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*Corresponding author: E-mail: ezenelson24@gmail.com; 
 
 
 

Asian Journal of Immunology 
 
1(1): 14-19, 2018; Article no.AJI.44952 
 

 
 

 

 

Missed Immunisation and Immunisation Drop-outs 
among Infants in Rural Health Facilities in  

Abakaliki, Nigeria 
 

N. C. Eze1*  
 

1
Department of Community Medicine, Federal Teaching Hospital Abakaliki, Nigeria. 

 
Author’s contribution  

 
Author NCE designed, analysed, interpreted and prepared the manuscript.  

 

Article Information 

 
DOI: 10.9734/AJI/2018/44952 

Editor(s): 

(1) Dr. Wagner Loyola, Department of Immunology, Brazilian Agricultural Research Corporation (Embrapa) Concordia,  

Canada. 

Reviewers: 

(1) Abram Wagner, University of Michigan, USA. 

(2) A. Shaikh Amir, Indira College of Pharmacy, Savitribai Phule Pune University, India. 

(3) Jose Manuel Jaramillo Ortiz, National University Jauretche, Argentina. 

Complete Peer review History: http://www.sciencedomain.org/review-history/27207 

 

 

 

Received 15
th

 August 2018  

Accepted 5
th

 November 2018 

Published 14
th

 November 2018 

 
 
ABSTRACT 
 

Background: Missed immunisation, immunisation drop-out and coverage rates at primary health 
care (PHC) level indicate the level at which communities utilise the preventive services and thus 
serve as a measure of the strength of the public health system. They also measure the 
effectiveness of the immunisation programme. The extent of missed immunisation and 
immunisation drop-out is not well known in the study area. This study, therefore, determined the 
extent of missed immunisation and immunisation drop-outs in Abakaliki.  
Materials and Methods: Descriptive cross-sectional analytical study design was used for the 
survey. Total number of infants in the health facilities was used as a sample size in this study (406 
infants at Mile-Four hospital and 281 infants at St. Vincent hospital). Data were extracted from the 
existing immunisation registers in the two health facilities studied. Statistical Package for Social 
Sciences (SPSS) version 22 was used for data analysis. Ethical approval for this study was 
obtained from the Research and Ethics Committee (REC) of the Federal Teaching Hospital 
Abakaliki (FETHA). 

Original Research Article 



 
 
 
 

Eze; AJI, 1(1): 14-19, 2018; Article no.AJI.44952 
 

 

 
15 

 

Results: Showed significant differences in the proportion of missed immunisations (39.7% in Mile-
Four and 48.4% in St. Vincent respectively, p=0.02) and immunisation drop-outs (35.7% in Mile-
Four and 47.7% in St.Vincent respectively, p=0.02).  The drop-out rate is 64.3% in Mile-Four and 
52.3% in St. Vincent. It also showed that 36.6% of male infants when compared to 34.8% of female 
infants dropped-out of the 3

rd
 dose of pentavalent vaccines in Mile-Four while 44.5% of male infants 

and 51.1% of female infants dropped-out 3
rd

 dose of pentavalent vaccines in St.Vincent hospital. 
There was no significant difference in the immunisation drop-out rates between male and female 
infants in the study groups (p>0.05). 
Conclusion: A higher proportion of infants missed immunisation and dropped out of vaccination at 
St.Vincent than Mile-Four. This calls for an aggressive public campaign on the need to ensure 
immunisation timeliness for effective immunisation in such rural areas. 

 

 
Keywords: Missed immunisation; immunization drop-out; infants; rural health facilities; Abakaliki. 
 

1. INTRODUCTION 
 
Immunisation drop-outs refer to infants who   
have used or missed immunisation services                
and do not return for subsequent vaccinations. 
When drop-outs exceed 10 percent, it indicates a 
problem of utilisation of services. In most  
settings where full immunisation coverage is low, 
most infants receive at least one dose of 
pentavalent vaccines, but the proportion                        
that receives the needed second and third               
doses drops significantly. Drop-out rates                      
are calculated as the percentage point difference 
between successive doses of a vaccine, 
expressed as a percentage of the first dose [1]. 
 
