CITATION
Ikechukwu, L. O., & Abdulrahman, M. (2026). A Comparative Analysis of the Factors Contributing to the Non-Completion of Childhood Immunization among Children Aged 12–23 Months in Urban and Rural Communities of the Federal Capital Territory, Abuja, Nigeria. International Journal of Research, 13(1), 416–428. https://doi.org/10.26643/ijr/2026/16
Lawrence
Okonkwo Ikechukwu¹, Muhammad Abdulrahman²
¹,
2 Faculty of Public
Health, Texila American University,
Guyana.
Abstract
Background: Childhood immunization
is a proven and cost-effective public health intervention for preventing
vaccine-preventable diseases. However, incomplete immunization remains a major
challenge in Nigeria, including the Federal Capital Territory (FCT), Abuja, where
disparities exist between urban and rural communities.
Objectives: This study
comparatively analyzed the factors contributing to the non-completion of
childhood immunization among children aged 12–23 months in urban and rural
communities of the FCT, Abuja.
Methodology: A descriptive
cross-sectional study was conducted among 320 caregivers of children aged 12–23
months, comprising 192 (60.0%) from rural and 128 (40.0%) from urban
communities. A multistage sampling technique was employed. Data were collected
using a structured, interviewer-administered questionnaire and analyzed using
SPSS version 26.0. Associations between variables were tested using chi-square
analysis at a 5% level of significance.
Results: 64.7% of children were
fully immunized, while 35.3% had incomplete immunization. Immunization
completion was higher in urban areas (71.9%) compared with rural areas (59.9%).
Caregiver educational level was significantly associated with immunization completion
(p = 0.001), with completion rates highest among caregivers with tertiary
education (78.6%) and lowest among those with no formal education (31.6%).
Awareness of immunization importance was significantly associated with
completion (69.4% vs. 44.1%; p = 0.005). Fear of vaccine side effects
significantly increased non-completion (49.5% vs. 27.1%; p = 0.001). Healthcare
system factors such as distance to health facility (p = 0.011), vaccine
stockouts (p = 0.004), unfriendly health worker attitude (p = 0.001), and
waiting time exceeding two hours (p = 0.012) were significantly associated with
non-completion. Community-related factors, including lack of community support
(p = 0.002), presence of anti-vaccine beliefs (p = 0.001), and non-participation
in sensitization meetings (p = 0.005), were also significant determinants.
Conclusion: Childhood immunization
completion in the FCT, Abuja remains suboptimal, particularly in rural
communities. Non-completion is driven by a combination of caregiver-related,
healthcare system, and community-level factors. Targeted interventions focusing
on caregiver education, health system strengthening, improved service
accessibility, and community engagement are essential to improve immunization
completion rates.
Keywords: Childhood immunization,
immunization completion, vaccination dropout, caregivers, urban–rural
disparities, Nigeria.
I) INTRODUCTION
Background
of the Study
Immunization has been described as
one of the most effective and cost-efficient public health strategies for
reducing childhood morbidity and mortality globally. It has been estimated that
vaccination prevents between two and three million deaths annually by
protecting children against vaccine-preventable diseases (VPDs) such as
measles, diphtheria, tetanus, and poliomyelitis (World Health Organization
[WHO], 2023). Despite this remarkable success, global data indicate that about
20 million children fail to receive the full course of essential vaccines
during their first year of life, leaving them vulnerable to infectious diseases
(UNICEF, 2022).
In sub-Saharan Africa, the
implementation of the Expanded Programme on Immunization (EPI) has improved
vaccination coverage since its introduction in 1974. However, the continent
continues to record the highest proportion of unimmunized and partially immunized
children worldwide. The WHO Regional Office for Africa (2022) reported that
more than 8 million African children still miss routine immunizations each year
due to barriers such as poor health infrastructure, limited access to care,
poverty, and sociocultural beliefs.
