




































_____________________________________________________________________________________________________ 
 
*Corresponding author: E-mail: oluohauche@yahoo.com; 
 
 
 

Asian Journal of Immunology 
 
1(1): 20-29, 2018; Article no.AJI.44878 
 

 
 

 

 

A Cross-sectional Study on Awareness, Attitude and 
Utilisation of Immunisation Services by Mothers of 

Under-five in Elele, Rivers State, Nigeria 
 

Kenechi A. Uwakwe1, Uche R. Oluoha1*, Anthony C. Iwu1, Chukwuma B. Duru1, 
Ernest Nwaigbo2 and Ijeoma N. Alex-Okedo3 

 
1
Department of Community Medicine, College of Medicine, Imo State University, Owerri, Nigeria. 

2
Department of Community Medicine, Imo State University Teaching Hospital, Orlu, Nigeria. 

3
Department of Community Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. 

 
Authors’ contributions 

 
This work was carried out in collaboration between all authors. Authors KAU and URO developed the 
research question, questionnaire design, write up and general coordination. Author ACI managed the 

data analysis. Author CBD did the literature review. Authors EN and INAO collected the data. All 
authors read and approved the final manuscript. 

 
Article Information 

 
DOI: 10.9734/AJI/2018/44878 

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

(2) Dr. Jaffu Othniel Chilongola, Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University 
College, Tumaini University, Tanzania. 

Reviewers: 
(1) Vinodkumar Mugada, Vignan Institute of Pharmaceutical Technology, India. 
(2) Alexandrina Cardoso, Escola Superior de Enfermagem do Porto, Portugal. 

Complete Peer review History: http://www.sciencedomain.org/review-history/27671 

 
 
 

Received 19
th

 September 2018 
Accepted 24

th
 November 2018 

Published 8
th

 December 2018 

 
 

ABSTRACT 
 

Introduction: Approximately 6.2 million under-five children die globally on annual basis and 
immunisation having been recognised as the most successful and cost-effective public health 
intervention of the 20

th
 century regarding the number of deaths averted can help to prevent 

approximately 2 million of these deaths if coverage is optimal. 
Objectives: To assess the awareness and attitude of mothers towards utilisation of immunisation 
services in Elele, Rivers State.  
Methodology: It was a descriptive cross-sectional study conducted between April and July 2015. 
The study population comprised of mothers with at least one under-five-year-old child. Stratified 
sampling technique was used, and data collection was with a pre-tested, semi-structured, 

Original Research Article 



 
 
 
 

Uwakwe et al.; AJI, 1(1): 20-29, 2018; Article no.AJI.44878 
 

 

 
21 

 

interviewer-administered questionnaire. Data analysis was done using IBM SPSS version 20. Level 
of statistical significance was set at p-value ≤ 0.05. 
Results: The average age of the respondents was 28.6 ± 5.3 years. Most (89.3%) had at least a 
secondary level of education. Respondents level of awareness of childhood immunisation was high 
(95.0%) and the major sources of information on immunisation were antenatal clinic (61.0%) and 
health workers (20.0%). Respondents' knowledge of vaccine-preventable diseases (VPD) was 
highest with poliomyelitis (76.0%) while diphtheria at 34.4% was the least known. Approximately 
seven percent (7.3%) of the respondents' children were unimmunized while 18.1% were partially 
immunised. Tetanus toxoid utilisation was significantly associated with respondents' level of 
education (χ

2 
= 9.44, p-value = 0.0240) while the odds of completing their children immunisation 

was higher if done in a hospital setting compared to home service {OR (95% CI): 4.03 (1.09 – 
14.95)}. 
Conclusion: Health education on some of the VPDs by healthcare personnel is advocated for the 
community. Greater efforts should be placed on strengthening routine immunisation as against 
supplemental immunisation since the former has a better immunisation completion rate. 
 

 
Keywords: Childhood; immunisation; mothers; utilisation; Nigeria. 
 

1. INTRODUCTION 
 
Approximately 6.2 million children under the age 
of five died globally in 2013 with sub-Saharan 
Africa contributing almost half (3 million) of these 
deaths [1]. The World Health Organisation had in 
2009 estimated that if global vaccine coverage 
increased to 90% by 2015, then approximately 
two million deaths of children under the age of 
five would be prevented [2]. 
 
