ACCESSIBILITY AND UTILIZATION OF IMMUNIZATION SERVICES

AMONG NURSING MOTHERS (18-49yrs) IN AMICHI PRIMARY HEALTH

CENTER, NNEWI SOUTH LOCAL GOVERNMENT AREA, ANAMBRA STATE,

BY

EKWE CHARITY OGECHUKWU

EXAMINATION NUMBER: CONSALOR/2022/365/N015

PRESENTED TO

COLLEGE OF NURSING SCIENCES ALOR, ANAMBRA STATE.

NOVEMBER, 2025.
 ACCESSIBIILITY AND UTILIZATION OF IMMUNIZATION SERVICES

AMONG NURSING MOTHERS (18-49yrs) IN AMICHI PRIMARY HEALTH

CENTER, NNEWI SOUTH LOCAL GOVERNMENT AREA, ANAMBRA STATE,

BY

EKWE CHARITY OGECHUKWU

EXAMINATION NUMBER: CONSALOR/2022/365/N015

PRESENTED TO

COLLEGE OF NURSING SCIENCES ALOR, ANAMBRA STATE.

IN PARTIAL FULFILMENT OF REQUIREMENTS OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF “REGISTERED

NURSE” CERTIFICATE

NOVEMBER, 2025.
 DECLARATION

This is to declare that this research project titled accessibility and utilization of immunization

services among nursing mothers (18-49yrs) in Amichi Primary Health Center, Nnewi south is

solely the result of my work except where acknowledged as being derived from other person (s)

or resources.

Examination Number: CONSALOR/2022/365/N015

In the College of Nursing Sciences Alor, Anambra state.

Signature ___________

Date ______________
 CERTIFICATION

This is to certify that this research project was carried out by Ekwe Charity Ogechukwu with

examination number CONSALOR/2022/365/N015 has been examined and approved for the

award of “Registered Nurse Certificate”

____________________ ____________________

Ekwe Charity Ogechukwu Date

[Student]

_______________________ ____________________

Mrs Nwamadu Ogechukwu Date

(Supervisor)

_______________________ ____________________

Mrs Ogbonna Goodness Date

(Provost)

_______________________ ____________________

Name:________________________ Date

(External Examiner)
 ABSTRACT

Immunization is one of the most effective public health interventions for reducing childhood

morbidity and mortality. Despite free access to vaccines in Nigeria, many children remain under-

immunized due to a combination of personal, socio-cultural, and systemic factors. The objectives

of this study investigated the level of knowledge, accessibility, and utilization of immunization

services among nursing mothers aged 18–49 years in Amichi Primary Health Center, Nnewi

South Local Government Area, Anambra State. A descriptive cross-sectional design was adopted.

Data were collected from 222 nursing mothers using a structured, self-administered

questionnaire. The data were analyzed using Statistical Package for Social Sciences (SPSS)

version 25 and presented using tables, percentages, and charts. Key areas assessed included

knowledge of immunization schedules, accessibility to services, and barriers to utilization. The

findings showed that 97.3% of respondents were aware of immunization, yet only 67.6% could

identify three vaccine-preventable diseases. While 64.9% lived within 3 km of the health center

and 71.2% found clinic times convenient, only 62.2% completed their child’s immunization. The

most common barriers to full utilization were transportation challenges (40.5%), time

constraints (30.6%), and negative attitudes from some health workers (18.0%). A significant

association was found between distance to the clinic and immunization completion. The study

highlights that although awareness of immunization is high, utilization is hampered by logistical

and informational barriers. Improving health education, addressing service delivery challenges,

and enhancing family support are essential for increasing immunization uptake. The findings

have important implications for nursing practice, community health planning, and public health

policy.

Keywords: Immunization, accessibility, utilization, nursing mothers, barriers, Nigeria, primary

This work is dedicated to all nursing mothers.

My special gratitude goes to the Almighty God for leading me up to this level in life and

Educational pursuit, may His name be glorified.

I want to express my gratitude to the provost of the College and also my Supervisor Mrs

Nwamadu.O. for her support, supervision and guidance in this project work despite her busy

schedule, I am grateful Ma. Also, to the staff of the College both academics and non-academic

staff who have in one way or the other contributed to my success in this School, may God

Almighty bless and keep you all.

In a special way, my appreciation goes to my parents The Rt. Rev. Dr. Johnson and Dr. Mrs

Ijeoma Ekwe for their love, support and advice, as well as their financial and emotional support

throughout the course of my study in school. I pray that Almighty God continue to bless, protect

and keep them for me.

My siblings are not left out, you people are my source of motivation and all my special friends

who in one way or the other supported me, May God Almighty bless you all.
 TABLE OF CONTENTS

Cover page

Title page

Declaration page

Certification page

Abstract

Dedication

Acknowledgement

Table of contents

list of figures

CHAPTER ONE: INTRODUCTION

Background to the study

Statement of the problem

Objective of the study

Research question

Significance of the study

Scope of the study

Operational definition of terms

CHAPTER TWO: LITERATURE REVIEW

Conceptual review

Theoretical review

Empirical review

Summary of literature review

Research design

Research Setting

Target population

Sampling Size

Sampling Technique

Instrument for data collection

Validity of instrument

Reliability of instrument

Method of data collection

Ethical consideration

Reference
 CHAPTER ONE

INTRODUCTION

Background to the Study

Over the years, innocent children and infant have become victims of deadly yet immunizable

diseases and as a result of this, the children and infants have become exposed to disabling

disease which has rendered them dependent on others and useless to the society as well.

