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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 27  |  Issue : 4  |  Page : 336-342

A rural/urban comparison of paternal involvement in childhood immunisation in Ogun Central Senatorial District, Nigeria


1 Department of Community Medicine, Babcock University, Ilisan, Ogun State, Nigeria
2 Department of Community Medicine and Primary Care, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
3 Department of Paediatrics, Babcock University, Ilisan, Ogun State, Nigeria
4 Deparment of Community Medicine and Primary Care, Federal Medical Centre, Abeokuta, Ogun State, Nigeria

Date of Submission28-Apr-2020
Date of Decision07-May-2020
Date of Acceptance18-Aug-2020
Date of Web Publication04-Nov-2020

Correspondence Address:
Dr. Kolawole Sodeinde
Department of Community Medicine, Babcock University, Ilisan, Ogun State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_101_20

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  Abstract 


Background: Paternal involvement in vaccination programmes is associated with improved uptake of childhood immunisation. However, paternal involvement is low in many climes including Nigeria. This study aimed to compare paternal involvement in childhood immunisation in urban and rural areas of Ogun Central Senatorial District, Nigeria. Materials and Methods: This was a comparative cross-sectional study involving 440 fathers each in urban and rural areas selected using a multistage sampling method. A structured interviewer-administered questionnaire was employed to obtain data. Analysis was done using SPSS version 20. Chi-square test was used to assess the associations between categorical variables, whereas t-test was used to compare the means of respondents' involvement scores. Logistic regression was used to determine the predictors of paternal involvement. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). P < 0.05 was taken as statistically significant. Results: The mean age of respondents in urban areas was 36.58 ± 6.76 and the mean age of respondents in rural areas was 37.61 ± 9.79. The difference in the mean age of urban and rural residents was not statistically significant (P = 0.07). Paternal involvement was significantly better among fathers in rural areas, with 79.8% of them having good involvement as compared to only 50.0% of the urban respondents (P = < 0.001). Being educated up to the tertiary level (adjusted OR [AOR] = 2.43, 95% CI = 1.66–3.57) was the predictor of involvement in childhood immunisation among fathers in the urban area. Among fathers in rural areas, being currently married (AOR = 4.51, 95% CI = 2.12–9.60) was the predictor of involvement in childhood immunisation.Conclusion/Recommendation: Paternal involvement in childhood immunisation is better among rural dwellers compared to urban dwellers. Educated and currently married fathers who have the propensity to be more involved can be trained as peer educators to encourage others to participate, particularly in the urban areas.

Keywords: Childhood immunisation, Ogun Central Senatorial District, paternal involvement, rural, urban


How to cite this article:
Sodeinde K, Amoran O, Abiodun O, Adekoya A, Abolurin O, Imhonopi B. A rural/urban comparison of paternal involvement in childhood immunisation in Ogun Central Senatorial District, Nigeria. Niger Postgrad Med J 2020;27:336-42

How to cite this URL:
Sodeinde K, Amoran O, Abiodun O, Adekoya A, Abolurin O, Imhonopi B. A rural/urban comparison of paternal involvement in childhood immunisation in Ogun Central Senatorial District, Nigeria. Niger Postgrad Med J [serial online] 2020 [cited 2020 Nov 24];27:336-42. Available from: https://www.npmj.org/text.asp?2020/27/4/336/299901




  Introduction Top


The development of affordable vaccines against various diseases that mostly affect underdeveloped nations is one of the targets of the Sustainable Development Goal (SDG) 3.[1] Vaccination is an effective strategy for the control of deadly communicable diseases and is known to prevent up to 3 million deaths annually.[2] It is also very cost-effective and is schemed in such a way that susceptible populations living in remote areas can have access to it.[2]

However, despite the established efficacy of immunisation, its poor coverage against childhood diseases remains a public health challenge in resource-limited climes of the world,[3] and vaccine-preventable diseases persist as the most common cause of death among children.[4] In 2016, almost 20 million infants globally did not receive routine immunisation with about three-fifths of them found in 10 under-developed countries, including Nigeria.[5] Only 1 out of 4 children aged 12–23 months in Nigeria completes their routine immunisation schedule.[6]

The interactions among various sociocultural factors peculiar to Nigeria partly contribute to the poor immunisation coverage in the country.[7] Such cultural factors like male dominance greatly determine the utilisation of health services by their partners and offsprings.[8] For instance, the decision to immunise children is seen as the man's prerogative in developing countries.[9] This may be counter-productive because women who do not make health-related choices less often complete immunisation for their children.[10],[11] Moreover, male sociodemographic attributes such as age and vaccination strategies that have reached out to men have positive results as regards childhood immunisation uptake.[9],[12] However, paternal involvement is suboptimal in different parts of the world,[13],[14] including Nigeria.[15] Women have been the focus of immunisation programmes in many nations, whereas fathers have been alienated because immunising children is considered to be their mothers' responsibility.[9],[16]