Immunisation has been recognised as the most 
successful and cost-effective public health 
intervention of the 20

th
 century regarding the 

number of deaths prevented per year [3]. 
Zangene et al. have also reported that childhood 
immunisation indirectly prevents infectious 
diseases in adults through herd immunity [4]. 
They found that the use of pneumococcal    
protein conjugate vaccine among children 
reduced the total number of invasive 
pneumococcal disease (IPD) cases and resulted 
in a 38% decrease in the rate of IPD among non-
vaccinated elderly adults through herd immunity 
[4]. 
 

Immunisation campaigns became more popular 
since 1988 when World Health Organisation 
(WHO) in conjunction with United Nations 
Children Fund (UNICEF), Rotary International, 
Bill and Melinda Gates Foundation and the 
United States Centre for Disease Control and 
Prevention (CDC) launched the polio eradication 
programme. Immunisation campaigns against 
polio and measles have yielded tremendous 
results globally and in Nigeria. Global polio cases 
have been reduced from 350,000 in 1988 to 74 
reported cases in 2015 (> 99% reduction) [5] 

Likewise, and global measles deaths have 
decreased by 79% from an estimated 651,600 in 
the year 2000 to 134,200 in 2015 [6]. Despite the 
success of expanded programme on 
immunisation (EPI), such as eradication of 
smallpox and global lowering of the incidence of 
polio and measles; many vaccine-preventable 
diseases remain prevalent especially in 
developing countries [7]. 
 
Child immunisation in Nigeria is provided through 
routine immunisation and catch-up supplemental 
immunisation campaigns (also known as 
National Immunisation Days) organised across 
the country or sub-nationally in selected areas 
[8,9]. A fully immunized child in Nigeria is 
expected to have received one dose of Bacillus 
Calmette-Guerin (BCG) at birth or soon after, 3 
doses each of diphtheria, pertussis and tetanus 
(DPT) and oral polio vaccines at 6, 10 and 14 
weeks and one dose of measles vaccine at 9 
months of age or thereabout [10,11]. Yellow 
fever vaccination is also given at 9 months. 
Vaccines introduced more recently and 
administered during the first year of life include 
hepatitis B, pneumococcus and rotavirus 
vaccines [9]. Also, vitamin A is administered at 9 
and 15 months [11]. As part of the Polio 
Eradication and Endgame Strategic Plan, 
inactivated polio vaccine was introduced in the 
routine immunisation schedule in 2015 and 
Nigeria participated in the April 2016 switch from 
trivalent to bivalent polio vaccine [12]. 
Furthermore, given the introduction of the second 
dose of measles vaccine and other booster 
doses by countries, improved coverage of routine 
immunisation is expected in the second year of 
life and beyond as this provides opportunities to 



 
 
 
 

Uwakwe et al.; AJI, 1(1): 20-29, 2018; Article no.AJI.44878 
 

 

 
22 

 

catch up on any missed immunisation from the 
first year [11]. 

 
Vaccine-preventable diseases account for about 
one in five child deaths in Nigeria, amounting to 
over 200,000 deaths per year [13]. Despite 
recent improvement, immunisation coverage in 
Nigeria is still abysmally low. According to 
Nigerian Demographic and Health Survey of 
2013, only 25% of children aged 12 – 23 months 
were fully vaccinated with BCG, Measles and 
three doses each of DPT and Polio vaccines 
[10]. Specifically, 51% received BCG vaccination, 
38% received the recommended three doses of 
DPT, 54% were fully vaccinated against polio, 
and only 42% received measles vaccine. 
Twenty-one percent (21%) of Nigerian children 
aged 12 – 23 months received no vaccination at 
all according to this survey [10]. Given that 
immunisation is not 100% effective [14], this high 
level of under-immunised and unimmunized 
children will impact negatively on the herd 
immunity thereby significantly increasing the risk 
of infection for vaccinated children. 

 
Asides operational factors relating to policies, 
vaccine funding, vaccine availability and health 
workers related factors, some researchers [7,15] 
have identified awareness, attitude and 
perception of parents/caregivers as major 
obstacles to high immunisation coverage. In spite 
of efforts directed at solving operational 
problems, immunisation coverage in Nigeria has 
persistently remained unacceptably low [16,17], 
examining maternal factors that could impede 
utilisation of immunisation cannot be 
overemphasised. The aim of this study is 
therefore to assess the awareness and attitude 
of mothers towards immunisation services and 
their utilisation of the services in Elele, Rivers 
State. 

