Background
Nigeria continues to experience high maternal and child mortality, despite extensive health reforms and international investment. Missed opportunities across the continuum of care, antenatal care (ANC), skilled birth attendance, facility-based delivery, and child immunization, contribute to these outcomes. Children who receive no vaccines (zero-dose) reflect a key vulnerability in service delivery.
Objective
To identify factors associated with zero-dose immunization and patterns of maternal healthcare utilization among women in six Nigerian states.
Methods
A cross-sectional household survey was conducted in Gombe, Kaduna, Kano, Katsina, Lagos, and Niger states. A total of 1,958 women aged 15-49 years with recent live births were interviewed. Structured questionnaires captured data on ANC attendance, delivery location and attendant, immunization status, and socio-demographic characteristics. Descriptive statistics, chi-square tests, and multinomial logistic regression were used to assess predictors of maternal and child health service utilization.
Results
Only 31% of women received complete care; 58% received partial care, and 11% received none. Zero-dose prevalence was significantly higher among children whose mothers had fewer than four ANC visits (35%), delivered at home (35%), or were attended by unskilled providers (39%). Lower zero-dose rates were found among those delivered in facilities (16%) or by skilled attendants (19%). Key predictors included maternal and paternal education, socioeconomic status, geographic location (notably Kano and Katsina), and maternal age.
Conclusions
Significant disparities in maternal and child health service utilization remain. Expanding ANC coverage, increasing skilled facility-based deliveries, and ensuring postnatal immunization linkage are essential to reduce zero-dose prevalence and promote equity in low-resource settings.