1.1 Introduction
Immunization is the process by which a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body's immune system to recognize and fight specific pathogens, thereby preventing morbidity and mortality associated with infectious diseases (World Health Organization, 2019). Immunization is widely recognized as one of the most effective public health interventions, particularly for children under five years, who are highly susceptible to preventable diseases such as measles, polio, diphtheria, and whooping cough (Adeniyi et al., 2023). The health and survival of children are closely linked to maternal knowledge, attitude, and practice regarding immunization. Knowledge refers to the awareness and understanding of immunization schedules, vaccine-preventable diseases, and the benefits of timely vaccination (Lamiya, Mundodan & Haveri, 2019).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the aim and objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.
1.2 Background of Study
Historically, immunization dates back centuries, with early attempts at disease prevention taking the form of variolation, a practice reported in ancient China and the Ottoman Empire, where individuals were deliberately exposed to small amounts of smallpox to induce immunity (World Health Organization, 2019). Edward Jenner's introduction of the smallpox vaccine in 1796 marked the modern era of immunization, establishing vaccination as a scientific method to prevent infectious diseases (Plotkin, 2014). Over time, vaccines have been developed for numerous childhood illnesses, including polio, measles, diphtheria, tetanus, pertussis, and hepatitis B, which have collectively reduced morbidity and mortality rates globally (Adeniyi et al., 2023).
In Nigeria, immunization programs have evolved significantly. According to Okoro et al. (2020), the Expanded Programme on Immunization (EPI) was introduced in 1979 to provide routine vaccination services to children under five, with the aim of reducing preventable childhood deaths. The National Primary Health Care Development Agency (NPHCDA) later assumed responsibility for coordinating immunization efforts, including the introduction of new vaccines such as the pentavalent vaccine and rotavirus vaccine. Despite these efforts, under-five mortality rates remain high in some regions due to incomplete vaccination coverage and irregular attendance at immunization sessions.
Immunization is globally acknowledged as a vital public health intervention that protects children from preventable diseases. According to the World Health Organization (2019), vaccines are essential in reducing childhood morbidity and mortality, particularly among under-five children who are highly vulnerable to infections such as measles, polio, diphtheria, pertussis, and tuberculosis. Immunization not only improves individual health outcomes but also contributes to community-wide herd immunity, preventing the spread of infectious diseases.
The success of immunization programs, however, depends largely on maternal knowledge, attitude, and practice regarding childhood vaccines. Lamiya, Mundodan, and Haveri (2019) reported that adequate maternal knowledge of immunization schedules, vaccine-preventable diseases, and the benefits of vaccination significantly influences adherence to immunization programs. They asserted that mothers with comprehensive knowledge are more likely to ensure that their children receive vaccines on time and complete the full immunization schedule.
Attitude towards immunization is another critical factor in vaccine uptake. Adeniyi et al. (2023) stated that positive maternal attitudes, including trust in vaccines and belief in their safety and efficacy, strongly correlate with higher immunization coverage. Conversely, misconceptions, fear of side effects, and cultural beliefs often undermine positive attitudes, leading to incomplete or delayed immunization. Similarly, Adefolalu, Kanma-Okafor, and Balogun (2019) affirmed that even when mothers are aware of the benefits of vaccines, negative attitudes and reluctance to utilize immunization services contribute to suboptimal child health outcomes.
The practice of immunization, which includes timely vaccination, retention of vaccination cards, and completion of the recommended schedule, is influenced by both maternal factors and health system-related issues. Nafila (2019) contended that practical barriers such as long waiting times at clinics, distance to health facilities, vaccine stock-outs, and inadequate record-keeping impede full immunization coverage. On the other hand, Tiwari and Vishwakarma (2019) reported that regular engagement with healthcare providers during antenatal visits improves maternal compliance with immunization practices, highlighting the importance of antenatal clinics as platforms for health education and vaccine promotion. This study is set against the backdrop of the need to assess the knowledge, attitude, and practice regarding immunization of under-five children among mothers attending antenatal clinics (ANC).
1.3 Statement of Problems
In many communities, mothers of children under five years still exhibit insufficient knowledge regarding immunization. Awareness of vaccines is generally present, but detailed understanding of which vaccines are given, the diseases they prevent, contraindications, and the correct immunization schedule is often lacking (Lamiya, Mundodan & Haveri, 2019).
