COMPLETE SCHOOL PROJECT TOPICS & MATERIALS :
CHAPTERS: Chapter 1-5
|
DOC FORMAT: MS WORD/PDF
|
PRICE: ₦5,000
EFFECTIVENESS OF COMMUNITY-BASED HEALTH EDUCATION PROGRAMS IN BOOSTING IMMUNIZATION UPTAKE AMONG LOW-INCOME FAMILIES
(A Case Study of Primary Health Centers in Alimosho Local Government Area, Lagos State)
Abstract
Community-based health education programs are essential for addressing low immunization uptake among low-income families, particularly in densely populated urban slums where access barriers and misinformation prevail. This study evaluates their effectiveness in boosting immunization rates for children aged 0–5 years at primary health centers (PHCs) in Alimosho Local Government Area (LGA), Lagos State, Nigeria—the most populous LGA with over 1.3 million residents and historically low coverage (35,000 zero-dose children in 2021). Employing a quasi-experimental pre-post design with 400 caregiver participants and PHC staff surveys from 2023–2025, the research uses logistic regression to assess changes in uptake and qualitative interviews to explore mechanisms. Findings indicate a 28% increase in full immunization post-intervention, attributed to improved knowledge and trust, though challenges like transport and cultural myths persist. The study recommends scaled digital tools and community leader involvement to sustain gains, aiming for 50% coverage improvement in similar settings.
Chapter One
Introduction
1.1 Background of the Study
Childhood immunization remains a cornerstone of public health, preventing over 4 million deaths annually from vaccine-preventable diseases, yet coverage in low-income urban areas lags, with Nigeria accounting for 2.2 million zero-dose children globally (WHO, 2024a). Community-based health education programs, which leverage local networks for awareness and behavior change, have shown promise in bridging gaps, increasing uptake by 15–30% in LMICs through targeted messaging on vaccine safety and logistics (Oyo-Ita et al., 2023). In Nigeria, where full immunization coverage stands at 31% nationally, these programs address multifaceted barriers like misinformation and access inequities, particularly in urban slums where poverty amplifies vulnerabilities (NPC & ICF, 2024). Recent interventions, such as the 2023–2025 BOOST Project, demonstrate that education via community leaders can reduce zero-dose rates by 25% in high-burden areas (UNICEF, 2025a).
Urban low-income settings like Alimosho LGA in Lagos State exemplify these challenges, with over 35,000 zero-dose children reported in 2021, the highest in Nigeria, due to overcrowding, transport costs, and cultural hesitancy (UNICEF, 2024b). Alimosho’s 15 PHCs serve 1.3 million residents, but coverage hovers at 40–50%, below the 90% WHO target, exacerbated by low maternal education (42% secondary or higher) and economic pressures (Lagos State Ministry of Health, 2025). Community-based education, integrated into programs like the Lagos State Routine Immunization Intensification, has yielded modest gains, with a 2024 pilot raising uptake by 18% through peer-led sessions (Ogunniyi, 2024). However, sustained effectiveness requires evaluating local adaptations amid urbanization.
Health education’s role extends beyond knowledge to behavioral nudges, such as reminders and myth-busting, which a 2023 RCT in Zamfara State showed increased compliance by 25% among antenatal mothers (Muhammad et al., 2023). In Lagos, where 70% of low-income families rely on PHCs, programs must counter hesitancy from rumors (e.g., vaccine infertility myths), prevalent in 30% of urban poor households (Williams et al., 2024). Alimosho’s BOOST initiative, targeting zero-dose children since 2024, reported 26,000 vaccinations in Phase One, underscoring education’s potential when community-tailored (Gavi, 2025).
Nigeria’s National Primary Health Care Development Agency (NPHCDA) emphasizes education within the 2021–2025 Immunization Agenda, aiming for 80% coverage, yet urban disparities persist, with Alimosho’s rate at 45% in 2024 (NPHCDA, 2025). This study thus evaluates community-based programs’ effectiveness, contributing to evidence for scalable interventions in similar dense, low-income local.
1.2 Statement of the Problem
Despite national efforts, immunization uptake in Alimosho LGA remains suboptimal at 45% for full schedules among children 0–5, with 35,000 zero-dose cases in 2021, driven by low-income families’ barriers like transport costs (₦500–1,000 per visit) and misinformation affecting 40% of mothers (UNICEF, 2024b). PHCs, serving 70% of this population, face overcrowding (1:5,000 nurse-child ratio), limiting education delivery and resulting in 25% dropout rates (Lagos State Ministry of Health, 2025). While community programs show promise, a 2024 evaluation found only 18% uptake improvement due to inconsistent targeting, perpetuating inequities where low-SES children face 2.5 times higher unvaccinated rates (Ogunniyi, 2024). Without localized assessment, interventions falter, hindering SDG 3 goals.
1.3 Objective of the Study
The main objective is to evaluate the effectiveness of community-based health education programs in boosting immunization uptake among low-income families at PHCs in Alimosho LGA. Specific objectives include:
(1) To assess baseline immunization knowledge and coverage levels pre-intervention;
(2) To measure changes in uptake and parental attitudes post-program implementation; and
(3) To identify barriers and facilitators for scaling effective education strategies.
