Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan

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n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); Skip to content Gates Open Research file_upload Submit via VeriXiv search clear search menu close clear Search Browse Gateways & Collections How to Publish Submit via VeriXiv My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Publication Charges Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Contact Blog My Account Submissions Content and Tracking Alerts My Details Sign In Submit via VeriXiv { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://gatesopenresearch.org/articles/8-48" }, "headline": "Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working...", "datePublished": "2024-05-31T12:13:34", "dateModified": "2025-05-27T15:05:19", "author": [ { "@type": "Person", "name": "Mofeyisara O. Omobowale" }, { "@type": "Person", "name": "Folakemi A. Amodu" }, { "@type": "Person", "name": "Olugbenga S. Falase" }, { "@type": "Person", "name": "Taiwo H. Olajide" }, { "@type": "Person", "name": "Olukemi K. Amodu" } ], "publisher": { "@type": "Organization", "name": "Gates Open Research", "logo": { "@type": "ImageObject", "url": "https://gatesopenresearch.org/img/AMP/Gates_image.png", "height": 600, "width": 47 } }, "image": { "@type": "ImageObject", "url": "https://gatesopenresearch.org/img/AMP/Gates_image.png", "height": 1200, "width": 94 }, "description": " Background Contextualizing childhood immunization in the context of children of working mothers can boost coverage and completion interventions. This study examines how informal working mothers perceive post-day-one routine immunization, and vaccines not covered under the National Program on Immunization (NPI), immunization schedules, timing, and duration. Methods The study utilized a mixed methods approach, including in-depth interviews and semi-structured questionnaire to capture immunization experiences and assess the context of post-day one. The study was conducted in Ibadan, Nigeria and involved 1,044 quantitative and 73 qualitative samples of working nursing mothers. Data were analyzed using descriptive statistics, chi-square test for proportions, and t-test for means (p<0.05), while qualitative data were subjected to content and thematic analysis. Results The average age of mothers participating in this study was 31.39±6.52 years. The mean age of children of mothers recruited into this study is 19.26 ±16.14 months. Majority of these mothers (95%) are married. Around three-quarters of women in this population ensured immediate immunization for their infants after birth, but less than a third achieved the complete age-specific vaccination series due to livelihood related causes, long waiting time spent in conventional immunization clinic. Around 40% of interviewed mothers vaccinated their children up to the third DPT dose, and just over 30% achieved full vaccination. Many informal working mothers, have practice of adding 'supplements' to their children's immunization, driven by a lack of sufficient information about the vaccines. Some mothers also seemed unaware of these specialized vaccines. Conclusions Promoting complete immunization requires more than just raising awareness about childhood vaccinations but close and quick immunization service delivery is required. It is crucial for mothers to possess comprehensive knowledge about the mechanics and operation of immunization. Achieving this understanding could involve translating vaccine names and functions into indigenous terms, enhancing clarity and comprehension. Furthermore, a firm grasp of the immunization schedule significantly contributes to successful immunization completion. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://gatesopenresearch.org/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://gatesopenresearch.org/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://gatesopenresearch.org/articles/8-48", "name": "Contextualizing post day-one childhood immunization in-take drop-off..." } } ] } Home Browse Contextualizing post day-one childhood immunization in-take drop-off... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Omobowale MO, Amodu FA, Falase OS et al. Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.12688/gatesopenres.15135.