DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA

Copyright © The Author(s). All Rights Reserved. © 2025 GLOBAL PUBLICATION HOUSE | GPH - International Journal of Health Sciences and Nursing (GPH-IJHSN) | Open Access under CC BY 4.0 License DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA By Author(s): ¹Dr. Odikeme D Eyidenghabofa, ²Dr. Charity Orisa-Ubi, ³ * Dr. Solomon M Uvoh, ⁴Dr. Kinanen D. Leziga ¹Department of health kinetic and health safety studies faculty of natural and applied Sciences, Ignatus Ajuru University of Education Port Harcourt river state, Nigeria ²Department of health kinetic and health safety studies faculty of natural and applied Sciences, Ignatus Ajuru University of Education Port Harcourt river state, Nigeria. ³Department of human Physiology College of health Sciences University of Port Harcourt river state, Nigeria ⁴Department of Emergency Medicine University of port Harcourt teaching hospital river state, Nigeria. Abstract Aim/Objective: This study investigated the determinants of immunization services utilization among nursing mothers in Bayelsa Central. The study adopted a descriptive cross-sessional research design. A total of 530 nursing mothers were sampled out of which 22 were discarded, hence 508 respondents were adopted for this study. Methods: A cross sectional descriptive approach was adopted for this study. The instrument used for data collection was a structured qquestionnaire titled, Determinants of Immunization Services Utilization among Nursing Mothers Questionnaire. The validity of the instrument was established by 3 community health experts in the Department of Human Kinetics, Health and Safety Studies. The research questions were tested using means, standard deviations, and analysis of variance at 0.05 significant. Results: The results shows high extent, proximity to health care facility (mean value: 2.88±0.68), availability of immunization materials (2.68±1.07), attitude of health care provider (3.35±0.49), mothers’ level of knowledge (2.81±0.65 among others, constituted determinants of immunization services utilization among nursing mothers in Bayelsa Central Senatorial District. Conclusion: It was concluded that lack of awareness creation, non-adherence to immunization protocol, adverse events following immunity are key to optimal vaccine utilization and immunization coverage. Based on the findings, it was recommended among others that Governments of Bayelsa State should make efforts to promote the sensitization of mothers/caregivers to improve their knowledge on routine immunization services. Keywords: Children, immunization, mothers, mortality, nursing.. How to cite: Eyidenghabofa, O., Orisa-Ubi, C., Uvoh, S., & Leziga, K. (2025). DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA. GPHInternational Journal of Health Sciences and Nursing, 8(2), 96-109. https://doi.org/10.5281/zenodo.18014618 * Corresponding author: Dr Solomon M Uvoh. Email: solomonu31(at)gmail(dot)com e-ISSN 3050-9629 p-ISSN 2795-3212 10.5281/zenodo.18014618 Volume 8, Issue 2 (July-December 2025) Manuscript ID: #02196 Page 96 of 108 Eyidenghabofa, O., Orisa-Ubi, C., Uvoh, S., & Leziga, K. (2025). DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA. GPH-International Journal of Health Sciences and Nursing, 8(2), 96-109. https://doi.org/10.5281/zenodo.18014618 © (GPH-IJHSN) | Vol. 8, Issue 02, (July-December 2025) | Open Access | www.gphjournal.org INTRODUCTION Mortality and morbidity rate increase have affected infants and children for some decades and has drawn the attention of the global community. This led to the meetings of the international bodies on how to curb these deaths among children. It therefore necessitated the emergence of the public health intervention strategies known as immunization and vaccination. The incidence of communicable and vaccine prevention diseases since the twentieth century considers immunization and vaccination as cost effective public health intervention strategies to prevent vaccine-preventable diseases (Cui & Gofin, 2017). Immunization as an intervention strategy is aimed at introduction of vaccines to a nonimmune host to produce the desired capacity to resist communicable diseases. It is believed to be one of the cost effective public health intervention towards bringing solution to this upsurge of communicable and vaccine preventable disease. Immunization is aimed at protecting recipients from vaccine preventable diseases which are responsible for about 25% deaths among under-5 year’s old children in developing