Provincial discrepancies are common in the use of family health services in many countries.[6],[17] For instance, the probability of urban children receiving full immunisation in Nigeria is nearly thrice of their rural counterparts.[6] Inequalities in the use of maternal and child health services between rural and urban communities are attributed to different factors like socioeconomic factors.[17] Paternal involvement in family health also differs in urban and rural climes and influences the patronage of health services.[18] Place of residence is more important in predicting full immunisation when compared to other personal attributes of children or their parents.[19] In Nigeria, 60%–70% of the populace live in rural areas[20] and with the prevalent rural–urban imbalances in immunisation coverage to the detriment of children in rural areas; rural–urban discrepancies and associated factors are particularly important for immunisation services.[21]

Since poor paternal involvement is implicated in reduced childhood immunisation uptake and increased dropout rates,[9],[16] it is pertinent to study fathers' role when considering the poor childhood immunisation coverage in Ogun State where only 24.4% of eligible children are fully vaccinated.[6] This is less than the national average of 25.0% for complete immunisation in Nigeria and much less than the average of 41% in the southwest region of the country where the study area is located.[6] Furthermore, Ogun State has the least reported immunisation rate and the highest dropout rate among children in the region.[6] This study aimed to compare paternal involvement in childhood immunisation in urban and rural areas of Ogun Central Senatorial District where the state capital is located.


  Materials and Methods Top


Ethical approval

Ethical approval was obtained from the Ethical and Research Committee of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State (OOUTH/HREC/64/2016). The approval was granted on 9 August 2016. Verbal and written informed consent was obtained from each participant. Strict confidentiality was maintained throughout the study.

Study area and study design

This community-based comparative cross-sectional study was conducted between October and December 2017 in urban and rural areas of Ogun Central Senatorial District. There are 6 local government areas (LGAs) in the senatorial district, with a projected population of 1,930,600 by the year 2016.[22] The selected rural LGA for the study was Odeda LGA. The LGA has a landmass of 1560 km2[23] and a projected population of 152,300 for 2016.[22] Odeda LGA has 29 government-owned primary healthcare facilities, 1 government-owned secondary health facility and 19 private health facilities.[24] Abeokuta South LGA was selected as urban LGA for this study. It has a projected population of 348,200 for 2016 and a landmass of 71 km2.[22] There are 11 government-owned primary healthcare facilities, 3 secondary health facilities, 1 tertiary hospital and 73 private hospitals in the local government.[24]

Study population and sample size estimation

The study included men, 18 years old and above, whose wives or partners (for those who are not married) had one or more live births in the last 5 years. The minimum sample size was calculated to be 361.1 from the formula for comparing proportions between two groups[25] using a standard normal deviate of 1.96, 95% confidence interval (CI) and power of 80%. Correcting for a possible 10% non-response rate, the final calculation was 401.2. We, however, studied a total of 440 fathers each in the designated rural and urban areas, which means that a total of 880 fathers were selected for the study.

Sampling method, data collection tools and techniques

We selected participants using a multistage sampling method. We used the balloting method (simple random sampling) to select one of the five urban LGAs in the senatorial district which came out to be Abeokuta South LGA and included Odeda LGA being the only rural LGA in the senatorial district. In the next stage, we used simple random sampling to select five wards apiece in the urban and rural LGAs that were selected based on the size and number of wards in each local government. Then, simple random sampling technique using the balloting method was used to select two settlements from each ward, giving an overall of ten settlements from each LGA. The settlements were taken as clusters. In single household houses, we interviewed the head of each household that was eligible. If the head of the household was not eligible, the next household was considered. If a building had more than one household, balloting was done to pick one out of the eligible households. If no household was eligible in the house, we moved to the next house. A total of 440 men each were selected in the urban and rural areas.

A structured interviewer-administered questionnaire that was developed by reviewing literature on the role of men in child health was used to elicit data. The questionnaire was translated to Yoruba, the local language, so that respondents could understand better and did a back-translation to English to ensure the questions had not lost their original meaning. The instrument was pre-tested among 40 fathers in Agege Local Government of Lagos State which was in the same geopolitical zone of the study area and forms the southern boundary of Ogun State where the Study area was located. Necessary adjustments were subsequently made to the questionnaire.

Eight research assistants with minimum educational qualification of Ordinary National Diploma were trained for about 2 h daily for 3 days as moderated by the researcher and afterward recruited for the study.