Nigeria, as the most populous country
in Africa, carries a substantial share of this burden. According to the
National Primary Health Care Development Agency (NPHCDA, 2023), approximately
2.5 million Nigerian children under the age of five fail to complete their
immunization schedules annually. Factors such as low parental education,
misinformation, religious and cultural resistance, and poor accessibility to
healthcare facilities have been consistently associated with incomplete
immunization (Adedokun, Uthman, & Wiysonge, 2020; Abdulraheem, Onajole,
Jimoh, & Oladipo, 2019).
Within the Federal Capital Territory
(FCT) Abuja, the problem remains significant despite the region’s relatively
better healthcare infrastructure. Studies conducted by Oche, Umar, and Ahmed
(2021) revealed that immunization dropout rates in some parts
of the FCT exceed the national average. Urban areas tend to experience
challenges related to vaccine hesitancy and misinformation, while rural
communities face long travel distances, inadequate cold chain storage, and
insufficient healthcare personnel. Furthermore, the COVID-19 pandemic disrupted
routine immunization activities across Nigeria, further worsening the number of
unimmunized and partially immunized children (NPHCDA, 2021).
It was within this context that the
present study was undertaken to comparatively analyze the factors contributing
to the non-completion of childhood immunization among children aged 12–23
months in urban and rural communities of the FCT, Abuja. The study sought to
identify and compare caregiver, healthcare system, and community-level
determinants influencing immunization completion to provide evidence-based
recommendations for improving vaccine coverage in the region.
Problem Statement
Although immunization is recognized
as one of the most cost-effective interventions for preventing childhood
deaths, its coverage remains suboptimal in Nigeria. The WHO recommends that all
children receive a complete schedule of routine vaccinations to achieve herd
immunity and reduce the incidence of VPDs. Nevertheless, available data show
that Nigeria continues to record high dropout rates between the first and third
doses of vaccines such as DPT (NPHCDA, 2023).
The FCT Abuja, despite being the
political and administrative hub of the country, has not achieved the expected
immunization coverage given its relatively advanced health infrastructure.
Studies conducted by Oche et al. (2021) indicated that the dropout rate for
routine childhood immunization in Abuja exceeds the national target, with both
urban and rural areas facing distinct challenges. Urban caregivers are often
influenced by misinformation and competing priorities, whereas rural caregivers
face barriers such as long distances to health facilities, vaccine stockouts,
and a shortage of trained health workers (Uzochukwu
& Onwujekwe, 2018).
The consequences of incomplete
immunization are severe. Children who fail to complete their vaccination
schedules are at increased risk of contracting preventable diseases such as
measles, pertussis, and polio, thereby undermining herd immunity and threatening
community health (WHO Africa, 2022). Outbreaks of these diseases continue to
occur in Nigeria, reflecting gaps in immunization coverage. Despite national
interventions such as the National Immunization Plus Days (NIPDs) and
community-based campaigns, many children in FCT Abuja still do not complete
their vaccination schedules.
This study was therefore conducted to
provide an in-depth understanding of the factors responsible for the
non-completion of childhood immunization in the FCT. By comparing urban and
rural contexts, the research aimed to generate evidence that could guide the
design of effective interventions and policies to close existing immunization
gaps.
Objectives of the Study
1.
Determine the proportion of children aged 12–23 months in FCT
Abuja who have not completed their immunization schedules in both urban and
rural communities.
2.
Assess caregiver-related factors influencing the
non-completion of childhood immunization in the FCT.
3.
Evaluate healthcare system–related factors contributing to
the non-completion of childhood immunization in the FCT.
4.
Examine community-level factors affecting the completion of
childhood immunization in the FCT.
Research Questions
1.
What proportion of children aged 12–23 months in FCT Abuja
have not completed their immunization schedules?
2.
What caregiver-related factors influence the non-completion
of childhood immunization in FCT Abuja?
3.
What healthcare system–related factors contribute to the
non-completion of childhood immunization in FCT Abuja?
4.
