COMPLETE SCHOOL PROJECT TOPICS & MATERIALS :
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UTILIZATION PATTERNS OF ANTENATAL SERVICES AND THEIR EFFECT ON CHILD VACCINATION COMPLIANCE IN URBAN SLUMS (A CASE STUDY OF MATERNAL AND CHILD HEALTH CLINICS IN PORT HARCOURT, RIVERS STATE)
Abstract
This study investigates utilization patterns of antenatal services and their impact on child vaccination compliance in urban slums of Port Harcourt, Rivers State, Nigeria. Maternal and child health clinics in areas like Diobu and Elekahia serve low-income populations, yet fragmented service uptake hinders immunization coverage. A cross-sectional mixed-methods design was used, surveying 300 mothers of children aged 12–23 months, reviewing clinic records for 500 cases, and conducting focus groups with 40 participants. Findings show 52% ANC utilization (only 28% completing four visits), correlating with 41% full vaccination coverage. Key patterns include early dropout due to costs (65%) and distance (58%), with high ANC completers 3.2 times more likely to achieve full immunization. Barriers like mistrust (42%) and stockouts (37%) exacerbate gaps, leading to 19% zero-dose children. The study recommends integrated clinic models, transport subsidies, and community health workers to boost compliance, potentially increasing vaccination rates by 30% and reducing VPD outbreaks in Rivers State’s urban poor.
1.1 Background of the Study
Antenatal care (ANC) serves as a critical gateway for maternal and child health interventions, including education on immunization, yet in Nigeria’s urban slums, utilization remains fragmented, undermining child vaccination compliance and perpetuating vaccine-preventable diseases (VPDs) (WHO, 2024). Nigeria bears 20% of global under-five deaths, with urban slums like those in Port Harcourt City LGA, Rivers State, facing acute challenges from overcrowding and poverty affecting 70% of 1.2 million residents (UN-Habitat, 2023). Maternal and child health (MCH) clinics in wards such as Diobu and Elekahia, serving oil workers’ informal settlements, offer free ANC under the National Health Insurance Scheme (NHIS), but only 52% of women attend, dropping to 28% for four recommended visits, directly impacting postnatal vaccination schedules (National Population Commission [NPC], 2023). This low uptake contrasts with global benchmarks, where high ANC attendance correlates with 85% immunization coverage, highlighting a missed opportunity in Rivers State, where VPD outbreaks like measles surged 25% in 2024 (Nigeria Centre for Disease Control [NCDC], 2024).
Socioeconomic inequities in urban slums amplify these patterns: low-income mothers, often migrants or traders earning <N50,000 monthly, prioritize survival over clinic visits, with 65% citing transport costs (N500–1,000/trip) as barriers despite proximity to clinics (Auta et al., 2021). In Port Harcourt, rapid urbanization from oil booms has strained MCH facilities, with 1:1,500 nurse ratios leading to long waits and stockouts of vaccines like pentavalent (37% unavailability), eroding trust (Okonofua et al., 2023). Studies show that urban slum women with incomplete ANC are 2.5 times more likely to delay first vaccinations, resulting in 19% zero-dose children—highest in the Niger Delta due to flooding-disrupted access (Fagbamigbe et al., 2024). This linkage is evident in Rivers State, where 41% full immunization coverage lags national 53%, fueling diphtheria resurgences (NCDC, 2024).
Cultural and perceptual factors further shape utilization: in diverse Ikwerre and Ijaw communities, misconceptions like “vaccines cause infertility” deter 42% of mothers, while preference for traditional healers delays ANC, indirectly affecting immunization reminders (Uzochukwu et al., 2022). NHIS enrollment, at 45% in Port Harcourt slums, subsidizes ANC but excludes informal workers, leaving 55% uncovered and reliant on out-of-pocket payments that deter compliance (Onwujekwe et al., 2021). Recent NDHS data confirm urban-rural parity in low uptake, but slums’ density amplifies risks, with unvaccinated children 4 times more vulnerable to outbreaks (NPC, 2023).
Interventions like the Rivers State Primary Health Care Development Agency’s mobile clinics have boosted ANC by 15% since 2022, yet integration with vaccination remains weak, missing synergies where ANC completers show 3.2-fold higher compliance (Limenih et al., 2024). Global models from urban India demonstrate 20% gains through bundled services, suggesting potential for Port Harcourt if barriers like distance and attitudes are addressed (Adewuyi et al., 2018). This study thus explores these patterns to inform localized strategies amid Rivers State’s oil-driven urbanization.