 
2. MATERIALS AND METHODS 
 
This was a cross-sectional descriptive study that 
was conducted in Elele community in Ikwerre 
Local Government Area of Rivers State between 
April and July 2015. The community has a total 
population of 20,620 according to the 2006 
national population census and a projected 
population of 27,712 in 2016 using 3% annual 
growth rate. 

 
Mothers with at least one child less than five 
years of age and who consented to participate in 
the study were included. Mothers who refused to 

give consent despite adequate explanations 
were excluded from this study. 
 

Sample size was determined using the Cochrane 
sample size formula for single proportion in 
population greater than 10,000 people; n = 
Zα

2
P(1- P)/d

2
, where n is the minimum sample 

size, Zα is the standard normal deviate at 95% 
confidence level (1.96), P is the proportion of 
fully vaccinated children from previous study 
(0.25) and d is the level of precision required, set 
at 0.05. The calculated sample size was 288. 
Considering a potential non-response rate of 
10%, the minimum sample size required is 317, 
however, 400 participants were enrolled for this 
study.  
 

Stratified sampling technique was utilized for this 
study. Respondents were stratified by those 
interviewed in their homes, hospitals, primary 
and secondary schools, university (Madonna 
University, Elele) and markets. A total of eighty 
eligible mothers were interviewed by trained 
interviewers in each of the five stratums on the 
first seen basis. Data was collected using a 
questionnaire design adapted from 2013 
Nigerian Demographic and Health Survey [10] 
and modified to suit the study environment 
following a pre-test. A semi-structured 
interviewer-administered questionnaire was used 
for this study.  
 

Data collected from mothers included mother’s 
age, mother’s highest educational level, marital 
status and occupation. Others were on 
awareness, knowledge, attitude and utilisation of 
immunisation services. 
 

Ethical approval for this research was obtained 
from Madonna University Ethical Review 
Committee with reference number ADM/E15/A 
VOL. 111/816 and informed consents were given 
by eligible mothers. Data entry and analysis were 
done using SPSS version 20. Data were 
analysed as proportions of responses and results 
presented as tables and charts. Association 
between variables was tested using the chi-
square test and level of significance was set at p 
< 0.05. 
 

3. RESULTS 
 

3.1 Sociodemographic Profile of 
Respondents 

 

The average age of the respondents was 28.6 ± 
5.3 years and Christianity (89.8%) was the 
dominant religion. The majority (96.3%) of the 



 
 
 
 

Uwakwe et al.; AJI, 1(1): 20-29, 2018; Article no.AJI.44878 
 

 

 
23 

 

participants were married and of Igbo (39.8%) 
and Ikwerre (38.8%) ethnic nationalities. Fairly 
equal proportions were unskilled (32.5%), and 
skilled (31.0%) workers and majority (89.3%) had 
post-primary education (Table 1). 
 

Table 1. Sociodemographic profile of 
respondents 

 

Variable Frequency 

n = 400 (%) 

Age (years)  
20 – 30 270 (67.5) 
31 – 40 124 (31.0) 
41 – 50 6 (1.5) 
Mean age ± SD 28.6 ± 5.3  
Religion  
Christianity 358 (89.7) 
Islam 36 (9.0) 
Others 6 (1.3) 
Marital status  
Single 10 (2.5) 
Married 385 (96.3) 
Divorced 1 (0.3) 
Widowed 4 (1.0) 
Ethnicity  
Igbo 159 (39.8) 
Ikwerre 155 (38.8) 
Yoruba 23 (5.8) 
Hausa 15 (3.8) 
Others 48 (12.0) 
Occupation  
Housewife 92 (23.0) 
Unskilled 130 (32.5) 
Semi-skilled 54 (13.5) 
Skilled 124 (31.0) 
Educational status  
None 14 (3.5) 
Primary 29 (7.3) 
Secondary 238 (59.5) 
Tertiary 119 (29.8) 

 

3.2 Respondents Level of Awareness of 
Immunisation 

 

Most of the respondents (95.0%) were aware of 
immunisation, but the majority (61.0%) do not 
know that there could be vaccination failure 
(Table 2). The major sources of information on 
immunisation were antenatal clinic (61.0%) and 
health workers (20.0%), (Fig. 1). 
 

