical Location on Participation: Based on several survey findings it appears that there is a perceived lack
of full participation on polio immunization based on geographical location in different rural and urban areas in Nigeria. A
study reported that out of 84 polio cases obtained so far 42%were from high risk LGAs in northern Nigeria (Baba and
Ayivor, 2012), 65.2% immunization coverage double the estimate of the zonal coverage (Ita et al, 2012), as more 50%
(Itimi et al, 2012) of the respondents in the urban community than in the rural community. The opposite result was found
in a study by epidemiologists that 77.7% (Antai, 2010) of the rural non-migrant children received Oral Polio Vaccine
(OPV)1, but most of the rural-urban had not been fully immunized as 8.5% only received OPV1. 77.11% difference in the
speed of immunization is associated with differences in accessibility of mothers to hospitals (Olawepo and Fashagbe,
2014), and another study reported that 67% of all cases were in local government areas (Baba and Ayivor, 2012).
Demographic Status: There is a strong agreement among researches concerning the influence of socio-economic
demographic status in relation to the full participation of the community towards polio immunization and health seeking
behavior. One of the studies found that 98% (Raji and Ndikom, 2013) of the respondents claimed that occupation allow
them to take their children for immunization, also positive findings at odd ratio 0.57(Antai, 2010) children of mothers
without employment had a high likelihood of full immunization. In contrast, children of poor mothers with an odd ratio of
0.45(Antai, 2010) had lower likelihood of full immunization, this agreed with 45% (Singh et al, 2012) of mothers with
lowest wealth quintiles. However, the likelihood of childhood immunization is significantly higher for children of mothers
34years or older with odd ratio of 1.54 and there is a likelihood of receiving full immunization among female children with
an odd ratio of 1.28 (Antai, 2012).
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Reasons for Acceptance and Rejection on Participation in Polio Immunization: Survey data indicates that the
majority of the respondents would not continue immunization if the child suffered adverse effects as 80% (Nnenna et al,
2013), and 37% (Baba and Ayivor, 2012) reject immunization because of the unreliable safety of the vaccine, 30%
(Ekurae, et al 2013)would not take their children because of the side effects,50% (Ekure, et al, 2013)would not immunize
their children if the child was taking antibiotics, 17.23% (Itimi et al 2012) due to adverse rumor, and 17.4% (Tagbo et
al,2012) due to ill health 37.2% (Oyefara et al, 2014) due to long distance, lastly42% (Baba and Ayivor, 2012) had no
reasons. 60% (Baba and Ayivor et al 2012)were obtained from endemic northern states Katsina, Kano and Kaduna due
to religious and cultural ethics. In contrast, over 40% (Ekure et al, 2013), would not accept polio vaccination during NIDs,
55.6% felt cost of immunization is affordable. Furthermore 38.8% (Abdulraheem, et al 2011), of the respondents disagree
with vaccine safety, 98.0% (Raji and Ndikom,2013)contended that they worry about the side effects of immunization, and
60.8%of the respondents disagree with immunization because of the health workers behaviour and attitudes. Similarly in
two other studies conducted it was found that 72.10% (Olawepo and Fashagba, 2014) of the respondents rejected polio
because of religion and culture factors, only 2%(Raji and Ndikom, 2013) of the respondents said that their religion did not
allow them to take their children for immunization.
Education: There are two themes identified with respect to the influence of education (knowledge), and awareness
in relation to the positive effects of polio vaccines towards eradication of the polio virus and improving the degree of
immunity into the body system of our neonates and infants children in our community. These themes include the level of
education and the level of awareness.
Level of Education: Based on several survey findings conducted at different aspects in Nigeria, there is consistent
agreement that education plays a great role in influencing the attitude, awareness, perception and full participation
towards polio immunization programs in the community. Survey data indicates that 98% (Iliayasu. Z, 2014) of the children
whose mothers had tertiary or secondary education may receive 4 total doses, compared to 85% whose mothers had
primary education or less, and 83% of children whose mothers had tertiary education in general. In another study, 64.6%
(Awodele et al, 2010), of the respondents had tertiary education and 32.2% were professionals, 55.0% (Alfred and Alfred,
2012), stated that there was high literacy level among the households which influence the rate of immunization coverage.
