Table 3 Summary of systematic review of factors influencing childhood immunization uptake in Africa

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