countries (Adedokun et al., 2017). However, there is an improved immunization rates thereby a reduced incidence rate of vaccine-preventable diseases in advanced nations. Decision to whether a child will receive a vaccine rested on the parents, who must obtain information about immunization and its benefits (Musa & kitoye,2024). Although Africa is undergoing health transitions with movements from predominantly communicable childhood killer diseases to noncommunicable ones already recorded in most countries. However, infectious diseases still pose a huge burden to most populations in the region. With reference to World Health Organization , communicable diseases burden, such as malaria, tuberculosis, measles, Hepatitis B and HIV/AIDS in Africa seems to be the highest in the world (Adedin et al., 2021). The majority of these communicable diseases are vaccine-preventable diseases , such as tuberculosis, tetanus, poliomyelitis, measles, diphtheria, pertussis, hepatitis B and yellow fever which contribute substantially to reduce mortality and morbidity among children below five years in developing countries. In Nigeria, they are responsible for 22% and 17% of under-five mortality and morbidity respectively. This is in spite of the fact that there has been a global decline in under-five mortality and morbidity. For instance, as at 2015, under-five mortality (U5MR) in the region was 83 deaths per 1000 live births .Communicable disease control involves mainly vaccination against viral and bacterial diseases. This does not only reduce the incidence of communicable disease but also reduce the economic and social disease burden of the communities, as it confers herd immunity on the population (Adedokun et al., 2017). Many vaccine preventable diseases transmission can be blocked by providing high immunization coverage to specific diseases. Two excellent examples to this are the certification of Nigeria for eradication of polio and the worldwide eradication of smallpox from many countries. The National Programme on Immunization guidelines, the World Health Organization, and the United Nations Children’s’ Fund , stipulated that a child should receive four doses of Oral Polio Vaccine . One dose of Hepatitis B Vaccine, three doses of DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA GPH-International Journal of Health Sciences and Nursing (GPH-IJHSN) | © 2025 | Open Access | Penta, three doses of Pneumococcal Conjugate Vaccine and Tetanus vaccine and a dose of Bacillus Calmette Guerin , measles and yellow fever vaccines. WHO (2018) report in Nigeria adopts the immunization schedule expressed by the Expanded Programmed on Immunization (EPI) which prescribes five visits to receive one dose of Bacillus Calmette Guerin and Yellow fever, four doses of oral polio vaccines, three doses of pentavalent, three doses of pneumococcus conjugate vaccine and tetanus vaccine, and a dose of measles vaccine. Additionally, doses of Vitamin A supplements are given at 6 and 12months respectively. These are aimed at protecting recipients from vaccine preventable diseases which are responsible for about 25% deaths among under-5 years. About a quarter of these resultant deaths are preventable by immunization (Adedokun et al., 2017). MATERIALS AND METHODS Study Area The area of this study was Central Senatorial District of Bayelsa State in the South-South region of Nigeria. Study Population The Population for this study included all nursing mothers with their children of age zero to five years. However, there is no available data for the said population in the study area from the office of the NPC as well as the LGAs. Sample size The Sample size for this study was 508 nursing mothers. The double population proportion formula was used to calculate the sample size of the participants. Instrument and data collection The instrument for data collection for this study was a self-structured with the ddeterminants of immunization services utilization among nursing mothers following an extensive literature review on the topic. A total of 530 copies of the questionnaire were administered and 508 copies were retrieved as 22 copies were discarded because they were not properly filled by the respondents. Hence, correctly filled 508 returned questionnaires were used for data analysis which yielded return rate of 95.8. Data analysis Data collected was coded and analyzed with the aid of SPSS version 25.0. Page No. 98 Eyidenghabofa, O., Orisa-Ubi, C., Uvoh, S., & Leziga, K. (2025). DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA. GPH-International