Table 3.
Summary of systematic review of factors influencing childhood immunization uptake in Africa
| Authors/year/Location | Method | Study design | Sample size | Results | Factors | Study quality |
|---|---|---|---|---|---|---|
| Sanou, 2009 (Nouna District, Burkina Faso) [31] | Nouna Health Research Centres Demographic Surveillance System (DSS). | Cross-sectional | n = 476 | Knowledge of the preventive objectives of immunization: Illiterate parent vs literate parents 7.8% Vs 90%, p = 0.030 completely immunized; Availability of a vaccination record document: Yes vs no: OR = 2.381; 95% CI: 1.436–3.948, p = 0.001; Religion: Muslims Vs Others OR = 1.813; 95% CI: 1.102–2.985, p = 0.019; Marital status: Monogamous parent’s vs polygamous parents; 61.4% vs 34.2%, p < 0.05; Economic status: 4th quartile vs 1st, 2nd and 3rd: OR = 2.100; 95% CI: 1.242–3.554, p = 0.006 |
1. Knowledge 2. Availability of child immunization record 3. Religion 4. Marital status 5. Economic status |
High |
| Chiabi, 2017 (Yaounde, Cameroon) [32] | Pre-tested questionnaire and children’s vaccination booklets | Cross-sectional | n = 400 | Maternal educational status: Higher education vs primary and secondary (AOR = 7.0; 95% CI: 2.16–22.68, p = 0.001). Paternal occupational status: Employed vs unemployed (AOR = 12.39; 95% CI: 2.21–69.26, p = 0.004) |
1. Maternal education 2. Paternal occupation |
High |
| Mwamba, 2017 (Kinshasa, Democratic Republic of Congo) [33] | Structured interview | Cross-sectional | n = 1224 | Distance to health facility: < 30 min vs > 30 min p = 0.04; Mothers thought child vaccine is up-to date: Yes vs No < 0.001. |
1. Distance to health facility 2. Mothers thought |
High |
| Aregawi, 2017 (Laelay Adiabo District, Northern Ethiopia) [34] | Structured questionnaire | Case-control | n = 270 |
Maternal knowledge on Immunization: Good vs poor (AOR = 3.3,95% CI:1.87–7.43). Post-natal care follow-up: Yes vs no (AOR = 5.2,95%CI:2.36–11.46). participation in women’s developmental groups: Good vs poor (AOR = 3.3,95%CI 1.54–7.08). Health extension worker visit: Yes vs no (AOR = 2.68,95%CI:1.30–5.51). Distance to health facility: < 30 min vs > 30 min (AOR =3.56,95%CI:1.58–8.01). Other reasons for defaulting: Child illness 21.1%; Forgetfulness 17.80%; Inconvenience time 8.9%; Lack awareness about vaccine 7.80%; Not knowing return for 2nd and 3rd dose 7.80%; Vaccine not available 5.60% and Fear of side effect 4.40%. |
1. Maternal knowledge on immunization 2. Post-natal care 3. Participation in women’s developmental groups 4. Health extension worker visit 5. Attitude 6. Lack of awareness 7. Lack of knowledge on EPI schedule 8. Availability of vaccine |
High |
| Animaw, 2014 (Arba Minch town and Zuria District, Southern Ethiopia) [29] | Semi structured questionnaire and child immunization record | Cross-sectional | n = 630 | Maternal educational status: Primary or above vs no education (AOR = 2.22; 95% CI 1.31,3.76). Accessible vaccination site: Yes vs no (AOR = 4.54; 95%CI:2.34,8.77). Nearest vaccine site: Health post vs outreach (AOR = 1.89; 95% CI: 1.07,3.33). |
1. Maternal education 2. Accessible vaccine site 3. Nearest vaccine site |
High |