Other findings prove that 50.1% of the households had tertiary education having no problem with polio participation,
(Nnenna et al, 2013), 86.9% of women with secondary education had fully immunized their children compared to 38.9%
of women without any formal education (Oyefara et al, 2014). One study reported that at odd ratio 2.05, of the children
whose mothers were more educated than their spouse, were likely to receive full immunization.
Level of Awareness: According to study findings from various researchers concerning the role of human
awareness on any innovation, awareness plays a key role in adoption of innovation especially with issues related to
health promotion and health seeking behavior. Polio immunization programs have gone through so many challenges
socially, politically, religiously and culturally. Levels of awareness in a community tend to determine the level of health
status, development and productivity. It was evident that a majority of the mothers 80% (Nnenna et al, 2013) knew and
were aware of the reasons why children are immunized. In another study, most mothers, 89.8% knew that the major
content of the vaccines substances could help prevent the killer disease (Nnenna et al, 2013). Also another study indicate
that 81.1% of the parents acknowledge that children who did not obtain or had an incomplete immunization were at risk of
poliomyelitis, (Ogwumikeet al, 2012), 100% of the respondent mothers were aware and had heard about the benefits of
immunization (Ekure et al,2013). Similar findings had also indicates that 100% (Raji and Ndikom, 2013) of the
respondents were conscious of where to get immunization., 93.8% (Awodele et al, 2010) are aware of the immunization,
and 98.1% said immunization could prevent disease, 77.8% (Ekure et al,2013) of the mothers are aware and recognized
the benefit of immunization as prevention of disease. Similarly one study found that 81.2% (Tagbo et al, 2012) of the
respondents had known the reasons of immunization. Another study reported 72.7% (Abdulraheem et al, 2011) of the
mothers were aware of the polio information through health workers. Some other studies verified that 82.5% (Ogwumeke
et al, 2012) of the respondents’ parents knew that paralytic poliomyelitis mainly affects children under 5years of age. Of
note, 79.6% (Ekure et al, 2013)of the nursing mothers were aware of BCG, similar results also supported mothers
awareness where 82.5% (Awodele et al, 2010) of the respondent mothers knew that immunization could be administered
as an inject able and mouth drop, in contrast with this study,12.8% of the mothers knew BCG was being given at birth.
Generally however 77% of the women in the selected rural communities had heard about the National Program of
Immunization NPI in one way or another (Olawepo and Fashagba, 2014).
Attitude Towards Polio Immunization: Attitudes and beliefs are synonymous with one another, and often influence
the behavior of human beings towards decision making. Attitudes of people are the most influential factor that determines
the success of innovation and adoption of programs like polio immunization. This study categorized attitude into two
themes; Nature of attitudes (positive or negative) and religious/traditional beliefs.
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Nature of Attitudes on Polio Immunization: Survey data indicates that participation (respondents) in polio
immunization develops a specific attitude towards acceptances or rejection of polio immunization programs in Nigeria.
Some studies found that 55.3% (Ogwumike et al, 2012) of the respondents were found to have a positive attitude, while
in another study, 52% (Singh et al, 2012) of the women indicated that wife beating is never acceptable and had a
correlation with being more likely to have their child fully immunized than those who believed that wife beating has
acceptable.
Religious and Traditional Beliefs on Polio Immunization: Mothers and parents in general, beliefs towards polio
immunization was quite encouraging, surveys carried out indicate that 98.7% of the mothers have a favorable disposition
to immunization, 80.9% of the respondent mothers would continue with immunization in view of the adverse effects,
(Nnenna et al, 2013). In addition to this, 59% (Ogwumike et al, 2012) of the mothers agreed that a paralytic poliomyelitis
child should be accepted as a normal child in the society, and immunization is the solution to this problem for the future
generation, (new born/neonates), 65.4% (Awodele et al, 2010) of the respondents believed that they can advise their
fellow women to receive immunization for their children. Furthermore 66.5% of the mothers were convinced that
immunization is necessary for their children, (Awodele et al,2010), and 64.6%of the respondent mothers reject the view of
spiritual witches or evil attacks as the cause of paralytic poliomyelitis (Ogwumike et al, 2012). Some surveys also
reported 98% (Raji and Ndikom, 2013)of the respondents stating that their religious beliefs did not affect their decision
towards child immunization and even some mothers disagreed with the notion that a mother’s occupation constitutes an
obstacle to their participation and compliance in child immunization. Lastly, 77% of the respondent mothers strongly
agreed that seeking medical help is the best treatment option for children with paralytic poliomyelitis, not spiritual and
witches, (Ogwumike et al, 2012). In all the survey articles reviewed, only one study with 1.5% (Awodele, et al, 2010)
reported some respondents who thought the polio vaccine/ immunization caused HIV/AIDS.
