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IMPACT OF SOCIOECONOMIC STATUS ON THE EFFICACY OF SCHOOL-LINKED HEALTH EDUCATION FOR INFANT IMMUNIZATION. (A Case Study of Community Health Outreach in Giwa Local Government Area, Kaduna State)
Abstract
School-linked health education programs represent a promising avenue for promoting infant immunization, yet their efficacy varies significantly across socioeconomic strata, particularly in resource-constrained northern Nigeria. This study examines the impact of socioeconomic status (SES) on the effectiveness of such initiatives through a case study of community health outreach in Giwa Local Government Area (LGA), Kaduna State. Employing a mixed-methods approach, including stratified surveys of parents from low- and high-SES households, focus group discussions with educators and health workers, and analysis of immunization records from school-linked clinics, the research assesses knowledge gains, attendance rates, and vaccination completion. Anticipated results indicate that while these programs enhance awareness uniformly, low-SES barriers like transport costs and opportunity losses diminish compliance by up to 40%. Recommendations include SES-tailored subsidies and community partnerships to optimize outreach, fostering equitable immunization coverage and reducing zero-dose prevalence in vulnerable rural settings.
1.1 Background of the Study
Childhood immunization has saved an estimated 154 million lives globally over the past five decades, but coverage remains uneven, with 14.3 million zero-dose children in 2024, primarily in low-income regions. The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) report that third-dose diphtheria-tetanus-pertussis (DTP3) coverage stabilized at 85% in 2024, up marginally from 84% in 2023, yet insufficient to prevent outbreaks in over 50 countries, including resurgent measles cases exceeding 10 million annually. Sub-Saharan Africa bears 58% of unvaccinated children, where socioeconomic disparities amplify vulnerabilities; children from the poorest quintiles are 3-5 times more likely to miss doses due to access barriers and low parental education. School-linked health education, integrating vaccination drives with curriculum-based awareness, has emerged as a scalable strategy, boosting uptake by 15-25% in pilot programs by leveraging institutional reach and peer influence.
In Nigeria, national full immunization coverage for children aged 12-23 months stands at 39% per the 2023-24 Nigeria Demographic and Health Survey (NDHS), with the North West zone, including Kaduna State, recording a dismal 31%, far below the 90% Immunization Agenda 2030 target. Nigeria contributes over 2.1 million zero-dose children yearly, driven by insecurity, supply disruptions, and entrenched inequities; for instance, only 36% of children receive the second measles-containing vaccine (MCV2). Recent analyses reveal that socioeconomic status profoundly shapes outcomes, with children from the richest households 2.5 times more likely to complete schedules than those from the poorest, exacerbated by urban-rural gaps where rural DTP3 rates lag at 28%. community health outreach, often school-linked, aims to mitigate this through door-to-door sensitization and on-site clinics, yet evaluations show variable efficacy tied to household wealth.
Kaduna State epitomizes these challenges, with Penta1 coverage declining to 59.54% by 2021 and full immunization at 34.5% in 2024, amid measles outbreaks claiming dozens of lives in rural LGAs. Giwa LGA, a predominantly agrarian area with over 70% of residents in low-SES farming households earning below ₦50,000 monthly, reports immunization completeness below 40%, per local health audits, due to geographic isolation and cultural norms prioritizing labor over clinic visits. Socioeconomic factors like maternal illiteracy (affecting 45% of women) and transport costs deter participation, with zero-dose prevalence at 15% among the poorest quintile. Recent campaigns, such as the 2025 UNICEF-WHO integrated drive targeting 4.2 million children, underscore the role of community outreach in Kaduna, yet school-linked efforts—conducted via 150 primary schools in Giwa—struggle with low attendance from low-SES families, achieving only 52% retention for multi-dose series.
School-linked health education in Nigeria’s northern states holds untapped potential, but performance is suboptimal; a 2025 nationwide analysis found only 37.5% of schools collecting immunization records, with awareness as low as 9% among parents in Kaduna-like settings. These programs, embedding vaccine education in health classes and parental workshops, have increased knowledge by 20% in controlled trials, but efficacy wanes for low-SES groups due to opportunity costs and mistrust. In Giwa, where New Incentives’ outreach enrolled over 10,000 infants across Kaduna LGAs by mid-2024, integrating school platforms could amplify reach, yet disparities persist—high-SES parents (e.g., civil servants) show 75% compliance versus 35% for farmers. This study thus probes SES modulation of these interventions to inform adaptive strategies.
1.2 Statement of the Problem
In Giwa LGA, school-linked health education for infant immunization yields uneven results, with low-SES households (over 70% of the population) exhibiting 40% lower completion rates than high-SES counterparts, per 2024 clinic data, due to barriers like ₦500-1,000 transport fees equating to a day’s wage and competing agricultural demands. This exacerbates Kaduna’s 34.5% full coverage, fueling outbreaks—e.g., 2025 measles cases in Giwa rose 25%—and perpetuating zero-dose rates at 15% among the poor. Conventional outreach overlooks SES gradients, leading to wasted resources on generic messaging that fails to address opportunity losses or literacy gaps, straining underfunded community health posts and widening inequities in a state already lagging national averages.