| Etana, 2012 (Ambo Woreda, Central Ethiopia) [35] | Structured questionnaire and child immunization record | Cross-sectional | n = 536 | Maternal Knowledge on benefit of immunization: Yes vs no (OR = 4.5; 95% CI: 2.5,7.9). Maternal Knowledge on age to start immunization: Yes vs no (AOR = 2.9, 95% CI: 1.9,4.6). Maternal knowledge on age to complete child immunization: Yes vs no (AOR = 4.3; 95%CI:2.3,8.0). ANC follow-up: Yes vs no (AOR = 2.4; 95% CI:1.2,4.9). Maternal knowledge on total immunization session: Yes vs no (OR = 1.7; 95%CI:1.1,2.5). Place of delivery: Hospital vs home (AOR = 2.1; 95% CI: 1.3,3.4). |
1. Maternal knowledge on benefit of vaccine 2. Knowledge on age to start child immunization 3. Knowledge on age to complete child immunization 4. ANC follow-up 5. Maternal knowledge on total immunization session 6. Place of delivery |
High |
| Negussie, 2016 (Arbegona district, southern Ethiopia) [23] | Structured questionnaire and focused group discussion | Mixed method | n = 548 |
Case-control findings Maternal Age: > 19 years vs < 19 years (AOR = 9.54; 95% CI: 5.03, 18.09, p = 0.001). Knew the benefits of immunization: Yes vs no (AOR = 5.51; 95% CI:1.52, 19.94. p = 0.009). Perception about vaccine side effects: Positive vs negative (AOR = 1.92; 95% CI:1.01, 3.70). Birth order: 1 vs 2–4 (AOR = 3.64; 95% CI:1.63, 8.14, p < 0.001); 1 vs > 5 (AOR = 5.27; 95% CI:2.20, 12.64, p = 0.002). Qualitative findings Maternal migration, fear of vaccine side effect, unavailability of vaccine, knowledge on EPI schedule. |
1. Maternal age 2. Knowledge on benefit of immunization 3. Perception about vaccine side effect 4. Birth order 5. Maternal migration 6. Availability of vaccine 7. knowledge on EPI |
High |
| Lakew, 2015 (Ethiopia) [20] | Ethiopian Demographic and Health Survey (EDHS) women questionnaire | Cross-sectional | n = 1927 | Source of immunization information: Immunization record vs mothers self-report (AOR = 7.7; 95% CI: 5.95–10.06). postnatal check-up: Yes vs no (AOR = 1.8; 95% CI: 1.28–2.56). women’s awareness of community conversation program: Yes vs no (AOR = 1.9; 95% CI: 1.44–2.49). wealth index: Rich vs poor (AOR = 1.4, 95% CI:1.06–1.94). |
1. Source of information 2. PNC check-up 3. Awareness 4. Wealth index |
High |
| Mohamud, 2014 (Jigjiga District, Somali National Regional State, Ethiopia) [36] | Structured questionnaire | Cross-sectional | n = 582 | Maternal age: > 20 years vs < 19 years (AOR = 2.19; 95% CI:1.26,3.83). Maternal literacy: Literate vs illiterate (AOR = 3.06; 95% CI:1.64,5.71). Place of residence: Urban vs rural (AOR = 2.04; 95% CI:1.33,3.13). Maternal TT vaccine: Yes vs no (AOR = 2.43; 95% CI: 1.56,3.77). Place of delivery: Hospital vs home (AOR = 2.02; 95% CI:1.24,3.28). Household visit by health workers: Yes vs no (AOR = 1.92; 95% 1.17,3.16). |
1. Maternal age 2. Maternal literacy 3. Place of residence 4. Maternal TT vaccine 5. Place of delivery 6. House hold visit by health workers |
High |
| Abebe, 2019 (Bassona Worena Woreda, Amhara Region, Ethiopia) [37] | Structured questionnaire and focused group discussion | Mixed method | n = 575 |
Cross-sectional findings Maternal age: > 40 years versus < 40 years (AOR = 1.9; 95% CI 1.12, 5.83). Awareness about immunization: Yes vs no (AOR = 2.8; 95% CI 1.67, 9.34). ANC follow-up: Yes vs no (AOR = 3.67; 95% CI 1.96, 6.78). Availability of health facility: Yes vs no (AOR = 1.49; 95% CI 1.06, 8.12). Qualitative findings Lack of awareness on immunization; no faith on immunization; ANC follow-up; availability of health facility |
1. Maternal age 2. Awareness 3. ANC follow-up 4. Availability of health facility 5. Lack of faith |