How do community-level factors affect the completion of
childhood immunization in FCT Abuja?
Research Hypotheses
Null Hypotheses (H₀):
1.
There is no statistically significant association between
caregiver-related factors and the non-completion of childhood immunization in
FCT Abuja.
2.
There is no statistically significant association between
healthcare system–related factors and the non-completion of childhood
immunization in FCT Abuja.
3.
There is no statistically significant association between
community-related factors and the non-completion of childhood immunization in
FCT Abuja.
Alternative Hypotheses
(H₁):
1.
There is a statistically significant association between
caregiver-related factors and the non-completion of childhood immunization in
FCT Abuja.
2.
There is a statistically significant association between
healthcare system–related factors and the non-completion of childhood
immunization in FCT Abuja.
3.
There is a statistically significant association between
community-related factors and the non-completion of childhood immunization in
FCT Abuja.
II)
METHODOLOGY
Study Design
This study adopted a descriptive cross-sectional design
aimed at assessing the factors contributing to the non-completion of childhood
immunization among children aged 12–23 months in both urban and rural
communities of the Federal Capital Territory (FCT), Abuja, Nigeria.
Study Population
The study population comprised caregivers of children aged 12–23 months
residing in the FCT, Abuja.
Sample and Sampling
Technique
The study utilized a multistage sampling technique to
ensure representativeness of both urban and rural communities within the FCT,
Abuja.
Sample Size Determination
The sample size was determined using Cochran’s formula (1977) for sample size estimation for
proportions (Cochran, 1977):
Where:
n = required sample size
Z-value
corresponding to the desired confidence level (e.g., 1.96 for 95% confidence
level)
P = estimated
prevalence of missed opportunities for immunization. Based on previous studies
in similar settings, an assumed prevalence of 30% was used (WHO, 2017).
d = margin of
error, set at 5% (0.05)
Substituting
these values:
The sample size was rounded down to 320 respondents for
convenience and even distribution between the two strata (urban and rural
areas). Hence, the final sample size used in this study was 320 caregivers (192 rural and 128
urban).
Data Collection
Data were collected using a structured, interviewer-administered
questionnaire designed based on the study objectives. Trained research
assistants fluent in English and local languages administered the
questionnaires face-to-face to ensure accuracy and
completeness of responses.
Data Analysis and
Presentation
Data were entered and analyzed using
Statistical Package for the Social
Sciences (SPSS) version 26.0. Results were presented in tables, charts, and graphs, with
statistical significance set at p <
0.05.
III)
RESULTS AND DISCUSSION
Socio-Demographic
Characteristics of Respondents
A total of 320 caregivers
participated in the study 192 (60%) from rural areas and 128 (40%) from urban communities
of FCT Abuja. Table .1 presents the socio-demographic characteristics of the
respondents.
Table 1: Socio-Demographic Characteristics of Respondents (n
= 320)
|
Variable |
Category |
Frequency
(n) |
Percentage
(%) |
|
Age
of caregiver (years) |
Below
20 |
22 |
6.9 |
|
20–29 |
118 |
36.9 |
|
|
30–39 |
124 |
38.8 |
|
|
40 and
above |
56 |
17.5 |
|
|
Sex |
Male |
42 |
13.1 |
|
Female |
278 |
86.9 |
|
|
Educational
level |
No
formal education |
38 |
11.9 |
|
Primary |
76 |
23.8 |
|
|
Secondary |
122 |
38.1 |
|
|
Tertiary |
84 |
26.3 |
|
|
Occupation |
Unemployed |
64 |
20.0 |
|
Self-employed |
160 |
50.0 |
|
|
Formal
employment |
72 |
22.5 |
|
|
Others |
24 |
7.5 |
|
|
Marital
status |
Single |
28 |
8.8 |
|
Married |
266 |
83.1 |
|
|
Widowed/Divorced |
26 |
8.1 |
|
|
Monthly
household income (₦) |
Below
₦20,000 |
92 |
28.8 |
|
₦20,000–₦50,000 |
136 |
42.5 |
|
|
Above
₦50,000 |
92 |
28.8 |
|
|
Religion |
Christianity |
186 |
58.1 |
|
Islam |
124 |
38.8 |
|
|
Others |
10 |
3.1 |
The majority of caregivers (38.8%)
were aged between 30–39 years, indicating that most respondents were in their
active reproductive and caregiving age. This is consistent with findings by Adedokun et al. (2020), which reported that caregivers within
this age group are typically responsible for childcare decisions.