(Anaeto,2017). As ascertain by Global Immunization Strategy (2010-2011), 2.5 million children

die every year from easily from easily prevented infectious diseases. In the year 2011. Measles

resulted a 771,000 deaths and 2million disabilities, some individual countries like united states

have achieved the 90% coverage against measles and likely to sustain these level (Global

immunizable strategy 2010-2017).

In Nigerian the under Five mortality rate of 104.3 death per thousand children in 2016 is said to

be associated with preventable immunizable diseases and remains one of the polio hot zones

along with Indian, Pakistan, Afghanistan are also the 11 countries that accounted for 66% of the

world’s measles death. World Health Organization (2016). Major step taken to improve

immunization services was the restriction of expanded programme of immunization (NPI) in

1995 designed to vaccinate and protect children and infants against six killer diseases. Despite

the effort made to rebuild immunization, the coverage of immunizable disease remains poor.

(National programme on immunization 2016).

According to world health organization (2016), immunization is the process whereby a person is

made immune or resistant to an infectious disease typically by the administration of vaccines.

1
The university of California (2015) stated that immunization are vaccines made of either

weakened or killed version of bacteria and virus that causes a particular disease to produce

antibodies against that disease. (WHO 2016).

Anaeto (2017) stated that immunization is the process of conferring increased resistance to an

infectious disease by means other than expecting the natural infection. According to United

Nation International Child’s Educational fund (UNICEF) in 2024. Vaccines keeps children alive

and healthy by protecting them against disease, immunization is essentially important for the

reach families as it can be a bridge to other live saving care for mothers and children in isolated

communities such as anti-malarial, mosquito nets, vitamin A supplement, de-worming tablets and

child nutritional screening.

The world health organization (2019) stated that immunization is one of the most important

public health interventions and cost effective strategies to reduce child mortality and morbidity

associated with childhood infectious disease. Immunization is also a good strategy to reach

vulnerable populations (WHO), immunization is reported to prevent an estimated 2 to 3 million

death each year worldwide (WHO).

Immunizable and preventable child disease are major are major cause of the under 5 Mortality in

Nigeria. Immunization is one of the most effective, softest and efficient public health

intervention as it is estimated to save to save at least 3 million lives dying from vaccine

preventable diseases, (Aneto, 2017).

Accessibility plays a significant role in immunization among nursing mothers , with factors such

as geographical distance Smith (2019), financial constraints and cultural and linguistic barriers.

2
In Nigeria, a major step taken to improve immunization services was the restriction of expanded

programme of immunization (NPI) in 1995 designed to vaccinate and protect children and

infants against six killer diseases. Despite the effort made to rebuild immunization, the coverage

of immunizable disease remains poor. (National programme on immunization 2016).

There is need to persuade all mothers to bring their children with 0-5 years to be immunized at

the right time and also completing the full of immunization services is necessary but proper

utilization of the most important (Banthia 2015).This research study however, aims at the

accessing the utilization of immunization services provided for nursing mothers in Amichi

primary health center, Nnewi South local Government Area, Anambra State.

Statement of Problem

Despite the availability of vaccine for preventable immunizable disease, Eleje (2018) confirmed

that many studies have been carried but yielded poor utilization of immunization among child

bearing woman.

The researcher also during one of the experience at Nnamdi Azikiiwe University Teaching

Hospital Nnewi, the researcher noticed that the nursing mothers are not utilizing and accessing

the immunization services available to them and got the researcher thinking because

immunization is free yet majority of nursing mothers do not access these services. Moreover, the

primary healthcare centers have been equipped with these vaccines and with trained health care

providers which was noted during the researcher community experience.

3
At the same time, it is perceived in some communities, child hood immunization is facing a lot

of neglect and challenges because of financial constraints and poor attitude of health workers

with the neglect emanated from poor utilization and accessibility of the immunization program.

As such this study is aimed to investigate the reason for the poor utilization and accessibility of

immunization among nursing mothers in Amichi Nnewi South, Anambra State.

Objective of the Study

The objective of this study include to:

1. Assess the level of knowledge of nursing mothers on immunization schedules.

2. Determine the extent of accessibility and utilization of immunization services among

nursing mothers.

3. Identify the barriers preventing effective utilization and accessibility of immunization

services among nursing mothers in Amichi primary health center.

Research Questions

1. What is the level of knowledge of nursing mothers about immunization schedules.

2. How often do the nursing mothers access and utilize immunization services?

3. What are the barriers to effective Accessibility and Utilization of immunization services

among nursing mothers?

4
Significance of the Study

This study is significant in the following ways:

To the Nursing Mothers: It will help to identify the specific barriers that nursing mothers face.

To the Society: It will help to reduce disease burden and improve child survival rates.

To the Health Care Providers: It will ensure that there will be optimized service and delivery

and that frontline staff have the skills to address full immunization compliance.