High |
|
Zewdie et al., 2016 (Hadiya zone, Southern Ethiopia) [38] |
Phenomenological method | Qualitative | n = 14 |
Lack of awareness on immunization; no faith on immunization; ANC follow-up; availability of health facility; knowledge of benefits of immunization; knowledge of vaccination schedules and service arrangements; lack of social support from family; loss of vaccination card; problems with vaccine supply and service arrangement; health systems and health care provider factors; poor counselling and client-provider relationships are influencing childhood immunization uptake. |
High | |
| Payne, 2013 (Gambia) [39] | Farafenni Health and Demographic Surveillance System (FHDSS). | Cross-sectional | n = 7363 | Ethnic group: Wolof vs Mandika (AOR = 1.52; 95% CI:1.28–1.81, p < 0.001). Wealth index: Quintile 5 vs Quintile 1 (AOR = 1.49; 95% CI: 1.09–2.04, p = 0.011). |
1. Ethnic group 2. Wealth index |
Moderate |
| Odutola, 2015 (Western region of Gambia) [40] | Structured questionnaire | Cross-sectional | n = 1154 | Place of birth: Hospital vs home (AOR = 1.47; 95% CI: 1.05–2.07, p = 0.001). Mode of transportation: Public transport vs walking (AOR = 1.54; 95% CI:1.20–1.97, p = 0.02). Birth order: > 2 vs < 2 (AOR:1.37; 95% CI: 1.04–1.79). |
1. Place of birth 2. Mode of transportation 3. Birth order |
High |
| Bosu, 1997 (Komenda-Edina-Eguafo-Abrem District of Ghana) [41] | Structured questionnaire and focused group discussion | Mixed method | n = 469 |
Cross-sectional findings Knowledge of EPI diseases: Inadequate Vs adequate: 30.35% vs 17.58% children not fully immunized. Mothers who never attend child immunization (n = 74): financial difficulties (37.8%); baby too young (14.9%); mothers travelled out of community (13.5%); mothers too busy (4.1%) |
1. Knowledge on EPI diseases 2. Financial difficulties 3. Mothers attitude |
Moderate |
| Anokye, 2018 (Koforidua, Ghana) [24] | Structured questionnaire | Cross-sectional | n = 280 | Marital status: Married vs divorced (AOR = 3.01; 95% CI: 1.59–58.2, p = 0.048); Employment status: Working part-time vs unemployed (AOR = 2.28; 95% CI:1.031–9.11, p = 0.049); Maternal income: > 100 cedes vs < 100 cedes (AOR = 2.41; 95% CI:1.56–2.01). |
1. Marital status 2. Employment status 3. Income |
High |
| Mutua, 2011 (Korogocho and Viwandani slums of Nairobi, Kenya) [42] | Nairobi Urban Health and Demographic Surveillance System (NUHDSS) | Cross-sectional | n = 1848 | Place of delivery: Hospital vs home (OR = 1.27; 95% CI: 1.002,1.619). Maternal education: Complete primary school vs not complete (OR = 1.3024; 95% CI: 1.011,1.676). Maternal age: > 20 years vs < 20 years (OR = 1.48; 95% CI: 1.057,2.079). |
1. Place of delivery 2. Maternal education 3. Maternal age |
High |
| Pertet, 2018 (pastoralist community of Kenya) [43] | An interviewer-administered questionnaire | Cross-sectional | n = 515 | lack of vaccines, p = 0.002; location of health facility, p = <.001; nomadic lifestyle: OR = 9.0; 95% CI: 1.11, 72.66, p = 0.006 |
1. Availability of vaccine 2. Location of health facility 3. Nomadic lifestyle |
High |
