Barriers and Challenges to Complete Childhood Immunization in Rural Communities of Nasarawa State, Nigeria: Implications for Health System Strengthening

Abstract

Aims: This study identified the barriers and challenges to complete childhood immunisation in rural communities of Nasarawa State, Nigeria, and examined their implications for health system strengthening, with attention to facility-level, environmental, access-related and caregiver-level barriers underlying persistently low coverage. Study Design: A descriptive cross-sectional survey. Place and Duration of Study: Rural communities served by general health facilities in Lafia, Akwanga, Andaha, Wamba, Nasarawa Toto and New Karu Local Government Areas of Nasarawa State, Nigeria; data collection was conducted in 2025. Methodology: The study population comprised 2,459 parents/caregivers of children aged 0–23 months registered for immunisation services at the selected facilities. A sample of 341 caregivers was determined using the Krejcie and Morgan (1970) table and selected through purposive sampling. Data were collected with a sixteen-item, interviewer-administered structured questionnaire comprising socio-demographic items and four Likert-scaled sections addressing the trend, prevalence, socio-demographic/health-system correlates, and, centrally, the barriers and challenges to complete childhood immunisation uptake. Data were analysed with SPSS using descriptive statistics (frequencies and percentages), with chi-square procedures applied to examine patterns of association. Results: Most caregivers were aged 15–24 years (44.0%), single (44.0%), tertiary-educated (70.1%) and self-employed (42.1%). Complete immunisation uptake among children aged 0–23 months was estimated at approximately 30% by most respondents (65.7% strongly agreed; 23.8% agreed), against a backdrop of substantial health-system barriers. Physical access constraints were the most strongly endorsed barrier, with 96.5% of respondents strongly agreeing that access difficulties disproportionately affect remote and rural communities. The disruption of facility operations and vaccine supply by flooding and environmental damage was affirmed by 84.2% of respondents, while 54.0% strongly agreed and a further 29.0% agreed that health facilities were poorly resourced, with minimal space and vaccine-handling equipment. Persistent misconceptions about children's readiness for vaccination were acknowledged by 82.7% of respondents. Distance to the general hospital (84.2% strongly agreed) and antenatal clinic attendance (71.0% strongly agreed) were the socio-demographic/health-system factors most strongly linked to these barriers and to complete immunisation status. Conclusion: Complete childhood immunisation coverage in rural Nasarawa State is constrained primarily by supply-side and structural health-system barriers, poor physical access, facility under-resourcing, environmental disruption of vaccine logistics, and, secondarily, by persistent caregiver misconceptions. These findings point to health system strengthening, rather than caregiver education alone, as the priority lever for improving coverage in this setting.