3.3 Knowledge and Attitude of 
Respondents towards Immunisation 
Services 

 

Most of the respondents believe that vaccination 
can prevent diseases in individuals and that 

immunisation is important (97.0% and 98.8% 
respectively). Concerning knowledge of vaccine-
preventable diseases (VPD), poliomyelitis was 
the one mothers had the most knowledge of 
(76.0%) while the least was diphtheria (34.4%). 
Most of the respondents (98.3%) believed that 
immunising their children will help avert VPD and 
will be encouraging other mothers to immunise 
their children (99.2%) just as 75.2% do not think 
that reactions from vaccination are lethal and 
98.5% believed that pregnant women should be 
vaccinated when necessary. 
 

Table 2. Respondents level of awareness of 
immunisation 

 

Variable Frequency  

n = 400 (%) 

Aware of immunisation  
Yes 380 (95.0) 
No 20 (5.0) 
Awareness of vaccination 
failure 

 

Yes 156 (39%) 
No 244 (61%) 

 

The most common reason for not fully 
immunising a child was ignorance (50.0%). 
Others were fever/illness (27.0%) and fear of 
injection abscess (19.0%), (Fig. 2). 
 

3.4 Utilization of Immunisation Services 
by Respondents 

 

Most of the respondents received tetanus toxoid 
during pregnancy (90.2%), had their under-five-
year-olds immunised (92.7%) and had 
immunisation cards (92.0%). However, only 
81.9% of respondents completed the 
immunisation schedule for their under- five-year-
olds children. BCG (90.0%) and OPV (77.3%) 
were the most common vaccines received by 
these children while the least common were DPT 
(22.3%) and yellow fever vaccine (46.5%). 
 

3.5 Effects of Mothers’ Educational 
Status on Selected Parameters 

 

The uptake of tetanus toxoid vaccination during 
pregnancy is significantly associated with 
educational status of mothers (χ

2 
= 9.44, p = 

0.0240) just as mothers with some level of 
education have greater odds of ensuring 
completion of scheduled vaccination for their 
under 5 children compared to mothers without 
formal education through this failed to reach 
statistical significance (χ

2 
= 2.02, p = 0.5690), 

Table 5. 



 
 
 
 

Uwakwe et al.; AJI, 1(1): 20-29, 2018; Article no.AJI.44878 
 

 

 
24 

 

 
 

Fig. 1. Source of information on immunisation 
 

Table 3. Knowledge and attitude of respondents towards immunisation services 
 

Variable
 

Frequency
 

n = 400 (%) 

Can vaccine prevent diseases in individuals?  
Yes 388 (97.0) 
No 12 (3.0) 
Is immunisation important?  
Yes 395 (98.8) 
No 5 (1.2) 
Knowledge of vaccine-preventable diseases (VPD)

**  

Tuberculosis 256 (64.0) 
Poliomyelitis 304 (76.0) 
Whooping coughs 168 (42.0) 
Diphtheria 137 (34.3) 
Tetanus 239 (59.8) 
Measles 275 (68.8) 
Yellow fever 224 (56.0) 
Will immunising your child help in averting VPD  
Yes 393 (98.3) 
No 7 (1.7) 
Will you be advising other mothers to immunise their children  
Yes 397 (99.2) 
No 3 (0.8) 
Can reactions from the vaccine kill  
Yes 99 (24.8) 
No 301 (75.2) 
Should pregnant women receive the vaccine  
Yes 394 (98.5) 
No 6 (1.5) 

 

3.6 Effects of Place of Immunisation on 
Completion of Vaccination 

 

Place of immunisation of under 5 children by 
their mothers has a statistically significant 
influence on the completion of vaccination                 

(χ
2 

= 9.69, p = 0.0080). Mothers whose              
children were vaccinated in a hospital               
setting were 4 times more likely to complete the 
vaccination compared to those vaccinated at 
home (OR = 4.03, p = 0.0369), Table 6. 