| Jani, 2008 (Southern Mozambique) [44] | Face to face Interview | Cross-sectional | n = 668 | Distance to health facility: Near vs far away (OR = 3.64; 95% CI: 1.71,7.74, p = 0.001). Maternal schooling: Yes vs no (OR = 2.24; 95% CI: 1.41,3.56, p = 0.001). Knowledge on EPI: Yes vs no (OR = 2.02; 95% CI: 1.19,3.42, p = 0.009). Religious beliefs: Yes vs no (OR = 1.65; 95% CI: 1.15,2.36, p = 0.004). Child born: Inside Mozambique vs outside (OR = 5.20; 95% CI: 3.35,11.51, p < 0.001). Place of delivery: Hospital vs home (OR = 1.78; 95% CI: 1.28,3.36, p = 0.03). Marital status: Married vs divorced or widowed (OR = 1.68; 95% CI: 1.07,2.64, p = 0.02). |
1. Distance to HF 2. Maternal schooling 3. Knowledge on EPI 4. Religious beliefs 5. Child born location 6. Place of delivery 7. Marital status |
High |
|
Umeh, 2018 Northern Nigeria [45] |
Face to face interview | Cross-sectional | n = 396 |
Compliant vs non-compliant Satisfaction with immunization p = 0.001; refusal to vaccination p = 0.001; doubt about Immunization p = 0.001; worries about Vaccination Safety p = 0.001; knowledge on importance of vaccination p = 0.001; seriousness of VPDs p = 0.045. |
1. Immunization satisfaction 2. Attitudes 3. Knowledge on important of vaccination 4. Seriousness of VPDs |
High |
|
Oladokun, 2010 (Ibadan, Nigeria) [46] |
Face to face interview | Cross-sectional | n = 248 | Maternal education: Primary vs none: OR = 5.90; 95% CI: 1.87,17.92, p = 0.002. Religion: Christianity vs Islam: OR = 3.05; 95%: 1.20,7.81, p = 0.019. Gender of child: Male vs female: OR = 2.98; 95% CI: 1.21, 7.35, p = 0.017. Mothers Beliefs and attitudes on Immunization: 248 defaulters: availability of vaccines 65 (26.2%); lack of knowledge on EPI 41 (16.5%); inconvenient time 34 (13.7%); lack of knowledge on benefit of immunization 24 (9.7%); child ill 25 (10.1%); Immunization is waste of time 129 (52%); immunization is harmful to children 81 (32.7%) |
1. Maternal education 2. Religion 3. Child gender 4. Mothers beliefs and attitude |
Moderate |
| Babalola, 2008 South and Northern Nigeria [47] | Face to face interview | Cross-sectional | n = 1472 | Place of delivery: Hospital vs home (OR = 2.54). child immunization record: Yes vs no (OR = 2.10). Immunization ideation: High vs low (OR = 6.04). |
1. Place of delivery 2. Child immunization record 3. Immunization ideation |
Moderate |
| Odusanya, 2008 Edo State, Nigeria [48] | Interviewer administer questionnaire | Cross-sectional | n = 339 | Child immunization record: Yes vs no (p = 0.002) | 1. Child immunization record | High |
| Taiwo, 2017 Kaduna State, Nigeria [49] | Semi-structured interviewer-administered questionnaire | Cross-sectional | n = 379 | Maternal education: educated vs uneducated (AOR = 1.90; 95% CI: 1.11,3.28). Maternal perception on immunization: Good vs poor (AOR = 2.60; 95% CI: 1.50,4.51). Maternal knowledge on immunization: Satisfactory vs unsatisfactory (135 (35.6%) vs 244 (64.4%)). |
1. Maternal education 2. Maternal perception 3. Maternal knowledge on immunization |
Moderate |
| Oku, 2017 Northern and Southern Nigeria [50] | Case study model | Qualitative | n = 15 | health workers shortages; training deficiencies; poor attitudes of health workers; long waiting times; attitudes among community members; engagement of traditional and religious institutions | High | |
| Adedire, 2016 Ogun State, Nigeria [27] | Semi-structured questionnaire | Cross-sectional | n = 750 | ANC follow-up: Yes vs no (AOR = 3.3; 95% CI:1.2, 8.3, p = 0.03). Maternal tetanus toxoid: At least a dose vs none (AOR = 3.2; 95% CI: 1.1,10.0, p = 0.04). Maternal knowledge on RI: Good vs poor (AOR = 2.4; 95% CI: 1.6,3.8, p < 0.001). Access to immunisation information in last 12 months: Yes vs no (AOR = 2.5, 95% CI:1.1, 2.5, p = 0.02). |
