ASSESSMENT OF THE KNOWLEDGE OF COMPLICATION OF NON IMMUNIZATION OF CHILDREN AMONG NURSING MOTHERS

ABSTRACT

This study examined the knowledge of nursing mothers concerning the complications associated with the non-immunization of children. A cross-sectional survey research design was adopted, and data were collected from 133 respondents through the administration of a structured questionnaire. The collected data were analysed using Statistical Package for the Social Sciences (SPSS), version 27, while a one-sample t-test was applied to test the formulated hypotheses. The study specifically investigated the factors influencing nursing mothers’ knowledge of the complications of non-immunization, the contribution of educational attainment to immunization decisions, and the extent to which socio-demographic characteristics influence their awareness of the potential consequences of failing to immunize children. The findings indicated that although most nursing mothers were aware of the dangers associated with non-immunization, their understanding of the seriousness and possible consequences of these complications was inadequate. The study further revealed that educational attainment and socioeconomic status significantly influenced mothers’ knowledge and immunization decisions, with higher levels of education associated with better-informed decisions. Limited access to health education and reliable health information was also identified as an important obstacle to understanding the consequences of non-immunization. The hypothesis-testing results indicated a significant relationship between educational attainment and knowledge of non-immunization complications, while socio-demographic characteristics were also found to influence the acquisition of relevant knowledge. The study concluded that improving access to health education and relevant information is essential, particularly among nursing mothers in communities with lower educational attainment. Such interventions would strengthen mothers’ understanding of the consequences of non-immunization, encourage informed vaccination decisions, and contribute to improved childhood immunization coverage.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Immunization is an essential public health intervention that protects children against various infectious diseases, many of which can cause serious complications or result in death. As one of the most effective strategies for preventing infectious diseases, vaccination has contributed significantly to reducing childhood illness and mortality worldwide. Vaccines provide protection against diseases such as measles, poliomyelitis, hepatitis B, and diphtheria, which may result in severe health complications, long-term disabilities, or death when not prevented or properly managed (Adeyanju et al., 2022). Despite the established effectiveness of immunization programmes, global reports continue to indicate considerable gaps in vaccination coverage, particularly in rural and underserved communities. Children in these areas remain exposed to vaccine-preventable diseases because of inadequate immunization coverage, which may be associated with misinformation, limited access to healthcare services, and reluctance to accept vaccines (UNICEF, 2020).

Nigeria continues to experience similar challenges in achieving adequate childhood immunization coverage. Although the government, in collaboration with international development partners, has introduced several initiatives to improve vaccination rates, difficulties remain in ensuring that every child receives the recommended vaccines, particularly those living in remote communities. Studies have indicated that some mothers do not possess sufficient knowledge of the complications that may arise when children are not immunized. This lack of awareness can contribute to hesitation or reluctance to seek vaccination services for their children (Obanewa & Newell, 2020). Identifying the factors responsible for this knowledge gap is therefore important in developing appropriate public health interventions that can encourage greater acceptance and utilization of immunization services.

Immunization programmes in Nigeria are affected by several challenges, including inadequate healthcare infrastructure, limited availability of vaccination services, and cultural beliefs that influence people's perceptions of vaccines. Among these challenges, vaccine hesitancy remains a major obstacle to achieving effective immunization coverage. Vaccine hesitancy refers to the delay in accepting or the refusal of available vaccines despite the availability of vaccination services (MacDonald, 2015). It is a complex phenomenon influenced by psychological, cultural, and social factors. For example, some mothers may have limited confidence in the healthcare system, while others may be influenced by inaccurate information concerning vaccine safety and effectiveness (Betsch et al., 2024). These circumstances may contribute to low vaccination rates and expose children to preventable infectious diseases that could otherwise be avoided through appropriate immunization.

The consequences of failing to immunize children can be serious and may include long-term disabilities, severe illness, and death. Vaccine-preventable diseases such as pneumonia, tuberculosis, and meningitis remain important contributors to childhood mortality in many low-income settings, including Nigeria (Piot et al., 2019). According to the World Health Organization, immunization prevents approximately two to three million deaths annually from diseases such as diphtheria, tetanus, and whooping cough (WHO/UNICEF, 2019). These figures demonstrate the important contribution of vaccination to reducing childhood illness and mortality. Nevertheless, reluctance to immunize children continues to represent a major public health concern, even where vaccines are available.

Recent studies have emphasized that nursing mothers' knowledge of the potential consequences of non-immunization plays an important role in determining their children's vaccination status. A mother's understanding of the health risks associated with failing to vaccinate her child can influence her willingness to seek immunization services (Betsch et al., 2024). In particular, some mothers in rural communities may not fully understand the possible consequences of leaving their children unprotected against vaccine-preventable diseases. This limited awareness may result in delayed vaccination or complete refusal, thereby increasing children's vulnerability to serious illnesses. Educational programmes that explain the dangers of non-immunization can help improve mothers' understanding and encourage greater acceptance of childhood vaccination. Such programmes are important in enabling mothers to make informed decisions concerning the health and well-being of their children.