Journal of Health Sciences and Nursing, 8(2), 96-109. https://doi.org/10.5281/zenodo.18014618 © (GPH-IJHSN) | Vol. 8, Issue 02, (July-December 2025) | Open Access | www.gphjournal.org RESULTS The results are presented in frequency distributions, percentage, mean and standard Deviation while the analysis of variance regression was to test the hypotheses at 0.05 level of significance. Table 1: Socio-demographic Characteristics of the Study Population Variables Frequency(n) Percentages (%) Age 15–20 229 45.08 21–30 37 7.29 31–40 51 10.04 41 and Above 191 37.59 Level of Education None 242 47.64 Primary 15 2.95 Secondary 51 10.04 Tertiary 200 39.37 Occupation Farming/Fishing 206 40.55 Housewife 163 32.09 Civil Servant 139 27.36 Location Remote Area 66 12.99 Rural 62 12.21 Semi-Urban 180 35.43 Urban 200 39.37 Marital Status Married 300 59.06 Single 208 40.94 Children 1 210 41.34 2–3 155 30.51 DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA GPH-International Journal of Health Sciences and Nursing (GPH-IJHSN) | © 2025 | Open Access | 4–5 143 28.15 Religion Christianity 285 56.10 Islam 100 19.69 Others 123 24.21 The findings from table1 reveal key demographic trends among the respondents. Age distribution shows 45.08% are 15–20 years old, while 37.59% are 41 and above. Education levels indicate 47.64% have no formal education, though 39.37% attained tertiary education. Occupation is dominated by farming/fishing (40.55%) and housewives (32.09%). Geographically, 39.37% reside in urban areas, while 35.43% live in semi-urban regions. Marital status shows 59.06% are married, and 41.34% have one child. Religiously, Islam is the least (19.69%), while Christianity dominate (56.10%). The data highlights a young, largely uneducated population engaged in agriculture, with significant urban presence. These insights can guide targeted interventions in education, employment, and social services to address demographic-specific needs. Table 2: Mean responses of extent to which proximity to health care facility constitutes a determinant of immunization services utilization among nursing mothers S/N Mothers Proximity to Health facility SA A D SD Mean Std. D Decision 1 Living close to health facility enhanced immunization uptake 217 168 82 41 3.10 0.95 High Extent 2 living far from the health facility does not affect immunization uptake 158 123 165 62 2.74 1.03 High Extent 3 High cost of transportation affects utilization of immunization services 202 123 120 63 2.91 1.06 High Extent 4 Proximity to health care facility facilitate completion of child’s immunization 129 201 154 24 2.86 0.85 High Extent 5 Being far from the health facility make one to go late for immunization programme 175 134 109 90 2.78 1.10 High Extent Grand mean 2.88 0.68 High Extent Page No. 100 Eyidenghabofa, O., Orisa-Ubi, C., Uvoh, S., & Leziga, K. (2025). DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA. GPH-International Journal of Health Sciences and Nursing, 8(2), 96-109. https://doi.org/10.5281/zenodo.18014618 © (GPH-IJHSN) | Vol. 8, Issue 02, (July-December 2025) | Open Access | www.gphjournal.org Table 2: present the mean responses of the extent to which proximity to health care facility constitutes a determinant of immunization services utilization among nursing mothers in Bayelsa Central. The table reveals the mean responses of item15 are 3.10, 2.74, 2.91, 2.86, and 2.78 respectively while the corresponding SD scores are 0.95, 1.03, 1.06, 0.85 and 1.10. These mean values were found to be above the decision mean score of 2.50, hence the respondents accepted that living close to health facility enhanced immunization uptake, living far from the health facility does not affect immunization uptake, High cost of transportation affects utilization of immunization services, proximity to health care facility facilitate completion of child’s immunization, and being far from the health facility make one to go late for immunization programme. The grand mean score of 2.88 and standard deviation score of 0.68 were obtained. This result shows that to a high extent proximity to health care facility constitutes a determinant of immunization services utilization among nursing mothers. Table 3: Mean responses of the extent to which availability of immunization materials constitutes a determinant of immunization services utilization among nursing mothers. S/N Availability of immunization material SA A D SD Mean Std. D Decision 6 The presence of working materials(vaccines) enhances immunization uptake 294 70 34 110 3.08 1.23 