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] Mofeyisara O. Omobowale https://orcid.org/0000-0002-9988-500X 1 , Folakemi A. Amodu https://orcid.org/0009-0000-3429-4682 1 , Olugbenga S. Falase 2 , Taiwo H. Olajide https://orcid.org/0000-0002-9548-9587 1 , Olukemi K. Amodu 1 Mofeyisara O. Omobowale https://orcid.org/0000-0002-9988-500X 1 , Folakemi A. Amodu https://orcid.org/0009-0000-3429-4682 1 , [...] Olugbenga S. Falase 2 , Taiwo H. Olajide https://orcid.org/0000-0002-9548-9587 1 , Olukemi K. Amodu 1 PUBLISHED 27 May 2025 Author details Author details 1 Institute of Child Health, University of Ibadan, Ibadan, Oyo, Nigeria 2 Department of Sociology, Lead City University, Ibadan, Oyo, Nigeria Mofeyisara O. Omobowale Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Folakemi A. Amodu Roles: Conceptualization, Investigation, Project Administration, Resources, Supervision, Writing – Review & Editing Olugbenga S. Falase Roles: Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation Taiwo H. Olajide Roles: Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Olukemi K. Amodu Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Contextualizing childhood immunization in the context of children of working mothers can boost coverage and completion interventions. This study examines how informal working mothers perceive post-day-one routine immunization, and vaccines not covered under the National Program on Immunization (NPI), immunization schedules, timing, and duration. Methods The study utilized a mixed methods approach, including in-depth interviews and semi-structured questionnaire to capture immunization experiences and assess the context of post-day one. The study was conducted in Ibadan, Nigeria and involved 1,044 quantitative and 73 qualitative samples of working nursing mothers. Data were analyzed using descriptive statistics, chi-square test for proportions, and t-test for means (p<0.05), while qualitative data were subjected to content and thematic analysis. Results The average age of mothers participating in this study was 31.39±6.52 years. The mean age of children of mothers recruited into this study is 19.26 ±16.14 months. Majority of these mothers (95%) are married. Around three-quarters of women in this population ensured immediate immunization for their infants after birth, but less than a third achieved the complete age-specific vaccination series due to livelihood related causes, long waiting time spent in conventional immunization clinic. Around 40% of interviewed mothers vaccinated their children up to the third DPT dose, and just over 30% achieved full vaccination. Many informal working mothers, have practice of adding 'supplements' to their children's immunization, driven by a lack of sufficient information about the vaccines. Some mothers also seemed unaware of these specialized vaccines. Conclusions Promoting complete immunization requires more than just raising awareness about childhood vaccinations but close and quick immunization service delivery is required. It is crucial for mothers to possess comprehensive knowledge about the mechanics and operation of immunization. Achieving this understanding could involve translating vaccine names and functions into indigenous terms, enhancing clarity and comprehension. Furthermore, a firm grasp of the immunization schedule significantly contributes to successful immunization completion. READ ALL READ LESS Keywords Post-day one immunization, Working mothers, Drop-off rate, Ibadan Corresponding Author(s) Mofeyisara O. Omobowale ( [email protected] ) Close Corresponding author: Mofeyisara O. Omobowale Competing interests: No competing interests were disclosed. Grant information: This work was supported by the Gates Foundation [OPP1217235]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Omobowale MO et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Omobowale MO, Amodu FA, Falase OS et al. Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.12688/gatesopenres.15135.2 ) First published: 31 May 2024, 8 :48 ( https://doi.org/10.12688/gatesopenres.15135.1 ) Latest published: 27 May 2025, 8 :48 ( https://doi.org/10.12688/gatesopenres.15135.2 ) Revised Amendments from Version 1 The title has been revised in line with reviewer’s suggestion. The abstract was slightly adjusted to sync with the review made in the body of the manuscript, including the result section. From introduction, some editorial adjustment was made to make the sentences meaningful. In the method a statement on how risk was minimized was added. Understudy description, few sentences were added to address language and reliability as raised by reviewer. The statistical analysis and result section was revised extensively to address issues raised by reviewer. The revised result section in the manuscript includes amendments to the result section, with some changes to Table 2,3, and Figure 1. The Results includes further analysis of data to show age specific drop-off rate among study population. The discussion section was extended and few additional references were added to present a clearer overview of the study and significance of contextualized post-day one childhood immunization. Data were updated to the database as indicated in the manuscript. The title has been revised in line with reviewer’s suggestion. The abstract was slightly adjusted to sync with the review made in the body of the manuscript, including the result section. From introduction, some editorial adjustment was made to make the sentences meaningful. In the method a statement on how risk was minimized was added. Understudy description, few sentences were added to address language and reliability as raised by reviewer. The statistical analysis and result section was revised extensively to address issues raised by reviewer. The revised result section