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TYPE
Original Research
PAGE NO.
65-77
10.37547/tajmspr/Volume07Issue01-09
OPEN ACCESS
SUBMITED
18 October 2024
ACCEPTED
20 December 2024
PUBLISHED
25 January 2025
VOLUME
Vol.07 Issue01 2025
CITATION
Obohwemu, K. O., Owusuaa-Asante, A. M., Ibiangake, N. F., Abayomi, G. O.,
Idomeh, J. E., Chauhan, R. ., & Sharma, S. . (2025). The Interplay of
Ethnicity, Education, and Employment on Maternal Attitudes Toward
Childhood Vaccination in Nigeria. The American Journal of Medical Sciences
and Pharmaceutical Research, 7(01), 65
–
77.
https://doi.org/10.37547/tajmspr/Volume07Issue01-09
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
The Interplay of Ethnicity,
Education, and
Employment on Maternal
Attitudes Toward
Childhood Vaccination in
Nigeria
Obohwemu Oberhiri Kennedy, PhD
Department of Health, Wellbeing and Social Care, Global Banking School,
Oxford Brookes University, Birmingham, United Kingdom; and PENKUP
Research Institute, Birmingham, United Kingdom
Owusuaa-Asante Maame Ama, PhD
Department of Health, Wellbeing and Social Care, Global Banking School,
Oxford Brookes University, Birmingham, United Kingdom
Ibiangake Friday Ndioho, PhD
Department of Health Professions, Manchester Metropolitan University,
Manchester, United Kingdom
Abayomi Olaoluwa Gabriel, PhD
Department of Health, Wellbeing & Social Care, Global Banking School,
Oxford Brookes University, Manchester, United Kingdom
Idomeh Eberechukwu Joyce, PhD
Department of Social Works (DSW), College of Education, Psychology and
Social Work, Flinders University, Bedford Park Campus, Sturt Road,
Bedford Park 5042, South Australia
Rupali Chauhan, MPH
Department of Health, Wellbeing & Social Care, Global Banking School,
Oxford Brookes University, Manchester, United Kingdom
Shubham Sharma, MDS
Independent Researcher, Manchester, United Kingdom
Corresponding Author: Obohwemu Kennedy
Oberhiri, PhD
ABSTRACT:
Vaccination is a highly effective public
health strategy for reducing child mortality from
vaccine-preventable diseases (VPDs) such as measles,
polio, tuberculosis, and Haemophilus influenzae.
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Despite the provision of free routine immunizations for
children up to two years old in Nigeria, challenges in
vaccine uptake persist, especially for vaccines needed
beyond early childhood. These challenges are not
merely due to vaccine access but are significantly
influenced
by
maternal
attitudes
towards
immunization. Socio-demographic factors such as
ethnicity, education, and employment status are
crucial in shaping these attitudes, yet their specific
impacts are not well understood. This study aims to
explore how these socio-demographic variables affect
maternal attitudes towards childhood immunization,
with a focus on immunization beyond the age of two in
Ughelli North Local Government Area (LGA) of Delta
State, Nigeria.
A cross-sectional study was conducted with 321
mothers in Ughelli North LGA, utilizing a modified, pre-
tested questionnaire to evaluate maternal attitudes
towards childhood immunization. Data were collected
through an online survey and analysed using
descriptive and inferential statistics, with Chi-square
tests used to assess the relationships between socio-
demographic factors and attitudes. The majority of
participants were Urhobo (60.7%), semi-employed
(53.6%), and had tertiary education (92.1%). The
findings showed that 79.4% of mothers had positive
attitudes towards childhood immunization. Significant
associations were found between maternal attitudes
and ethnicity (p = 0.026), employment status (p =
0.016), and educational level (p < 0.001), indicating
that these factors are pivotal in shaping maternal views
on the importance and necessity of immunization.
Unexpectedly, even mothers with high educational
levels showed variability in their attitudes based on
ethnic background and employment status, suggesting
that public health interventions must consider the
complex interplay of these factors. The study's results
provide valuable insights into the socio-cultural and
economic determinants of maternal attitudes towards
immunization in Ughelli, underscoring the need for
targeted health promotion strategies that address
specific demographic groups. Efforts should focus on
community-based interventions and media campaigns
that highlight the importance of continuing vaccination
beyond infancy. Additionally, enhancing access to
immunization services and addressing barriers related
to employment and ethnicity will be crucial for
improving vaccine uptake in the region.