Most respondents were female (86.9%),
reflecting the societal norm that mothers primarily oversee child health
matters in Nigeria.
Educational attainment varied, with
38.1% having secondary education and 26.3% tertiary education. Notably, 11.9%
lacked formal education, a factor linked to poor health literacy and lower
immunization completion (Adebayo et al., 2022).
Most caregivers (83.1%) were married,
and half were self-employed. The relatively low income levels observed (71.3%
earning ≤₦50,000 monthly) suggest that economic constraints could impact the
ability to access immunization services, especially in rural areas—a finding
consistent with Abdulraheem et al. (2019).
Proportion of Immunization
Completion among Children
The analysis revealed that 64.7% of
children aged 12–23 months had completed their full immunization schedule,
while 35.3%
did not. Table 2 shows the immunization completion rate by location.
Table 2: Immunization Completion by Residence (n = 320)
|
Location |
Fully
Immunized |
Not
Fully Immunized |
Total |
Completion
Rate (%) |
|
Urban (n = 128) |
92 |
36 |
128 |
71.9 |
|
Rural (n = 192) |
115 |
77 |
192 |
59.9 |
|
Total |
207 |
113 |
320 |
64.7 |
Immunization completion was higher in urban areas
(71.9%) than in rural areas (59.9%).
The lower rural completion rate aligns with Oche et al. (2021), who reported that limited healthcare
access, longer distances to facilities, and transportation costs contribute to
lower immunization coverage in rural communities.
Overall, the 35.3% dropout rate
suggests persistent barriers despite ongoing national programs. These findings
reflect the broader pattern reported by NPHCDA (2023) and WHO (2023),
showing that Nigeria still struggles to reach optimal immunization coverage
levels due to inequities between urban and rural populations.
Caregiver-Related Factors
Influencing Non-Completion
Table 3 presents caregiver-related
determinants of immunization completion. Variables included caregiver
education, awareness, and beliefs.
Table 3: Association between
Caregiver Factors and Immunization Completion (n = 320)
|
Variable |
Category |
Fully
Immunized (%) |
Not
Fully Immunized (%) |
χ² |
p-value |
|
Education level |
No
formal |
31.6 |
68.4 |
18.42 |
0.001* |
|
Primary |
48.7 |
51.3 |
|||
|
Secondary |
70.5 |
29.5 |
|||
|
Tertiary |
78.6 |
21.4 |
|||
|
Awareness of immunization importance |
Yes |
69.4 |
30.6 |
7.83 |
0.005* |
|
No |
44.1 |
55.9 |
|||
|
Decision maker for child’s vaccination |
Self |
71.2 |
28.8 |
6.92 |
0.031* |
|
Spouse/others |
54.9 |
45.1 |
|||
|
Fear of side effects |
Yes |
50.5 |
49.5 |
11.60 |
0.001* |
|
No |
72.9 |
27.1 |
*Significant at p < 0.05
Educational level was significantly
associated with immunization completion (p = 0.001).
Caregivers with tertiary education were more likely to complete immunizations
than those without formal education. This supports findings by Adedokun et al. (2020) and Adebayo
et al. (2022) that education improves understanding and trust
in vaccines.
Awareness of immunization importance
also showed a strong association (p = 0.005), implying that
sensitization and health promotion play a vital role.
