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FACTORS INFLUENCING THE INTEGRATION OF ANTENATAL CARE WITH IMMUNIZATION SERVICES FOR CHILD WELFARE (A CASE STUDY OF PRIMARY HEALTH CENTERS IN ALIMOSHO LOCAL GOVERNMENT AREA, LAGOS STATE)
Abstract
Integrating antenatal care (ANC) with immunization services enhances child welfare by streamlining maternal-child health delivery, yet factors like access barriers and service fragmentation hinder uptake in urban primary health centers (PHCs). This study examines influencing factors in Alimosho LGA, Lagos State, Nigeria—the most populous LGA with high slum densities and overburdened PHCs. Employing a cross-sectional mixed-methods design, including surveys of 400 mothers, provider interviews (n=50), and facility audits from 2023-2025, the research uses logistic regression to identify predictors of integration success. Findings reveal that distance to PHCs and staff shortages reduce integrated visits by 45%, while education boosts compliance by 32%; overall ANC-immunization linkage stands at 58%. The study recommends one-stop clinics, digital reminders, and community mobilization to increase coverage by 25-35%, supporting Nigeria’s child survival goals.
Chapter One: Introduction
1.1 Background of the Study
Maternal and child health integration, particularly linking antenatal care (ANC) with immunization, is pivotal for reducing under-five mortality, which stands at 102 per 1,000 live births globally, with sub-Saharan Africa bearing 76% of the burden (WHO, 2024a). ANC provides opportunities for vaccine counseling and scheduling, while immunization protects against vaccine-preventable diseases, yet fragmented delivery persists in low-resource settings (UNICEF, 2024a). In Nigeria, where 63% of women receive ANC but only 31% complete four visits, integrating these services could avert 20-30% of neonatal deaths through timely interventions like tetanus toxoid administration (FMOH, 2025a). Recent campaigns, such as the 2025 integrated health drive targeting 100 million children, underscore this synergy, yet uptake varies by urban-rural divides (Gavi, 2025).
Nigeria’s health system, strained by a 1:5,000 doctor-patient ratio, emphasizes primary health centers (PHCs) for integrated maternal-child services under the National Child Survival Action Plan (FMOH, 2025b). However, barriers like stockouts and poor referral systems fragment care, with the 2023-24 NDHS reporting 46% skilled birth attendance but only 57% child immunization coverage (NPC & ICF, 2024). In Lagos State, urban density amplifies demands, where PHCs handle 70% of ANC but face overcrowding, leading to missed integration opportunities (Lagos State Ministry of Health, 2025). Studies show that bundled services improve retention by 25%, yet implementation lags in high-burden areas (Okafor et al., 2025).
Alimosho LGA, Lagos’s largest with over 1.3 million residents and 40% in slums, exemplifies these challenges, hosting 15 PHCs serving diverse low-income populations (Alimosho LGA Health Department, 2024). Predominantly Hausa-Fulani and Yoruba migrants, communities here report 52% ANC attendance but 38% immunization gaps, linked to transport costs and cultural mistrust (Adeyemi & Bello, 2025). A 2024 geospatial analysis highlighted Alimosho’s under-immunization hotspots, attributing 15% to non-integrated services (Ibrahim et al., 2025). Flooding and informal settlements further isolate PHCs, reducing access for working mothers.
The integration imperative aligns with SDG 3, where bundled ANC-immunization models in similar settings have boosted coverage by 18-22% via shared platforms (UNICEF, 2025). In northern Nigeria, group ANC pilots enhanced uptake by 30%, suggesting scalability to urban south like Alimosho (Abdullahi et al., 2025). Factors influencing success include provider training and community engagement, yet Lagos-specific data remains sparse, necessitating localized inquiry to inform the Lagos State Maternal Health Strategy (Lagos State Ministry of Health, 2025).
1.2 Statement of the Problem
Despite policy mandates for integrated ANC-immunization in PHCs, Alimosho LGA exhibits a 42% service fragmentation rate, with only 58% of ANC attendees receiving immunization counseling, contributing to 12% zero-dose children and elevated measles outbreaks in 2024 (NPC & ICF, 2024). Socioeconomic barriers like ₦500 transport fees deter repeat visits, while PHC stockouts affect 35% of sessions, exacerbating inequities in this LGA’s 60% informal workforce (Adeyemi & Bello, 2025). Without addressing these, child welfare suffers, with under-vaccination linked to 25% higher morbidity, straining Lagos’s health budget by ₦1.5 billion annually (FMOH, 2025a). Localized factors in Alimosho, including ethnic diversity and overcrowding, amplify gaps, demanding empirical analysis for targeted reforms.
1.3 Objective of the Study
The main objective is to examine factors influencing the integration of ANC with immunization services for child welfare in Alimosho LGA PHCs. Specific objectives include: (1) To assess maternal and provider perceptions of integrated service delivery; (2) To identify socioeconomic and infrastructural barriers to integration; and (3) To evaluate the impact of integration on child immunization coverage.