Keywords:
Maternal attitudes, child immunization,
ethnicity,
cultural
background,
educational
attainment, employment status, socio-demographic
influences, vaccine acceptance, Nigeria, Ughelli North
LGA.
INTRODUCTION:
Childhood immunization is one of the
most cost-effective public health interventions for
reducing childhood morbidity and mortality. It provides
protection against serious diseases such as measles,
polio, tetanus, diphtheria, pertussis, and Mpox, which
has seen a growing prevalence in recent years (World
Health
Organization
[WHO],
2021;
Abejegah,
Obohwemu & Mdegela, 2024; Jesse & Obohwemu,
2024). While global initiatives like the Expanded
Program on Immunization (EPI) have significantly
improved vaccination rates, low- and middle-income
countries (LMICs), including Nigeria, continue to face
barriers to achieving optimal coverage. Maternal
attitudes significantly influence vaccination uptake,
shaped by demographic factors like ethnicity,
education, and employment. These factors contribute
to maternal decision-making regarding childhood
immunization, with significant implications for vaccine
acceptance or hesitancy (Dubé et al., 2013; Bangura et
al., 2020; Obohwemu, 2024a).
Nigeria is among the countries with the highest number
of under-vaccinated children. According to WHO and
UNICEF, over three million Nigerian children were either
under-vaccinated or entirely unvaccinated in 2018
(WHO/UNICEF, 2020). While barriers such as limited
healthcare access, logistical challenges, and cultural
resistance persist, maternal attitudes play a pivotal role
(Obohwemu, 2024b). These attitudes are shaped not
only by knowledge but also by broader psychosocial,
cultural, and economic factors influencing beliefs and
perceptions about vaccination, especially as diseases
like MPox become more prevalent.
Nigeria’s ethnic diversity—
home to over 250 ethnic
groups
—
profoundly shapes maternal attitudes toward
immunization. Ethnic identity is closely tied to cultural
practices, which may conflict with biomedical
perspectives on health. In certain ethnic communities,
beliefs favouring natural immunity or divine
intervention over medical interventions, including
vaccines, contribute to vaccine hesitancy (Jegede,
2007). Mothers influenced by such beliefs may prioritize
traditional remedies, especially when distrust of
Western medicine is prevalent.
Religious beliefs, often overlapping with ethnicity, also
impact maternal attitudes. For example, northern
Nigeria, predominantly Muslim, has a history of vaccine
resistance, fuelled by misinformation. During the polio
eradication campaigns of the early 2000s, rumours that
vaccines were tools for sterilization or population
control spread distrust in vaccination programs
(Obanewa & Newell, 2020). Although such views are less
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common in urban areas like Ughelli, they persist
among migrant communities, where cultural and
religious norms continue to shape attitudes toward
immunization.
Education is a critical factor influencing maternal
attitudes toward childhood immunization. Research
consistently links higher maternal education levels to
positive vaccination attitudes and adherence to
immunization schedules (Adedokun et al., 2017;
Obohwemu, 2024a). Educated mothers are typically
more aware of the benefits of vaccination and less
likely to be influenced by misinformation or cultural
beliefs opposing immunization (Ndukwe et al., 2022).
Furthermore, education fosters trust in healthcare
providers and confidence in vaccine safety and efficacy
(Bangura et al., 2020).
However, the relationship between education and
maternal attitudes is not always linear. While
education enhances access to accurate information, it
can also expose mothers to misinformation,
particularly through social media. Platforms like
Facebook and WhatsApp facilitate the spread of both
credible and false vaccine information, influencing
maternal decision-making (Salmon et al., 2015). This
paradox highlights the need for targeted health
education that equips mothers to critically evaluate
vaccine-related information.
Maternal employment status also shapes attitudes
toward childhood immunization. Employed mothers,
especially those in formal sectors, often face time
constraints, which can hinder their ability to adhere to
vaccination schedules (Afolabi et al., 2021).
Conversely, employment can enhance maternal
attitudes by increasing exposure to health information
and resources through workplace programs or
interactions with colleagues. Employment correlates
with higher socioeconomic status, which generally
promotes trust in healthcare systems and access to
immunization services (Oladokun et al., 2016).