Caregivers who personally made
vaccination decisions had higher completion rates than those relying on spouses
or relatives. This reflects the influence of household gender roles on child
health decisions, similar to findings by Olorunsaiye et al. (2020).
Fear of vaccine side effects was
another major factor (p = 0.001). Misconceptions and past adverse reactions
discouraged many caregivers, echoing results from Anyanwu et al. (2021)
that fear and misinformation drive immunization dropouts.
Healthcare System Related
Factors
Table 4: Association between Healthcare System Factors and
Immunization Completion (n = 320)
|
Variable |
Category |
Fully
Immunized (%) |
Not
Fully Immunized (%) |
χ² |
p-value |
|
Distance to facility |
<1
km |
72.5 |
27.5 |
9.12 |
0.011* |
|
1–5
km |
63.2 |
36.8 |
|||
|
>5
km |
52.1 |
47.9 |
|||
|
Vaccine stockouts |
Yes |
54.8 |
45.2 |
8.33 |
0.004* |
|
No |
71.5 |
28.5 |
|||
|
Attitude of health workers |
Friendly |
70.8 |
29.2 |
12.24 |
0.001* |
|
Neutral/rude |
52.0 |
48.0 |
|||
|
Waiting time >2 hrs |
Yes |
56.3 |
43.7 |
7.90 |
0.012* |
|
No |
70.1 |
29.9 |
*Significant at p < 0.05
Healthcare system factors showed
strong associations with immunization completion. Caregivers living within 1 km of a facility
had significantly higher completion rates (p = 0.011), supporting Abdulraheem et al. (2019)
that distance affects service utilization.
Frequent vaccine stockouts
were a critical deterrent (p = 0.004), reflecting systemic supply issues identified
by Oche et
al. (2021).
The attitude of health workers
was another significant factor (p = 0.001). Caregivers encountering
friendly, communicative staff were more likely to complete vaccination. Poor
provider interaction discourages return visits, as supported by Adebayo et al. (2022).
Lastly, long waiting times
at health facilities significantly reduced completion rates (p = 0.012),
similar to findings by Olusanya et al. (2020), which stressed the need for
improved service efficiency.
Community-Related Factors
Table 5: Association between Community Factors and
Immunization Completion (n = 320)
|
Variable |
Category |
Fully
Immunized (%) |
Not
Fully Immunized (%) |
χ² |
p-value |
|
Community
support for immunization |
Yes |
71.8 |
28.2 |
9.45 |
0.002* |
|
No |
54.0 |
46.0 |
|||
|
Presence
of anti-vaccine beliefs |
Yes |
48.9 |
51.1 |
13.72 |
0.001* |
|
No |
72.6 |
27.4 |
|||
|
Participation
in sensitization meetings |
Yes |
70.4 |
29.6 |
10.03 |
0.005* |
|
No |
56.0 |
44.0 |
*Significant at p < 0.05
Community influence plays a crucial
role in immunization behaviors. Respondents from supportive communities were
significantly more likely to complete immunizations (p = 0.002).
Anti-vaccine beliefs, often driven by misinformation or religious
misconceptions, were linked with non-completion (p = 0.001),
echoing Umeh
et al. (2022) and Adedokun et al. (2020).
Participation in sensitization
meetings increased completion rates, confirming that community engagement is an
effective strategy for promoting vaccine uptake, consistent with Umeh et al. (2022)
and WHO
(2023) recommendations for community mobilization.
IV)
SUMMARY AND CONCLUSION
Summary of Findings
The immunization completion rate was 64.7%,
while 35.3%
of children had incomplete immunization. Urban communities recorded a higher
completion rate (71.9%) compared to rural areas (59.9%).
The disparity reflects uneven access to health services, lower awareness, and
logistical challenges faced by rural caregivers.
Educational level showed a strong positive association (p = 0.001); caregivers
with tertiary education had the highest completion rates. Awareness of immunization
importance positively influenced completion (p = 0.005). Decision-making autonomy
increased completion rates (p = 0.031), showing that empowered caregivers are
more likely to ensure full vaccination. Fear of side effects discouraged
immunization completion (p = 0.001), highlighting the impact of misinformation
and negative experiences.
