Acceptance Without Adherence: Health System Bottlenecks and Residual Vaccine Hesitancy in Maternal and Child Healthcare Utilisation in Kwara State, Nigeria
Abstract:
Caregiver acceptance of routine immunisation in Kwara State, Nigeria, is generally high, yet persistent missed doses and incomplete continuity of maternal–child care signal significant coverage bottlenecks. This study examined utilisation patterns, knowledge, attitudes, and residual hesitancy among 1,173 caregivers of children aged 0–23 months across six Local Government Areas to identify independent predictors of zero-dose status, missed immunisation visits, and suboptimal antenatal care attendance. Data were analysed using SPSS v28. While ANC attendance reached 87.4% and facility delivery 80.4%, only 47.3% of ANC attendees completed at least four visits, and 13.9% reached the eight-contact standard. Despite high vaccine safety perceptions (96.6%), 9.7% of children were zero-dose for Penta-1, and 9.1% of caregivers reported missed immunisation visits. In adjusted models, the strongest protective factor against zero-dose status was receiving immunisation reminders, underscoring the critical role of systematic patient tracking in overcoming service-side barriers. Community rumours discouraging immunisation significantly increased the odds of zero-dose status and missed visits, while urban/peri-urban residence was strongly protective against missed visits. These findings demonstrate that in Kwara State, acceptance is not the binding constraint. Closing the immunisation gap requires reliable system performance, structured reminders, and risk communication that actively engages residual safety concerns through trusted interpersonal channels.References:
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