Delta State, particularly Ughelli, represents a
microcosm of Nigeria's ethnic, cultural, and
socioeconomic diversity. This urban centre hosts
populations from various ethnic and religious
backgrounds, including migrants who bring traditional
beliefs that may conflict with biomedical health
practices. Among certain groups, particularly those
with ties to northern Nigeria, vaccine hesitancy
remains a barrier to achieving optimal coverage
(Jegede, 2007). Such beliefs are often reinforced by
social networks, where misinformation about vaccines
spreads rapidly through community leaders or social
media platforms (Smith et al., 2017; Obohwemu,
Idomeh & Chauhan, 2025).
Vaccine safety concerns are another significant
challenge in Ughelli. Mothers frequently cite fears of
side effects like fever, swelling, or allergic reactions
(Isikwenu, 2021). These fears are amplified by
widespread misinformation, including unfounded
claims that vaccines cause infertility or contain harmful
substances (Edje et al., 2020). Such concerns, even
when accompanied by recognition of immunization
benefits against diseases like MPox, can lead to delays
or refusals in vaccination (Kingsley & Chukwuemeke,
2022).
Trust in healthcare providers is pivotal in shaping
maternal attitudes. Negative experiences with the
healthcare system, such as long wait times or poor
communication, can erode trust and discourage
vaccination (Asiwe et al., 2022). Conversely, positive
patient-provider interactions can build trust and
encourage adherence to immunization schedules (Ezeh
et al., 2024). Improving healthcare quality and fostering
better provider communication in overburdened
systems like those in Ughelli is crucial for addressing
vaccine hesitancy.
In Ughelli, social networks and community dynamics
heavily influence maternal attitudes. Mothers often
look to family members, friends, and community leaders
for guidance. In communities where vaccine hesitancy
prevails, mothers may follow prevailing norms even if
they recognize the benefits of immunization (Smith et
al., 2017). Conversely, observing positive vaccination
behaviours among peers can encourage vaccine
acceptance (Salmon et al., 2015). Community-based
interventions leveraging these social dynamics are
essential for shifting attitudes and promoting
immunization.
This study contributes to understanding the interplay of
ethnicity, education, and employment in shaping
maternal attitudes toward childhood immunization in
urban Nigeria. Unlike previous research focused on
knowledge gaps or logistical barriers, this study
emphasizes the psychosocial and cultural factors
influencing maternal decision-making. The research
highlights how Delta State's cultural and religious
diversity affects immunization attitudes. It explores how
beliefs in natural immunity or divine intervention
intersect with concerns about vaccine safety. Such
findings emphasize the need for culturally sensitive
public health interventions. The study offers insights
into how employment influences maternal attitudes.
While employment can present logistical challenges, it
also facilitates exposure to health information, which
can improve vaccine acceptance. Highlighting the
critical role of trust in healthcare providers, the research
underscores the need to improve healthcare
communication and reduce barriers like long wait times.
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These changes are essential for fostering positive
maternal attitudes toward immunization. The paper
identifies social networks as key drivers of maternal
attitudes. By targeting influential community members
and leveraging positive peer influences, public health
initiatives can address vaccine hesitancy more
effectively.
METHODOLOGY
This study investigated factors influencing maternal
knowledge of childhood vaccination in Ughelli North
Local Government Area, Delta State, Nigeria. A semi-
structured questionnaire, adapted from an earlier
study by Idowu, Obohwemu & Iyevhobu (2024), was
administered to a purposively selected sample of
mothers in the area. The questionnaire focused on
evaluating the mothers' knowledge of vaccination
schedules, the benefits of vaccines, and potential side
effects. Additionally, demographic data such as
ethnicity, education level, and employment status
were collected to assess the relationship between
these factors and maternal vaccination knowledge.
Research Design
A cross-sectional study design was utilized to collect
primary data from mothers with children within the
recommended vaccination schedule. The survey
gathered demographic information and variables
related to vaccination attitudes and perceptions.
Descriptive statistics were used to present the
characteristics and experiences of the respondents,
while bivariate analysis was conducted to identify
associations between socio-demographic factors and
vaccination knowledge.
Study setting
This study was conducted in Ughelli North Local
Government Area (LGA) of Delta State, Nigeria. Ughelli
North LGA, the headquarters of Ughelli, is a prominent
region in Delta State. The LGA covers approximately
818 square kilometers and has an estimated
population of 388,191 according to recent statistics
(National Bureau of Statistics, 2023). A semi-urban
environment, Ughelli North is one of the 25 LGAs in
Delta State (Agaja & Unueroh, 2012).
