Zero-dose vaccination, referring to children who have never received any routine immunization, remains one of the biggest threats to child survival in sub-Saharan Africa. Despite years of investment in Nigeria's Expanded Programme on Immunization (EPI), some urban families are still being left behind. This study explored how health system gaps and behavioral communication factors shape vaccination uptake among under-five children in Kano Metropolis.
A community-based cross-sectional survey was conducted across eight Local Government Areas in 2024 among 389 caregivers of under-five children, selected through multi-stage sampling. Data were analyzed using SPSS and presented as frequencies and percentages.
Zero-dose prevalence stood at 8%, concentrated in Kumbotso, Nassarawa, Tarauni, and Ungogo LGAs. Although most caregivers (94.4%) were aware of vaccination benefits, barriers such as long waiting times (68.7%), fear of side effects (17%), and financial constraints (5.6%) hindered uptake. Long waiting times were largely caused by staff shortages, poor client flow, and the vial-opening policy that delays vaccination until enough children are present.
While nearly all mothers (95.9%) attended antenatal care (ANC), few received feedback on the specific vaccines to be given after delivery, especially when they gave birth in another facility. Strengthening caregivers' agency, the confidence and power to act, through empathetic communication, feedback, and timely service can turn awareness into action, in addition improving coordination between antenatal care and immunization units, ensuring consistent community engagement, and addressing operational barriers will be key to achieve equitable immunization coverage and ensuring no child is left behind.
Zero-dose vaccination, referring to children who have never received any routine immunization, remains one of the biggest threats to child survival in sub-Saharan Africa. Despite years of investment in Nigeria's Expanded Programme on Immunization (EPI), some urban families are still being left behind. This study explored how health system gaps and behavioral communication factors shape vaccination uptake among under-five children in Kano Metropolis.
A community-based cross-sectional survey was conducted across eight Local Government Areas in 2024 among 389 caregivers of under-five children, selected through multi-stage sampling. Data were analyzed using SPSS and presented as frequencies and percentages.
Zero-dose prevalence stood at 8%, concentrated in Kumbotso, Nassarawa, Tarauni, and Ungogo LGAs. Although most caregivers (94.4%) were aware of vaccination benefits, barriers such as long waiting times (68.7%), fear of side effects (17%), and financial constraints (5.6%) hindered uptake. Long waiting times were largely caused by staff shortages, poor client flow, and the vial-opening policy that delays vaccination until enough children are present.
While nearly all mothers (95.9%) attended antenatal care (ANC), few received feedback on the specific vaccines to be given after delivery, especially when they gave birth in another facility. Strengthening caregivers' agency, the confidence and power to act, through empathetic communication, feedback, and timely service can turn awareness into action, in addition improving coordination between antenatal care and immunization units, ensuring consistent community engagement, and addressing operational barriers will be key to achieve equitable immunization coverage and ensuring no child is left behind.
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