This study examines the predictors of Bacille Calmette-Guérin (BCG) immunization status among infants in northern Nigeria using a behavioral-ecological model. The findings show only 37.3 percent of the children had received BCG vaccine, and reveal that BCG immunization status in northern Nigeria is influenced by multiple layers of factors, including child's characteristics, parental or household factors, community characteristics, vaccine supply and the policy environment. At the child's level, place of birth and ownership of an immunization card are the two most significant predictors. The parental and household predictors of BCG immunization status include maternal use of antenatal care, maternal knowledge about immunization, maternal exposure to child health information, social influence and paternal approval of immunization. Both the regularity of vaccine supply to the health facility and the state of residence are associated independently with BCG immunization status. These findings stress the need for interventions at multiple levels in order to increase BCG immunization status.
Al-Sheikh, O.G., Al-Samarrai, J.I., Al-Sumaidaie, M.M., Mohammad, S.A. and Al-Dujaily, A.A. (1999) `Immunization Coverage among Children Born between 1989 and 1994 in Saladdin Governorate, Iraq', Eastern Mediterranean Health Journal5(5): 933-40.
2.
Anand, S. and Bärnighausen T. (2007) `Health Workers and Vaccination Coverage in Developing Countries: an Econometric Analysis', Lancet369(9569): 1277-85.
3.
Babalola, S. (2007) `Household Baseline Survey on Factors Affecting Routine Immunization in Northern Nigeria, July/August 2007: Report of Pertinent Findings', report submitted to PRRINN (Available online at: http://www.jhuccp.org/africa/nigeria/documents/prrinn_finalhousehold.pdf ).
4.
Bardenheier, B., Gonzalez, I., Washington, M., Bell, B., Averhoff, F.Massoudi, M., Hyams, I., Simard, E. and Yusuf, H. (2003) `Parental Knowledge, Attitudes and Practices Associated with Not Receiving Hepatitis A Vaccine in a Demonstration Project in Butte County, California', Pediatrics112(4): e269-74.
5.
Bates, A.S. and Wolinsky F.D. (1998) `Personal, Financial and Structural Barriers to Immunization in Socioeconomically Disadvantaged Urban Children', Pediatrics101(4): 591-6.
6.
Belcher, D.W., Nicholas, D.D., Ofosu-Amaah, S. and Wurapa, F.K. (1978) `A Mass Immunization Campaign in Rural Ghana: Factors Affecting Participation', Public Health Reports93(2): 170-6.
7.
Bobo, J.K., Gale, J.L., Thapa, P.B. and Wassilak, S.G. (1993) `Risk Factors for Delayed Immunization in a Random Sample of 1163 Children from Oregon and Washington', Pediatrics91(2): 308-14.
8.
Brofenbrenner, U. (1977) `Toward an Experimental Ecology of Human Development' , American Psychologist32(7): 513-31.
9.
Chhabra, P., Nair, P., Gupta, A., Sandhir, M. and Kannan, A.T. (2007) `Immunization in Urbanized Villages of Delhi', Indian Journal of Pediatrics74(2): 131-4.
10.
Cohen, D.A., Scribner, R.A. and Farley, T.A. (2000) `A Structural Model of Health Behavior: a Pragmatic Approach to Explain and Influence Health Behaviors at the Population Level' , Preventive Medicine30(2): 146-54.
11.
Cohen, D.A., Mason, K., Bedimo, A., Scribner, R., Basolo, V. and Farley, T.A. (2003) `Neighborhood Physical Conditions and Health', American Journal of Public Health93(3): 467-71.
12.
Cohen, L. and Chehimi, S. (2007) `Beyond Brochures: the Imperative for Primary Prevention' , in L. Cohen, V. Chavez and S. Chehimi (eds) Prevention Is Primary: Strategies for Community Well Being, pp. 3-24. San Francisco, CA: Jossey-Bass.
13.
Cutts, F.T., Rodrigues, L.C., Colombo, S. and Bennett S. (1989) `Evaluation of Factors Influencing Vaccine Uptake in Mozambique', International Journal of Epidemiology18(2): 427-33.
14.
Cutts, F.T., Diallo, S., Zell, E.R. and Rhodes, P. (1991) `Determinants of Vaccination in an Urban Population in Conakry, Guinea', International Journal of Epidemiology20(4): 1099-1106.
15.
Favin, M., Naimoli, G. and Sherburne, L. (2004) Improving Health through Behavior Change: A Process Guide on Hygiene Promotion, Joint Publication7, URL (consulted 22 December 2007): http://www.ehproject.org/PDF/Joint_Publications/JP007-CIMCIProcessGuideWeb.pdf .
16.
Feilden Battersby Analysts (2005) The State of Routine Immunization Services In Nigeria and Reasons for Current Problems. Bath: Health Systems Analysts, Feilden Battersby Analysts, URL (consulted 15 December 2007): http://www.technet21.org/backgrounddocs.html .
17.
Gage, A.J., Sommerfelt, E. and Piani, A. (1997) `Household Structure and Childhood Immunization in Niger and Nigeria', Demography34(2): 295-309.
18.
McLeroy, K., Bibeau, D., Steckler, A. and Glanz, K. (1988) `An Ecological Perspective on Health Promotion Programs', Health Education and Behavior15(4): 351-77.
19.
National Immunization Coverage Survey (NICS) Study Group (2007) Preliminary Report on National Immunization Coverage Survey, 2006. Abuja: National Program on Immunization.
20.
Nuwaha, F., Mulindwa, G., Kabwongyera, E. and Barenzi, J. (2000) `Causes of Low Attendance at National Immunization Days for Polio Eradication in Bushenyi District, Uganda', Tropical Medicine and International Health5(5): 364-9.
21.
Parashar, S. (2005) `Moving Beyond the Mother-Child Dyad: Women's Education, Child Immunization and the Importance of Context in Rural India', Social Science and Medicine61(5): 989-1000.
22.
Sallis, J.F. and Owen, N. (2002) `Ecological Models of Health Behavior', in G.K. Glanz, B.K. Rimer and F.M. Lewis (eds) Health Behavior and Health Education: Theory, Research and Practice (3rd edn), pp. 462-84. San Francisco, CA: Jossey-Bass.
23.
Waters, H., Dougherty, L., Tran, N., Charles, S., Tegang, S.P., Long, K., Wolfe, N.D. and Burke, D.S. (2004) `Coverage and Costs of Childhood Immunizations in Cameroon', Bulletin of the World Health Organization82(9): 668-75.
24.
Wood, D., Halfon, N., Donald-Sherbourne, C., Mazel, R., Schuster, M., Hamlin, J., Pereyra, M., Camp, P., Grabowsky, M. and Duan, N. (1998) `Increasing Immunization Rates among Inner-city, African American Children: a Randomized Trial of Case Management', Journal of the American Medical Association279(1): 29-34.