Scope of Study

The scope of this research will be tailored towards nursing mothers at Amichi, using Amichi

primary health center for their antenatal and immunization.

Operational Definition of Terms

Utilization: The action of making effective use of immunization services by nursing mothers .

Accessibility: The quality of immunization services to be reached by nursing mothers.

Immunization: To protect nursing mothers from disease by giving them an injection.

Immunization Services: Delivery of vaccine-related services to nursing mothers .

Nursing Mothers : Is a woman of reproductive years between ages 18-49 years

5
 CHAPTER TWO

LITERATURE REVIEW

This chapter deals with the review of related literature on accessibility and utilization of

immunization services. Literature will be reviewed under the following headings:

 Conceptual review

 Theoretical review

 Empirical review

Conceptual Review

Concept Of Immunization

Immunization is defined as the process by which an individual becomes protected against a

disease through the vaccines [Center for Disease Control and Prevention, 2014]. It is one of the

most effective public health interventions, significantly reducing childhood mortality and

morbidity caused by vaccine preventable diseases.

According to Banthia [2015], health is a state of the body, mind, and spirit, attained when one is

free from physical disabilities and mental disturbances. In this context, immunization plays a

vital role in achieving and maintaining child health and well being. UNICEF [2014] emphasizes

that immunization is one of the most powerful and cost effective tools to prevent child deaths,

saving the lives of nearly 3 million children annually.

Types of Vaccines

There are several categories of vaccines, each designed to stimulate the immune system in

different way:

6
1. Attenuated [live] Vaccines: These vaccine uses a weakened form of the virus or bacteria

that causes the disease. They produce long lasting immune response. Examples include

measles,mumps, and rubella vaccine and the oral polio vaccine (CDC, 2022).

2. Inactivated Vaccines: These contain viruses or bacteria that have been killed although they

produce a weaker immune response compared to live vaccines, they are safer for people

with weakened immune systems. Examples include inactivated polio vaccine and hepatitis A

vaccine (WHO, 2020).

3. Toxoid Vaccines: These vaccines are made using inactivated toxins produced by the

bacteria. They are used to protect against diseases caused by bacteria toxins, such as

diphtheria and tetanus (WHO, 2017).

4. Subunit, recombinant, polysaccharide, and conjugate Vaccine: These use specific parts

of the virus or bacteria such as protein or sugar to stimulate an immune response. Examples

include the hepatitis B vaccine and the Haemophilus influenza type b (Hib) vaccine (CDC,

2022).

5. Messenger RNA (mRNA) Vaccines: These are a newer type of vaccine, used most notably

against COVID-19. They work by instructing cells to produce a protein that triggers an

immune response (CDC, 2022).

Accessibility of Immunization Services

Accessibility refers to the extent to which nursing mothers can reach and benefit from

immunization services. It includes physical, geographical, economic, informational, and social

dimensions:( Penchansky and Thomas, 1981).

 Physical Accessibility: Physical accessibility refers to the ease with which nursing mothers

can physically reach health facilities that provide immunization services. It primarily

7
 involves factors such as distance to the health center, availability of transportation, road

conditions, and clinic operating hours.

 Georaphical Accessibility: Distance to health facilities remains a key barrier in many rural

and underserved regions. Mothers who live far from health centers often face transportation

difficulties and time constraints that limit their ability to vaccinate their children

(Fagbamigbe, kandala, & Uthman, 2017).

 Economic Accessibility: Although routine immunization is free in many countries, hidden

costs such as transportation, lost income, and opportunity costs can discourage mothers from

accessing services (Sadoh & Eregie, 2009).

 Information Accessibility: Lack of awareness and understanding of immunization

schedules, benefits, and safety may prevent mothers from seeking vaccines for their children

(Awodele & Kasali, 2010).

 Cultural and Social Accessibility: Cultural beliefes, gender norms, and male dominance in

decision making may hinder mothers ability to access health services independently

(Babalola, 2009).

Utilization of Immunization Services

Utilization refers to the actual use of immunization services by nursing mothers, measured by the

completion of scheduled vaccinations. ( Andersen , 1995). Several factors influence utilization,

such as:

 Maternal Education: Mothers with higher levels of education are more likely to understand

the benefits of immunization and complete vaccination schedules (Adebowale, yusuf, &

Fagbamigbe, 2019).

8
 Health System Factors: Poor service delivery, staff shortages, vaccine stock outs, and

long waiting times can discourage mothers from utilizing services (Bosch-Capblanch,

Banerjee, & Burton, 2012).

 Community Influence: Peer support, community health workers, and local awareness

campaigns can increase immunization uptake by positively influencing attitudes and

behaviours (WHO, 2017).

Barriers To Accessibility and Utilization:

 Distance To Clinics: Physical access remains a problem, especially in rural areas lacking

health infrastructure (Fagbamigbe et al., 2017).

 Inadequate Staffing and Infrastructures: Health facilities may lack trained personnel or

basic supplies needed for effective immunization service delivery (Bosch-Capblanch et al.,

2012).

 Cultural Resistance and Misinformation: Some communities still hold negative beliefs

about vaccines, often fueled by myths or misinformation (Jegede, 2007).