1. ANC follow-up 2. Maternal TT 3. Maternal knowledge on RI 4. Accessibility |
High |
| Adedokun, 2017 Nigeria [18] | Secondary analyses from the 2013 Nigeria Demographic and Health Survey (NDHS) | Cross-sectional | n = 5754 | Maternal education: secondary or higher vs none (AOR = 2.14; 95% CI:1.59,2.86 secondary or higher vs primary: AOR = 1.42; 95% CI:1.14,1.76). Birth order 1st -3rd order vs 4th -6th order (AOR = 1.53; 95% CI:1.24,1.86). Access to health facility: Not a problem vs problem (AOR: 1.28;1.02,1.57). |
1. Maternal education 2. Birth order 3. Accessibility |
High |
| Antai, 2009 Nigeria [51] | Secondary analyses from the 2003 Nigeria Demographic and Health Survey (DHS) | Cross-sectional | n = 3725 | Ethnicity: Hausa/Fulani vs Igbo (AOR = 2.47; 95% CI:1.28,4.76). | 1. Ethnicity | High |
| Ijarotimi, 2018 Oyo State, Nigeria [52] | interviewer administered questionnaires | Cross-sectional | n = 449 | Maternal educational status: > Primary vs none (AOR = 6.4; 95% CI:2.9,14.0). Maternal religion: Christian vs Muslims (AOR = 2.2; 95% CI: 1.3–3.7). Wealth index: Richest vs poorest (AOR = 14.5; 95% CI:8.2–20.5). |
1. Maternal education 2. Religion 3. Wealth index |
High |
| Chambongo, 2016 Ileje District, Tanzania [28] | Structured questionnaire | Cross-sectional | n = 380 | Place of birth: Health facility vs home (AOR = 14.4; 95% CI:8.04–25.8). Perceived quality of vaccine provider client’s relationship: Positive vs negative (AOR = 1.86; 95% CI: 1.03–3.5). Satisfaction with vaccine services: Satisfied vs unsatisfied (AOR = 2.63; 95% CI:1.1–6.3). |
1. Place of birth 2. Perceived quality of vaccine provider client’s relationship 3. Satisfaction with vaccine services: |
High |
|
Semali, 2010 Tanzania [53] |
Secondary analyses from the 1990, 1996 and 2004 Tanzania DHS | Cross-sectional | n = 4471 | Residence: Urban vs rural (AOR = 1.4; 95% CI: 1.0–1.9). Number of children under five years: < 2 vs > 2 (AOR = 1.4; 95% CI: 1.0–1.8). Wealth index: Least poor vs most poor (AOR = 1.9; 95% CI: 1.1–3.7). |
1. Residence 2. Number of children under five years 3. Wealth index |
Moderate |
| Vonasek, 2016 Rural Sheema District Southwest Uganda [54] | Face-to-face interviews | Cross-sectional | n = 476 | Stated reasons to immunize children protect children from disease: Yes vs no (PR = 1.35; 95% CI: 1.01, 1.80). | 1. Knowledge | Moderate |
| Kiptoo, 2015 East Pokot, Baringo, Kenya [26] | Structured questionnaire | Cross-sectional | n = 298 | Maternal level of education: primary vs none (OR = 3.55; 95% CI: 1.49–8.47; p = 0.0049). knowledge on immunization schedule: yes vs no (OR = 9.04; 95% CI: 1.37–7.87; p < 0.0001). Nomadic lifestyle: yes vs no (OR = 11.06; 95% CI: 4.29–28.54; p < 0.0001). Distance to health facility: < 1-h vs > 1 h (OR = 18.24; 95% CI: 5.56–59.80; p < 0.0001). Area of residence: urban vs rural (OR = 12.3; 95% CI: 4.77–31.73; p < 0.0001). Place of birth: hospital vs home (OR = 4.5; 95% CI: 1.7–11.61; p < 0.0001). |
1. Maternal level of education 2. Knowledge on immunization schedule 3. Nomadic lifestyle 4. Distance to health facility 5. Area of residence 6. Place of birth |
High |