0% 

6% 7% 
6% 

61% 

20% 

Source of information on 
immunisation (n = 400) 

Mass media 

Parents 

Friends 

Antenatal clinic 

Health worker 



 
 
 
 

Uwakwe et al.; AJI, 1(1): 20-29, 2018; Article no.AJI.44878 
 

 

 
25 

 

 
 

Fig. 2. Reasons were given by some respondents for not fully vaccinating their children 
 

Table 4. Utilisation of immunisation services by respondents 
 

Variable Frequency 

n = 400 (%) 

Received tetanus toxoid during pregnancy  
Yes 361 (90.2) 
No 39 (9.8) 
Children under 5 years of age immunised  
Yes 371 (92.7) 
No 29 (7.3) 
Have immunisation cards  
Yes 368 (92.0) 
No 32 (8.0) 
Place of immunisation  
At home 13 (3.5) 
Hospital 131 (35.3) 
Health centre 227 (61.1) 
Completion of immunisation (n = 371)  
Yes 304 (81.9) 
No 67 (18.1)  
Vaccines received by under 5 children  
BCG 360 (90.0) 
OPV 309 (77.3)  
DPT 89 (22.3) 
HBV 188 (47.0) 
Pentavalent vaccine 216 (54.0) 
Yellow fever vaccine 186 (46.5) 
Measles vaccine 253 (63.3) 

 

4. DISCUSSION 
 

This study describes the knowledge, attitude and 
utilisation of immunisation services by mothers of 
under-five children in Elele, a suburban 

community in Rivers State. It has been known 
that successful immunisation of children depends 
substantially on mothers’ existing knowledge and 
positive disposition [18]. 

 

0% 

27% 

19% 
50% 

1% 3% 

Reasons for not fully vaccinating their 
children (n = 67) 

Fever / Illness 

Fear of injection abscess 

Ignorance 

Cost 

Religious / Cultural beliefs 



 
 
 
 

Uwakwe et al.; AJI, 1(1): 20-29, 2018; Article no.AJI.44878 
 

 

 
26 

 

Table 5. Effects of mothers’ educational status on selected parameters 
 

Variable Yes 
n =351(%) 

No 
n = 49 (%) 

Χ
2 

OR (95% CI) p-Value 

Tetanus toxoid utilization      

None 
Primary 
Secondary 
Tertiary 

10(2.8) 
29(8.3) 
212(60.4) 
100(28.5) 

4(8.2) 
0(0.0) 
26(53.1) 
19(38.8) 

9.44 1.00 
25.25(1.25  - 510.67) 
3.26(0.95 – 11.15) 
2.11(0.60 – 7.41) 

0.02 
0.04 
0.06 
0.25 

Completion of immunisation by 
children 

n = 329 (%) 
 

n = 71(%) 
 

 
 

 
 

 
 

None 
Primary 
Secondary 
Tertiary  

10(3.0) 
23(7.0) 
200(60.8) 
96(29.2) 

4(5.6) 
6(8.5) 
38(53.5) 
23(32.4) 

2.02 1.00 
1.53 (0.35 – 6.65) 
2.11 (0.63 – 7.06) 
1.67 (0.48 – 5.80) 

0.57 
0.57 
0.23 
0.42 

 
Table 6. Effects of the place of immunisation on completion of vaccination 

 

Variable Yes 
n = 304 (%) 

No 
N = 67 (%) 

Χ
2 

OR (95% CI) P - Value 

Place of immunisation 
Home 
Hospital 
Health centre 

 
9 (3.0) 
118 (38.8) 
177 (58.2) 

 
4 (6.0) 
13 (19.4) 
50 (74.6) 

 
9.69 

 
1.00 
4.03 (1.09 – 14.95) 
1.57 (0.47 – 5.32) 

 
0.01 
0.04 
0.47 

 
Almost ninety percent (89.3%) of mothers in the 
current study had at least a secondary level of 
education. This probably explained the high level 
of awareness (95%) of immunisation services by 
respondents in this study. The above average 
literate level of participants in this study could 
also be responsible for their high level of 
knowledge and attitude towards immunisation 
services. Most mothers in this study believe that 
immunisation is important (98.8%) and can 
prevent vaccine-preventable diseases (98.3%). 
Also, their knowledge of the different vaccine-
preventable diseases (VPD) is above average 
except for pertussis (whooping cough) and 
diphtheria. The rarity with which these two VPD 
are seen in the study area presently could be the 
reason for the low awareness. 
 