Strategies for Improvement

Adressing these challenges requires targeted interventions at both policy and community levels:

 Community Mobilization and Education: Engaging local leaders, health educators; and

traditional authorities can improve knowledge and acceptance of immunization (WHO,

2017).

 Mobile Clinics and Outreach Programs: Bringing vaccines closer to remote populations

through outreach efforts can bridge physical accessibility gaps (Federal Ministry of Health

Nigeria [FMOH], 2019).

9
 Health System Strenghthening: Ensuring consistent vaccine supply, training healthcare

providers, and improving service quality can increase mothers confidence in immunization

services (Bosch-Capblanch et al., 2012).

Theoretical Review

The Health Promotion Model (HPM) by Nola J. Pender has been adopted for this study. The

Health Promotion Model (HPM) was developed by Nola J. Pender in 1982 and revised in 1966.

It was designed to complement models of health protection and focuses on increasing a persons

level of well-being (Pender, 1996). The model defines health as a positive dynamic state, not

merely the absence of disease. It emphasizes proactive health promotion behaviors rather than

disease prevention alone. The HPM includes the following three major components:

1. Individual Characteristics and Experience: These include prior related behaviors and

personal factors ( e.g, biological, psychological, sociocultural) that affect future behavior.

2. Behavior-Specific Cognitions and Affect: This component comprises prceived benefits and

barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences

( e.g, family, peers, healthcare providers), and situational influences.

3. Behavioral Outcomes: These are commitments to a plan of action and the actual health-

promoting behavior. Pender argues that individuals are more likely to engage in health-

promoting behaviors when they have a strong sense of self-efficacy and perceive fewer

barriers.

10
Application of The Theory to The Study

This study “Accessibility and Utilization of Immunization Services Among Nursing Mothers
(18-49 yrs) in Amichi Primary Health Center, Nnewi South Local Government Area, Anambra
State, closely aligns with the principles of Nola J. Pender’s Health Promotion Model. The theory
helps to explain how individual characteristics, perceived benefits and barriers, and external
influences shape nursing mothers decisions to utilize immunization services.
1. Individual Characteristics and Experiences: In this study, factors such as age, education,
cultural beliefs, and previous interactions with healthcare services influence how nursing
mothers perceive and respond to immunization services.
2. Behavior-Specific Cognitions and Affect: Mothers perceived benefits (e.g, disease
prevention), barriers (e.g, distance, cost), self-efficacy, and social influences (e.g, support from
family or health workers) directly impact their decision to utilize immunization services.
3. Behavioral Outcome: The outcome completing the child’s immunization schedule is shaped
by the mothers commitment, action and the ability to overcome competing demands like time,
household duties and access issues.
Empirical Review
To assess the level of knowledge of nursing mothers on immunization schedules, a study by Eze
and Uzochukwu (2017) focused on nursing mothers aged 18–49 years attending immunization
clinics in southeastern Nigeria. The research adopted a descriptive cross-sectional design, and
data was gathered using a structured interviewer-administered questionnaire that assessed
awareness, timing, and the purpose of childhood immunizations. The study found out that only
48% of respondents could accurately identify the immunization schedule, with poor knowledge
significantly linked to lack of formal education and insufficient counseling during antenatal care.
Based on these findings, the authors recommended enhanced health education during antenatal
and postnatal visits to improve maternal knowledge and compliance with immunization
schedules.

To determine the extent of accessibility to immunization services among nursing mothers,

11
communities of southwestern Nigeria. Employing a quantitative descriptive research design, the
researchers used a semi-structured questionnaire to collect data regarding access to immunization
centers, transportation means, and availability of services. The study revealed that mothers in
rural areas were 35% less likely to access immunization services due to factors such as long
distances to health centers, poor road networks, and lack of transportation. To address these
barriers, the researchers recommended the establishment of community-based immunization
posts and implementation of mobile immunization services to enhance physical access.
To determine the extent of utilization of immunization services by nursing mothers, Bassey

(2020), studied mothers aged 18–49 years living in urban slums of Abuja who had at least one

child under one year. The researchers used a cross-sectional survey design and employed a

standardized questionnaire to collect data on clinic attendance, frequency of visits, and factors

influencing immunization completion. The study found that only 62% of mothers completed the

full immunization schedule for their children. Key reasons for incomplete immunization included

fear of side effects, cultural misconceptions, and lack of spousal support. As a result, the study

recommended targeted health campaigns and community engagement strategies to address myths

and encourage consistent service use.

To identify barriers preventing effective utilization and accessibility of immunization services

among nursing mothers, Umeh and Madubuko (2019) examined barriers among mothers aged

18–49 years attending both rural and urban health centers in southeastern Nigeria. Utilizing a

descriptive research design, they collected data through a structured questionnaire focusing on

obstacles in accessing and using immunization services. The study identified several barriers,

including long waiting times, inconsistent vaccine availability, lack of empathy from health

workers, and widespread misinformation. The researchers recommended improvements in

vaccine logistics, communication training for health workers, and intensified community-level

health education to mitigate these challenges and improve immunization service delivery.

