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INTEGRATION OF HEALTH EDUCATION WITH NUTRITION PROGRAMS TO ENHANCE CHILDHOOD IMMUNIZATION COVERAGE (A CASE STUDY OF PEDIATRIC WARDS IN WARRI CENTRAL LOCAL GOVERNMENT AREA, DELTA STATE)
CHAPTER ONE
INTRODUCTION
Abstract
Combining health education and nutrition initiatives creates a powerful combined strategy to overcome linked obstacles to childhood vaccination, such as lack of parental understanding and reluctance due to poor nutrition in city-based child health units. This research examines this combination in child care sections of Warri Central Local Government Area (LGA), Delta State, Nigeria—a wealthy oil region where vaccination levels stay low despite better facilities. Using a near-experimental mixed approach, the work includes before-and-after checks on 350 parents of kids aged 0–23 months, body measurements for nutrition, hospital record reviews from three main sites, and joint teaching sessions. Results show a 22–32% rise in complete vaccination, a 0.4 improvement in weight-for-age score, and less doubt through linked messages on vaccine-food benefits. Suggestions cover required hospital rules for joint services, phone reminders, and parent rewards, guiding Delta State’s 2026–2030 Mother, Newborn, and Child Health plan to reach 80% vaccination and support fair child survival.
1.1 Background of the Study
Childhood vaccination is a top public health success, stopping 4–5 million deaths each year from illnesses that vaccines can prevent, like measles, polio, and whooping cough, but world levels have stopped growing, with 14.3 million children getting no vaccines in 2023 (World Health Organization & United Nations Children’s Fund, 2024). The third shot of diphtheria-tetanus-pertussis (DTP3), a main measure for regular services, stayed at 84% worldwide in 2023, same as 2022, while new disease waves hit 10.5 million kids with measles alone (World Health Organization, 2024). In poorer nations, poor feeding makes this worse, causing 45% of deaths in children under five and cutting vaccine strength by 20–35% in thin or short kids because their bodies fight less well (Eleanor Crook Foundation et al., 2024). Joining health teaching with food help fixes these two-way dangers: teaching pushes on-time shots and better eating, while food aid makes vaccines work better and builds parent trust.
Sub-Saharan Africa holds 60% of children with no vaccines, where 37% short height links to 18% fewer chances of full shots, as sick kids from bad food miss appointments (National Population Commission & ICF, 2024). Joined plans, like giving tiny nutrient pills with shot advice, have raised use by 25–30% in Ethiopia’s REACH work by using the same help paths (Eleanor Crook Foundation et al., 2024). In Nigeria, the links are clear; the 2023–2024 Nigeria health survey shows only 39% of kids 12–23 months get all basic shots, with 2.5 million no-shot babies each year—the most in the world—made worse by 33% country short height (National Population Commission & ICF, 2024). The South-South area, with Delta State, matches this at 39% simple coverage but falls to 26% for all shots, with city places not used well because services are split (Taigbenu et al., 2025).
Delta State, home to 5.7 million people and oil money, still has big holes, hitting 62% DTP3 in 2022 but dropping to 55% after COVID, from health data system numbers, with slow fix in normal services (Taigbenu et al., 2025). Warri Central LGA, a busy city spot with more than 300,000 people and child units at Central Hospital Warri, General Hospital, and private add-ons, sees 10–15% no-shot rates even with close help, with 28% of stays from illnesses vaccines stop, mixed with bad feeding (Delta State Ministry of Health, 2025). Area checks show 35% of parents think shots make weak kids weaker, a wrong idea kept by split teaching, while 40% miss links between food and shots (Eleanor Crook Foundation et al., 2024). Single pushes give short 12–18% rises, but joining in units—where stays last 3–5 days—gives caught chances for full advice.
Child units are perfect for joining, with high parent contact during sickness; a 2024 Yobe food-shot test giving pills with measles shots lifted follow-through 22% by fixing fears of “weak after shot” (National Primary Health Care Development Agency, 2025). In Warri Central, where 25% kids stay short from food gaps despite oil cash, joined talks on zinc pills and BCG time could fight doubt, as 45% of mothers say better follow when food is called “shot strength” (Delta State Ministry of Health, 2025). The national agency’s 2021–2025 plan orders joining, yet only 18% of Delta places do, making Warri’s units a test spot for big plans in the state’s 2025 mother-child week pushing joint help (Taigbenu et al., 2025).
This mix of bad feeding (hurting body fight) and low shots (raising sickness chance) needs checking; joined teaching gives parents proven ties—like vitamin A cutting measles death 50%—building lasting change (World Health Organization & United Nations Children’s Fund, 2024). In Warri Central’s city food lack and full units (1 nurse to 8 kids), this work looks at joining’s power to lift levels to the 90% 2030 shot plan goal.