Immunisation coverage which is the indicator of 
access to the preventive services at PHC level is 
measured by the percentage of infants who have 
received the appropriate immunisations. 
Immunisation coverage is calculated as the total 
number of infants that have received all their 
immunisations up to the measles vaccine, 
divided by the total population of children under 
one year old in a given area [1]. However, 
differences in the indicators of access and 
utilisation of immunisation services exist. 
Indicators of access to health services among 
other factors include a level of education, sex, 
patriarchal social arrangement, rural residence, 
poverty, religious and cultural beliefs about 
certain diseases and location of health facilities 
etc. Indicators of utilisation of immunisation 
services include quality of staff skills, protocols of 
treatment, availability of supplies and 
environment of health facilities, physical and 
financial accessibility of services, knowledge of 
which services exist, education about how to 
best utilise self and practitioner-provided services 
and cultural norms of treatment [2,3]. Vaccination 
is typically offered free in Primary health care 

centres and are usually not compulsory for 
school enrolment. Childhood vaccines are given 
at interval of 0, 6

th
, 10

th
, 14

th
 week and 9

th
 month 

of birth.  Immunisation drop-out usually are due 
to far distance to health facility. The extent of 
missed immunisation and immunisation drop-out 
is not well known in the study area. This study, 
therefore, determined the extent of missed 
immunisation and immunisation drop-outs in 
Abakaliki. 
 

2. MATERIALS AND METHODS  
 
This study was carried out at Mile four and St. 
Vincent hospitals (in Ebonyi and Izzi Local 
Government Areas respectively) in Ebonyi State. 
Both private facilities are in the rural area. 
Descriptive cross- sectional analytical study 
design was used for the survey. Data were 
extracted from the existing immunisation 
registers in the two health facilities studied. A 
total number of infants in the health facilities was 
used as sample size for the study (406 infants at 
Mile-Four hospital and 281 infants at St. Vincent 
hospital, both in Abakaliki, Ebonyi State). 
Statistical Package for Social Sciences (SPSS) 
version 22.0 was used for data analysis. Chi-
squared test was to determine association or 
differences between proportion of the variables 
and the level of statistical significance was set at 
p< 0.05 and confidence level at 95%. Ethical 
approval for this study was obtained from the 
Research and Ethics Committee (REC), Federal 
Teaching Hospital Abakaliki (FETHA), Ebonyi 
State, Nigeria. 
  

3. RESULTS 
 
A total of 687 infants were studied, 406 (59%) in 
Mile-Four and 281 (41%) in St. Vincent. These 
figures were the number of infants recorded as at 



 
 
 
 

Eze; AJI, 1(1): 14-19, 2018; Article no.AJI.44952 
 

 

 
16 

 

the time of data extraction. Review of 
immunisation register showed significant 
differences in the proportion of missed 
immunisations (39.7% in Mile four and 48.4% in 
St. Vincent respectively, p=0.02) and 
immunisation drop-outs (35.7% in Mile Four and 
47.7% in St. Vincent respectively, p=0.02).  
Table 1 showed that the proportion of infants 
who missed immunisations was 39.7% in Mile-
Four and 48.4% in St. Vincent. The difference in 
proportion of infants who missed immunisation 
was statistically significant (p=0.02). Table 2 
showed that the proportion of male and female 
infants who missed penta-valent vaccines. The 
difference in their proportion was not significant. 
Table 3 showed that 35.7% of infants dropped 
out of pentavalent vaccines 3 in Mile-Four when 
compared with 47.7% who dropped out of 
pentavalent vaccines 3 in St. Vincent. The 
difference in their proportions was statistically 
significant (p=0.02). The drop-out rate is 64.3% 
in Mile-Four and 52.3% in St.Vincent. Table 4 
showed that 36.6% of male infants and 34.8% of 
female infants dropped-out of 3

rd
 dose of 

pentavalent vaccines in St. Vincent while            
44.5% of male infants and 51.1% of female 
infants dropped-out 3

rd
 dose of pentavalent 

vaccines in Mile-Four. There was no significant 
difference in the immunisation drop-out rates 
between male and female infants in the study 
groups (p>0.05). 
 