7. Discussion
Parent’s Education: By observing the nature of critical review, the homogeneous data indicated that, it is possible to draw
a conclusion about parent’s educational level as the most vital role in decision making towards achieving maximum
coverage of polio eradication in Nigeria. The vast majority of the mothers interviewed possessed some formal education
that encouraged them to summit their children for polio immunization (Alfred and Alfred, 2012). It can also be deduced
that mothers with a high education level are more likely to immunize their children than those mothers with primary or non
formal education. Similarly some surveys conclude that women who were more educated than their spouses were more
likely to give full immunization to their children, than women without education, (Antai, 2012). Further surveys reported
that the level of households’ education contributes significantly to the acceptance of polio immunization, (Nnennaet al,
2013). Awareness is another key role in the adoption of new ideas towards solving human problems, especially that relate
to health seeking behavior. In the surveys conducted, a majority of the mothers were aware about the vaccines and
reasons for immunization, and even had some knowledge of the chemical constituents of vaccines and its usage as to
help in the prevention of killer diseases (Nnenna et al, 2013). It is important to note that a majority of the mothers and
both parents were aware of and had heard about the benefits of the vaccines, (Ekure et al, 2013). Parents also
acknowledged that children who did not receive polio vaccines were high at risk of poliomyelitis (Ogwumike et al, 2012)
because they know that paralytic poliomyelitis affects children under five years of age. A majority of the mare also do
aware of where to get immunization for their children (Raji and Ndikom, 2013) and are aware that immunization could
really prevent poliomyelitis disease and total paralysis (Ekuna et al, 2013). Other mothers had confirmed that oral polio
vaccine immunization could be in the form of an injection or mouth-drop, (Awodele et al, 2010) and that BCG is given to
children at birth. Almost all the women in the rural communities were aware of the polio immunization program (Olawepo
and Fashagba, 2014).
Parents (Mothers) Attitudes: Mothers whose children suffered from polio attack resulting in partial or total paralysis
did not believe the physical deformity was a result of spiritual witches or evil (Ogwumike et al, 2012). Religious and
cultural beliefs had shown that health seeking behavior is in line with the Islamic and Christian jurisprudence (Raji and
Ndikom, 2013). It is also encouraging to state that any adverse effects or reaction is not regarded as an illness worse
than poliomyelitis. Some mothers continued taking their children for vaccination even if the side effects persisted (Nnenna
et al, 2013). A majority of the nursing mothers were greatly convinced that immunization is necessary for children from 0-
5 years old, (Awodele et al, 2010). In contrast only 1.5% of the mothers had the belief that polio vaccines cause
HIV/AIDS. This was due to the political and social propaganda deduced from several conspiracy theories in order to avert
the efforts of the international organizations in eradicating the poliovirus from the human race.
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Parents (Mothers) Participation: According to various study outcomes, mothers’ participation towards polio
immunization was far beyond expectation. The rate at which mothers participated in child immunization was quite
overwhelming because a greater percentage of the respondent mothers embraced in totality the program of polio
immunization in spite of human commitments and struggle especially in Nigeria. Parents need not be forced to immunize
their children, and do not have to do with door to door approach (Alfred and Alfred, 2012), and children were immunized
irrespective of their gender, male or female, (Oladejo et al, 2013). Geographical location also helps to determine the level
of community participation towards polio eradication. This is evident because a study reported that there is a higher
immunization participation coverage in urban areas than rural (Itimi et al, 2012), and the speed of immunization coverage
is highly associated with access roads, hospitals, and other health facilities.
