Antenatal Care and Maternal Sociocultural Determinants of Childhood Immunization in Northern Nigeria

Antenatal Care and Maternal Sociocultural Determinants of Childhood Immunization in Northern Nigeria by Amaka Tonia Okafor MPH, University of Ibadan, 2014 MSc, University of Lagos, 2007 BSc, Nnamdi Azikiwe University, 2002 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University May 2019 Abstract Immunization has been recognized globally as a cost-effective public health intervention. However, despite its benefits, children in northern Nigeria are still adversely affected by the negative consequences of inadequate uptake of immunization. The purpose of this study was to assess antenatal care and maternal sociocultural determinants that influence childhood immunization within 2 months of birth in northern Nigeria. Constructs of social cognitive theory were applied to this retrospective correlational cross-sectional inquiry involving women 15-49 years old in northern Nigeria. Secondary data (the 2013 Nigeria Demographic and Health Survey) were analyzed using univariate, bivariate andImmunization has been recognized globally as a cost-effective public health intervention. However, despite its benefits, children in northern Nigeria are still adversely affected by the negative consequences of inadequate uptake of immunization. The purpose of this study was to assess antenatal care and maternal sociocultural determinants that influence childhood immunization within 2 months of birth in northern Nigeria. Constructs of social cognitive theory were applied to this retrospective correlational cross-sectional inquiry involving women 15-49 years old in northern Nigeria. Secondary data (the 2013 Nigeria Demographic and Health Survey) were analyzed using univariate, bivariate and multivariate logistic regression. Statistically significant (p < 0.05) predictors of uptake of childhood immunization within 2 months of birth were the person who delivered antenatal care, the number of antenatal care visits, the number of tetanus injections, maternal educational level, religion, wealth index, husband/partner educational level, and the person who decides on health care. Educated Christian women from middle-class or rich homes, whose husbands/partners were also educated and who jointly decided on health care, made numerous contacts with health care professionals, and received at least one tetanus injection during antenatal care, had a higher likelihood of immunizing their children within 2 months of birth. The positive social change implications for this study include providing evidence of deterrents to childhood immunization that could lead to relevant policies and interventions leading to healthier children, communities, and society. Antenatal Care and Maternal Sociocultural Determinants of Childhood Immunization in Northern Nigeria by Amaka Tonia Okafor MPH, University of Ibadan, 2014 MSc, University of Lagos, 2007 BSc, Nnamdi Azikiwe University, 2002 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University May 2019 Dedication This degree is one of the highest points in my career and academic success. I have always dreamt of obtaining my doctorate, but at some point, with all the health and financial challenges I faced, it became a distant dream that I never thought I could attain. But here I am, hands on my computer, wrapping up my work. So, it is quite emotional and elating for me to write this dedication. I dedicate this work to my parents, Mr. Anthony and Mrs. Mabel Nzom. I am deeply grateful to God to have kept you both to witness this point of my life. My dad has always been even more excited than I am about this program and has always inquired about my progress. My mum is one of my greatest backbones, supporting and encouraging me to keep on. I have come this far in my academic life because of my parents, and I want to use this medium to thank them for being with me all the way through. Acknowledgments This section affords me another opportunity to also express my gratitude to all whose efforts have led to the success of my program. I am deeply grateful to my kindhearted husband, Mr. Eugene Ezenwa Okafor; I could not have come this far without your support and encouragement. He made many sacrifices to ensure I complete this program. I also thank my lovely and beloved children, Chibuzor, Chetanna, and Chidimma, my Walden baby. You all sacrificed the times you could have spent with me, while I studied. I also thank Elizabeth; you are like a daughter to me. I am grateful to my siblings, Buchi, Ada, Lota, and Ndu, for your concern and immense supportespecially for the help you offered on the use of certain computer skills. I am deeply grateful to my parents for their financial support, and the sleepless nights my mum had to endure when I had my Walden baby so that I could turn in my discussions and assignments on time. Also, I thank my friend and mentor Dr. Henry Debem, whose support helped me achieve this. My appreciation is incomplete without mentioning my friend, sister, and confidante, Dr. (Mrs.) Ayima Lott-J, and her husband; your immense support, financial and moral, are beyond words. Thank you for being my alarm clock and much more. The academic support I received from my chair, Professor Peter Anderson, was instrumental to the success of this work. My supervisory committee members: Dr. Kai. Stewart (committee member) and Dr. Richard Palmer (URR), were awesome and very understanding; thank you. Finally, and most importantly, I am deeply grateful to our Lord Jesus Christ, whose love and faithfulness overshadows me as I count his innumerable blessings.