Research proposal sample
CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This chapter examines existing literature on factors influencing the completion of immunization schedules for children under one year old. The discussion is structured into three key sections: (1) mothers’ knowledge of immunization schedules, (2) socio-economic factors affecting immunization completion, and (3) cultural influences on immunization adherence.
2.2 Socio-Economic Factors Affecting Immunization Completion
Demographic research consistently highlights socio-economic status as a critical determinant of childhood immunization rates across different societies (Blaikie et al., 2014). Studies indicate that maternal empowerment significantly influences immunization participation, with less empowered women in India, Bangladesh, and Pakistan showing lower engagement (Bhandari, 2007). Employed mothers tend to prioritize immunization more than unemployed mothers, while lower-income households exhibit reduced participation in partial immunization (Bhandari et al., 2009).
Contrastingly, Antai (2009) found higher immunization rates in rural areas compared to urban settings. Accessibility to health facilities also plays a crucial role; studies in Bangladesh and China revealed that vaccination coverage declines with increasing distance from health centers (Breiman et al., 2009; Han, 2014). Similarly, Uganda faces challenges in rural immunization due to poor infrastructure, particularly during rainy seasons (Bbaale, 2006).
Parental occupation further influences immunization outcomes. Children of parents in white-collar jobs have better immunization rates than those in agriculture or blue-collar roles (Bbaale, 2013). Economic constraints, including transportation costs, disproportionately affect poor and remote populations (Streefland, 2013). Additionally, parental support and time constraints—such as forgetting appointments or childcare responsibilities—contribute to missed vaccinations (Babirye, 2015; Ticker, 2009).
Religious beliefs also shape immunization behavior. In Nigeria, misinformation linking polio vaccines to sterility led to low vaccination rates in Muslim communities (Kapp, 2009). Similarly, religious leaders’ endorsements can significantly sway public vaccination attitudes (Ruijs et al., 2013).
2.3 Mothers’ Knowledge of Immunization Schedules
Research on maternal knowledge of immunization presents mixed findings. While some studies report high awareness (Gellin et al., 2011), others highlight gaps in understanding. For instance, illiterate mothers often undervalue immunization due to limited knowledge (Ibnouf, 2009; Easterly, 2009). Maternal education strongly correlates with better immunization adherence (Njau, 2014), and paternal education similarly influences participation (Jamil, 2010).
The CDC (2011) emphasizes that multiple vaccine doses are essential for effective immunity. In Uganda, only 45% of parents recognized the importance of influenza vaccination, suggesting a need for better education on vaccine benefits and contraindications (James, 2009). Misconceptions—such as avoiding vaccination during minor illnesses—further delay immunization (Gellin et al., 2011). Overall, knowledge gaps among parents and health workers hinder optimal immunization coverage.
2.4 Cultural Beliefs and Attitudes Impacting Immunization
Cultural norms often hinder immunization uptake. Gender disparities are evident in some societies, where boys receive preferential treatment over girls (Gindler, 2011). Studies in India and Nepal found lower immunization rates among female children (Borooah, 2009; Basel, 2012), though some research reports no gender-based differences.
Local perceptions of risk, shaped by cultural and religious beliefs, influence vaccine acceptance (Ministry of Health, 2006). Traditional medicine—including herbal and spiritual practices—can also reduce immunization rates, as seen in Haiti (Chen, 2013). Addressing these cultural barriers is essential for improving vaccination coverage.