in the manuscript includes amendments to the result section, with some changes to Table 2,3, and Figure 1. The Results includes further analysis of data to show age specific drop-off rate among study population. The discussion section was extended and few additional references were added to present a clearer overview of the study and significance of contextualized post-day one childhood immunization. Data were updated to the database as indicated in the manuscript. See the authors' detailed response to the review by Olayinka Ibrahim See the authors' detailed response to the review by Charles Olomofe READ REVIEWER RESPONSES Introduction Childhood immunization has become an important contributor to the control and management of mortality and vaccine-preventable diseases among children in low-income countries ( Abbas et al. , 2020 ; Hilton et al. , 2006 ). Nigeria has developed several strategies for combating vaccine-preventable diseases since 1979 when it adopted the expanded program for immunization (EPI), and these efforts have drastically reduced the rate of under-five morbidity and mortality. This is further evidenced by the country recently attaining a polio-free status ( Ekwebelem et al. , 2021 ). However, a low completion rate of immunization, low coverage and increased drop-off rate are among major challenges militating against arrays of approaches, which low-income countries like Nigeria have deployed to increase completion, coverage and demand ( Adedokun et al. , 2017 ). Nigeria is still plagued with one of the highest rates of under-five mortality in the world ( Matthew Ayodele et al. , 2024 ; Mutiu et al. , 2019 ), the second largest after Pakistan ( Asim et al. , 2015 ). Nigerian 2016 Multiple Indicators Cluster Survey/National Immunization Survey Coverage (MICS/NICS) revealed that 77% of children aged 12–23 months in Nigeria have not received all the routine vaccinations according to the recommendation of the national EPI schedule. In addition, 40% of children in the above age group did not receive any vaccinations, meaning that the 90% national target that has been set by the country was not met. Likewise, 33% of children aged 12 to 23 months received three doses of Penta vaccines, while 31% of children who received Penta 1 vaccines did not complete the three-dose series ( Oleribe et al. , 2017 ; WHO, 2017 ). Overall, the national immunization coverage average is still far from the World Health Organization (WHO) recommended coverage rate ( Chido-Amajuoyi et al. , 2018 ; Obiajunwa & Olaogun, 2013 ; Oleribe et al. , 2017 ). The 2018 NDHS reports show that the percentage of children aged 12–23 months who have received all basic vaccinations was 43.0% in south West Nigeria, while only 34.9% of this age group have received all age-appropriate vaccinations in the region. Individual states have varying levels of vaccine uptake such as Oyo state in the South-Western region with 23.3% coverage in the number of children of all basic vaccinations and 16.6% with all age-appropriate vaccinations. The average immunization coverage of the state is low and puts the region behind the South-South and South-Eastern regions of the country with higher coverage ( McGavin et al. , 2018 ). Studies over the years, have revealed many contextual determinants including but not limited to mother’s educational status, employment status, income, age, marital position, religious inclination, ethnic division, child’s age, birth order and ease of accessing health center to influence the uptake and completion of childhood immunization ( Adenike et al. , 2017 ; Mutiu et al. , 2019 ; Omobowale, 2021 ; Ophori et al. , 2014 ; Tagbo et al. , 2012 ). Similar studies conducted in different locations and populations in the country revealed a largely similar set of factors militating against the uptake and completion of immunization by children all over Nigeria with the factors being stronger determinants among some populations as compared to others ( Abdullahi, 2018 ; Adeloye et al. , 2017 ; Adeyinka, 2012 ). The variation in the nature and impact of these factors in different sub-cultures/population of the country is an indication of the contextual differences in population subsets, which have been limitedly explored. Contextualizing post-day-one childhood immunization among working mothers as a subset of Ibadan, cultural group encompasses examination of interpretations, understanding within a trick of social/cultural perspectives, the nature of social/cultural reality, social explanations of knowledge, and interactions regarding childhood immunization as a social (health) process in childcare. Maternal factors and the context in which they manifest play an important role in the access, uptake, and completion of immunization of under-five children. These contextual maternal factors consequentially affects the immunization coverage rate in the country ( Fatiregun & Okoro, 2012 ). Statistically, children of young mothers (15–24 years), illiterate mothers, mothers who did not attend ante-natal clinics, mothers who delivered