4. DISCUSSION 
  
In this study, a significantly lower proportion of 
infants (39.7%) in Mile Four than St.Vincent 
(48.4%) missed immunisation. More infants 
missed immunisations in increasing interval 
(most commonly missed are 14

th
 week vaccines 

compared to 10
th
 week vaccines and least 

missed are 6
th
 week vaccines). This may be due 

to the fact that as immunisation time intervals 
increase, caregivers tend to forget the exact date 
of immunisation of their infants thereby making 
immunisation timeliness unrealisable and putting 
such infants temporally at risk of infection by 
vaccine preventable diseases [4]. This finding is 
at variance with that found in Nnewi in a study of 
mother-neonate pairs where most commonly 
missed immunisations were BCG, OPV0 and 
OPV1, HBV1and DPT1 compared to the 10

th
 

week and 14
th
 week vaccines. In that study, 

mother’s age, education and knowledge of 
immunisation were not significantly associated 
with missed immunisation. There was 

comparable proportion of missed immunisations 
(pentavalent vaccines 1 and 3) between the male 
and female infants who were vaccinated three (3) 
months before the intervention. This may explain 
the importance attached to both male and female 
infants now unlike olden days when preference 
was given to male infants in the African society. 
A higher proportion of infants missed OPV3, 
Pentavalent 3 vaccines and PCV3 than the 6

th
 

and 10
th
 week vaccines. The prevalence of 

missed immunisation in Mile-Four (39.7%) is 
higher compared to those reported in Nnewi 
(17%) [5], Benin City (27.6%) [6] among mothers 
of infants 6 months to 1 year and consistent with 
that in Calabar (39.1%) [7] but lower than the 
57.1% reported in India [8]. The missed vaccines 
would invariably reduce herd immunity of such 
population and consequently make such               
infants prone to vaccine preventable diseases 
[4]. The commonest vaccines missed were 
OPV1, HBV1 and DPT1 (40.38%), followed by 
BCG and   OPV0 (38.46%), and OPV2, HBV2, 
and DPT2 (11.54%). The finding of higher rate of 
missed immunisation is in keeping with other 
study elsewhere [9] suggesting that the            
reasons for this high level of missed 
immunisation have not been adequately 
addressed. These should be addressed through 
adequate communication between mothers and 
health workers, training of health workers and 
policy flexibility [5]. 
 
Lower proportion of infants in Mile-Four (35.7%) 
than St.Vincent (47.7%) dropped-out of 
vaccination. There was a statistically significant 
difference in the proportion of infants who 
dropped-out of vaccination in the groups. This 
significant dropout rate among the infants would 
invariably compromise the herd immunity of such 
population and consequently make such infants 
prone to vaccine preventable diseases with 
attendant morbidity and mortality [4].  
 
There was no significant difference in the 
immunisation drop-out rates between male 
(36.6%) and female (34.8%) infants in Mile-Four 
and St.Vincent (male; 44.5% and female; 
51.1%). The cumulative drop-out rates were 
64.3% in Mile-Four and 52.3% in St.Vincent. This 
may be due to the fact that most infants               
were delivered in the facility and as their 
mother’s postnatal care services ended, they 
continued the immunisation in a nearby health 
facility [5]. 

 



 
 
 
 

Eze; AJI, 1(1): 14-19, 2018; Article no.AJI.44952 
 

 

 
17 

 

Table 1. Proportion of infants who missed immunisations in both facilities 

 
Variables Mile-Four (n=406) Freq. (%) St. Vincent (n=281) Freq. (%) χ

2
  (p-value) 

Number who missed immunisation    
 Yes 161 (39.7) 136 (48.4) 5.17 (0.02)٭ 
 No 245 (60.3) 145 (51.6)  
Number who missed each vaccine    
 BCG 0 (0.0) 0 (0.0)  
 OPV0 0 (0.0) 0 (0.0)  
 HB0 2 (0.5) 0 (0.0)  
 OPV1 60 (14.8) 22 (7.8)  
 Pentavalent1 11 (2.7) 5 (1.8)  
 PCV1 26 (6.4) 7 (2.5)  
 OPV2 89 (21.9) 57 (20.1)  
 Pentavalent2 80 (19.7) 58 (20.6)  
 PCV2 99 (24.4) 57 (20.3)  
 OPV3 152 (37.4) 136 (48.4)  
 Pentavalent3 146 (36.0) 135 (48.0)  
 PCV3 161 (39.7) 136 (48.4)  

 statistically significant٭
 

Table 2. Within group comparison between Sex of infants and missed immunisation in both facilities 
 