| Kagone, 2017 Nouna, North West Burkina Faso [55] | Nouna Health and Demographic Surveillance System (NHDSS) | Cross-sectional | n = 6579 | Maternal educational status: educated vs non educated (AOR = 1.08; 95% CI: 1.02–1.13; p = 0.02) | 1. Educational status | High |
| Gidado, 2014 Zamfara state, Nigeria [15] | Structured interviewer-administered questionnaire | Cross-sectional | n = 450 | Satisfactory knowledge on routine immunization: yes vs no (AOR = 18.4; 95% CI = 3.6–94.7). Level of education: secondary education vs none (AOR = 3.6; 95% CI = 1.2–10.6) |
1. Satisfactory knowledge on routine immunization 2. Level of education |
Moderate |
| Duru, 2016 Imo state, Nigeria [56] | Semi structured, interviewer administered questionnaire | Cross-sectional | n = 743 | Maternal age (year): 25–29 vs < 25 (OR = 2.1; 95% CI: 1.12–4.05; p < 0.01). Maternal level of education: primary vs none (OR = 7.5; 95% CI: 1.27–44.08, p < 0.05). Knowledge about immunization: good vs poor (OR = 37.71; 95% CI: 4.74–299.62; p < 0.0001). |
1. Maternal age 2. Maternal level of education 3. Knowledge about immunization |
Moderate |
| Legesse, 2015 Southeast Ethiopia [16] | Pre-tested, interviewer administered questionnaire | Cross-sectional | n = 591 | Antenatal care follow-up: yes vs no (AOR = 3.7; 95% CI: 2.3–5.9). Maternal occupation: farmer vs housewife (AOR = 1.9; 95% CI: 1.1–3.1). Paternal level of education: > secondary vs illiterate (AOR = 3.1; 95% CI: 1.3–7.4). Family income: > 1000 52 USD vs < 52 USD (AOR = 3.2; 95% CI: 1.4–7.4). Distance to health facilities: < an hour vs > an hour (AOR = 3.1; 95% CI: 1.5–6.3). Ever discussed about immunization with HEWs: yes vs no (AOR = 2.4, 95% CI: 1.3–4.2). Maternal knowledge on immunization: good vs poor (AOR = 2.5; 95% CI: 1.5–4.2). |
1. Antenatal care follow-up 2. Maternal occupation 3. Paternal level of education 4. Family income 5. Distance to heath facilities 6. Ever discussed about immunization with HEWs 7. Maternal knowledge on immunization |
High |
| Oliveira, 2014 Angola [25] | interviewer administered questionnaire | Cross-sectional | n = 1209 | Child age (years): > 1 vs < 1 (APR = 1.78; 95% CI: 1.53–2.07). Family size: 2–3 vs > 6 (APR = 1.34; 95% CI: 1.05–1.71). Knowledge of immunization programs: yes vs no (APR = 1.32; 95% CI: 1.07–1.63). Appliances: radio vs television or none (APR = 1.45; 95% CI: 1.05–1.99). |
1. Child age 2. Family size 3. Knowledge of immunization programs 4. Appliances |
High |
| Bbale, 2013 Uganda [19] | Uganda Demographic Health Survey (UDHS) | Cross-sectional | n = 7591 |
Maternal educational status: primary education vs no education (increase probability of fully immunized child 8–14%; p < 0.05); secondary education vs no education (increase probability of child receiving three doses of DPT and oral polio vaccines: 6–7%; p < 0.05); primary education vs no education (increase probability of child receiving three doses of oral polio vaccines: 7–11%; p < 0.01). Wealth index: rich vs poor (increase probability of child being vaccinated against polio and measles by 7%; p < 0.05). |
1. Maternal educational status 2. Wealth index |
Moderate |
| Gunnala, 2016 Nigeria [57] | Pre-tested, interviewer administered questionnaire | Cross-sectional | n = 7815 | Common reported reason for non-vaccination: lack of maternal knowledge on vaccines and vaccination services (50%), poor maternal attitude towards immunization (16%), lack of access to routine immunization services (15%) and fear of side effects (9%). |