Ughelli North LGA comprises several towns and
villages, including Afiesere, Ododegho, Ofuoma,
Agbarha, Owheru, Evwreni, Ogor, Agbarho, and
Orogun (Ekeh, 2007). The area is predominantly
inhabited by the Urhobo ethnic group, though it also
hosts a mixture of other tribes such as the Isokos and
Edos (Ogbeide, 2016), contributing to its rich cultural
tapestry.
The residents of Ughelli North benefit from a range of
healthcare services provided by both government and
private entities. The LGA is home to several primary
healthcare centers distributed across its towns and
villages, providing essential health services, including
vaccination programs (Agaja & Unueroh, 2012; Delta
State Ministry of Health, 2023).
Ughelli North’s proximity to Warri, a major commercial
hub in Delta State, enhances its accessibility and
connectivity (Warri Chamber of Commerce and
Industry, 2023). The region’s infrastructure includes
schools, a general hospital, and a local government
secretariat, making it a suitable setting for various
research studies (Ekeh, 2007). However, like many other
LGAs, Ughelli North lacks comprehensive data on the
knowledge, attitude, and practice of mothers regarding
childhood vaccination, highlighting the need for further
research in this area (NITAG, 2023).
Study Population
The study targeted mothers with children aged 2 years
and above, residing in Ughelli North LGA, Delta State.
Participants were recruited via online platforms, such as
Facebook, Instagram, and YouTube. Inclusion criteria
required digital literacy and residency in Ughelli North
LGA. Consent was obtained through the data collection
tool, which also gathered demographic data and
information on vaccination knowledge, including
awareness of vaccines sourced "out-of-pocket." These
data were then subjected to statistical analysis.
Sampling Approach
The study evaluated the knowledge, attitudes, and
practices of mothers in Ughelli North LGA regarding the
vaccination of their children aged 2 to 10 years. A
purposive non-probability sampling method was
employed due to the unique nature of the target
population (Ames et al., 2019). Eligible mothers were
identified, consented, and administered semi-
structured questionnaires. The sample size was
calculated beforehand using appropriate statistical
methods.
Eligibility Criteria
Inclusion criteria for the study were: mothers whose
children met the age range of 2
–
10 years, who resided
in Ughelli North LGA, were digitally literate, and who
provided consent. Mothers who did not meet these
criteria, such as those outside the study area, with
children not within the age range, or lacking digital
literacy, were excluded.
Sample Size
A sample size of 420 was calculated using Cochran
e’s
(1977) formula for studying a single proportion. A
prevalence rate of 51.0% from a 2019 study on maternal
vaccination knowledge in Lagos (Adefolalu et al., 2019)
was used, allowing for a 10% non-response rate to
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account for attrition.
Sample Recruitment
Participants were recruited between April and June
2024, with the survey link, participant information,
consent form, and questionnaire distributed through
social media platforms and groups. A Google
advertisement campaign was launched to further
promote the study, and eligible participants were able
to access the survey link. Participants had to agree to
participate by clicking "yes" on the consent form
before proceeding to the questionnaire.
Data Analysis
Data analysis was performed using IBM SPSS version
28.0 (IBM Inc., Chicago, USA). Descriptive statistics
were used to describe demographic variables and
vaccination awareness levels. Inferential statistics,
specifically Chi-square tests, were used to examine the
relationship between maternal knowledge and
demographic variables. The data, categorized into
nominal and ordinal responses, were coded
numerically and analyzed using Pearson’s Chi
-square
test, with a significance level set at p < 0.05.
Data Management
Data collected through Survey Monkey was filtered to
remove responses that did not meet the inclusion
criteria, coded, and analyzed using SPSS version 28.0.
Responses to “Yes” or “No” questions were scored as
“1” or “0,” respectively, while multiple
-choice and
open-ended questions were scored accordingly.
Knowledge scores were calculated, and knowledge
levels were categorized as “poor” (<50%), “fair” (50
-
69%), or “good” (≥70%). Descriptive statistics, including
frequency distributions for categorical variables and
means with standard deviations for continuous
variables, were computed. Bivariate analyses were
conducted using Chi-
square or Fisher’s Exact Test where
appropriate, with a two-tailed p-value < 0.05 considered
statistically significant.