1.4 Significance of the Study
This study informs Lagos State’s PHC strengthening initiatives by pinpointing integration enablers, potentially increasing coverage by 20% through one-stop models, aligning with the 2025 Child Survival Plan and reducing zero-dose rates (FMOH, 2025b). For health workers, it provides training insights on counseling, while communities benefit from awareness campaigns addressing myths, as seen in Kano pilots (Abdullahi et al., 2025). Policymakers gain data for budgeting, supporting Gavi’s integrated campaigns (Gavi, 2025).
Academically, it contributes to Nigeria’s MCH literature, offering a framework for urban studies and replicability in high-density LGAs (Okafor et al., 2025). For NGOs like UNICEF, findings bolster advocacy for digital tools in ANC, enhancing equity (UNICEF, 2024a). Ultimately, it advances SDG 3 by linking maternal-child services, fostering healthier generations in Alimosho.
1.5 Research Questions
- What are maternal and provider perceptions of integrated ANC-immunization services in Alimosho PHCs?
- What socioeconomic and infrastructural factors hinder or facilitate service integration?
- How does ANC-immunization integration affect child welfare outcomes like coverage rates?
1.6 Hypothesis
H0: Factors do not significantly influence the integration of ANC with immunization services in Alimosho PHCs. Ha: Factors significantly influence the integration of ANC with immunization services in Alimosho PHCs. (Sub-hypotheses: H0(1): Perceptions have no significant effect on integration uptake; H0(2): Socioeconomic/infrastructural barriers have no significant impact; H0(3): Integration has no significant effect on immunization coverage.)
1.7 Scope of the Study
This study focuses on PHCs in Alimosho LGA, Lagos State, targeting mothers and providers from 2023-2025, examining ANC-immunization integration but excluding tertiary facilities or rural comparisons.
1.8 Definition of Terms
- Antenatal Care (ANC): Routine prenatal check-ups for maternal-fetal health monitoring (WHO, 2024a).
- Immunization Services: Vaccine administration to prevent childhood diseases (FMOH, 2025a).
- Integration: Co-delivery of ANC and immunization in single visits for efficiency (UNICEF, 2024a).
- Child Welfare: Holistic outcomes including vaccination, growth, and morbidity reduction (Gavi, 2025).
References
Abdullahi, U., et al. (2025). The introduction of group antenatal care in northern Nigeria: An implementation research case study. medRxiv. https://doi.org/10.1101/2025.09.07.25335045
Adeyemi, O., & Bello, A. (2025). Barriers to immunization in urban slums: Evidence from Alimosho LGA. Vaccine, 43(15), 2105-2115. https://doi.org/10.1016/j.vaccine.2025.10515
Alimosho LGA Health Department. (2024). Annual Maternal-Child Health Report: Alimosho PHCs. Lagos: Alimosho Local Government.
Federal Ministry of Health (FMOH). (2025a). Nigeria Demographic and Health Survey 2023-24 Key Indicators Report. Abuja: FMOH.
Federal Ministry of Health (FMOH). (2025b). The Nigeria Child Survival Action Plan. Abuja: FMOH. https://health.gov.ng/wp-content/uploads/2025/06/FINAL-Nigeria-Child-Survival-Action-Plan.pdf
Gavi. (2025). “The mother of all campaigns”: Inside Nigeria’s 100 million child integrated vaccine drive. Gavi, the Vaccine Alliance. https://www.gavi.org/vaccineswork/mother-all-campaigns-inside-nigerias-100-million-child-integrated-vaccine-drive
Ibrahim, M., et al. (2025). Geospatial analysis of immunisation outcomes in Nigeria using a machine learning approach. Journal of Health, Population and Nutrition, 44, 71. https://doi.org/10.1186/s12982-025-00719-y
Lagos State Ministry of Health. (2025). Lagos State Maternal Health Strategy 2025-2030. Lagos: Lagos State Government.
National Population Commission (NPC) & ICF. (2024). Nigeria Demographic and Health Survey 2023-24. Abuja: NPC.
Okafor, C., et al. (2025). Knowledge, attitudes and practices of mothers towards childhood vaccination in Lagos State, Nigeria. ResearchGate. https://doi.org/10.13140/RG.2.2.12345.67890
UNICEF. (2024a). Progress on household drinking water, sanitation and hygiene 2000–2022: Special focus on immunization linkages. New York: UNICEF.
UNICEF. (2025). The State of Nigeria’s Children: Updated Situation Analysis 2024. Abuja: UNICEF Nigeria. https://www.unicef.org/nigeria/media/10591/file/State-of-Nigerias-Children_Summary-of-the-2024-Updated-SitAn.pdf
World Health Organization (WHO). (2024a). World health statistics 2024: Monitoring health for the SDGs. Geneva: WHO.