Socio-Economic, Geographic, and Security Barriers to Caregiver Immunization Compliance: A Qualitative Survey at a Tertiary Hospital in North-Central Nigeria

Terkaa Terrumun Bitto; Cynthia C. Akasike; Saanmoiyol T. Ikpa; Grace Nwunuji Rimamnunra

doi:10.5455/CRJMED.335333

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Original Article
Online Published: 26 Sep 2026

crjmed. 0; 0(0):

doi: 10.5455/CRJMED.335333

Socio-Economic, Geographic, and Security Barriers to Caregiver Immunization Compliance: A Qualitative Survey at a Tertiary Hospital in North-Central Nigeria

Terkaa Terrumun Bitto, Cynthia C. Akasike, Saanmoiyol T. Ikpa, Grace Nwunuji Rimamnunra.

Abstract
Abstract
Background/Objectives: Routine childhood immunization remains one of the most cost-effective public health interventions, yet completion rates in Nigeria continue to fall short of national and global targets. Structural, socio-economic, and security-related barriers increasingly shape whether caregivers sustain immunization schedules to completion, particularly in conflict-affected regions of North-Central Nigeria. This study examined the drivers of immunization non-compliance among caregivers attending a tertiary hospital Child Welfare Clinic in Benue State, Nigeria.
Methods/Subjects: A qualitative survey was conducted among caregivers of children attending the Child Welfare Clinic at Benue State University Teaching Hospital (BSUTH), Makurdi. Information about caregiver awareness of immunization services and reasons for default in completion child immunization schedules were obtained. Qualitative transcripts were analysed using thematic content analysis.
Results: Among caregivers who defaulted, travel distance to the health facility was the leading reason (22.0%), followed by death of the index child (13.8%), service dissatisfaction (8.3%), and civil/political unrest and insecurity (8.3%). Financial constraints and job-related migration each accounted for 5.5% of defaults each. Qualitative accounts linked local unrest, communal clashes, herdsmen-related killings, and armed robbery to population displacement that impaired clinic attendance.
Conclusion: Addressable structural, logistical, and security-related challenges — rather than caregiver perception or vaccine hesitancy — are the predominant drivers of incomplete childhood immunization in this setting. Interventions prioritizing geographic access, community security, and continuity of care during periods of displacement are likely to yield greater gains in immunization completion than awareness-focused campaigns alone.

Key words: Caregivers; Cause of Death; Cost-Benefit Analysis; Cross-Sectional Studies; Immunization Schedule

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How to Cite this Article

Pubmed Style

Bitto TT, Akasike CC, Ikpa ST, Rimamnunra GN. Socio-Economic, Geographic, and Security Barriers to Caregiver Immunization Compliance: A Qualitative Survey at a Tertiary Hospital in North-Central Nigeria. crjmed. Online First: 26 Sep, 2026.

doi:10.5455/CRJMED.335333

Web Style

Bitto TT, Akasike CC, Ikpa ST, Rimamnunra GN. Socio-Economic, Geographic, and Security Barriers to Caregiver Immunization Compliance: A Qualitative Survey at a Tertiary Hospital in North-Central Nigeria. https://www.crjmed.com/?mno=335333 [Access: September 26, 2026].

doi:10.5455/CRJMED.335333

AMA (American Medical Association) Style

Bitto TT, Akasike CC, Ikpa ST, Rimamnunra GN. Socio-Economic, Geographic, and Security Barriers to Caregiver Immunization Compliance: A Qualitative Survey at a Tertiary Hospital in North-Central Nigeria. crjmed. Online First: 26 Sep, 2026.

doi:10.5455/CRJMED.335333

Vancouver/ICMJE Style

doi:10.5455/CRJMED.335333

Harvard Style

Bitto, T. T., Akasike, . C. C., Ikpa, . S. T. & Rimamnunra, . G. N. (0) Socio-Economic, Geographic, and Security Barriers to Caregiver Immunization Compliance: A Qualitative Survey at a Tertiary Hospital in North-Central Nigeria. crjmed, Online First: 26 Sep, 2026.

doi:10.5455/CRJMED.335333

Turabian Style

Bitto, Terkaa Terrumun, Cynthia C. Akasike, Saanmoiyol T. Ikpa, and Grace Nwunuji Rimamnunra. 0. Socio-Economic, Geographic, and Security Barriers to Caregiver Immunization Compliance: A Qualitative Survey at a Tertiary Hospital in North-Central Nigeria. Cross River Journal of Medicine, Online First: 26 Sep, 2026.

doi:10.5455/CRJMED.335333

Chicago Style

Bitto, Terkaa Terrumun, Cynthia C. Akasike, Saanmoiyol T. Ikpa, and Grace Nwunuji Rimamnunra. "Socio-Economic, Geographic, and Security Barriers to Caregiver Immunization Compliance: A Qualitative Survey at a Tertiary Hospital in North-Central Nigeria." Cross River Journal of Medicine Online First: 26 Sep, 2026.

doi:10.5455/CRJMED.335333

MLA (The Modern Language Association) Style

doi:10.5455/CRJMED.335333

APA (American Psychological Association) Style

doi:10.5455/CRJMED.335333

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