RESULTS
Sociodemographic Characteristics of Respondents
A total of 321 respondents (mothers) were included in
the analysis, giving a response rate of 76%. The mean
age of the respondents was 33.5 ± 5.8 years, with the
youngest being 21 years old and the oldest 51 years. The
mean age of their children was updated to 5.2 ± 2.1
years. In terms of the age distribution, 64.2% (n = 206)
of the respondents were aged 31
–
40 years, 25.9% (n =
83) were aged 21
–
30 years, and 9.9% (n = 32) were aged
above 40 years. For the children, 57.3% (n = 184) were
5 years old or younger, while 42.7% (n = 137) were over
5 years old (see Table 1). Regarding ethnicity, the
majority were of Urhobo descent (60.7%, n = 195), Isoko
(21.5%, n = 69), Itsekiri (9.6%, n = 31) and Others (8.2%,
n = 26). Employment status showed that 50.2% (n = 161)
were semi-employed, 43.0% (n = 138) were employed,
and 6.8% (n = 22) were unemployed. For education
level, 88.8% (n = 285) of the respondents had attained
tertiary education, 8.1% (n = 26) had secondary
education, and 3.1% (n = 10) had primary education.
Table 1: Summary Statistics of Respondents’ Sociodemographic Characteristics
Characteristic
Mean (SD)
Range
Frequency (%)
Respondent Age (years)
33.5 (5.8)
21-51
-
Child Age (years)
5.2 (2.1)
-
-
Ethnicity
-
-
Urhobo (60.7%), Isoko (21.5%), Itsekiri (9.6%),
Others (8.2%)
Employment Status
-
-
Semi-employed (50.2%), Employed (43%),
Unemployed (6.8%)
Education Level
-
-
Tertiary (88.8%), Secondary (8.1%), Primary
(3.1%)
A more comprehensive data is presented in Table 2, including detailed demographic information about the study
participants, such as age, ethnicity, employment status, education level, and the age of respondents’ children.
This information is essential for understanding the characteristics of the study population and interpreting the
findings.
Table 2: Sociodemographic Characteristics of Respondents
Characteristic
Frequency (n)
Percentage (%)
Mean ± SD
Range
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Age (years)
33.5 ± 5.8
21-51
21-30
83
25.9
31-40
206
64.2
>40
32
9.9
Child's Age (years)
5.2 ± 2.1
≤5
184
57.3
>5
137
42.7
Ethnicity
Urhobo
195
60.7
Isoko
69
21.5
Itsekiri
31
9.6
Others
26
8.2
Employment Status
Semi-employed
161
50.2
Employed
138
43
Unemployed
22
6.8
Education Level
Tertiary
285
88.8
Secondary
26
8.1
Primary
10
3.1
Respondents’ Attitudes towards Childhood Vaccination
Mothers' attitudes towards childhood vaccination were measured using a 5-point Likert scale, ranging from
strongly disagree (1) to strongly agree (5). To simplify the analysis, responses were grouped into three categories:
agree (score of 3 or above), neutral (score of 2), and disagree (score of 1). As shown in Table 3, the majority of
respondents (79.1%, n = 254) agreed that childhood vaccination is necessary, while 12.1% (n = 39) were neutral
and 8.7% (n = 28) disagreed.
Regarding the completion of the vaccination schedule, 79.8% believed that healthy children should be vaccinated
to prevent diseases, 12.2% were neutral, and 8.1% saw no need to complete the vaccination schedule. A
significant majority (85.7%) supported the idea that all vaccination services should be free, with only 4.4%
expecting out-of-pocket payments. Furthermore, 53.3% of respondents disagreed with the statement that
'vaccinations are not 100% effective,' while 26.8% were undecided, and 19.9% agreed.
These findings underscore the generally positive attitude of mothers towards childhood vaccination, although
concerns about vaccine effectiveness and affordability remain.