Distance to health facility affected uptake (p = 0.011), with
those living closer more likely to complete immunization. Vaccine stockouts were a major deterrent (p = 0.004),
reflecting supply chain inefficiencies. Health worker attitude (p = 0.001)
and long
waiting times (p =
0.012) influenced caregivers’ willingness to return for subsequent doses.
Community encouragement and mobilization enhanced completion (p = 0.002). Anti-vaccine beliefs and
misinformation significantly reduced completion (p = 0.001). Participation in community
sensitization programs improved immunization adherence (p =
0.005).
Therefore, the study demonstrates
that childhood immunization completion in FCT Abuja is influenced by a mix of individual, structural,
and social factors. Educated and empowered caregivers in
supportive communities with accessible, efficient healthcare services are more
likely to complete vaccination schedules for their children. Addressing these
barriers holistically can significantly improve immunization coverage and
reduce vaccine-preventable diseases among children in both urban and rural
settings.
Conclusion
This study concludes that childhood immunization
completion remains suboptimal in the Federal Capital Territory,
Abuja, with significant disparities between urban and rural communities.
Despite government and partner efforts to promote full immunization, several
challenges persist.
The major determinants of
non-completion include low caregiver education, poor awareness, long distance to health facilities, vaccine stockouts, negative health worker attitudes, and community
misinformation about vaccines. These factors collectively
hinder caregivers’ ability and willingness to complete their children’s
vaccination schedules.
The findings affirm that both demand-side factors
(caregiver knowledge, beliefs, and autonomy) and supply-side
factors (health system accessibility and quality) influence immunization completion.
Therefore, achieving complete immunization coverage requires multi-dimensional
interventions that empower caregivers, strengthen the health system, and
mobilize community support.
Ultimately, the study emphasizes that
improving immunization outcomes in the FCT Abuja is not only a matter of
vaccine availability but also of education, accessibility, communication, and
community trust. Strengthening these components will be
essential for Nigeria to meet its commitments under Sustainable Development
Goal (SDG) 3—ensuring healthy lives and promoting well-being
for all.
Recommendations
·
Improve Accessibility and Service Delivery
·
Enhance Health Worker Capacity and Motivation
·
Promote Community Engagement and Ownership
·
Policy and Monitoring Interventions
·
Strengthening
caregiver education and empowerment enhances informed decision-making.
·
Investing
in healthcare infrastructure and supply chains promotes equitable access.
By addressing these areas, Nigeria
can accelerate progress toward universal immunization coverage and the
reduction of vaccine-preventable morbidity and mortality among children under
five years of age.
Ethical Consideration
Ethical
approval was obtained from the appropriate Health Research Ethics Committee
prior to data collection. Permission was also obtained from facility managers
in the Federal Capital Territory, Abuja. Informed consent was obtained from all
participants, and participation was voluntary with the right to withdraw at any
time. Confidentiality and anonymity were maintained, and all data were securely
stored and used solely for research purposes. The study adhered to the
principles of the Declaration of Helsinki and national ethical guidelines.
Limitation of the Study
The cross-sectional design limits
causal inference. Data were based on self-reports, which may be affected by
recall and social desirability bias. Findings may not be fully generalizable
beyond the study area. Despite these limitations, the study provides useful
evidence on factors influencing childhood immunization completion.
Lawrence Okonkwo
Ikechukwu conceptualized the study, conducted data collection, performed data
analysis, and drafted the initial manuscript.
Muhammad
Abdulrahman contributed to study design refinement, data interpretation,
critical revision of the manuscript for intellectual content, and final
approval of the version to be published.
Conflict
of Interest
The authors
declare no conflict of interest.
This research received no
specific grant from any funding agency in the public, commercial, or
not-for-profit sectors.
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