Demographic status also plays a vital influence towards acceptance of polio immunization among various
communities in Nigeria, survey data reported that the level of employment or occupation is likely related to high
participation of community members into health related activities like polio immunization. A majority of the respondents
claimed that occupation did not deter them from immunizing their children. Mothers with employment are more likely to
immunize their children than those without occupation (Antai, 2010). Mothers continue to accept polio vaccines for their
children even if there are high adverse reactions (Nnenna et al, 2013). But there are certain percentages of mothers that
disagree with polio immunization simply because of health workers negative and antisocial attitudes (Raji and Ndikom,
2013) and some mothers reject and did not fully participate because of religious and cultural principles (Olawepo and
Fashagba,2014).
8. Conclusion
From this systematic review, there is a need to educate the community to become aware about their sensitization and
mobilization on the effects and disastrous nature of paralytic poliomyelitis. There also a need to educate mothers about
the significant value and impact of polio vaccines to benefit the immunity of their infant children. Moreover, emphasis
should be placed on educating the community and in cooperating with associations, organizations, social clubs,
traditional leaders, occupational leaders involved in the polio immunization activities. In addition, future surveys should
focus on assessing the opinions and behavior of parents with respect to socio-economic characteristics in direct
proportional relation to the high rate of paralytic poliomyelitis victims in the society. Adult education programs in the rural
areas should be implemented to reduce the rate of illiteracy, misguidance, lack of awareness, and conservative attitudes
from different communities in Nigeria. The government at all levels should review the curriculum in education and include
professional social and psychological knowledge that will help health workers to effectively deliver modern services and
practices to the patients. In the community context, health seeking education, health living education so as to improve the
individual and community health status.
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S/N Year First Author Study Design Study participants Settings Respnse
Rate and
Sample size measured Outcome Conclusion
1 2010 Antai, D Rhetrospective
Demographic Health
Survey
Stratified two stage
Cluster sampling of
migrants Mothers
and children
Rural and Urban
areas
89% (Sample
size of 6029
children from
n=2735
mothers)
Commmunity and individual
characteristics determinants of
immunization participation
The study revealed that their is individual
and community level influence
associated with full children immunization
2 2010 Awodele.O
Descriptivecross-
sectionalstudy and
Standard structured
questionnairre
Recruiting all
Mothers attending
antenatal Clinics
Lagos
stateUniversity
Teaching Hospital
93.8%
(n=274) Knowledge and attitude
The study revealed that majority of the
mothers had good knowledge of
immunization, and awareness, no
relationship between ethnicity and
awareness
3 2011
A
bdulraheem,
I S
Cross Sectional study
design by using
immunization cards
Cluster Sampling
Technique of
Mothers of Children
within one year of
age
Rural Areas 96.8%
(n=1117) Knowledge, attitudes, beliefs
and perception of mothers
The study revealed that the reasons for
missed immunization include parente
ojection and disagreement about
immunization safety and religious
affliation
4 2012 Antai, D Rhetrospective
Demographic Health
Survey
Stratified two-stage
cluster sample
design of Lived born
children
Rural Areas 100% (n=
24,910)
A
ttitude of gender in equities of
parents and child immunization,
socio-cultural context, local
perception of decisional process
in households and of childhood
disease
The study findings indicates that
autonomy and power relationship dictate
the fate of the family,and determine the
decision making
5 2012 Ita, A O Cross sectional study
design, structured
questionnaire Random sampling Rural Areas 100%
(n=2432)
Perception of mothers, and
psychological fear of sude
reaction
Based on the findings of this research,
there is relatively high immunization
coverage, availability of health facilities,
and delivery by trained personnel is
associated with full immunization. Fear of
side reaction is one of the reasons of
immunization failure
6 2012 Alfred, S D Interviewed structured
questionnairre Random samples of
households Rural and Urban
areas 100%
(n=180) participation, perception
awareness and religion The degree of partcipation is more on
younger mothers which is related to high
ISSN 2039-2117 (online)
ISSN 2039-9340 (print)
Mediterranean Journal of Social Sciences
MCSER Publishing, Rome-Italy
Vol 6 No 2 S1
March 2015
415
awareness
7 2012 Baba M M Rhetrospective data Regional sampling of
endemic states Rural and urban 100% (11
states)
Acceptance, missed, and non-
compliance of polio
immunization
There is decline in political over sight at
critical juncture and non
implementationof emergncy plans in the
key infected areas
8 2012 Itimi, K Cross sectional
comparative study
design
Random sample of
the female head
households
Rural and Urban
Areas % not stated,
(n=558)
A
ttitudes and perception.