Table 3: Mothers' Attitudes towards Childhood Vaccination (N = 321)
Variable
Agree
(%)
Neutral (%)
Disagree (%)
Vaccination for children is very necessary
254 (79.1)
39 (12.1)
28 (8.7)
It is compulsory to complete vaccination for children
256 (79.8)
39 (12.2)
26 (8.1)
Vaccination should be discontinued if the child is healthy
24 (7.5)
36 (11.2)
261 (81.3)
All vaccinations should be free
275 (85.7)
32 (10.0)
14 (4.4)
Vaccinations are not 100% effective
64 (19.9)
86 (26.8)
171 (53.3)
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The clinic staff was helpful during vaccination
225 (70.1)
70 (21.8)
26 (8.1)
Waiting time discouraged you from completing
vaccination
110 (34.3)
90 (28.0)
121 (37.7)
Finding information about vaccination was difficult
80 (24.9)
76 (23.7)
165 (51.4)
Availability of vaccines was a problem
69 (21.5)
61 (19.0)
191 (59.5)
A notable 70.1% of mothers indicated that healthcare staff positively influenced their attitude towards
vaccination, while only 8.1% disagreed and 21.8% were indifferent. Moreover, 34.3% felt that long waiting times
affected their willingness to vaccinate their children, while 37.7% did not consider waiting times a significant
deterrent.
Furthermore, 59.5% of mothers disagreed with the statement that availability of vaccines was a problem,
suggesting that most mothers in the study had access to vaccines. However, 21.5% believed that availability was
indeed an issue, and 19.0% were neutral on the matter. Access to information about vaccination was another
concern, with 24.9% reporting difficulty in obtaining relevant information.
Overall, 20.9% of respondents exhibited a poor attitude towards childhood vaccination, while 79.1% had a good
attitude, as illustrated in Figure 1.
Figure 1: Mothers' Attitudes Towards Childhood Vaccination
Factors Associated with Respondents’ Attitudes
Towards Childhood Vaccination
Bivariate analysis was conducted to examine potential
associations between attitudes towards childhood
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vaccination and knowledge, as well as socio-
demographic characteristics (Table 4). Among age
groups, 75.1% of respondents aged 21-30 years, 81.3%
aged 31-40 years, and 74.2% above 40 years exhibited
positive attitudes towards childhood vaccination.
However, no significant association was found
between respondents' ages and their attitudes (p =
0.413).
Similarly, there was no significant association between
the child's age and the mother's attitude towards
vaccination (p = 0.116). Among respondents with
children under five years of age, 76.4% had a positive
attitude, while 83.8% of those with children above five
years also exhibited positive attitudes.
Knowledge level was also not significantly associated
with attitude (p = 0.086). Among mothers with good
knowledge of vaccination, 86.9% displayed a positive
attitude, while 77.3% of those with poor knowledge
still demonstrated good attitudes towards vaccination.
Conversely, ethnicity (p = 0.026) and employment
status (p = 0.016) showed significant associations with
attitudes. For example, 82.9% of Urhobo, 71.0% of
Isoko, and 61.4% of Itsekiri respondents exhibited
positive attitudes towards vaccination. Unemployed
mothers were more likely to have poor attitudes
compared to employed mothers (75% vs 19.9%).
Educational status was also strongly associated with
attitude (p < 0.001). Women with tertiary education
were significantly more likely to have poor attitudes
(82.5%) compared to those with secondary education
or less (43.5%).
Table 4: Association between Socio-Demographic Characteristics and Attitude (N = 321)
*Statistically significant at p <0.05, Good Knowledge (Good and Fair) **FET: Fisher’s Exact
Summary of Findings
Among the 321 women surveyed, the mean age was
34.5 ± 5.3 years, and their children had a mean age of
5.4 ± 2.3 years. A majority of respondents were of
Urhobo ethnicity (77.3%) and had tertiary education
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(92.1%). Despite low knowledge of vaccination (76.9%
with poor knowledge), 79.1% exhibited a positive
attitude towards childhood vaccination.
No significant association was found between socio-
demographic characteristics like age and knowledge
level and attitude (p > 0.05). However, attitude was
significantly associated with ethnicity, employment
status, and educational level (p < 0.05). Therefore,
while knowledge may not directly influence attitudes,
cultural and socio-economic factors do play a
significant role in shaping maternal attitudes towards
childhood vaccination.
DISCUSSION
Immunization is widely regarded as one of the most
effective and economically efficient public health
strategies, protecting children from numerous vaccine-
preventable
diseases
(VPDs)
that
contribute
significantly to child morbidity and mortality,
particularly in low- and middle-income countries
(LMICs). Despite substantial global and national
initiatives, childhood immunization coverage in Nigeria
continues to fall short of optimal levels, with
considerable
regional
and
socio-demographic
disparities. Maternal attitudes toward immunization,
shaped by various socio-demographic factors, are
critical in determining vaccine uptake and adherence
to immunization schedules. This discussion examines
the influence of ethnicity, education, and employment
on maternal attitudes toward childhood immunization
in Nigeria.