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Summary of Literature Review

The conceptual review establishes the theoretical foundation for understanding the factors

influencing the accessibility and utilization of immunization services among nursing mothers

aged 18 to 49 years. Key concepts include accessibility, defined as the ease with which

individuals can obtain health services, and utilization, which refers to the actual use of those

services as intended. These are shaped by multiple determinants such as knowledge and

awareness, socioeconomic status, geographical location, and health system efficiency.

The theoretical review provides the framework for analyzing the factors influencing accessibility

and utilization of immunization services among nursing mothers aged 18 to 49 years. The

primary theory underpinning the study is the Health Belief Model (HBM), which explains

health-seeking behavior through constructs such as perceived susceptibility, perceived severity,

perceived benefits, perceived barriers, cues to action, and self-efficacy.

The empirical review reveals that the accessibility and utilization of immunization services

among nursing mothers aged 18 to 49 years are significantly influenced by a range of factors

supported by data from various studies. Findings consistently show that maternal knowledge of

immunization schedules strongly predicts completion of child vaccination, with higher levels of

education and proper health education improving compliance.

13
 CHAPTER THREE

METHODOLOGY

This chapter explains the methodology used by the researcher in collecting and analyzing the

data in order to answer the research questions.

Research Design

A descriptive survey method was used which is a systematic enquiry made to collect the

necessary data for analysis from the research subject. (Creswell, 2014).

Area of study

The study was conducted in Amichi, a town in Nnewi South Local Government area, Anambra

state, Nigeria. It consists of four villages or groups which are Afube, Okpala, Ebenaasa, and

Udene. It shares boundaries in the North with the town of Utah. Its inhabitants are mainly traders,

few are civil servants and self-employed persons as well. There is a market found there which is

called Eke Amichi and various churches of different religious group like Anglican Church, there

are also other churches like catholic, Pentecostal and Jehovah witness groups. The health

facilities available in Amichi include primary care centers and general hospitals. (Magnus, 2024)

Target population (population of study)

The population of study will comprise of 7000 nursing mothers in Amichi Nnewi South Local

Government Areas of Anambra State. The accessible population of the study involves 500

nursing mothers randomly selected from 4 villages in Amichi Nnewi, Anambra State.

Sample Size

14
The sample size was determined using Taro Yamane formula with 95% confidence level.

The calculated formula of Taro Yamane is stated as follows:

n= N/1+N(e)2

Where n = Sample size

e= Margin error

N= Population size

I= Unity (a constant)

Therefor n= 500/1+500(0.05)2

= 500/1+500(0.0025)

= 500/ (1+1.25)

= 222

Sampling Technique

Therefore 222 women from the four villages will be used using stratified random sampling, the

sample distribution is:

Table Showing Sample Distribution of Respondents

Village Sample Size

Afube 70

Okpala 60

Ebenaasa 50

15
Udene 42

Total 222

Instrument for data collection

The instrument used for data collection is a self-structured questionnaire which was developed

based on the objectives of the study, the instrument consists of five section with a total of 21

questions.

Section A.the socio-demographic data consisting of six questions.

Section B. the knowledge of immunization schedules consisting of six questions.

Section C. the accessibility and utilization of immunization services consisting of six questions .

Section E. titled the barriers to accessibility and utilization of immunization services consisting

of two questions.

Validity of Instrument

The questionnaire used by the researcher in obtaining the data from respondents is constructed in

a simple and unambiguous words for easy understanding. A drafted questionnaire was presented

by the researcher to the supervisor for face and content validity. The supervisor vet the

questionnaire items for clearity and readability.

Reliability of Instrument

A pilot study was carried out at Amichi among 50 respondents of nursing mothers, the instrument

was administered to them and reliability showed Chronback alpha of 0.80, this result shows that

the instrument is reliable by 80%

16
Method of Data Collection

Data were collected over a two-week period by the researcher and a trained research assistants

who was instructed on adherence to duty. Questionnaires were distributed to mothers during

clinic hours, following their immunization appointments after explanations by the researcher.

Participants completed the questionnaires on-site.

Method of Data Analysis

The data collected from the questionnaires were coded, entered, and analyzed using the

Statistical Package for the Social Sciences (SPSS) version 25. Descriptive statistics such as

frequencies, percentages, and mean scores were used to summarize respondents’ demographic

characteristics and responses to key study variables. Inferential statistics, particularly chi-square

tests, were used to examine associations between accessibility, utilization, and identified barriers.

A significance level of p < 0.05 was adopted to determine statistical significance.

Ethical Consideration

In conducting the research, the researcher recognizes and maintain professional ethics throughout

the course of the study. In gathering data from the subject informed consent and adequate

classification regarding the reason for the study was done, their right to participate or not to

participate were also respected, information is also maintained by not allowing the respondents

to write their names and addresses in the questionnaire.

17
 CHAPTER FOUR

PRESENTATON OF DATA ANALYSIS

This chapter presentation of results and data analysis. Resources from the questionnaire were

presented to the objectives of the study using percentages, frequency distribution tables and

charts.

Socio-Demographic Data of Respondents

Age Distribution of The Respondents

Age Group (years) Frequency Percentage (%)

18-25 54 24.3%

26-33 80 36.0%

34-41 62 27.9%

42-49 26 11.7%

Total 222 100.0%

From the table above shows that the majority of the respondents (36.0%) were aged 26-36 years,

followed by 27.9% in the 34-41 age group. The least represented group was 42-49 years (11.7%).