Healthcare professionals also play an important role in providing accurate information and improving public understanding of immunization. Research has shown that healthcare providers, particularly nurses, have considerable influence on parents' attitudes and decisions concerning childhood vaccination. Nursing mothers frequently depend on healthcare professionals for guidance about vaccines, and the recommendations they receive can influence their decisions to immunize their children (Opel et al., 2013). However, the ability of healthcare providers to address vaccine hesitancy depends largely on their knowledge, communication skills, and ability to explain the importance of vaccination clearly. Nurses who understand vaccine safety, effectiveness, and the consequences of non-immunization are better positioned to educate mothers, respond to their concerns, and encourage appropriate immunization practices.

The Nigerian healthcare system faces several challenges that affect the effective delivery of immunization services. These include inadequate healthcare facilities, shortages of trained healthcare personnel, and ineffective communication strategies. Such challenges are particularly evident in rural communities, where healthcare facilities may be widely dispersed and transportation difficulties can prevent mothers from accessing vaccination services. In addition, cultural practices, religious beliefs, and community perceptions can influence attitudes towards immunization. For example, some communities may hold misconceptions about vaccine safety or believe that vaccination is unnecessary when a child appears physically healthy (Adeyanju et al., 2021). When these beliefs occur alongside inadequate knowledge of the consequences of non-immunization, they may increase vaccine hesitancy and contribute to poor immunization coverage.

Evidence from previous research suggests that adequate knowledge of vaccine-preventable diseases and their possible complications is an important factor in improving childhood immunization rates. Mothers who understand the health consequences of leaving their children unvaccinated may be more willing to utilize available immunization services. This emphasizes the need for carefully planned educational interventions that provide clear and evidence-based information about the dangers of non-immunization. Such interventions should address the specific areas where mothers lack adequate knowledge, particularly in rural communities where access to reliable health information may be limited. Healthcare professionals at different levels of service delivery should also be involved to ensure that accurate information reaches mothers and supports informed vaccination decisions.

1.2 Statement of the Problem

Immunization is widely recognized as one of the most effective interventions for preventing infectious diseases among children. However, considerable gaps in childhood vaccination coverage remain in different parts of Nigeria, particularly in rural and underserved communities. Despite the efforts of the government and international health organizations to improve immunization services, many children remain unvaccinated or incompletely vaccinated, thereby exposing them to diseases that could otherwise be prevented (Betsch et al., 2024). One of the important factors contributing to this challenge is vaccine hesitancy, which may arise from inadequate awareness of the potential health consequences of non-immunization. Although several studies have investigated the factors responsible for vaccine hesitancy, limited attention has been directed specifically towards nursing mothers' knowledge of the complications associated with failing to immunize their children.

Previous studies have largely examined vaccine hesitancy in relation to general socio-demographic and socioeconomic characteristics, access to healthcare services, and cultural beliefs (Opel et al., 2013). However, there remains a need for more detailed investigations into the specific knowledge gaps among nursing mothers concerning the immediate and long-term health consequences of non-immunization. Although some studies have examined mothers' attitudes towards vaccination, they have not always adequately established how these attitudes relate to mothers' understanding of the serious complications associated with vaccine-preventable diseases (Piot et al., 2019). Consequently, there is still a need to understand how awareness of these complications influences mothers' decisions concerning childhood immunization in Nigeria.

Furthermore, although healthcare professionals are widely acknowledged as important influences on parental attitudes towards vaccination (MacDonald, 2015), insufficient attention has been given to assessing how effectively healthcare workers, particularly nurses, educate mothers about the dangers of non-immunization. This creates a need for research examining the contribution of nurses and other healthcare providers to improving mothers' knowledge of vaccine-preventable diseases and their associated complications. Strengthening this aspect of healthcare education may contribute to increased acceptance and utilization of immunization services. In addition, much of the existing research has concentrated on urban populations, while rural communities, where immunization coverage may be particularly low, have received comparatively limited attention (Obanewa & Newell, 2020). These communities often experience additional difficulties, including poor access to healthcare facilities and the widespread influence of misconceptions about vaccination.

In view of these concerns, this study seeks to assess the knowledge of nursing mothers regarding the complications associated with non-immunization. It aims to examine the factors influencing their level of awareness and determine how educational attainment contributes to their decisions concerning childhood vaccination. The study is expected to provide a better understanding of the relationship between maternal knowledge and immunization behaviour while generating information that can support the development of targeted health education strategies. It will also highlight the importance of healthcare professionals, particularly nurses, in addressing knowledge gaps and promoting improved childhood immunization practices.

1.3 Objectives of the Study

The general objective of this study is to assess the knowledge of nursing mothers regarding the complications associated with the non-immunization of children.