at home or maternity homes, mothers who had no access to media, and mothers who had little, or no knowledge of immunization were more likely not to complete or receive any immunization ( Adedokun et al. , 2017 ; The National Demographic Health Survey, 2013 ). Children of mothers who are aware of immunization at birth are 1.9 times more likely to be fully immunized, while children of mothers who had secondary and tertiary education are two times more likely to be fully immunized than those children whose mothers had primary or no formal education ( NDHS, 2018 ). Other important factors that are maternal-related are the level of education, higher income, and easy access to healthcare establishments among others ( Fatiregun & Okoro, 2012 ). Although, several studies have explored factors that are associated with the low vaccine uptake among Nigerian children, which have been attributed to low immunization coverage, nursing mother’s poor knowledge about immunization, and educational status, among other factors ( Abdullahi, 2018 ; Abdulraheem et al. , 2011 ; Antai, 2010 ; Antai, 2012 ; Anyene, 2014 ; Oladepo et al. , 2019 ). The contextual understanding, the interplay between social/cultural interpretations, explanations and interactions that dictates the social reality of working in the informal sector and the up-take of childhood immunization beyond first schedule and post day-one in South-Western Nigeria, needs to be explored. The success of completing the immunization exercise is contingent on the contextual experiences and understanding of mothers who value the significance of childhood immunization. Contextualizing childhood immunization will advance appropriate intervention that will help in increasing immunization coverage and completion among working mothers. The proper monitoring of children in the immunization routine activities cannot be detached from the socio-cultural informed understanding of mothers who are the primary caregivers. This study explored the contextual understanding of informal working mothers on post-day-one childhood immunization in different specific areas including the contextual understanding of the concept of immunization, vaccines not under the National Program on Immunization (NPI), immunization schedule and period as well as the timing and duration of the immunization. Methods Ethical considerations Ethical approval was received from both University of Ibadan/UCH Research Ethics Committee (UI/EC/20/0058) on 23/05/2020 and Oyo State Research and Ethics Review Committee (AD 13/479/1777B) on 20/05/2020. During the data collection, the study details, purpose, and participants’ right to privacy were explained to all participants, with the clarification of the right to withdraw at any time from the interview. Informed consents were obtained both verbally and written. The participants in this study were not exposed to any serious know risk. The research team employed various means of protection to minimize risk. Their participation in this study cost them nothing invasive, incentives and transportation were provided at every required instant. Participants through the findings and discussions of this study were more enlightened about childhood immunization along with other minor health-related services benefits provided to them. Study description A mixed methods approach was adopted for this study to gain a more comprehensive knowledge of the phenomenon studied. The study was conducted in Ibadan, a major city in Oyo state. The city hosts large markets with a huge population of mothers from diverse cultures in Nigeria. A total of 1,044 (quantitative samples) and 73 (qualitative samples) nursing mothers were sampled from both rural and urban markets of Ibadan, using explanatory sequential mixed methods design. A pretested interviewer administered questionnaire, immunization record assessment, and in-depth interviews with mothers and health workers were employed in the study. The eligible study population comprised of all consenting nursing mothers working within the markets who have commenced childhood vaccination, and health workers in the selected study sites. A total number of 1,044 working mothers were sampled from 13 randomly selected markets (Agbeni, Bodija, Gbagi, Oje, Oja Oba, Ojoo, Dugbe, Sango, Mokola, Orita Merin, Bode, Olomi, Ikereku, Olulosin, Ogunranti 2 and Academy) in Ibadan metropolis, Nigeria for the study. The qualitative data were obtained through unstructured interview guide for in-depth interviews (IDI) with 73 consenting purposively selected working nursing mothers in selected markets. Four IDIs were conducted in all markets except in Bodija, Agbeni and Gbagi markets where 7 IDIs were conducted due to the larger number of nursing mothers in the markets. The interviews were stopped when saturation was reached. In-depth interviews help deepen knowledge by bringing focused, insightful and improved understanding of the study ( Brounéus, 2011 ). The questionnaire were written in English and Yoruba Languages, running it through processes of translation and