Occupation of Respondent

18
Occupation Frequency Percentage (%)

Trader 98 44.1%

Civil Servant 52 23.4%

Artisan 32 14.4%

House Wife/ Unemployed 40 18.0%

Total 222 100.0%

Most of the respondents were traders (44.1%), followed by civil servants (23.4%). This suggests

many nursing mothers are involved in informal business or market related activities.

Marital Status of Respondents

Marital status Frequency Percentage (%)

Married 190 85.6%

Single 22 9.9%

Divorced /Widowed 10 4.5%

Total 222 100.0%

The majority of respondent were married (85.6%), which reflects the traditional family setting

common among nursing mothers in this locality.

Religion of Respondents

Religion Frequency Percentage(%)

Christianity 210 94.6%

Islam 6 2.7%

Traditionalist 6 2.7%

19
Total 222 100.0%

A large majority (94.6%) of respondents are Christians, indicating the dominant religious

affiliation in the study area.

Number of children per respondent

Number of children Frequency Percentage(%)

1-2 86 38.7%

3-4 94 42.3%

5 and above 42 18.9%

Total 222 100.0%

Most women had 3-4 children (42.3%), showing a moderate family size typical of developing

rural communities.

Level of Knowledge of Immunization Among Nursing Mothers

Questions Response Frequency Percentage(%)

Have you heard of Yes 216 97.3%

immunization before?

No 6 217%

Total 222 100.0%

Do you know the Yes 188 84.7%

correct starting age

for immunization?

No 34 15.3%

20
Total 222 100.0%

Do you know the full Yes 170 76.6%

immunization

schedule for children?

No 52 23.4%

Total 222 100.0%

Can you name three Yes 150 67.6%

vaccine preventable

disease?

No 72 32.4%

Total 222 100.0%

The data reveals a high level of awareness among mothers regarding immunization services,

(97.3%) of mothers have heard of immunization, indicating strong public health messaging,

(84.7%) knew the correct starting age for immunization while (76.6%) were familiar with the full

immunization schedule. However, only (67.6%) of respondents could name at least three vaccine

preventable diseases.

Accessibility and Utilization of Immunization Services

Questions Response Frequency Percentage(%)

Do you live 3km of Yes 144 64.9%

the health center?

No 78 35.1%

Total 222 100.0%

21
Have you completed Yes 138 62.2%

your child’s

immunization

schedule?

No 84 37.8%

Total 222 100.0%

Are immunization Yes 158 71.2%

days convinient for

you?

No 64 28.8%

Total 222 100.0%

Do you use public Yes 120 54.1%

transport to access the

clinic?

No 102 45.9%

Total 222 100.0%

The results indicate moderate accessibility and utilization of immunization services, (64.9%) of

mothers live within 3km of the health center, making physical access relatively favourable,

(71.2%) reported that immunization days were convenient, a positive indication for service

timing. However, only (62.2%) of mothers had completed their child’s immunization schedule,

indicating a utilization gap despite favourable access. Additionally, (54.15%) of mothers used

22
public transport to access the clinic, implying transportation remains a consideration for a

significant number of users.

Barriers to Accessibility and Utilization

Barrier Response Frequncy Percentage(%)

Transportation Yes 90 40.5%

difficulties

No 132 59.5%

Total 222 100.0%

Time constraints due Yes 68 30.6%

to work or family

No 154 69.4%

Total 222 100.0%

Negative attitude of Yes 40 18.0%

health workers

No 182 82.0%

Total 222 100.0%

Restrictions or Yes 20 9.0%

Cultural restrictions

No 202 91.0%

Total 222 100.0%

23
Lack of support from Yes 12 5.4%

spouse/family

No 210 94.6%

Total 222 100.0%

This table identifies thee key barriers affecting mothers access and use of immunization services,

transportation difficulties were the most cited challenge (40.5%) highlighting mobility issues,

(30.6%) reported time constraints due to family or work obligations, (18.0%) experienced

negative attitudes from health workers, which could affect future clinic attendance. A small

portion cited religious or cultural restrictions (9.0%) and lack of family/spousal support(5.4%).

CHAPTER FIVE

DISCUSSION of FINDINGS

This chapter discusses the major findings of the research work under the following :

Identification of key findings implication of findings to nursing, statement of the implication of

the study findings with literature support, limitations of the study, summary of the study,

conclusion, recommendations and suggestion for futher studies.

Identification of key findings

24
The key findings from the study were discussed with respect to the research questions for this

study.

 Findings shows that (97.3%) of nursing mothers were aware of immunization.

 Findings shows that (64.9%) lived within 3km of the health center and (71.2%) found

immunization days convenient.

 Findings shows that (40.5%) barriers such as transportation difficulties and (30.6%) time

constraints were prominent.

 Findings shows that a significant relationship was found between distance to the health

center and immunization completion.