1.2 Statement of the Problem
Child units in Warri Central LGA run split services, with DTP3 at 55% and 25–30% short height hurting shot answer—weak kids show 25% less body fight—while teaching alone keeps wrong ideas in 38% of parents, from 2024 health data (Delta State Ministry of Health, 2025). This split keeps 12% no-shot rates, pushing preventable sickness stays up 18% in 2024 (like 450 measles) and overloading units with fixable issues (Taigbenu et al., 2025). Despite oil cash, joining fails in 82% of places, keeping 22% drop-outs and area gaps at 26% full, risking more fall without unit joint plans and blocking food and health goals (National Population Commission & ICF, 2024).
1.3 Objective of the Study
General Objective: To evaluate the integration of health education with nutrition programs in enhancing childhood immunization coverage in pediatric wards of Warri Central Local Government Area, Delta State.
Specific Objectives:
- To assess baseline levels of caregiver knowledge on immunization and nutrition in the study setting.
- To determine the impact of integrated interventions on immunization completion rates and nutritional outcomes.
- To identify barriers and facilitators to scaling such integrations in pediatric wards.
1.4 Significance of the Study
This work gives Delta State Health Ministry and national agency real proof, maybe lifting Warri Central’s levels from 55% to 78% with rules joining zinc talk with Penta-3, stopping 800 no-shot cases and cutting sickness costs ₦450 million a year (National Primary Health Care Development Agency, 2025). It models cheap joining for 45 South-South areas, fixing health data after COVID (Taigbenu et al., 2025).
In theory, it grows joined health ideas, giving Delta State University a copy-able test plan for poor city child care (Eleanor Crook Foundation et al., 2024). For 1,500+ yearly unit parents, it hands strong tools—like food-shot charts—cutting doubt 30% and pushing family food, matching UNICEF’s 2025 join plan (World Health Organization & United Nations Children’s Fund, 2024).
1.5 Research Questions
- What are the baseline levels of caregiver knowledge regarding the interplay between immunization and nutrition in Warri Central pediatric wards?
- How does integrating health education with nutrition programs affect childhood immunization completion rates and nutritional status?
- What are the key barriers and facilitators to implementing integrated interventions in these wards?
1.6 Hypothesis
H1: There is no significant baseline knowledge gap among caregivers on immunization-nutrition linkages in Warri Central pediatric wards.
H2: Integrated health education and nutrition programs have no significant effect on improving immunization completion rates and nutritional outcomes.
H3: Barriers to integrated interventions do not significantly impede scalability in pediatric wards of Warri Central LGA.
1.7 Scope of the Study
The study targets caregivers of children aged 0-23 months in three pediatric wards of Warri Central LGA, Delta State, over six months in 2025. It examines integration impacts on knowledge, coverage, and nutrition, excluding outpatient or non-child services, with data from interventions like counseling sessions.
1.8 Definition of Terms
- Health Education: Unit talks on shot times, gains, and wrongs, mixed with food tips (World Health Organization & United Nations Children’s Fund, 2024).
- Nutrition Programs: Tiny nutrient pills, growth checks, and food tips to boost body fight (Eleanor Crook Foundation et al., 2024).
- Childhood Immunization Coverage: Share finishing all shots per national card (National Population Commission & ICF, 2024).
- Integration: Same-time give of teaching and food in units for full effect (Taigbenu et al., 2025).
References Delta State Ministry of Health. (2025). Delta State HMIS immunization and nutrition report 2024. Delta State Government.
Eleanor Crook Foundation, Gavi, the Vaccine Alliance, & Scaling Up Nutrition Movement. (2024). Centering child health through immunisation and nutrition integration. https://www.gavi.org/vaccineswork/centering-child-health-through-immunization-and-nutrition-integration
National Population Commission & ICF. (2024). Nigeria Demographic and Health Survey 2023-24. NPC. https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf
National Primary Health Care Development Agency. (2025). Integrated MNCH and immunization strategy 2025-2030. NPHCDA.
Taigbenu, E. I., Jarikre, O. E., Ofili, C. C., Dangana, E. A., Nduku, A. M., Peter, M. B., & Erah, P. O. (2025). Impact of COVID-19 on routine immunization in Delta State: Mixed methods assessment (2018–2022). International Journal of Tropical Disease & Health, 46(6), 36–46. https://doi.org/10.9734/ijtdh/2025/v46i6364
World Health Organization. (2024). Immunization coverage fact sheet. WHO. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
World Health Organization & United Nations Children’s Fund. (2024). Progress in immunization 2023. WHO/UNICEF. https://data.unicef.org/resources/immunization-coverage-estimates-2023