back translations by experts in the language. Mothers of children below the age of five years in selected markets were, purposively identified, approached for explanations and consent for participation in the study. Non-consenting mothers were exempted, while all consenting mothers either verbally or written were recruited for the study. However, in all markets, market leaders and significant others of the mothers had earlier been identified, visited, and carried along from the inception of the study. The in-depth interview focused on nursing informal mothers with children below 5 years of age to sufficiently explore, understand, and contextualize post-day-one childhood immunization narratives, challenges, and possible solutions. Interviews were transcribed, and coded using process coding methods when observable and conceptual action in the data were linked to process codes, intertwined with the dynamics of vaccination time, such as things that emerge, change, occur in particular sequences, or become strategically implemented. Process coding is appropriate for virtually all qualitative studies, particularly for grounded theory research that extracts participant action/interaction and consequences ( Miles & Huberman, 1994 ). The data were also categorized and subjected to content analysis. Statistical analysis The quantitative dataset was entered and analyzed using statistical packages for Social Sciences (SPSS, version 20 windows). Descriptive statistics of the demographic details of the recruited mothers were done. Results were represented by numbers, percentages and expressed by mean. Chi-square test was used to observe the difference between the proportions, t-test was applied to observe- the difference between the two means for normally distributed continuous data. A p-value less than 0.05 was considered as significant. Results Demographic information of working mothers in Ibadan The mean age of mothers enrolled in this study was 31.39 ±6.52 years and the average age at first parturition is 24.12±4.38 years. The mean age of children of mothers recruited into this study is 19.26 ±16.14 months. The mean number of days from birth to first vaccination for children of mothers in this study was 1.95 days and the average number of children per mother in our study is 2.43. Half of the mothers in this study (53.8%) completed secondary school. About one-fifth of the study population had tertiary-level education, while more than a third of the population had no form of education. The distribution of educational levels of mothers is presented in Table 1 . The majority of the mothers (95%) in this study were married while all the others are single mothers including never married, divorced and widowed. Most mothers (82.9%) that had antenatal care during their pregnancy attended health care facilities for their antenatal services, while others patronized unorthodox care centers for their antenatal care, including 13.6% that had their antenatal care in faith homes. About 76% and 16.4% of respondents in this population delivered their last child at a healthcare facility and mission house, respectively while others delivered their babies at other unorthodox care centers (see supplementary figure). About three-quarters of the women in this population immunized their children immediately after birth. Less than a third of the children in this population had completed the age-specific vaccinations. (see supplemental tables) Table 1. Educational attainment of working mothers. Highest level of education Educational attainment Frequency Percent Cumulative Percent No education 37 3.7 3.8 Others 4 .4 4.2 Quranic school uncompleted 2 .2 4.4 Quranic school completed 1 .1 4.5 Primary uncompleted 4 .4 4.9 Primary completed 72 7.2 12.1 Secondary uncompleted 111 11.1 23.3 Secondary completed 536 53.8 77.0 Tertiary uncompleted 49 4.9 81.9 Tertiary completed 180 18.1 100.0 Total 996 100.0 Table showing the highest educational attainment by mothers in the study. Note that 48 mothers do not disclose their educational status. More than half of the women vaccinated their children on day zero, while about 22.4% of mothers vaccinated their children within the first week of birth ( Table 2 ). Mothers in the urban markets are more likely (OR-1.934 C.I 1.317-2.841) to have completed the age-specific immunization schedule for their children (14th week -42.57% ,9th month -33.95%) when compared to their counterparts in the rural market. More than half (53.3%) of the children of mothers in the rural markets dropped off the immunization schedule before they were fully vaccinated. As presented in Figure 1 below, almost 40% of the mothers interviewed vaccinated their children till the third dose of DPT and just a little above 30% completely vaccinated their children. There was a steady decline in vaccine uptake with the increasing age among children in the Ibadan population as depicted in Figure 1 below. Table 2. Age at which children of working mothers started immunization after birth. Age Frequency Percentage Day 0 554 53.1 Days 1-7 234 22.4 