1. Lack of maternal knowledge on vaccines 2. Poor maternal attitude towards immunization 3. Lack of access 4. Fear of side effects |
High |
| Chris-Otubor 2016 Nigeria [58] | semi-structured questionnaire | Cross-sectional | n = 232 | Maternal education: primary or secondary vs none; marital status: married vs single or separated or divorced; religion: Islam vs Christian, geopolitical zone: and the mother or the father of the child been immunized as children significantly influenced maternal knowledge on childhood immunization (p < 0.05). |
1. Maternal education 2. Marital status 3. Religion 4. Geopolitical zone 5. Mother or father being immunized as children |
High |
| Tadesse, 2009 Ethiopia [59] | structured questionnaire | Case-control | n = 264 | Current postnatal care visit: yes vs no (AOR = 19.52; 95% CI: 1.68–226.29. Perceived health institution support: positive attitude vs negative attitude (AOR = 2.71; 95% CI 1.39–5.26). knowledge of immunization schedule: yes vs no (AOR = 3.01; 95% CI: 1.42–6.35). knowledge on OPV schedule: yes vs no (AOR = 6.52; 95% CI: 1.35–31.39). knowledge on measles: yes vs no (AOR = 34.72; 95% CI: 12.74–94.64). knowledge on benefit of vaccines: yes vs no (AOR = 6.36; 95% CI: 1.24–9.53). |
1. Postnatal care visit 2. Perceived health institution support 3. Knowledge on immunization schedule 4. Knowledge on OPV schedule 5. Knowledge on measles 6. Knowledge on benefit of vaccines |
High |
| Kio, 2016 Ogun state, Nigeria [60] | Structured pre-tested questionnaire | Cross-sectional | n = 120 | Reason for defaulting: 52% or respondents are lacking knowledge on child immunization schedule, 47.5% reported lack of awareness on immunization in their areas, 54.2 reported negative cultural belief on immunization in their areas, 43.8% believes immunization to has adverse effects, 54.2% reported communicable diseases has to do nothing with routine immunization and 51% reported their children to be available for immunization only if the schedule is convenient for them |
1. Lack of maternal knowledge on child immunization schedule 2. Lack of awareness on immunization 3. Cultural beliefs 4. Adverse effects 5. Lack of knowledge routine immunization 6. Convenient time |
Moderate |
| Awosan, 2018 Sokoto state, Nigeria [61] | standardized, structured, interviewer- administered questionnaire | Cross-sectional | n = 220 | 55.5% of the respondents are having poor knowledge of the child that requires immunization and its benefits. 50.9% of the respondents are having poor knowledge on vaccine preventable diseases (VPDs). Knowledge on VPDs: good vs poor (85.2% vs 46.4% p < 0.05 children fully immunized). |
1. Knowledge on immunization 2. Knowledge on VPDs |
High |
| Ekure, 2013 Southwest, Nigeria [62] | interviewer-administered questionnaire | Cross-sectional | n = 36 | > 30% of the respondents reported not to take their children back to complete RI if they develop any adverse effect and > 40% of the respondents reported not to allow their children to receive polio vaccine. |
1. Fear of adverse effects 2. Poor attitude |
High |
| Canavan, 2014 Uganda [63] | Uganda demographic Health Survey (UDHS) | Cross-sectional | n = 474 | Maternal educational status: secondary school or higher vs no formal education (AOR = 3.39; 95% CI:1.20–9.51). Place of delivery: public hospital vs home (AOR = 3.94; 95% CI: 2.12–7.33). |