On the other hand, the attitude of mothers toward immunizing their under-five children is often positive. Many mothers recognize that immunization is beneficial and essential for child health. In addition, some mothers still hold fears of side-effects, misunderstand the purpose of certain vaccines, or prioritize other responsibilities over clinic visits, which negatively affects immunization uptake (Adeniyi et al., 2023).
Furthermore, full adherence to immunization schedules, retention of vaccination cards, and timely administration of vaccines are inconsistent. Many children do not receive the full schedule of vaccines or receive them late due to factors such as long waiting times, distance to health facilities, indirect costs, and poor record-keeping (Adefolalu, Kanma Okafor & Balogun, 2019). It is against this backdrop that this study seeks to examine the knowledge, attitude, and practice regarding immunization of under-five children among mothers attending antenatal clinic (ANC).
1.4 Aim and Objectives of Study
The aim of this study is to analyze the knowledge, attitude, and practice regarding immunization of under-five children among mothers attending antenatal clinics (ANC).
The objectives of this study include:
- To assess the level of knowledge of mothers attending ANC regarding vaccines and immunization schedules for under-five children.
- To examine the attitudes of mothers toward immunization and identify factors influencing positive or negative perceptions.
- To evaluate the practice of mothers in ensuring timely and complete vaccination of their under-five children.
- To identify existing system issues that hinder effective immunization coverage in the study area.
- To recommend strategies to improve maternal knowledge, attitudes, and practices for optimal immunization uptake.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the level of knowledge of mothers attending ANC regarding immunization of under-five children?
- What are the attitudes of mothers toward immunization, and what factors influence these attitudes?
- What practices do mothers exhibit in ensuring timely and complete vaccination of their children?
- What system-related issues hinder effective immunization coverage in the study area?
- What interventions can be implemented to improve maternal knowledge, attitude, and practice regarding immunization?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant relationship between maternal knowledge and the practice of immunization of under-five children among mothers attending ANC
- H1: There is a significant relationship between maternal knowledge and the practice of immunization of under-five children among mothers attending ANC
Hypothesis Two
- H0: Maternal attitudes toward immunization does not significantly influence the practice of ensuring complete vaccination of under-five children
- H1: Maternal attitudes toward immunization significantly influence the practice of ensuring complete vaccination of under-five children
1.7 Significance of Study
It is believed that at the completion of the study, the findings will be significant to health educators and practitioners as it will accentuate the effectiveness of antenatal clinics as platforms for promoting immunization awareness and compliance. The research will also be beneficial to government agencies and non-governmental organizations involved in public health programs.
Furthermore, this study will have practical implications for mothers themselves, as it will emphasize the importance of complete and timely immunization, reinforce positive attitudes, and encourage proactive engagement with health services.
Lastly, the study will serve as a reference for future researchers by contributing to the body of knowledge on maternal health behavior and immunization practices.
1.8 Scope of Study
The scope of this research is focused on analyzing the knowledge, attitude and practice regarding immunization of under-five children among mothers attending antenatal clinic in Lagos State, Nigeria.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Immunization: The process of making an individual resistant to infectious diseases through the administration of vaccines, thereby stimulating the immune system (World Health Organization, 2019).
Under-Five Children: Refers to children from birth to five years of age, a critical period for preventive healthcare interventions (Adeniyi et al., 2023).
Knowledge: The awareness and understanding of mothers regarding vaccine-preventable diseases, immunization schedules, and benefits of vaccination (Lamiya, Mundodan & Haveri, 2019).
Attitude: The beliefs, perceptions, and disposition of mothers toward immunization, including trust in vaccines and willingness to participate in immunization programs (Adefolalu, Kanma-Okafor & Balogun, 2019).
Practice: The actions taken by mothers to ensure timely and complete immunization of their under-five children, such as attending clinics, maintaining vaccination cards, and following recommended schedules (Nafila, 2019).
Antenatal Clinic (ANC): A health facility where pregnant women receive regular medical care and health education during pregnancy, often including guidance on child immunization (Tiwari & Vishwakarma, 2019).
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