Days 8-14 43 4.1 Day 14 above 213 20.4 Total 1044 100.0 The table depicts the distribution of the timing when newborns received that first vaccination in the population. About half of the population were not vaccinated at day zero and as much as one-fifth of the population got their first vaccine at above two weeks of age. Table 3. Childhood immunization completion rate and drop-off rate among working mothers by Market region stratification. Population Stratification Summary Statistics Completion at 14 weeks Completion at 9 Months Drop off rate Total Population Market Population Urban 367(42.57%) 293(33.95%) 358(41.55%) 863 Rural 48(26.80%) 38(20.99%) 97(53.3%) 181 Total Study Population 415(39.81%) 331(31.7%) 455(43.6%) 1044 Table showing the age-specific immunization completion and drop-off rates in the population. Figure 1. Age Specific completion rate of each vaccine among children of informal working mothers in Ibadan Nigeria. The Figure 1 shows the progressive decline in the number of children taking their vaccinations as they advance in age. The most vaccine taken in the population is the first dose of Hepatitis B and the lowest taken vaccine is the yellow fever vaccination taken at age 9 months 1 . The dropout rate compares the number of infants who begin the immunization schedule to the number who complete it. And the completion rate here refers to fully vaccinated children, those that received the complete recommended vaccination that is appropriate for age as recommended in the National Immunization scheme. Informal working mother’s contextual understanding of childhood immunization To clarify the understanding of the informal working mothers on childhood immunization, various questions from the perspectives of working mothers were sought, which included their understanding and interpretations of the reason for childhood immunization. One of the informal working mothers defined immunization as a disease-preventing vaccine to secure the future as thus: Immunization is those vaccines that we take to prevent diseases that can affect children in the future. It is something like preventing. We take Hepatitis B, Diabetes, Hepatitis B1, and B2, we just collected it (Agbeni Market IDI). The mother here has a layman understanding of vaccines as prevention but seems not to know some of the vaccines and their functions as she added diabetes to the list of mentioned vaccines. Another working mother whose opinion was generally shared by many mothers explained the importance of childhood immunization from a preventive perspective also: I know that it prevents paralysis and it is good for a child. It also prevents jedo-jedo (Hepatitis) and diseases like romolapa - romolese (Polio) and yinrun - yinrun (Meningitis) (Agbeni Market IDI). Post-day-one childhood immunization is an exercise that should be taken seriously. In explaining some of the diseases that post-day-one immunization prevents, a working mother emphasized that a good mother needs to take immunization very seriously by ensuring that all children take it. She said: Immunization is good and a true mother should make the effort to ensure that she takes it for her children completely, and we can see its work in our children. So, it is very good and necessary (Agbeni Market IDI). Confirming the above statement, a mother also opined that: I know that immunization is important for a child and it is something good that parents should take for infants. It prevents diseases such as polio, diarrhea, tuberculosis, and measles (Gbagi Market IDI). A respondent emphasized the reason and importance of childhood immunization and also as a means of preserving culture and socialization processes because the immunization exercise is a continuous process that is passed from one generation to another: I know that it’s good because the parents who gave birth to us also immunized us when we were young. So, when we give birth to a child, we need to immunize them also (Gbagi Market IDI). Obviously, it can be deduced from the narratives above that the informal working mothers have the layman's knowledge of childhood immunization. Most informal working mothers see childhood immunization as an exercise to prevent children from diseases and other ailments, which may affect children. Also, immunization is recognized as a means of preventing children from sudden death and securing their future. However, in spite of the working mothers’ awareness on childhood immunization, some of the mothers do not know the specific vaccines their children receive. Many of them take the vaccines as instructed and on the general assumption that ‘it is good for children’ as adduced by one of the interviewees: We have been taking it (immunization), we have taken all the ones that the child is supposed to take, and the ones they carry around that they bring to the market, we also take that one. But I don’t know the name of the vaccines, they only said it is good (Agbeni Market IDI). As a result of inadequate information that exists on the kind of immunization that children receive, it was