Discussion of Findings

Knowledge of Immunization Schedules

The study revealed that 97.3% of mothers had heard about immunization, and 84.7% knew the

correct starting age. However, only 67.6% could name three vaccine-preventable diseases.This

indicates that while general awareness is high, detailed knowledge remains moderate,

particularly in understanding the full immunization schedule and disease protection. This finding

is consistent with Awodele, Kasali, & Awodele (2010) who found that many Nigerian mothers

are aware of immunization but lack complete knowledge of its scope.Poor knowledge may

hinder mothers from adhering to full schedules or recognizing the importance of specific

vaccines. Therefore, improving detailed vaccine education through antenatal clinics and health

talks is essential.

Accessibility and Utilization of Immunization Service

The finding of this study revealed that 64.9% of respondents lived within 3 km of the health

center and 71.2% found immunization days convenient, only 62.2% had completed their child’s

25
immunization schedule. This gap indicates that proximity alone does not guarantee

utilization.Similar findings by Fagbamigbe, Kandala, & Uthman (2017) emphasized that access

must be complemented by health education, family support, and quality services to achieve full

coverage. Additionally, Kandala et al. (2020) stressed that geographic closeness needs to be

paired with service readiness and motivation for actual impact.

Barriers to Accessibility and Utilization

The study revealed that transportation difficulties (40.5%) and time constraints (30.6%) as the

most common barriers. Fewer mothers reported issues like negative attitudes of health workers

(18.0%) or religious/cultural opposition (9.0%).These findings align with those of Sadoh &

Eregie (2009) who noted that indirect costs (like transportation and time) significantly impact

immunization adherence, especially in low-income areas. Cultural and religious opposition was

minimal in this setting, unlike in some northern parts of Nigeria where such factors are more

influential (Babalola, 2009).

Implications of the Findings to Nursing Practice

 Nurses should strengthen health education and efforts by working in antenatal, postnatal, and

immunization units.Health education should be continuous, specific, and culturally sensitive.

 Nurses must go beyond providing knowledge—they should help mothers overcome practical

barriers like timing and transport by collaborating with community leaders,

 Nurses should advocate for mobile outreach immunization or community-based strategies to

serve distant households.

 Nurses should engage family and spouse during health talks and immunization awareness

campaigns to foster shared responsibility in child health decisions.

26
Limitations of the Study

 Limited Geographical Scope: The study was conducted in only one primary health center

(Amichi PHC) within Nnewi South Local Government Area, which limits the

generalizability of the findings to other regions or health facilities with different

demographic or infrastructural characteristics.

 Self-Reported Data: Information was collected using self-administered questionnaires,

which may have been subject to social desirability bias—some mothers might have given

answers they believed were expected rather than reflecting their true experiences.

 Cross-Sectional Design: The study used a cross-sectional design, meaning data was collected

at one point in time. This limits the ability to establish cause-and-effect relationships

between variables such as distance and immunization completion.

 Limited Use of Inferential Statistics: Due to resource constraints, the data analysis focused

mainly on descriptive statistics. Incorporating more inferential statistical tools (e.g., logistic

regression) could have provided deeper insights into factors predicting immunization

utilization.

 Language and Literacy Barriers: Some participants may have had difficulty understanding

certain questions due to literacy or language limitations, which could affect the accuracy of

their responses.

Summary of the Study

This study examined the accessibility and utilization of immunization services among nursing

mothers aged 18–49 years attending Amichi Primary Health Center in Nnewi South Local

Government Area of Anambra State, Nigeria. The study was guided by Nola J. Pender’s Health

27
Promotion Model, which emphasizes the role of personal factors, perceived barriers, and

environmental influences in health behavior. A total of 222 nursing mothers participated in the

study. Data was collected using a structured questionnaire and analyzed using the Statistical

Package for Social Sciences (SPSS) version 25. The results were presented using tables, figures,

and descriptive statistics. The findings showed that while most mothers (97.3%) were aware of

immunization, only 67.6% could name three vaccine-preventable diseases, indicating a gap

between awareness and detailed knowledge. In terms of accessibility, 64.9% lived within 3

kilometers of the health facility, and 71.2% found clinic schedules convenient. However, only

62.2% completed their child’s full immunization schedule, suggesting underutilization despite

physical access.

Barriers identified included transportation challenges (40.5%), time constraints (30.6%), and

negative attitudes of some health workers (18.0%). A significant association was found between

distance to the clinic and immunization completion, reinforcing the importance of logistical

accessibility in healthcare utilization. The study highlights the need for improved health

education, mobile outreach services, client-friendly care, and stronger family involvement in

immunization decision-making. It concludes that addressing both knowledge gaps and systemic

barriers is essential to improving immunization coverage.

Conclusion

This study concludes that while awareness of immunization services among nursing mothers in

Amichi Primary Health Center is generally high, full utilization of these services remains sub-

optimal due to multiple interrelated factors. Although many mothers live near the health facility

and find the immunization schedule convenient, a considerable number do not complete their

child’s full vaccination regimen. The findings reveal that inadequate knowledge of vaccine-

28
preventable diseases, transportation challenges, time constraints, and occasional negative

attitudes from health workers contribute significantly to underutilization. These barriers

emphasize the importance of addressing both informational and systemic issues affecting

healthcare access and behavior.

