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Impact of Preconception Immunization Services on Immunization Uptake among Women Planning Pregnancy in Nigeria

Abstract

Preconception immunization is an important component of preventive reproductive healthcare because it provides women with an opportunity to review their vaccination status and receive recommended vaccines before pregnancy. Appropriate immunization before conception may help protect women from vaccine-preventable infections and reduce potential risks to mothers and their future pregnancies. Despite the importance of vaccination, some women planning pregnancy in Nigeria may have incomplete or uncertain immunization histories due to limited awareness, inadequate access to vaccination services, poor documentation, misconceptions about vaccines, financial and geographical barriers, and limited integration of immunization into preconception and family planning services. Preconception immunization services provide an opportunity to assess vaccination status, identify missing or incomplete vaccinations, provide appropriate counselling, administer recommended vaccines when indicated, and establish follow-up for outstanding doses. Against this background, this study investigates the impact of preconception immunization services on immunization uptake among women planning pregnancy in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Health Promotion Model. The Health Belief Model explains how women's perceptions of susceptibility to vaccine-preventable diseases, perceived severity of infection, perceived benefits of immunization, perceived barriers, and cues to action may influence vaccination decisions. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence women's utilization of preventive and reproductive health services. The Health Promotion Model emphasizes individual experiences, perceived benefits and barriers, interpersonal influences, and behavioural factors that influence participation in preventive healthcare activities. Collectively, these theoretical perspectives provide a suitable framework for explaining how preconception immunization services may influence immunization uptake among women planning pregnancy in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women of reproductive age who are planning pregnancy and attending selected primary healthcare centres, hospitals, family planning clinics, preconception care clinics, and community health programmes across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, clinics, and eligible women. Preconception immunization services will be assessed using indicators such as availability of vaccination assessment, review of immunization history, vaccination-status verification, counselling on recommended vaccines, vaccine eligibility assessment, vaccine administration, availability of vaccines, healthcare-provider recommendations, documentation of vaccination, appointment reminders, and follow-up for incomplete vaccinations. Immunization uptake will be assessed using indicators such as receipt of recommended vaccines before pregnancy, completion of required vaccine doses where applicable, timely vaccination, documented vaccination status, attendance for scheduled vaccination appointments, and acceptance of recommended vaccines. Data will be collected using structured questionnaires, immunization cards or records, preconception clinic registers, vaccination registers, healthcare records, and relevant immunization programme documents. Descriptive statistics will be used to summarize participants' characteristics, availability and utilization of preconception immunization services, vaccination status, and immunization uptake patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of preconception immunization services on immunization uptake. Where a quasi-experimental design is adopted, immunization uptake among women exposed to structured preconception immunization services may be compared with uptake among women receiving routine care, while relevant demographic, socioeconomic, reproductive, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that preconception immunization services have a significant positive impact on immunization uptake among women planning pregnancy in Nigeria. Women who receive systematic assessment and counselling through preconception immunization services are expected to have higher uptake of recommended vaccines than women without access to such services. Reviewing vaccination histories may help identify women with incomplete or uncertain immunization status, while counselling may improve understanding of vaccine benefits, eligibility, timing, and safety before pregnancy. Integrating immunization services into preconception and family planning care may also provide convenient opportunities for women to receive appropriate vaccines before conception. However, vaccine hesitancy, misconceptions, inadequate vaccine availability, incomplete immunization records, financial constraints, geographical barriers, and limited healthcare-worker capacity may reduce uptake. The study therefore expects accessible, well-integrated, evidence-based, and appropriately targeted preconception immunization services to contribute significantly to improved immunization uptake among women planning pregnancy in Nigeria. The study is expected to contribute to the literature on preconception immunization, immunization uptake, reproductive health, maternal health, preventive healthcare, vaccine-preventable diseases, preconception care, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, family planning clinics, immunization programmes, healthcare providers, development partners, and policymakers regarding strategies for strengthening preconception preventive services. The study will also provide evidence-based recommendations for integrating immunization assessment and appropriate vaccination into routine preconception and family planning services, improving vaccination documentation, strengthening healthcare-worker training, increasing awareness among women planning pregnancy, improving vaccine availability, establishing follow-up systems for incomplete vaccinations, and promoting informed acceptance of recommended vaccines across Nigeria.

Keywords: Preconception immunization services, immunization uptake, women planning pregnancy, preconception care, vaccination, reproductive health, maternal health, preventive healthcare, vaccine-preventable diseases, Nigeria, public health.