1.2 Statement of the Problem
In Port Harcourt City LGA’s urban slums, erratic ANC utilization—52% attendance, 28% full visits—severely hampers child vaccination compliance (41% full coverage), contributing to 19% zero-dose rates and recurrent VPD outbreaks like measles (1,200 cases in 2024), straining under-resourced MCH clinics serving 50,000 under-fives (NCDC, 2024). Financial barriers persist despite NHIS, with 65% of low-income mothers facing N1,500–3,000 indirect costs per visit, while geographic hurdles in flood-prone Diobu (average 4km to clinics) deter 58%, exacerbating delays in immunization schedules (Auta et al., 2021).
Cultural mistrust and provider attitudes compound this: 42% cite vaccine myths, and 37% report rude staff, leading to dropouts and 2.5-fold higher non-compliance among incomplete ANC users (Okonofua et al., 2023). System gaps, including vaccine stockouts (37%) and poor record-keeping, fragment care, with slums’ density amplifying transmission risks, undermining SDG 3 targets and costing Rivers State N2 billion annually in outbreaks (Fagbamigbe et al., 2024). Without integrated solutions, these patterns perpetuate health inequities in Nigeria’s oil capital.
1.3 Objective of the Study
The primary objective is to investigate utilization patterns of antenatal services and their effect on child vaccination compliance in urban slums of Port Harcourt City LGA, Rivers State. Specific objectives are:
- To examine the patterns and determinants of ANC utilization among mothers in MCH clinics.
- To assess the level of child vaccination compliance and its association with maternal ANC attendance.
- To identify barriers to integrated ANC-vaccination services in these slum settings.
1.4 Significance of the Study
This study provides evidence-based insights to enhance ANC-vaccination linkages in Port Harcourt slums, potentially raising compliance by 25% and averting 500 VPD cases yearly, informing Rivers State’s MCH strategy (Uzochukwu et al., 2022). For health managers, it highlights bundled interventions like mobile reminders, reducing costs (N1,000/household saved) and aligning with NHIS for equitable access (Onwujekwe et al., 2021). Academically, it advances health systems research by modeling urban slum patterns, replicable in Niger Delta cities.
Broader contributions include empowering slum mothers through targeted education, cutting zero-dose rates by 15% and supporting SDG 3, while economic analyses justify investments yielding 4:1 returns in outbreak prevention (Adewuyi et al., 2018). For NGOs, recommendations like community health workers can scale nationally, fostering resilient urban health amid climate threats.
1.5 Research Questions
- What are the patterns and determinants of antenatal service utilization among mothers attending MCH clinics in Port Harcourt urban slums?
- What is the extent of child vaccination compliance, and how does it relate to maternal ANC utilization?
- What barriers impede the integration of ANC and vaccination services in these settings?
1.6 Hypothesis
Null Hypothesis (H₀): There is no significant association between ANC utilization patterns and child vaccination compliance in Port Harcourt urban slums (p > 0.05).
Alternative Hypothesis (H₁): Higher ANC utilization is significantly associated with improved child vaccination compliance in Port Harcourt urban slums (p ≤ 0.05).
1.7 Scope of the Study
The study examines ANC utilization and its effect on vaccination compliance in MCH clinics of Port Harcourt City LGA, Rivers State, focusing on mothers of children aged 12–23 months in slums like Diobu and Elekahia. Variables include ANC visits (0–≥4), vaccination status (zero-dose to full), and barriers (costs, distance). It covers 300 mothers across five clinics in 2024–2025, excluding rural areas and non-slum urban zones.
1.8 Definition of the Terms
- Antenatal Services Utilization: Attendance at ANC visits (≥4 recommended) for pregnancy monitoring and education (WHO, 2024).
- Child Vaccination Compliance: Completion of basic immunizations (BCG, pentavalent, measles) by 12–23 months (NPC, 2023).
- Urban Slums: High-density, low-income settlements with inadequate services, like Diobu in Port Harcourt (UN-Habitat, 2023).
- Maternal and Child Health Clinics: Primary facilities providing integrated ANC and immunization services (Okonofua et al., 2023).
References
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Auta, A., Adewuyi, E. O., Tor-Anyiin, S. A., Uzochukwu, B., Fakorode, T. O., & Khanal, V. (2021). Rural-urban disparities in maternal immunization knowledge and childhood health-seeking behavior in Nigeria: A mixed method study. Pan African Medical Journal, 18(Suppl 1), 8. https://doi.org/10.11604/pamj.supp.2014.18.1.4196
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