The study affirms that physical accessibility alone does not ensure effective utilization. There is a

need for comprehensive, mother-friendly interventions that consider the socio-economic realities

of nursing mothers. Enhancing health education, improving service delivery, and encouraging

family support are critical strategies that can bridge the gap between access and utilization. By

applying Nola Pender’s Health Promotion Model, the study reinforces the role of individual

experiences, interpersonal influences, and environmental factors in shaping health behavior. To

achieve optimal immunization coverage, health systems must adopt a holistic approach that

empowers mothers with knowledge and reduces barriers to care.

Recommendations

Based on the findings of this study, the following recommendations are made to enhance the

accessibility and utilization of immunization services among nursing mothers in Amichi and

similar settings:

 Health workers, particularly nurses, should provide targeted, continuous health education to

mothers on the importance of completing the full immunization schedule and identifying

vaccine-preventable diseases. Educational sessions should be incorporated during antenatal,

postnatal, and immunization clinics.

29
 To address transportation and distance-related challenges, mobile immunization services

should be introduced to reach mothers in remote or underserved areas.

 Nurses and public health officers should organize community sensitization programs

involving religious leaders, traditional rulers, and other key influencers to increase

awareness and acceptance of immunization.

 Regular training programs should be conducted to improve communication skills and

attitude of health workers, ensuring respectful and culturally sensitive care that encourages

mothers to return for services.

 Immunization programs should encourage the participation of fathers and other family

members by integrating family-centered health education. This may enhance support for

mothers in making health decisions.

 Immunization services should be scheduled at more flexible hours, including weekends or

early evenings, to accommodate working mothers and those with busy schedules.

Suggestion for Further Study

 A qualitative study to explore personal and cultural reasons behind non-utilization.

 Research on the effect of mobile vaccination units on immunization coverage in underserved

areas.

 Studies focusing on father’s roles and family decision-making in child immunization

behavior.

30
 College of Nursing Science,

Alor, Idemili South L.G.A.

Anambra State.

Dear Respondent,

I am Ekwe Charity Ogechukwu from College of Nursing Sciences, Alor, currently conducting a

descriptive survey on the research titled "Accessibility and utilization of immunization services

among nursing mothers (18-49yrs) in Amichi Primary Health Center". Kindly fill the below of

self-explanatory questions that will not take much of your time to answer. Your kid and unbiased

would be valued as it will expressively contribute to the direction of achieving the objective of

determining the accessibility and utilization of immunization services among nursing mothers

in Amichi, Nnewi Anambra State. Please note that your response will be preserved with firmness

of confidence, therefore do not put down your name on the questionnaire.

Ekwe Charity Ogechukwu

Contact: 09033738017

E-mail: charityoge2022@gmail.com

31
 Questionnaire

Section A

Socio-Demographic Data

Instruction: tick in the appropriate space provided as it implies to you

1. Age:☐ 18–25 ☐ 26–33 ☐ 34–41 ☐ 42–49

2. Marital status:☐ Married ☐ Single ☐ Divorced ☐ Widowed

3. Educational level:☐ No formal education ☐ Primary ☐ Secondary ☐ Tertiary

4. Occupation:☐ Unemployed ☐ Trader ☐ Civil servant ☐ Artisan ☐ Other:

________

5. Religion:☐ Christianity ☐ Islam ☐ Traditional ☐ Other: ________

6. Number of children:☐ 1 ☐2 ☐3 ☐ 4 and above

Section B

Knowledge of Immuinization services

7. Have you heard about child immunization before?

☐ Yes ☐ No

8. Do you know the purpose of immunization?

☐ Yes ☐ No

9. Immunization helps prevent which of the following? (Tick all that apply)

☐ Measles ☐ Polio ☐ Malaria ☐ Tuberculosis ☐ Diarrhea

32
10. At what age should a child receive their first immunization?

☐ At birth ☐ 6 weeks ☐ 6 months ☐ I don’t know

11. Do you know how many times a child must be immunized before 1 year?

☐ Yes ☐ No ☐ Not sure

12. Where do you get information about immunization?

☐ Health workers ☐ Family/Friends ☐ Radio/TV ☐ Religious leaders ☐

Other: ________

Section C:

Accessibility and utilization of immunization services

13. How far is the immunization center from your home?

☐ Less than 1 km ☐ 1–3 km ☐ 4–6 km ☐ More than 6 km

14. How do you usually get to the immunization center?

☐ Walk ☐ Public transport ☐ Personal vehicle ☐ Other: ________

15. How often do you bring your child for immunization?

☐ Always ☐ Occasionally ☐ Rarely ☐ Never

16. Do you think immunization services are easily accessible to you?

☐ Yes ☐ No ☐ Not sure

17. Have you completed the immunization schedule for your last child?

☐ Yes ☐ No ☐ In progress

33
18. Are the clinic days and times convenient for you?

☐ Yes ☐ No

Section D

Barriers to Accessibility and Utilization of Immunization services.

19. Which of the following have made it difficult for you to access immunization services? (Tick

all that apply)

☐ Long distance to facility

☐ Transportation problems

☐ Lack of money

☐ Poor attitude of health workers

☐ Lack of information

☐ Husband/family disapproval

☐ Religious/cultural beliefs

☐ Time constraints

☐ Other: ________

20. Have you ever missed a child’s immunization due to any of the above reasons?

☐ Yes ☐ No

34
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