Respondents’ educational status is significantly 
associated with tetanus toxoid utilisation during 
pregnancy, and educated mothers have higher 
odds of completing their children immunisation 
schedule compared to mothers with no formal 
education. The significant impact of maternal 
education on the utilisation of immunisation 
services have also been noted by other authors. 
Tagbo et al. in their study on mothers' 
knowledge, perception and practice of childhood 
immunisation in Enugu, South Eastern Nigeria 
observed that educated mothers are more likely 
to immunise their children at an appropriate age 
as well as utilise supplemental immunisation 

campaigns [19]. Kabir et al. had also noted that 
mothers with formal education were more likely 
to be aware of the need for childhood 
immunisation compared to those who had no 
formal education [20]. It could then be inferred 
that the more educated a population is, the 
higher the immunisation coverage. However, a 
study by Manjunath and Pareek in India found 
that literacy status did not significantly influence 
immunisation coverage rates [7].

 

 

Most of the respondents in this study immunised 
their children (92.7%) and have immunisation 
cards (92.0%). However, only 81.9% completed 
the immunisation schedule for their children. 
Thus, 7.3% of the respondent's children received 
no immunisation, and almost one-fifth (18.1%) 
were partially immunised. The percentage of fully 
vaccinated children is appreciably higher than 
the 55% reported for Rivers State in the 2013 
Nigeria Demographic and Health Survey (NDHS) 
[10]. The NDHS 2013 also reported that nearly 
21% of Nigerian children were unimmunized [10]. 
The differences could be due to immense 
socioeconomic, ethnic and cultural diversity of 
the country. Tagbo et al. reported routine 
immunisation rejection rate of 4% in Enugu [19] 
Compliance to routine immunisation is generally 
high in the South Eastern part of Nigeria [10]. 
 
Ignorance (50%), child’s febrile illness (27%) and 
fear of injection abscess (19%) were given as the 



 
 
 
 

Uwakwe et al.; AJI, 1(1): 20-29, 2018; Article no.AJI.44878 
 

 

 
27 

 

major reasons for not fully immunising a child in 
this study. Vonasek et al. identified being fearful 
of side effects (46%), ignorance, disinterest or 
laziness (42%) and travel or financial constraint 
(18%) as the major reasons parents do not fully 
immunise their children in their study on 
childhood immunisation in rural Uganda [21]. 
Other workers in Ethiopia and Kenya had 
reported busy schedules of parents as the major 
reason for not completing their children 
immunisation schedule [22,23]. These 
discrepancies may reflect true differences in 
barriers to immunising children in the different 
study communities. It may also be a reflection of 
the different study designs used. 
 
The major sources of information on 
immunisation were from antenatal clinic (61%) 
and health workers (20%). Adeyinka et al. in their 
study in Igbo-ora in Oyo State, South Western 
Nigeria also reported antenatal care (65.7%) and 
health educators (19.2%) as the major sources of 
knowledge about immunisation [24]. This 
underlines the need for continuous training and 
re-training of health workers concerning 
immunisation services as this has been shown to 
have a direct impact on knowledge, awareness 
and utilisation of immunisation services by 
mothers [25]. 
 
Place of immunisation also has a statistically 
significant impact on the completion of 
immunisation in this study. We observed that 
mothers generally preferred to have their children 
vaccinated in a hospital setting rather than at 
home. Some researchers have reported that 
mothers preference for immunising their children 
in hospitals is based on their belief that the child 
will be properly assessed before the vaccination 
[19]. Another reason given by mothers for 
preference of hospital vaccination was that they 
believed that hospital staff were more competent 
compared to campaign vaccinators [19]. It has 
been reported that the rejection rate is higher for 
supplemental immunisation compared to routine 
immunisation [19]. These findings are important 
in policy formulation and suggest that greater 
attention is focused on the more acceptable 
routine immunisation. 
 

5. CONCLUSION  
 

Given that antenatal clinics and health workers 
were the major sources of information on 
immunisation, there is a need to continually 
update the knowledge of these categories of 
persons on immunisation. The importance of 

regular public enlightenment on immunisation 
cannot be overemphasised given that the major 
reasons some mothers deny their children 
immunisations were ignorance and unfounded 
fears. Lastly, since immunisation completion rate 
is better among children immunised in hospital 
settings in comparison to those immunised at 
home, greater attention should be given to 
routine immunisation as against supplemental 
immunisation. 

 
ETHICAL APPROVAL AND CONSENT 
 
Ethical approval for this research was obtained 
from Madonna University Ethical Review 
Committee with reference number ADM/E15/A 
VOL. 111/816 and informed consents were given 
by eligible mothers. 
 

COMPETING INTERESTS 
 
Authors have declared that no competing 
interests exist. 
 

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© 2018 Uwakwe et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License 
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