observed and confirmed that some working mothers use ‘pharmaceutical supplements’ as an addition, a practice, which could be detrimental to the health of the children. A mother emphasized thus: I don’t know the name of the vaccine when it is not the only one. We also use Babyrex and vitamins for her [the child], and when we go to the clinic, they say that one is for romolapa-romolese (polio) or something like that. Also, I used to hear the advertisement, because they don’t write the name of the vaccine for us, they just write 3 letters, and you know it is only the nurses who know what they mean by that (Agbeni Market IDI). Yet another working mother noted that: I don't know the names, but they say some prevent measles, some for polio, yellow fever, and so on. So, all I know is that they prevent those diseases (Bodija Market IDI). Although the immunization card has a record of the vaccines received and the next vaccine to be administered, most mothers do not understand the actual vaccine to be received as explained by a working mother whose child had incomplete vaccination thus: It (Immunization) is good, it is very good for the body. It kills all diseases that are in the body, such as fever, cough, iko ahubi (coarse cough), and iko ahugbe (dry cough). It is good for children, the way they give them in stages is how we take it, and we have the record. They gave us cards. When we were supposed to receive it, we went to the place and they gave us the next date and wrote the next vaccines that we would take on the next appointment. (Bodija IDI Market). Informal working mothers, in most cases, do not also know and understand the specific vaccines given to their children. While they are aware of when their children were given the previous immunization through the immunization card, in most cases, they are oblivious of the specific vaccine received as well as the functions but rely on the health workers to tell them. A working mother opined that: When we gave birth after 7 days, they gave the baby at the hand, and buttocks, after that, at the two hands when she was 2 months but I can’t remember the name of the vaccine. It is good to take it. For the 3 months, I don’t know the name of the vaccine. When we get there, the nurses will explain it to us (Bodija Market IDI). Likewise, another working mother said: I can’t remember the vaccine that was given to my baby but it is in my baby’s card. They usually write the one that he will receive there, but I can’t really remember. I know BCG and Rotavirus, the one that prevents meningitis, but I don’t know the timing of these vaccines, despite the fact that I have four children (Gbagi Market IDI). The above indicate lack of informed understanding of vaccine among mothers may have implication for of timely and complete vaccination of their children across groups. Informal working mother’s understanding of vaccines not under NPI Most informal working mothers are informed about ‘special vaccines’, which are not under the NPI, these are government-approved but not subsidized vaccines. They know that these vaccines exist and are good for children, but the vaccines are not free. There are suggestions that all working mothers should get these vaccines, but, the cost of these vaccines, remains a major problem for most mothers as explained by one of them: Of all the vaccines, the BCG is very important, the PCV, and the Rotavirus. They are all good. For the Rotavirus, if not that it is expensive for most of the parents, it would have been good for everybody to take it for their children (Gbagi IDI). A working mother who has been informed but could not afford one of the special vaccines opined that although the vaccines are crucial for the children, the government needs to support parents by subsidizing the cost of the special vaccines. Yes, there is one that they said is ROTA (Rotavirus), but it is too expensive, and I feel if it is something that is very important the government will subsidize it and it will be free for everybody so I am not bothered about it but some people still go to pay for it and take for their child. Out of a hundred maybe few people will be able to afford that money. So, I did not bother to immunize my child against Rotavirus. I only take the free ones. It is only Rota that I know is not free (Agbeni Market IDI). An informal working mother who knows more about the functions of the special vaccines talked about the time that a child should get them. She explained that: So, the vaccines that we are talking about, are what we call special vaccines. The one that stops Igbegburu (Dysentery), there is Meningitis, and different ones are available. Those ones, would not tell you at the clinic that they are available. Like the one for Rotavirus, a child between 6 weeks and 10 weeks, is supposed to receive it. So, some are to be taken after one year, one for 9 years for females (Agbeni Market IDI). However, some working mothers do not know if there are special vaccines that require any payment. While responding to a question on the special vaccines, a woman