High Extent 7 Lack of working materials (vaccines) hampers immunization uptake 199 54 83 172 2.55 1.31 Low Extent 8 Absence of required immunization material(vaccine) can reduce immunization uptake 191 74 118 125 2.65 1.21 High Extent 9 Borrowing of immunization materials(vaccines) from other facility can stop the continuous patronage to immunization uptake 191 43 78 196 2.45 1.33 Low Extent 10 Late arrival of immunization materials(vaccines) can reduce the attendance of mothers to immunization 204 76 95 133 2.69 1.24 High Extent Grand mean 2.68 1.07 High Extent From the result above, the mean responses and standard deviation score of items 6-10 are 3.08 and 1.23, 2.55 and 1.31, 2.65 and 1.21, 2.45 and 1.33, 2.69 and 1.24 respectively. The mean responses of item 6-8 and 10 are above the decision mean while item 9 is less than the decisions mean score of 2.50. It means the respondents agreed that the presence of vaccines enhances immunization uptake, lack of vaccines hampers immunization uptake, absence of DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA GPH-International Journal of Health Sciences and Nursing (GPH-IJHSN) | © 2025 | Open Access | required immunization material can reduce immunization uptake and late arrival of immunization materials can reduce the attendance of mothers to immunization, meanwhile they disagreed that borrowing of immunization materials from other facility can stop the continuous patronage to immunization uptake. The grand mean score was found to be 2.68. This value of the grand mean indicated that to a high extent availability of immunization materials constitute determinants of immunization services utilization among nursing mothers. Table 4: Mean responses of the extent to which attitude of health care provider constitutes a determinant of immunization services utilization among nursing mothers. S/N Attitude of health care providers SA A D SD Mean Std. D Decision 11 Welcoming of clients by greeting enhances immunization uptake 334 131 33 10 3.55 0.70 High Extent 12 Putting on smiling face to clients enhances immunization uptake 263 214 31 0 3.46 0.61 High Extent 13 Health workers shouting at clients for not paying money for consumables hampers immunization uptake 226 151 81 50 3.09 1.00 High Extent 14 Health workers fighting with mothers hinders immunization uptake 295 152 50 11 3.44 0.76 High Extent 15 Health workers slapping a mother during immunization can hamper immunization uptake 275 102 90 41 3.20 1.00 High Extent Grand mean 3.35 0.49 High Extent The mean responses of item 11-15 were 3.55, 3.46, 3.09, 3.44 and 3.20 respectively. Judging from the mean values of the above items that are above the decision mean of 2.50 suggested that the respondent’s agreed to the fact that welcoming of clients by greeting enhances immunization uptake, putting on smiling face to clients enhances immunization uptake, health workers shouting at clients for not paying money for consumables hampers immunization uptake, health workers fighting with mothers hinders immunization uptake and health workers slapping a mother during immunization can hamper immunization uptake. The result also reveals a grand mean score of 3.35 which shows that to a high extent attitude of health care provider constitutes a determinant of immunization services utilization among nursing mothers’. Page No. 102 Eyidenghabofa, O., Orisa-Ubi, C., Uvoh, S., & Leziga, K. (2025). DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA. GPH-International Journal of Health Sciences and Nursing, 8(2), 96-109. https://doi.org/10.5281/zenodo.18014618 © (GPH-IJHSN) | Vol. 8, Issue 02, (July-December 2025) | Open Access | www.gphjournal.org Table 5: Mean responses of the extent to which mothers’ level of knowledge constitutes a determinant of immunization services utilization among nursing mothers. S/N Mothers’ Level of Knowledge SA A D SD Mean Std. D Decision 16 Immunization is the world’s safest method to protect children from life threatening illness 212 141 136 19 3.07 0.91 High Extent 17 Immunization can be given to both adults and children 144 52 200 112 2.45 1.12 Low Extent 18 Immunization keeps my children free from vaccine preventable diseases 204 118 167 19 3.00 0.94 High Extent 19 Immunization is most cost-effective ways to protect children against death 160 94 215 39 2.74 0.99 High Extent 20 Children always fall sick when they are immunized 140 105 213 50 2.66 0.99 High Extent Grand mean 2.81 0.65 High Extent The mean responses of item 16-20 are 3.07, 2.45, 3.00, 2.74, and 2.66. Observationally, mean