1. Maternal educational status 2. Place of delivery |
High |
| Omotora, 2012 Borno state, Nigeria [64] | Phenomenological method | Qualitative | n = 120 |
The main reasons for not fully supporting immunization program in some areas includes: inadequate adequate information about logistics and time of immunization programme, lack of adequate involvement of traditional and religious leaders and poor attitude of health workers. Mothers need incentives in order for them to take their children for immunization in forms of soap and complimentary health care services. |
1. Inadequate adequate information about logistics and time of immunization programme 2. Lack of adequate involvement of traditional and religious leaders 3. Poor attitude of health workers. 4. Incentives |
High |
| Tamirat, 2019 Ethiopia [65]. | Ethiopia Demographic and Health Survey (EDHS, 2016). | Cross-sectional | n = 1909 | Maternal employment status: employed vs unemployed (AOR = 1.62, 95% CI: 1.31, 2.0). Wealth index: rich vs poor (AOR = 1.44, 95% CI: 1.07, 1.94). Maternal education: Primary school vs no formal education (AOR = 1.38,95% CI: 1.07, 1.78). ANC follow-ups (AOR = 2.79, 95% CI:2.17 3.59). Place of delivery: hospital vs home (AOR = 1.76, 95% CI: 1.36, 2.24). |
1. Maternal employment status 2. Wealth index 3. Maternal education 4. ANC follow-ups 5. Place of delivery |
High |
| Kinfe, 2019 Ethiopia [66]. | Ethiopia Demographic and Health Survey (EDHS, 2016). | Cross-sectional | n = 1929 | Maternal education: Primary vs no formal education (AOR = 1.58, 95% CI: 1.1, 2.28). Paternal employment status: Employed vs unemployed (AOR = 2.1, 95% CI: 1.32, 3.35). ANC visit: yes vs no (AOR = 1.94, 95% CI: 1.31, 2.86). Availability of child immunization record: yes vs no (AOR = 1.61, 95% CI: 1.21, 2.16). |
1. Maternal education 2. Paternal employment status 3. ANC visit 4. Availability of child immunization record |
High |
|
Girman, 2019 Ethiopia [67]. |
pretested interviewer-administered questionnaire | Cross-sectional | n = 620 | Antenatal care visit: yes vs no (AOR = 2.75, 95%CI: 1.52–5.0). Maternal education: higher education vs no formal education (AOR = 2.39, 95%CI: 1.06–5.36). Maternal knowledge on immunization: Good vs poor (AOR = 3.70, 95%CI: 2.37–5.79). Distance to health facility: short vs long (AOR = 2.65, 95%CI: 1.61–4.36). Place of delivery: hospital vs home (AOR = 2.58, 95%CI: 1.66–3.99). |
1. ANC visit 2. Maternal education 3. Maternal knowledge on immunization 4. Distance to health facility 5. Place of delivery |
High |
| Akwataghibe, 2019 Nigeria [68]. | Semi-structured interviews and focused group discussion | mixed methods | n = 215 | Health service factors like absence of delivery services, shortage of health workers, unavailability of vaccines at scheduled times, and indirect costs of immunization contributed to low utilization. |
1. Absence of delivery services 2. Shortage of health workers 3. Unavailability of vaccines at scheduled times 4. Indirect costs of immunization |
High |
|
Mekonnen, 2020 Ethiopia [69]. |
Interviewer-administered questionnaire | Cross sectional study design | n = 821 | Maternal education: >secondary education vs no formal education (AOR = 2.391; 95% CI: 1.317–4.343). Wealth index: riche vs poor (AOR = 2.381; 95% CI: 1.502–3.773). ANC follow-up: yes vs no (AOR = 2.844; 95% CI: 1.310–6.174). |
1. Maternal education 2. Wealth index 3. ANC follow-up |
High |