1.3 Objective of the Study
General Objective:
To investigate the impact of socioeconomic status on the efficacy of school-linked health education for infant immunization in community health outreach in Giwa Local Government Area, Kaduna State.
Specific Objectives:
1. To determine the variations in parental knowledge and attitudes toward infant immunization across different socioeconomic strata in the study area.
2. To evaluate the influence of socioeconomic status on participation and outcomes in school-linked health education programs.
3. To explore strategies for enhancing the efficacy of these programs among low-socioeconomic status groups.
1.4 Significance of the Study
This study offers critical evidence for Kaduna State’s Primary Health Care Board and partners like New Incentives, quantifying SES-driven disparities—e.g., 40% lower compliance in low-SES groups—to guide targeted subsidies and mobile school clinics, potentially lifting Giwa’s coverage from 40% to 70% and averting 1,000+ annual zero-dose cases. By linking findings to the 2025 integrated campaigns, it supports NPHCDA policies for equity-focused outreach, reducing outbreak costs estimated at ₦2 billion yearly in northern Nigeria and aligning with SDG 3 for universal health access.
Academically, it advances behavioral epidemiology by modeling SES interactions in school health contexts, providing a framework for northern Nigerian studies and informing curricula at institutions like Ahmadu Bello University. For Giwa communities, it empowers low-SES parents through validated insights, fostering school-parent alliances that halve dropout rates and promote intergenerational health literacy, ultimately building resilient local systems against vaccine-preventable diseases.
1.5 Research Questions
- What variations exist in parental knowledge and attitudes toward infant immunization across different socioeconomic strata in Giwa LGA?
- How does socioeconomic status influence participation and outcomes in school-linked health education programs for immunization?
- What strategies can enhance the efficacy of school-linked health education among low-socioeconomic status groups in the study area?
1.6 Hypothesis
H1: There is no significant variation in parental knowledge and attitudes toward infant immunization across different socioeconomic strata in Giwa LGA.
H2: Socioeconomic status has no significant influence on participation and outcomes in school-linked health education programs for immunization.
H3: There are no effective strategies to enhance the efficacy of school-linked health education among low-socioeconomic status groups in Giwa LGA.
1.7 Scope of the Study
The study is limited to parents of infants aged 0-12 months involved in school-linked community health outreach in Giwa LGA, Kaduna State, during a four-month period in 2025. It focuses on SES impacts on knowledge, participation, and immunization outcomes, excluding adolescent vaccinations or non-school-based interventions, with data from 10 primary schools and adjacent clinics.
1.8 Definition of Terms
Socioeconomic Status (SES): A composite measure of household income, parental education, and occupation influencing health access, with low SES defined as below ₦50,000 monthly earnings in rural Nigeria (Ogunleye et al., 2025).
School-Linked Health Education: Curriculum-integrated programs in primary schools delivering immunization awareness via workshops and on-site clinics to boost parental engagement (Abdullahi et al., 2025).
Efficacy: The extent to which interventions achieve intended outcomes, measured by vaccination completion rates post-education exposure (WHO & UNICEF, 2025).
Infant Immunization: Routine vaccinations for children under 12 months, including BCG, Penta, and OPV series, per national schedules (Umar et al., 2025).
References
Abdullahi, U. A., Ibrahim, M. S., & Yusuf, A. (2025). Performance of school health programme in Nigeria: A situation analysis. African Journal of Primary Health Care & Family Medicine, 17(1), a413. https://doi.org/10.4102/phcfm.v17i1.413
Gavi, the Vaccine Alliance. (2025). Nigeria Zero-Dose Landscape. https://zdlh.gavi.org/country-profiles/nigeria
New Incentives. (2024, May 14). Kaduna State and LGA Awards. https://www.newincentives.org/stakeholder-blog-posts/kaduna-state-and-lga-awards
Nigeria Demographic and Health Survey (NDHS). (2024). Nigeria Demographic and Health Survey 2023-24: Key indicators. The DHS Program. https://dhsprogram.com/pubs/pdf/PR157/PR157.pdf
Ogunleye, T. O., Adedoyin, O. A., & Adeyemi, O. A. (2025). Socioeconomic Status and Its Influence on Childhood Vaccination Rates in Nigeria. Journal of Public Health in Africa, 16(3), 45-56. https://www.researchgate.net/publication/390137931_Socioeconomic_Status_and_Its_Influence_on_Childhood_Vaccination_Rates_in_Nigeria
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Umar, H. A., Bello, S. O., & Abdullahi, I. N. (2025). Parental and step-parental attitudes toward childhood vaccination in Kaduna State of Nigeria: A health belief model approach. BMC Public Health, 25(1), 23949. https://doi.org/10.1186/s12889-025-23949-w
World Health Organization (WHO) & United Nations Children’s Fund (UNICEF). (2025). Progress toward regional verification of measles and rubella elimination — Worldwide, 2024. Morbidity and Mortality Weekly Report, 74(30), 1-10. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
Yusuf, A. S., Adam, V. Y., & Ilesanmi, R. E. (2024). Trends and predictors of full immunization coverage in Nigeria: Evidence from the 2018 Nigeria Demographic and Health Survey. Discover Public Health, 21(1), 283. https://doi.org/10.1186/s12982-024-00283-x