The specific objectives are to:

Assess the level of knowledge among nursing mothers regarding the complications of non-immunization.

Identify the factors influencing nursing mothers' knowledge of the complications associated with non-immunization.

Determine the influence of educational attainment on nursing mothers' decisions to immunize their children.

1.4 Research Questions

The following research questions were formulated to guide the study:

What is the level of knowledge among nursing mothers regarding the complications associated with non-immunization?

What factors influence nursing mothers' knowledge of the complications of non-immunization?

How does educational attainment influence nursing mothers' decisions concerning the immunization of their children?

1.5 Research Hypotheses

The following null hypotheses were formulated for the study:

There is no statistically significant relationship between the educational level of nursing mothers and their knowledge of the complications associated with non-immunization.

Knowledge of the complications of non-immunization is not significantly associated with nursing mothers' decisions to immunize their children.

Socio-demographic characteristics do not have a statistically significant influence on nursing mothers' knowledge of the complications associated with non-immunization.

1.6 Significance of the Study

This study is important because it seeks to provide useful information about the knowledge gaps that may exist among nursing mothers concerning the complications associated with non-immunization. Immunization is an essential intervention for protecting children against preventable diseases. However, despite its established benefits, the failure to immunize children remains a concern, particularly in rural and underserved communities. One factor that may contribute to inadequate immunization coverage is the limited awareness among parents, especially nursing mothers, of the serious consequences that may arise when children are not vaccinated. Understanding the extent of this knowledge gap is therefore necessary for addressing vaccine hesitancy and promoting improved childhood health outcomes.

The findings of this study are expected to contribute to the development of more effective health education strategies aimed at increasing nursing mothers' awareness of the possible consequences of non-immunization, including severe illnesses, long-term disabilities, and death. By identifying the specific areas in which mothers have inadequate knowledge, healthcare professionals and policymakers may be better positioned to design appropriate educational interventions. Such programmes can emphasize the importance of childhood immunization, explain the risks associated with leaving children unvaccinated, and provide information on the protective benefits of vaccines. Improved understanding may encourage nursing mothers to make informed decisions concerning their children's vaccination, thereby supporting increased immunization coverage and reducing preventable childhood illnesses and deaths.

Furthermore, the study may provide relevant information for improving immunization campaigns, particularly in rural and vulnerable communities where vaccine hesitancy may be more pronounced. These communities often face challenges such as inadequate access to healthcare facilities, cultural misconceptions, and exposure to inaccurate information about vaccines. By identifying the specific knowledge gaps affecting nursing mothers, health education programmes can be designed to address the needs and concerns of these populations. This approach may make immunization campaigns more effective and help overcome some of the barriers that prevent mothers from seeking vaccination services for their children.

The study will also emphasize the important role of healthcare providers, particularly nurses, in reducing the knowledge gap concerning childhood immunization. Nurses are often among the first healthcare professionals to interact with nursing mothers and are therefore in a strategic position to provide relevant health information, explain the benefits of vaccination, and address concerns about vaccine safety. The findings may offer useful insights into how healthcare providers can improve their communication approaches and strengthen their contribution to promoting childhood immunization.

In addition, the research may be useful to healthcare administrators and policymakers in planning interventions that address the educational and informational needs of nursing mothers. It may also serve as a reference material for students, researchers, and other health professionals interested in maternal knowledge, vaccine acceptance, and childhood immunization.

Ultimately, the findings of this study are expected to contribute to improved childhood immunization practices, a reduction in vaccine-preventable diseases, and the protection of public health in Nigeria, particularly among vulnerable and underserved populations.

1.7 Scope of the Study

This study will be conducted in a selected healthcare facility within the study area and will focus on nursing mothers with children below five years of age. It will specifically examine their knowledge of the complications associated with the non-immunization of children, including the factors that may influence their level of awareness and understanding of the possible consequences of failing to immunize their children.

1.8 Operational Definition of Terms

Immunization: The process of administering vaccines to individuals, particularly children, to stimulate the body's immune system and provide protection against specific infectious diseases.

Non-immunization: The failure, refusal, or omission to administer recommended vaccines to children according to the established immunization schedule.

Complications: Adverse health consequences that may arise when children are not protected against vaccine-preventable diseases. These may include severe illness, disability, and death.

Nursing Mothers: Women who are breastfeeding or caring for children below five years of age, as defined within the context of this study.

Knowledge: The level of understanding and awareness nursing mothers possess concerning immunization, the consequences of non-immunization, and the possible complications associated with vaccine-preventable diseases.

Health Education: The provision of relevant health information and educational activities designed to improve individuals' understanding of health-related issues and encourage appropriate health decisions and practices.

Socio-demographic Factors: Personal and social characteristics that may influence an individual's knowledge, attitudes, and decisions. These include age, educational attainment, income level, and occupation.

Vaccination Decision: The decision made by a mother to either accept or decline the administration of recommended vaccines to her child.