Data management and analysis

The questionnaires were cross-checked for errors, and necessary corrections were made. Statistical analysis was done using SPSS version 20.0 (IBM SPSS Inc., Chicago, IL). Composite variables (aggregate scores) for paternal involvement were computed from items on the questionnaire. Male involvement was scored as follows: option 'yes' was assigned the mark '1' and 'no' was assigned '0'. Seven items of male involvement were assessed which gave a maximum score of 7 and a minimum score of 0. The mean score for paternal involvement was determined, and scores from the average score and above were regarded as good involvement, whereas scores less than the mean score were regarded as poor involvement. The dependent variable was paternal involvement in childhood immunisation, whereas independent variables were sociodemographic characteristics including age, educational status, marital status, ethnicity, religion, occupation and place of residence. Categorical variables were summarised as frequencies and percentages, whereas continuous variables were presented as means and standard deviations. Results were presented in tables. Chi-square was used to determine the associations between categorical variables, whereas the Student's t-test was used to compare the means of respondents' ages and paternal involvement scores in childhood immunisation in rural and urban areas. Variables that were significant in the bivariate analysis were inputted in the binary logistic regression model to predict factors responsible for paternal involvement in childhood immunisation. Results were presented in odds ratios and 95% CIs. P < 0.05 was considered statistically significant.


  Results Top


[Table 1] shows the fathers' sociodemographic characteristics. The highest proportion of the respondents was in the age group of 31–40 years in both the urban (52.5%) and rural (42.3%) communities. The mean age of respondents in urban areas was 36.58 ± 6.76 and the mean age of respondents in rural areas was 37.61 ± 9.79. The difference in the mean age of urban and rural residents was not statistically significant (P = 0.07). About half (48.2%) of the respondents in the urban area had tertiary education as compared to only 14% of the rural dwellers. In the urban area, only a few (8.4%) of the respondents had no form of formal education as compared to 21.1% of rural dwellers. The association between educational attainment and place of residence was statistically significant (χ2 = 13.07, P < 0.001).
Table 1: Sociodemographic characteristics of respondents (n=440)

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[Table 2] shows that paternal involvement is higher among rural men than urban in all the activities related to childhood immunisation. The majority (97.7% – rural and 96.4% – urban) of the fathers permitted their children to be vaccinated, with a significantly higher proportion among the fathers living in rural areas (P = 0.001). A significantly higher proportion of fathers living in the rural area also reminded their wives of their children's immunisation schedules (rural: 91.1% and urban: 51.8%; P < 0.001) and accompanied children and wives for their children's immunisation (rural: 64.5% and urban: 32.0%; P < 0.001). A higher proportion of rural respondents (79.8%) had good involvement in childhood immunisation as compared to only 50.0% of the urban respondents. The difference was statistically significant (P < 0.001).
Table 2: Male involvement in childhood immunisation (n=440)

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[Table 3] shows the association between sociodemographic factors and male involvement in both rural and urban areas. There was no association between age and marital status with the level of paternal involvement in children's immunisation in the urban area (P = 0.12 and 0.07, respectively). Furthermore, occupation, religion and ethnicity showed no significant association with male involvement in the urban areas (P = 0.09, 0.12 and 0.18 respectively). However, the level of education was significantly associated with paternal involvement in the urban area (P < 0.001). In the rural area, there was no association between age, education, occupation and religion with the level of paternal involvement in children's immunisation (P = 0.06, 0.07, 0.58 and 0.21, respectively). However, marital status and ethnicity were significantly associated with paternal involvement in the rural area (P < 0.001 and 0.03, respectively).
Table 3: Association between sociodemographic characteristics of respondents and paternal involvement in childhood immunisation in urban and rural communities (n=440)

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[Table 4] shows that being educated up to the tertiary level (adjusted odds ratio [AOR] = 2.43, 95% CI = 1.66–3.57) was the predictor of involvement in childhood immunisation among fathers in the urban area. In the rural area, being currently married (AOR = 4.51, 95% CI = 2.12–9.60) remained the predictor of paternal involvement in childhood immunisation in the rural area of Ogun Central Senatorial District.
Table 4: Predictors of male involvement in childhood immunisation

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  Discussion Top


Most fathers both in urban and rural areas of this study had some levels of formal education. However, there were more educated men in the urban area as compared to the rural area. This agrees with the report of the Nigerian National Demographic Health Survey that reported more educated men in the urban area.[6] Similar findings have also been documented in other places in the world. For instance, an Indonesian study of the factors associated with the rural–urban disparities in measles vaccination uptake revealed that 98.6% of the fathers who were dwelling in the urban regions had at least primary education as compared to 94.7% of their rural counterparts.[17]

Different explanations may be proposed for the higher proportion of educated men in urban areas. It may be due to easy accessibility to educational institutions which are more in urban climes. Moreover, there are more salaried and skilled works in urban areas as opposed to rural areas.[6] To be employed in such jobs, some level of education is needed.

