title: Rural-urban disparities in maternal immunization knowledge and childhood health-seeking behavior in Nigeria: a mixed method study.
abstract: BACKGROUND
  Immunization and appropriate health-seeking behavior are effective strategies to reduce child deaths.
  
  
  OBJECTIVE
  To compare maternal knowledge about immunization, use of growth chart and childhood health-seeking behavior in rural and urban areas.
  
  
  METHODS
  A cross-sectional comparative study done in Lagos, Nigeria. Questionnaire survey and focus group discussions were done. 300 respondents were selected by multi-stage sampling while discussants were purposively selected.
  
  
  RESULTS
  Awareness of immunization was high but knowledge of vaccine preventable diseases (VPDs) was poor in both areas. Urban women utilized preventive services more; growth monitoring (p<0.001) and immunization (p<0.001) while higher proportions of rural women utilized nutritional counseling (p=0.005) and treatment of illness (p<0.001). Growth chart utilization was better in the urban areas (p<0.001). Increasing maternal education increased use of growth chart in both areas. Both groups of women use multiple treatment sources for children (more in urban), determined by cost, time, perceived severity of illness and type of ailment (urban) and peculiarity of illness (rural). There is a preference for orthodox care in the rural area.
  
  
  CONCLUSIONS
  Knowledge of VPDs was poor and multiple treatment sources were common among rural and urban women. Education is vital to improve immunization knowledge and health-seeking behavior in both areas.
authors.affiliation: Department of Community Health & Primary Care, College of Medicine, Idi-Araba, P.M.B. 12003, Lagos, Nigeria.
authors.forename: Ifeoma P
authors.initials: IP
authors.lastname: Okafor
authors.affiliation: Leverage Consulting Ltd, Road 425, Zone 6, Abuja, Nigeria.
authors.forename: Duro C
authors.initials: DC
authors.lastname: Dolapo
authors.affiliation: Department of Community Health & Primary Care, Lagos University Teaching Hospital, Idi-Araba, P.M.B. 12003, Lagos, Nigeria.
authors.forename: Modupe O
authors.initials: MO
authors.lastname: Onigbogi
authors.affiliation: Department of Community Health & Primary Care, Lagos University Teaching Hospital, Idi-Araba, P.M.B. 12003, Lagos, Nigeria.
authors.forename: Iruoma G
authors.initials: IG
authors.lastname: Iloabuchi
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D003140:Communicable Disease Control / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007114:Immunization; D007407:Interviews as Topic; D008297:Male; D009549:Nigeria; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Immunization; Nigeria; child health; growth chart; health-seeking behavior