Variables Mile Four (n=406) St.Vincent (n=281) 

Missed  immunisation Missed  immunisation 

Yes Freq. (%) No Freq. (%) Total χ
2  

(p-value) Yes Freq. (%) No Freq. (%) Total χ
2 
(p-value) 

Sex of 
infants 

Pentavalent  
vaccines1 

   Pentavalent  
vaccines1 

   

Male 4 (2.0) 201 (98.0) 205 (100) 0.90 (0.34) 4 (2.7) 142 (97.3) 146 (100) FT (0.37) 
Female 7 (3.5) 194 (96.5) 201 (100)  1 (0.7) 134 (99.3) 135 (100)  
 Pentavalent  

vaccines 3 
   Pentavalent  

vaccines 3 
   

Male 76 (37.1) 129 (62.9) 205 (100) 0.22 (0.63) 65 (44.5) 81 (55.5) 146 (100) 1.51 (0.21) 
Female 70 (34.8) 131 (65.2) 201 (100)  70 (51.9) 65 (48.1) 135 (100)  

FT=Fisher’s exact test 
 



 
 
 
 

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18 

 

Table 3. Proportion of clients who dropped- out of vaccines in both facilities 
 

Variables Mile-Four 
(n=406) Freq. (%) 

St.Vincent 
(n=281) Freq. (%) 

χ
2
  (p-value) 

Number who 
dropped-out  
vaccines 

   

Yes 145 (35.7) 134 (47.7) 6.10 (0.02)٭ 
No 251 (64.3) 147 (52.3)  
Drop-out rate 64.3% 52.3%  
Number who  
dropped-out  
each vaccine     

   

OPV3 147 (36.2) 134 (47.7) 9.05 (<0.01)* 
Pentavalent3 145 (35.7) 134 (47.7) 9.87 (<0.01)* 
PCV3 152 (37.4) 136 (48.4) 7.11 (0.01)* 

 statistically significant٭

 
Table 4. Within group comparison between sex of infants and immunisation drop-outs in both facilities (3

rd
 dose of pentavalent vaccines) 

 

Variables Mile Four (n = 406) St.Vincent (n=281) 

Immunisation drop-out Immunisation drop-out 

Yes Freq. (%) No Freq. (%) Total χ
2 
 (p-value) Yes Freq. (%) No Freq. (%) Total χ

2 
 (p-value) 

Sex of infants Pentavalent 3    Pentavalent 3    
Male 75 (36.6) 130 (63.4) 205 (100) 0.13 (0.71) 65 (44.5) 81 (55.5) 146 (100) 1.22 (0.26) 
Female 70 (34.8) 131 (65.2) 201 (100)  69 (51.1) 66 (48.9) 135 (100)  



 
 
 
 

Eze; AJI, 1(1): 14-19, 2018; Article no.AJI.44952 
 

 

 
19 

 

5. CONCLUSION 
 
Higher proportion of infants missed immunisation 
and dropped out of vaccination in St.Vincent than 
Mile-Four hospital. This finding calls for an 
aggressive public campaign on need to ensure 
immunisation timeliness for effective 
immunisation in such rural areas. 
 

CONSENT 
 
As per international standard or university 
standard, patient’s written consent has been 
collected and preserved by the author(s). 
 

ETHICAL APPROVAL 
 
Ethical approval for this study was obtained from 
the Research and Ethics Committee (REC), 
Federal Teaching Hospital Abakaliki (FETHA), 
Ebonyi State, Nigeria. 

 
COMPETING INTERESTS 
 
Author has declared that no competing interests 
exist. 

 
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_________________________________________________________________________________ 
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provided the original work is properly cited. 
 
 
 

 
 

Peer-review history: 
The peer review history for this paper can be accessed here: 

http://www.sciencedomain.org/review-history/27207 

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