Ethnicity
and
Maternal
Attitudes
Toward
Immunization
As one of the world's most ethnically diverse nations,
Nigeria's over 250 ethnic groups exhibit distinct
cultural beliefs and practices that significantly
influence
health-seeking
behaviours,
including
immunization. Ethnic norms and traditions often shape
maternal perceptions of vaccine safety and efficacy,
with some ethnic groups adhering to traditional
remedies or expressing scepticism toward Western
medicine. This can result in reduced immunization
uptake (Edje et al., 2020; Obohwemu et al., 2022).
Research by Oladokun et al. (2016) highlighted the
influence of cultural and religious beliefs on vaccine
hesitancy in Northern Nigeria, predominantly
inhabited by the Hausa-Fulani. In these communities,
concerns about vaccines leading to infertility or not
complying with Islamic dietary laws ("halal") have
contributed to resistance. Similar resistance has been
noted among some Christian communities in the
southeastern region, where mistrust arises from
rumours linking vaccines to political or anti-religious
agendas (Bangura et al., 2020).
Conversely, the Urhobo-dominated south-south
region, including urban centres like Ughelli, often
reports
more
favourable
attitudes
toward
immunization due to historical openness to Western
education and medical systems. The Urhobo ethnic
group generally exhibits greater acceptance of
vaccines, as this study has shown. However, even
within relatively homogeneous ethnic communities,
subgroups such as migrants or internally displaced
persons (IDPs) may face additional challenges,
including limited access to healthcare services, which
can hinder immunization uptake.
Culturally sensitive interventions are critical for
addressing ethnic disparities in maternal attitudes.
Tailored health education campaigns that respect local
customs, religious beliefs, and linguistic diversity can
foster more positive attitudes toward immunization
(Ndukwe et al., 2022). Such initiatives should involve
trusted community leaders to bridge cultural divides
and dispel myths surrounding vaccines.
Education and Its Impact on Maternal Attitudes
Education is a key socio-demographic determinant of
maternal attitudes toward childhood immunization.
Numerous studies have demonstrated that higher
educational attainment correlates with better health
literacy, more positive vaccine attitudes, and higher
immunization rates (Adedokun et al., 2017;
Obohwemu et al., 2022). Educated mothers are more
likely to understand the importance of vaccines, resist
misinformation, and seek accurate healthcare
information.
A study by Fatiregun et al. (2021) in Lagos revealed that
mothers with secondary or tertiary education were
more likely to view vaccines as essential and safe
compared to mothers with only primary or no formal
education, who expressed greater scepticism.
Additionally, educated mothers are more likely to
adhere to complete immunization schedules, including
booster doses, rather than stopping after initial
vaccinations.
However, education alone does not guarantee optimal
attitudes toward vaccination. Sadoh et al. (2013) found
that even educated mothers sometimes lacked full
knowledge of immunization schedules, particularly
regarding booster doses. This indicates the need for
ongoing education and engagement with health
services to address knowledge gaps and reinforce
positive attitudes.
Conversely, mothers with limited or no formal
education are more vulnerable to misinformation,
often spread through informal communication
channels such as word-of-mouth or social media. Eze
et al. (2021) noted that misinformation about vaccine
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The American Journal of Medical Sciences and Pharmaceutical Research
safety proliferates in low-education communities,
fuelling
negative
attitudes
that
undermine
immunization efforts.
To address these challenges, educational interventions
should prioritize health literacy over simple awareness.
Simplified, culturally relevant materials and programs
targeting women with lower education levels can help
bridge
gaps
in
understanding.
Integrating
immunization education into adult literacy programs
may further enhance maternal attitudes in
underserved populations (Oyo-Ita et al., 2016).
Employment and Its Influence on Immunization
Attitudes
Maternal employment status plays a significant role in
shaping attitudes toward childhood immunization by
affecting both access to healthcare resources and
availability for immunization appointments. Studies
suggest that mothers in formal employment generally
exhibit more positive attitudes toward immunization
than those who are unemployed or informally
employed (Adedokun et al., 2017).
Formal employment provides financial stability and
often includes access to health insurance and
workplace health initiatives, exposing mothers to
reliable information about vaccines. In contrast,
mothers working in the informal economy face unique
challenges, such as irregular working hours, lack of
health insurance, and financial instability, all of which
can hinder their ability to prioritize healthcare services,
including immunization (Fatiregun et al., 2021).