Men's responsibility in family health issues has since been identified and stressed by state and international movements.[26],[27] In the area of childhood immunisation, several studies have revealed a positive relationship between paternal involvement and uptake.[9],[16] Although it was discovered in this research that paternal involvement in childhood immunisation was good in both rural and urban areas, the practice was significantly higher among rural participants as compared to their urban counterparts. The high level of involvement among fathers in this study was at variance with what was reported in Uganda which reported low involvement in childhood immunisation among fathers.[28]

Various reasons may account for more paternal participation in childhood immunisation in rural areas. First is the type of occupation. In the rural area, the most common occupation is agricultural work, as opposed to civil service in the urban area. Men in the rural community were probably involved in agricultural work with their wives and children and therefore were found in the company of their families on more occasions. This would have made them more involved in childhood immunisation activities. On the other hand, participants who were residing in urban areas were mostly civil servants and professionals. This type of work would probably have engaged them more, take them away from home and afforded them little or no time to assist in the vaccination of their children.

Furthermore, since it is obvious that more health facilities are situated in urban areas and health workers preferred to be posted to these areas, men in a rural area may consciously give support to their wives and children to utilise the limited healthcare facilities in the rural area which are usually more difficult to access geographically than urban health facilities.[29] Furthermore, there is a report of overcrowding of urban health facilities against rural health facilities which may lead to delay in accessing health.[30] The increase in waiting time in the urban areas may, therefore, prevent men from visiting the health facility with their families for childhood immunisation. Several studies have revealed more delays for childhood immunisation in urban areas as compared to rural areas.[31],[32]

This study revealed that rural fathers who attended immunisation sessions with their children were double their counterparts who did the same in the urban area. The implication of this is that rural men could have received more information concerning the relevance of adequate vaccination of their children in the process and therefore be encouraged to give their wives and children the necessary support for increased immunisation uptake, hence the increased participation in childhood immunisation among rural participants as compared to their urban counterparts. Reports have it that children of men who accompany wife to health facilities usually have a better history of vaccination uptake.[33]

There are other recognisable benefits of accompanying wives and children to health facilities. It makes men to understand the process of raising healthy and productive children. There is also better communication between couples which leads to mutual understanding in decision-making, particularly as it concerns the health of their children and by extension the whole family. However, a lower proportion of men accompanied their spouses to health facilities in both urban and rural areas when compared with involvement in other activities that relate to childhood immunisation such as allowing the child to be vaccinated, reminding wife of immunisation appointments and helping with house chores, whereas the wife is away for immunisation and providing financial support. It has been shown that only a few men go together with their wives to health facilities for maternal and child health services.[34] This may be due to traditional norms and values which made childhood immunisation and general care of children to be the responsibility of the woman, and it would be unacceptable for men to be involved.[9],[16]

Our study reported a significantly better paternal involvement in childhood immunisation among educated men as compared to uneducated men in the urban area as against the rural area. Higher involvement among educated men in the urban area may be due to possible increased access to information on immunisation among the educated men since urban residents have more access to information as compared to their rural counterparts.[35] Moreover, it has been shown that educated men acquire more information and are more involved in child health as compared to uneducated men.[36] Contrary to our finding where no significant association existed between paternal education and involvement in the rural area, a research that was carried out in rural Guinea-Bissau reported higher involvement in maternal and child health among educated men.[37]

Reports have it that men who are from minority ethnic groups participate more in childhood immunisation as compared to indigenous men of the study area.[38] This agreed with what obtained in the rural area of this current study where the non-indigenous participants had a significantly better involvement than the indigenous Yoruba fathers. However, there was no association between ethnicity and paternal involvement in urban areas.

In this study, paternal involvement in childhood immunisation is also significantly better among currently married fathers in the rural area. Men who are living together with their wives may receive encouragement from their spouses to be more involved with childhood immunisation activities, for instance, as opposed to men who were divorced or widowed after the birth of the index child. Besides, a man may enjoy the company of his wife better during immunisation schedules than his relatives or any other woman who may be helping him in caring for the child.


  Conclusion Top


Male involvement in childhood immunisation was better among fathers dwelling in rural areas as compared to their counterparts in the urban area. More interventional programmes to improve male involvement in the urban area should be encouraged. This should also be encouraged in the rural area to sustain the propensity reported in this study. Educated and currently married fathers who tend to be more involved can be trained as peer educators to encourage others to participate.

Acknowledgements

The authors wish to acknowledge the participants for their contribution to the successful completion of this work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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