Comparism of immunization
coverage by assessing the the
possible effects participation,
The immunization coverage in the rural
areas is better than that of urban
communities which is attributed to better
mobilization
9 2012
Ogwumike, O
O
Cross sectional study, a
structured researcher
administered
questionnaire
Ramdom sampling of
Parents Hospitals and
Schools 100%
(n=217) Knowledge, attitudes and beliefs The study revealed good knowledge,
attitudes, and beliefs about paralytic
poliomyelitis
10 2012 Tagbo, B N
Cross sectional
descriptive study,
structured interviewer
administered
questionnaire
Random sampling of
Mothers with atleast
one child less than
five years
Children clinic of
University of
Nigeria teaching
hospital Ituku-
Ozalla
100%,
(n=207) Knowledge, perception and
practice
Most mothers has favourable disposition
about immunization, good knowledge
and positive perception towards
vaccination, maternal education is
associated with knowledge and
acceptance of immunization
11 2012 Singh, K
Rhetrospective
Descriptive survey
design from Nigeria
Demographic Survey
Not stated Rural and Urban
areas 100%
(n=3454) Maternal autonomy and attiudes,
towards decision making
This survey revealed the importance of
autonomy and positive attitues towards
as a key child health outcomes and
influence of cultural context
12 2013 Fatima, R
Cross sectional
survey,interviewer
administered
questionnaire
Systematic sampling
method nursing
mothers with chldren
of 0-12months
Urban area 100%
(n=153) Participation and perception of
nursing mothers
The study revealed that nursing mothers
has fear over side effects, occupation
and religion is not a barrier, health
workers behaviour discourage
compliance
13 2013 Nnenna , B N
Cross sectional survey,
using structured
interviewer administered
questionnaire
Random sampling of
mothers with atleast
one <5 years
Urban area,
children clinics of
University of
Nigeria Teaching
Hospital
100%
(n=235)
Mothers knowledge and
perception of adverse events
following imunization
There is poor knwledge of immunization
and the adverse events that could follow
immunizationthere need for effective
community participation
14 2013 Oladejo, O P Descrptive cross
sectional study
Simple random
sampling of children
and young adults
Federal Medical
Centre Bida and
Genral Hospital
Bida
100%
(n=200) Serological response of OPV
recipients
The study indicates that the responsives
against polio virus vaccinnes varied
much between children at different ages
15 2013 Ekure, E N
Discriptive cross
sectional study using
interviewer-
administered
questionnaire
Convenience and
Simple sampling of
mothers
Urban area Ile-Ife
town hall 90% (n= 40) Mothers knowledge, attitudes,
and practice of chlid
immunization
The survey revealed that there is gaps of
knowledge and negative attitudes
towards children immunization
16 2014 Olawepo, R A Cross sectional study
survey,using structured
questionnare
Random sampling of
mothers Rural Areas 100%
(n=427)
Assessment of awareness,
source of information and
moothers participation in polio
immunization
The findings of the research shows that
there was ide acceptability and this
could a reflection of health behaviour of
nusing mothers towards child
immunization
17 2014 Oyefara, J L Cross sectional survey,
structured questionnaire
Multi stage Random
sampling of rural
mothers Urban settings 94% (n=280) Motherseducation, wealth,
religiousand occupational status
towards polio immunization
There is significants role of mothers
characteristics in immunzation
18 2014 Iliayasu, Z Cross sectional survey,
using self completed
questionnaire
Seroprevalence
survey, through
enrolment and
screening of infants
child
Murtala muhammad
specialist hospital 95% (n=327) The seroprevalence to poliovirus
type 1 and type 3 among
children aged 36-47 months
Ther is lower seroprevalence, than the
required level of expectation the
persistance of immunity gapsin the 36-47
months group is wide
