Mothers’ knowledge, perception and practice of childhood immunization in Enugu

Introduction: Immunization has been shown to be the most successful and cost-effective public health intervention in the 20 century. In the developing world, it does not only prevent about three million child deaths annually, but also has the potential to prevent additional two million deaths if coverage improves. However, immunization coverage has remained low in Nigeria although vaccines are provided relatively free by the government. Efforts have focused on the health worker, health system and logistics with little attention being paid to maternal factors like knowledge, perception, beliefs and practice. Objectives: To assess mothers’ knowledge, perception and practice of routine and campaign immunization in Enugu. Methods: A structured questionnaire was administered to 207 mothers who have at least one child less than 5 years of age, attending children outpatient and immunization clinics at the University of Nigeria Teaching Hospital, Enugu. Results: Forty-eight per cent of the mothers had tertiary education, 42% had secondary education, and 9% had primary education while 1% had no formal education. Eighty-two per cent knew that children are immunized to prevent major killer diseases, 14% and 3.4% believed it was to prevent all diseases, and to treat diseases respectively. Most mothers took their children to health facilities for routine immunization (95.2%) and also accepted immunization on immunization campaign days (75.4%). However, 23.6% had never immunized their children during campaigns. On the other hand, 13% (27) of mothers had out-rightly rejected immunization during campaign while 85% (177) had never rejected immunization. The remaining 2% were not immunized due to reasons other than rejection. More mothers significantly rejected campaign immunization than the number that did not go for routine immunization (p=0.000). Maternal highest educational level was significantly associated with knowledge of reason for immunization and acceptance of immunization (p=0.000). Religious denomination was not significantly associated with rejection of campaign immunization (p=0.056). Conclusion: Most mothers studied had good knowledge and positive perception and practice of immunization. However, the Campaign immunization rejection rate was relatively high for the south eastern Nigeria where it is often assumed that non-compliance is not a problem. Similarly, the proportions of mothers with wrong knowledge and poor perception of immunization require policy attention. Maternal education was significantly associated with knowledge and acceptance of immunization. These findings are important in the design and implementation of childhood immunization programmes.