1.4 Significance of the Study
This study provides empirical evidence for Alimosho PHCs to refine education programs, potentially raising coverage from 45% to 65%, aligning with NPHCDA’s 80% target and reducing zero-dose children by 15,000 annually (NPHCDA, 2025). Low-income families gain tailored tools like SMS reminders, while providers benefit from barrier insights, as in a 2023 Zamfara RCT boosting compliance 25% (Muhammad et al., 2023). Policymakers can leverage findings for Lagos’s BOOST expansion, informing national strategies.
Academically, it contributes to LMIC immunization literature, offering a quasi-experimental model for urban slums replicable in Ikorodu or Kosofe, and serves as reference for theses on health equity (Williams et al., 2024). For NGOs like UNICEF, it supports advocacy for community-led models, enhancing SDG 3 progress in Nigeria’s 2.2 million zero-dose burden (UNICEF, 2025a). Ultimately, it advances child health equity, averting preventable deaths.
1.5 Research Questions
- What are the baseline levels of immunization knowledge and coverage among low-income families in Alimosho PHCs?
-
How effective are community-based health education programs in changing uptake and parental attitudes post-implementation?
-
What barriers and facilitators influence the scaling of these education strategies for sustained immunization gains?
1.6 Hypothesis
H0:Community-based health education programs have no significant effect on immunization uptake among low-income families in Alimosho LGA.
Ha: Community-based health education programs have a significant effect on immunization uptake among low-income families in Alimosho LGA.
1.7 Scope of the Study
This study is delimited to evaluating community-based health education programs at PHCs in Alimosho LGA, Lagos State, focusing on low-income families with children aged 0–5 from 2023–2025. It excludes private facilities or older age groups.
1.8 Definition of Terms
Community-Based Health Education Programs: Locally delivered awareness initiatives using peer networks and PHC extensions to promote immunization (Oyo-Ita et al., 2023).
Immunization Uptake: Completion of full vaccine schedules for children 0–5 (WHO, 2024a).
Low-Income Families: Households below ₦50,000 monthly earnings, per national poverty line (World Bank, 2024).
References
Adeniyi, A. A., et al. (2023). Oral health in Nigeria: Current challenges and future prospects. African Journal of Oral Health, 10(2), 45–56. https://doi.org/10.4314/ajoh.v10i2.3
Bayelsa State Ministry of Health. (2025). Annual Maternal-Child Health Report: Yenagoa LGA. Yenagoa: Bayelsa State Government.
Federal Ministry of Health (FMOH). (2025a). Nigeria Demographic and Health Survey 2023-24 Key Indicators Report. Abuja: FMOH.
Gavi. (2025). 70% and counting: How Lagos is fending off misinformation to get more girls protected from cancer. Gavi, the Vaccine Alliance. https://www.gavi.org/vaccineswork/70-and-counting-how-lagos-fending-misinformation-get-more-girls-protected-cancer
Lagos State Ministry of Health. (2025). Lagos State Maternal Health Strategy 2025-2030. Lagos: Lagos State Government.
Muhammad, Y., et al. (2023). Theory-based immunisation health education intervention in improving child immunisation uptake among antenatal mothers attending federal medical centre in Nigeria: A study protocol for a randomized controlled trial. Trials, 23(1), 973. https://doi.org/10.1186/s13063-022-06973-4
National Primary Health Care Development Agency (NPHCDA). (2025). National Immunization Coverage Survey 2024. Abuja: NPHCDA.
NPC & ICF. (2024). Nigeria Demographic and Health Survey 2023-24. Abuja: NPC.
Ogunniyi, T. J. (2024). Revealing the challenges and efforts of routine immunization coverage in Nigeria. Health Science Reports, 7(8), e70000. https://doi.org/10.1002/hsr2.70000
Oyo-Ita, A., et al. (2023). Interventions for improving coverage of childhood immunisation in low- and middle-income countries. Cochrane Database of Systematic Reviews, (12), CD012914. https://doi.org/10.1002/14651858.CD012914.pub3
UNICEF. (2024b). Health workers are reaching zero-dose children in Nigeria’s urban slums. UNICEF. https://www.unicef.org/stories/sowc-2023/nigeria-vaccination-campaign-urban-slums
UNICEF. (2025a). 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
Williams, S. V., Akande, T., & Abbas, K. (2024). Systematic review of social determinants of childhood immunisation in low- and middle-income countries and equity impact analysis of childhood vaccination coverage in Nigeria. PLOS ONE, 19(3), e0297326. https://doi.org/10.1371/journal.pone.0297326
World Bank. (2024). Nigeria Urbanization Review: Infrastructure deficits and health risks in informal settlements. Washington, DC: World Bank Group.
World Health Organization (WHO). (2024a). *World health statistics 2024: Monitoring health for the SDGs*. Geneva: WHO.