Background Vaccine preventable diseases are still the most common cause of childhood mortality, with an estimated 3 million deaths every year, mainly in Africa and Asia. An estimate of 29% deaths among children aged 1–59 months were due to vaccine preventable diseases. Despite the benefits of childhood immunisation, routine vaccination coverage for all recommended Expanded Programme on Immunization vaccines has remained poor in some African countries, such as Nigeria (31%), Ethiopia (43%), Uganda (55%) and Ghana (57%). The aim of this study is to collate evidence on the factors that influence childhood immunisation uptake in Africa, as well as to provide evidence for future researchers in developing, implementing and evaluating intervention among African populations which will improve childhood immunisation uptake. Methods We conducted a systematic review of articles on the factors influencing under-five childhood immunisation uptake in Africa. This was achieved by using various keywords and searching multiple databases (Medline, PubMed, CINAHL and Psychology & Behavioral Sciences Collection) dating back from inception to 2020. Results Out of 18,708 recorded citations retrieved, 10,396 titles were filtered and 324 titles remained. These 324 abstracts were screened leading to 51 included studies. Statistically significant factors found to influence childhood immunisation uptake were classified into modifiable and non-modifiable factors and were further categorised into different groups based on relevance. The modifiable factors include obstetric factors, maternal knowledge, maternal attitude, self-efficacy and maternal outcome expectation, whereas non-modifiable factors were sociodemographic factors of parent and child, logistic and administration factors. Conclusion Different factors were found to influence under-five childhood immunisation uptake among parents in Africa. Immunisation health education intervention among pregnant women, focusing on the significant findings from this systematic review, would hopefully improve childhood immunisation uptake in African countries with poor coverage rates.

Background Childhood immunisation coverage is very low in Nigeria (31%) with Zamfara State being amongst the states with the poorest coverage (<10%). Lack of maternal knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions of religious regulations of antenatal mothers towards childhood immunisation are the contributory factors to poor childhood immunisation uptake. This study aims is to develop, implement and evaluate the effects of an immunisation health educational intervention with application of Social Cognitive Theory on pregnant women to improve knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions on religious regulations regarding childhood immunization uptake in Federal Medical Centre Gusau, Zamfara State, Nigeria. Methodology The study will be a single-blind parallel-group randomised controlled trial, where baseline data will be collected from 392 estimated antenatal mothers, after that they will be evenly randomised using randomly generated permuted block sizes (each containing two intervention and two control assignments). The study participants will be antenatal mothers of ages 18 years and above who are in third trimesters and attending Federal Medical Centre Gusau, Zamfara State, Nigeria; during the study period and fulfilled all the inclusion and exclusion criteria. The intervention group will undergo five-health education sessions on immunisation, which will be strictly guided by Social Cognitive Theory-based intervention module: while the control group will receive usual care (standard care). Follow-up data will be collected using the same questionnaire at 6-weeks post-delivery, 10-weeks post-delivery and 14-weeks post-delivery. The generalized linear mixed model will be carried-out to determine the overall effect of the intervention after controlling for 14 potential confounding variables. An intention to treat analysis will also be carried-out. Childhood immunisation uptake is the primary outcome while the secondary outcomes are: improved knowledge scores, attitude scores, outcomes expectation, self-efficacy scores, cultural beliefs scores and assumptions on religious regulations scores. Discussion The study will be a randomised controlled trial, that focuses on the effects of an immunisation health educational intervention with application of Social Cognitive Theory on pregnant women to improve knowledge, attitude, outcome expectations, self-efficacy, cultural beliefs and assumptions on religious regulations regarding childhood immunisation uptake in Federal Medical Centre Gusau, Zamfara State, Nigeria. Trial registration Pan African Clinical Trial Registry PACTR202006722055635. Protocol registered on 09 June 2020.

Abstract Background:Vaccine Preventable Diseases are still the most common cause of childhood mortality with an estimated of approximately 3 million death every year mainly in Africa and Asia and about 29% of deaths among children aged 1–59 months were as a result of vaccine preventable.Despite the benefit of childhood immunization uptake, routine vaccination coverage for all recommended Expand Program on Immunization vaccines has remained poor in some African countries such as Nigeria (31%), Ethiopia (43%), Uganda (55%) and Ghana (57%). The aim of this study is to collate evidence on the factors that influences childhood immunization uptake in Africa and also provide evidence for future researchers in developing, implementing and evaluating intervention among African populations that will improve childhood immunization uptake.Methods: We conducted a systematic review of articles on the factors influencing under-five childhood immunization uptake in Africa through using various keywords and we searched multiple databases (Medline, PubMed, CINAHL and Psychology and behavioural data collection) dated from inception to 2019. Results: Of 17,208 records citations retrieved, 240 abstracts were screened leading to 46 included studies: Thefactors that were found to influence the childhood immunization uptake were classified into modifiable and non-modifiable factors and were further classified into different groups based on its relevance. Themodifiable factors include: obstetric factors, maternal knowledge, maternal attitude and self-efficacy and maternal outcome expectation. Whereas non-modifiable factors were sociodemographicfactors of parent and child, logistic factors and administration factors.Conclusion: There were different factors found to be influencing under-five childhood immunization uptake among parents in Africa. Immunization health education intervention should be designed among pregnant women using social cognitive theory SCT which will enable researchers to tackle cognitive factors as well as some environmental factors that could be modifiable which may hopefully improve childhood immunization uptake in a country with poor coverage like Nigeria.

Background: Vaccine preventable diseases are still the most common cause of childhood mortality, with an estimated 3 million deaths every year, mainly in Africa and Asia. An estimate of 29% deaths among children aged 1–59 months resulted from vaccine preventable diseases. Despite the benefits of childhood immunisation uptake, routine vaccination coverage for all recommended Expand Program on Immunisation vaccines has remained poor in some African countries, such as Nigeria (31%), Ethiopia (43%), Uganda (55%) and Ghana (57%). The aim of this study is to collate evidence on the factors that influence childhood immunisation uptake in Africa as well as to provide evidence for future researchers in developing, implementing and evaluating intervention among African populations which will improve childhood immunisation uptake. Methods: We conducted a systematic review of articles on the factors influencing under-five childhood immunisation uptake in Africa. This was achieved by using various keywords, searching multiple databases (Medline, PubMed, CINAHL and Psychology and behavioural data collection) dated back from inception to 2020. Results: Out of 18,708 recorded citations retrieved, 324 abstracts were screened leading to 51 included studies. The factors that were found to influence childhood immunisation uptake were classified into modifiable and non-modifiable factors and were further classified into different groups based on relevance. The modifiable factors include obstetric factors, maternal knowledge, maternal attitude, self-efficacy and maternal outcome expectation. Whereas non-modifiable factors were sociodemographic factors of parent and child, logistic factors and administration factors. Conclusion: Different factors were found to influence under-five childhood immunisation uptake among parents in Africa. Immunisation health education intervention among pregnant women focusing on the significant findings from this systematic review would hopefully improve childhood immunisation uptake in African countries with poor coverage rates.