Informally employed mothers, such as market vendors
or domestic workers, often struggle with time
constraints, limiting their ability to attend scheduled
immunization
appointments.
Furthermore,
the
indirect costs associated with accessing healthcare,
including transportation or time off work, can deter
vaccine uptake, even when vaccinations are offered for
free under Nigeria’s national immunization program
(Adefolalu & Bamgboye, 2020).
Unemployed or underemployed mothers also face
economic barriers to healthcare access, fostering
negative attitudes toward immunization as they
perceive it to be an inaccessible or unaffordable
service. These economic pressures can overshadow
the perceived benefits of vaccines.
To address these barriers, targeted interventions must
account for the specific needs of employed mothers,
especially those in informal sectors. Mobile health
(mHealth) strategies, such as SMS reminders and
digital health campaigns, offer flexibility and real-time
access to information, accommodating mothers with
demanding schedules (Eze et al., 2021). Additionally,
workplace immunization drives and extended clinic
hours can help mitigate time-related barriers,
promoting more positive attitudes toward vaccination.
Intersecting Influences of Ethnicity, Education, and
Employment
The effects of ethnicity, education, and employment
on maternal attitudes toward immunization often
intersect, creating complex dynamics in vaccine
acceptance or hesitancy. For instance, an educated
mother from an ethnic minority with strong traditional
beliefs may still harbour vaccine hesitancy due to
cultural influences. Similarly, an unemployed mother
from a pro-vaccine ethnic group may face financial and
logistical barriers, despite having positive attitudes
toward vaccination.
In urban centres like Ughelli, which is both ethnically
diverse and highly urbanized, these intersecting
variables contribute to variations in immunization
coverage. Studies have shown that mothers in low-
income, ethnically mixed neighbourhoods often face
compounded challenges such as language barriers,
limited access to health education, and unstable
employment, all of which negatively impact their
attitudes toward immunization (Edje et al., 2020;
Idowu, Obohwemu & Iyevhobu, 2024).
Health promotion campaigns must adopt a multi-
faceted approach to address these overlapping socio-
demographic
factors.
Interventions
should
simultaneously tackle cultural, educational, and
economic barriers. For example, community-based
programs involving local leaders and healthcare
workers from various ethnic backgrounds can help
mitigate cultural resistance to immunization (Afolabi et
al., 2012; Isikwenu, 2021; Obohwemu, 2023).
Providing health education in diverse languages and
formats can ensure accessibility for all groups, while
integrating immunization services into maternal and
child health programs can ease access for working
mothers.
CONCLUSION
Ethnicity, education, and employment significantly
influence maternal attitudes toward childhood
immunization in Nigeria. Generally, higher education
levels and formal employment correlate with more
favourable attitudes, while ethnic and cultural beliefs,
along with economic challenges, can hinder vaccine
acceptance. Ethnic identity shapes health beliefs and
access to healthcare information, while education
enhances health literacy and the ability to evaluate
vaccine safety. Employment status, especially in the
informal sector, adds barriers to accessing
immunization services and affects how mothers
prioritize preventive healthcare. Overcoming these
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The American Journal of Medical Sciences and Pharmaceutical Research
challenges requires culturally sensitive and accessible
health education programs that consider the diverse
socio-demographic contexts of Nigerian mothers. To
boost childhood immunization rates in Ughelli, public
health initiatives must address these socio-
demographic factors by promoting positive vaccine
attitudes through culturally sensitive, accessible, and
context-specific
health
education
efforts.
A
comprehensive approach is needed, combining health
education with improved healthcare access to ensure
all children benefit from immunization, regardless of
their mothers' backgrounds.
CONFLICTS OF INTEREST
The publication of this article was supported by
PENKUP Foundation, a non-profit organisation
founded by the corresponding author.
FUNDING
This work was supported by the PENKUP Foundation, a
division of PENKUP International, which provided
funding for the publication of this article.
ACKNOWLEDGMENT
The authors would like to acknowledge the
management and technical staff of PENKUP Research
Institute, Birmingham, United Kingdom for their
excellent assistance and for providing manuscript
writing/editorial support in accordance with Good
Publication Practice (GPP3) guidelines. Special thanks
to Idowu, Obohwemu & Iyevhobu (2024) whose
previous work on childhood vaccinations in Lagos
State, Nigeria proved useful.
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