ABSTRACT Background: Despite increase in global immunization coverage, many children around the world especially in developing countries still left unimmunized. In 2008, 17% of children under one five years in low- and middle-income countries die because of vaccine preventable diseases before they reach their fifth birthdays. Immunizable diseases account for 22% of under-five deaths in Nigeria and poor knowledge and attitude have been responsible for non-immunization of children. Objective: To assess factors related to poor utilization of immunization services among children under five years. Method: A descriptive cross sectional study was used to conduct a study from April to October, 2017 at Muramba HCIII in Kisoro district using a convenient sampling method. A total of 96 children of under five years were selected to participate in the study. Data entry and analysis was performed using SPSS version 20 software package. Results: Majority 97.9% of the respondents had heard about immunization and vaccine preventable disease and 42% correctly mentioned the objective of immunization. The study revealed that , 57% knew less than two vaccine preventable diseases and about 46% of them said age at the child begins immunization is six weeks after birth, 48.9% of the respondents reported three sessions needed to complete immunization, and 58.3% reported nine months as age to complete immunization. Conclusion: Antenatal follow up, institutional delivery and knowledge of mothers about the age at which child begins and finishes the immunization are significant ii predictor of child immunization status. The health authorities should work to raise awareness of the community on immunization, antenatal care and institutional delivery utilizations and should increase ANC follow up and institutional delivery services which in turn increase the immunization coverage among children.

TABLE OF CONTENTS

ABSTRACT............................................................................................................................... i

DECLARATION..................................................................................................................... iii

APPROVAL ............................................................................................................................ iv

TABLE OF CONTENTS................................................................................................................vii

Acknownlegement………………………………………………………………..…iv

Dedication……………………………………………………………………………v

DEFINITION OF TERMS ....................................................................................................... x

LIST O F ABBREVIATIONS................................................................................................. xi

CHAPTER ONE....................................................................................................................... 1

1.0 Introduction......................................................................................................................... 1

1.1 Background of the study ..................................................................................................... 1

1.2 Statement of the problem.................................................................................................... 3

1.3 Purpose of the study............................................................................................................ 4

1.4 General objectives............................................................................................................... 4

1.5 Specific objectives of the study .......................................................................................... 5

1.6 Research questions.............................................................................................................. 5

1.7 Justification of the study ..................................................................................................... 5

CHAPTER TWO: LITERATURE REVIEW........................................................................... 7

2.0 Introduction......................................................................................................................... 7

2.2 Socio-cultural factors associated with utilization of immunization services...................... 8

2.2.1General perception of immunization................................................................................. 8

2.3.1. Maternal characteristics.................................................................................................. 9

2.2.3 Distance from Booth/Accessibility ................................................................................ 10

2.2.4 Socio-ecomonic Status................................................................................................... 11

2.3 Attitude of mothers towards immunization of under five children................................... 12

CHAPTER THREE: METHODOLOGY ............................................................................... 13

3.0 Introduction....................................................................................................................... 13

3.1 Study Design and rationale ............................................................................................... 13

3.2 Study area ......................................................................................................................... 13

viii

3.3 Study Population............................................................................................................... 14

3.4 Sample Size determination and rationale.......................................................................... 14

3.3.2 Sampling procedure and rationale.................................................................................. 15

3.5 Inclusion and exclusion criteria ........................................................................................ 16

3.5.1 Inclusion criteria ............................................................................................................ 16

3.5.2 Exclusion criteria ........................................................................................................... 16

3.6 Definition of variables ...................................................................................................... 16

3.6.1 Dependent variables....................................................................................................... 16

3.6.2 Independent variables .................................................................................................... 16

3.7 Research instruments........................................................................................................ 17

3.8 Pre-testing of the research Instrument .............................................................................. 17

3.9 Data collection procedure ................................................................................................. 17

3.9.1 Data management and quality control ........................................................................... 17

3.9.2 Data procesing and analysis........................................................................................... 18

3.10 Ethical considerations..................................................................................................... 18

3.11 Anticipated study limitations.......................................................................................... 18

3.12 Dissemination of results.................................................................................................. 19

CHAPTER FOUR: RESULTS ............................................................................................... 20

4.1 Introduction....................................................................................................................... 20

4.2 Demographic data ............................................................................................................. 20

4.3 Knowledge of mothers towards immunization of children of under five years................ 24

4.4 Social cultural factors associated with utilization of immunization services.................... 29

4.5 Attitude of mothers towards immunization ...................................................................... 32

CHAPTER FIVE: DISCUSSION, CONCLUSIONS, RECOMMENDATIONS AND

IMPLICATIONS TO NURSING ........................................................................................... 36

5.1 Introduction....................................................................................................................... 36

5.2 Demographic data ............................................................................................................. 36

5.3 Discussions of the study.................................................................................................... 37

5.3.1Knowledge of mothers /caretakers on immunization...................................................... 37

5.3.2 Social cultural factors associated with utilization of immunization services................. 38

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5.3.3 Attitude of mothers towards immunization ................................................................... 39

5.4 Conclusion ........................................................................................................................ 40

5.5 Recommendations............................................................................................................. 40

5.6 Implications to Nursing practice ....................................................................................... 41

APPENDICES ........................................................................................................................ 48

APPENDIX I: INFORMED CONSENT FORM.................................................................... 48

APPENDIX II: SEMI -STRUCTURED QUESTIONNAIRE................................................ 49

APPENDIX III: MAP OF UGANDA SHOWING KISORO DISTRICT.............................. 57

APPENDIX IV: MAP OF KISORO SHOWING MURAMBA SUB COUNTY................... 58

Appendix v: Introductory letter……………………………………………...……...59