Maternal Health Literacy and Childhood Immunization Uptake

Abstract

Childhood immunization remains one of the most effective public health interventions for preventing vaccine-preventable diseases, yet coverage in Nigeria continues to exhibit marked regional and socio-economic disparities. Maternal health literacy has emerged as an important but insufficiently explored determinant of childhood immunization behaviour, particularly within complex socio-cultural contexts. This study examined the relationship between maternal health literacy and childhood immunization uptake in North-Central Nigeria, with attention to the social and structural factors shaping mothers’ vaccination decisions. A cross-sectional mixed-methods design was employed among 400 mothers of children aged 0–23 months selected from urban and rural communities. Maternal health literacy was assessed across functional, interactive, and critical domains using an adapted, context-specific version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). Childhood immunization status was determined using maternal reports and immunization cards where available. Quantitative data were analysed using descriptive statistics, chi-square tests, and multivariate logistic regression, while qualitative data from focus group discussions and in-depth interviews were analysed thematically. Findings showed that 55% of children were fully immunized, with significantly higher coverage in urban than rural communities. Higher maternal health literacy was strongly associated with full immunization, particularly functional, interactive, and critical literacy domains (p < 0.001). Qualitative results revealed that family influence, community norms, religious beliefs, misinformation, and access barriers moderated the effect of literacy on immunization behaviour. The study concludes that maternal health literacy is a key predictor of childhood immunization uptake, but its effectiveness is shaped by broader socio-cultural and structural conditions, underscoring the need for integrated literacy-based and community-focused immunization interventions.