CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Despite decades of investment in Nigeria’s Expanded Programme on Immunization (EPI), routine immunization (RI) coverage remains well below national and global targets. According to the 2021 Multiple Indicator Cluster Survey/National Immunization Coverage Survey, just 36?% of Nigerian children aged 12–23?months received all recommended vaccines, while 18?% received none (United Nations Children’s Fund & National Bureau of Statistics, 2021). In Borno State, still recovering from insurgency the situation is marginally better but far from ideal: a 47.7?% full?immunization rate places Maiduguri Metropolis below the 80?% national goal (Nigeria National Bureau of Statistics, 2021). Globally, vaccine?preventable diseases account for nearly 1.5?million under?five deaths annually; one of the most cost?effective interventions, RI could avert over 3?million child deaths each year if coverage reached 90?% (World Health Organization, 2023). At the primary?health?centre (PHC) level in Maiduguri Metropolis, Borno State’s capital, RI services constitute the backbone of child?health delivery. However, PHC reporting data from 2022 show that fewer than 60?% of facilities achieve the minimum 80?% coverage for pentavalent and measles vaccines (National Primary Healthcare Development Agency, 2021). Contributing factors include logistical challenges—cold?chain failures, vaccine stock?outs—and community?level barriers such as safety concerns, cultural resistance, and poor appointment adherence (Omoleke et al., 2023). Without a clear, localized understanding of these impediments, efforts to strengthen RI risk overlooking the very obstacles undermining uptake in Maiduguri’s catchment population.

1.2 Statement of the Problem

Although national policies envisage 90?% RI coverage by 2025, Maiduguri Metropolis continues to record suboptimal immunization rates at its PHCs. Recent facility audits reveal that up to 40?% of children who start their vaccination schedules fail to complete them, and many caregivers cite distance to centres, lack of appointment reminders, and mistrust of vaccine safety as key deterrents (Omoleke et al., 2023). Concurrently, intermittent power supply and inadequate cold?chain equipment lead to frequent stock?outs, while health?worker shortages and poor client–provider interactions further erode community confidence. This constellation of demand? and supply?side barriers has not been systematically quantified for Maiduguri’s PHCs, leaving policymakers without the granular evidence necessary to tailor interventions effectively.

1.3 Aim and Objectives of the Study

The primary aim of this study is to evaluate routine immunization coverage and identify key barriers at primary health centres in Maiduguri Metropolis, Borno State.

1. 1.3.1 Specific Objectives
2. To determine the proportion of children aged 0–23?months who complete the full RI schedule at selected PHCs.
3. To assess the functionality of cold?chain equipment and vaccine stock?out frequency.
4. To explore caregiver knowledge, attitudes, and practices regarding childhood vaccination.
5. To identify health?system factors (staffing, provider attitudes, appointment management) that influence RI uptake.

1.4 Research Questions

1. What percentage of eligible children complete the full RI schedule at PHCs in Maiduguri Metropolis?
2. How often do cold?chain failures and vaccine stock?outs occur at these facilities?
3. What are caregivers’ principal reasons for delaying or foregoing scheduled immunizations?
4. Which health?system factors most strongly affect caregiver engagement with RI services?

1.5 Scope of the Study

This cross?sectional study will be conducted in six purposively selected PHCs, two each from Maiduguri Metropolitan, Jere, and Konduga LGAs—to capture urban and peri?urban dynamics. Data collection will run from September?2024 through February?2025. Quantitative facility audits will document cold?chain status, stock?out records, and coverage data drawn from RI registers. Concurrently, structured caregiver interviews (n?300) will elicit socio?demographic information, vaccination knowledge, and perceived barriers. Finally, in?depth interviews with PHC staff (n?18) will probe operational challenges in delivering RI services.

References

National Primary Healthcare Development Agency. (2021). Nigeria National Immunisation Coverage Survey 2020: Final Report. Abuja, Nigeria: Author.

Omoleke, S. A., Omotara, B. A., Oyeyemi, A. L., Beida, O., & Etatuvie, S. O. (2023). Immunisation services in North?Eastern Nigeria: Perspectives of critical stakeholders to improve uptake and service delivery. Journal of Public Health in Africa, 14(11), 1807. https://doi.org/10.4081/jphia.2023.1807

United Nations Children’s Fund, & National Bureau of Statistics. (2021). Multiple Indicator Cluster Survey/National Immunization Coverage Survey 2021: Nigeria. Abuja, Nigeria: UNICEF/NBS.

World Health Organization. (2023). Immunization coverage: Global summary. Geneva, Switzerland: WHO.