value of item 16, 18, 19 and 20 are above the decision mean score of 2.50 whereas the mean value of item 17 is less than the decision mean score. From the result, the respondents agreed that immunization is the world’s safest method to protect children from life threatening illness, immunization keeps my children free from vaccine preventable diseases, immunization is one of the most cost-effective ways to protect children against death and children always fall sick when they are immunized while they strongly disagreed that immunization can be given to both adults and children. The grand mean score was found to be 2.81. This indicated that to a high extent mothers’ level of knowledge constitutes a determinant of immunization services utilization among nursing mothers. DETERMINANTS OF IMMUNIZATION SERVICES UTILIZATION AMONG NURSING MOTHERS IN BAYELSA CENTRAL SENATORIAL DISTRICT, NIGERIA GPH-International Journal of Health Sciences and Nursing (GPH-IJHSN) | © 2025 | Open Access | DISCUSION Proximity to health care facility and immunization services utilization Regarding the influence of health facility proximity on the utilization of immunization services, it was identified in this study that staying close to the healthcare facility significantly affected the level of utilization of immunization services among mothers. It was reported to account for 13.3% of the utilization of immunization services. This finding is also shared by the reports of previous authors, who have reported the influence of health facility proximity on the utilization of immunization services among other health care services provided in conventional health care settings (Fikiri et al., 2016; Gao et al., 2021). The proximity to healthcare facilities is a critical determinant of access to and uptake of preventive health interventions, including childhood immunizations. This relationship underscores the importance of geographical accessibility as a cornerstone of effective primary healthcare (Kurayi, 2022). When health facilities are located closer to communities, individuals, especially mothers and caregivers, find it easier to reach them for routine immunization schedules, thereby improving coverage rates. Conversely, long distances, poor transportation infrastructure, and high travel costs can deter families from completing immunization schedules, leading to increased vulnerability to vaccine-preventable diseases. Thus, the finding reinforces the need to ensure the equitable distribution of health facilities and the decentralization of immunization services to ensure no child is left unvaccinated due to physical barriers (So Yoon Sim, et al., 2022). With regards to health system strengthening, this finding highlights the need to incorporate spatial accessibility into national immunization and primary healthcare strategies. Policymakers should prioritize the establishment of more primary health centres in underserved and rural areas where distance remains a key obstacle. Additionally, outreach programs and mobile vaccination clinics can bridge service gaps in remote communities. Integrating Geographic Information Systems (GIS) into health planning can further guide the optimal placement of health facilities to maximize population coverage within reasonable travel times (Gao et al., 2021). By addressing geographic inequities, the health system not only increases immunization uptake but also enhances trust, satisfaction, and engagement between communities and healthcare providers. Such interventions align with the principles of Universal Health Coverage, which emphasize that everyone should have access to essential health services without geographical or financial hardship (Abubakar et al., 2021). The finding also highlights important implications for maternal and child health outcomes. Immunization is one of the most cost-effective interventions for preventing morbidity and mortality in children. When proximity facilitates higher immunization rates, communities’ benefit from herd immunity, reduced disease outbreaks, and overall improved child survival rates. Moreover, the frequent contact between caregivers and healthcare providers during immunization visits can strengthen health education, promote better maternal health-seeking behaviors, and encourage the use of other preventive services such as antenatal care, growth monitoring, and family planning. Therefore, improving accessibility to immunization services contributes not only to vaccination coverage but also to broader maternal and child health Page No. 104