surprisingly said: Is that also an injection [vaccine]? We don’t pay for any vaccine in the place where we take vaccine o, we don’t pay for the vaccine (Agbeni Markets IDI). Correspondingly, a working woman who is completely unaware of special vaccines also explained that: They should let us know about it [special vaccines], because I have never heard of it. Even the first one we received was at the local government, the one for three months or six weeks, and after birth before naming. It was at a local government that we received it (Agbeni Market IDI). However, a woman was able to get one of the special vaccines for her children in order to prevent diseases. I have heard one that prevents meningitis. It is a good vaccine because I got it for my 2nd and 1st child, because of the disease in the area. We are told to get it for them after 1year (Agbeni Market IDI). The quantitative data of this study also confirms that the completion rate for special vaccines, particularly, Rotavirus 2 is very low as only a 7.5% rate had been completed. Clearly, it can be inferred that the available special vaccines are not free, hence, they are unavailable in many immunization clinics and unaffordable to mothers who live barely on and/or below the poverty line 3 . by the working mothers. What inhibits most mothers from getting their children vaccinated with these “special vaccines” was the associated cost of the vaccines. Besides, some working mothers do not know that these vaccines exist and they do not have the knowledge of their functions. For the vaccines to be accessed and affordable, the government needs to subsidize and made them easily accessible. Informal working mother’s understanding of immunization schedule and period Childhood immunization schedules and period guide mothers on when to take their child(ren) for the next immunization appointment. There is no doubt that the immunization schedule and period will be taken seriously based on the contextual understanding of mothers. Even with the immunization card as a reminder, working mothers who are too busy with their daily work or who do not understand the importance of immunization are at risk of missing the next period of immunization. A mother explained how informed she was on the immunization schedule: Yes, they tell us. When the child was 3 months, they tell us to come for vaccination, then for 6 months, and after 6 months. They [Nurses] tell when to come next whether by 8 months or 9 months and the date for the next appointment is written in our immunization cards so that when you look at it you remember when to go for the next appointment (Agbeni Market IDI). While referring to the lecture received by health workers, a mother stated the specific times given to her on the immunization schedule as: At birth, one month, 3 months, 6months, 9months, and 1 year, that was how we were lectured (Agbeni Market IDI). Similarly, another woman explained the immunization schedule as starting from: A day after birth, 41 days, 2 months, 3 months, 6 months, 9 months, and 1 year (Agbeni Market IDI). In addition, an informal mother emphasized the immunization schedule with personal experience: At birth, 2 months, 3 months, 6 months, although the vaccine is given in the child's mouth, 9 months, and 1 year. I know a child is supposed to complete the vaccination at 2 years because when I gave birth to my 2nd child, the schedule was completed at 18 months but for my 1st born, it was completed at 12 months so now I think the vaccination schedule ends at 2 years (Agbeni IDI). However, a woman who knows that various vaccines exist for the immunization of children but does not know how and when to take them for her child responded: There are a lot of vaccines like my baby now has taken the vaccines like six times. But I do not know how many vaccines a child should take (Bodija IDI). Different from the unknown woman, another working mother makes use of any available moment to immunize her child as explained thus: I take it from any clinic depending on my location at that moment and I sometimes take the child to the father's village, because the healthcare people often come there. Recently, when I came home, I was passing through Ojee, and I came across some set of healthcare persons giving vaccines, and I took my child to them (Agbeni market IDI). Another woman emphasized that: On the day I took the first one, if it was after a month or three months, they would have given me the date for my next appointment. So, it’s the date that I bear in mind to go next, so when I get there, if it’s available, fine I will take it, and if it’s not, they will tell me to come the following week (Gbagi market IDI). However, the schedule and period of immunization make it easy for informal working mothers to know when and where to immunize their child(ren). It serves as a guide as one woman noted: You know it is always scheduled, so that makes it easier. Just like after giving birth, you get some; there is another one at six weeks, then ten weeks, 14 weeks then, 9 months, 1 year, and the like. One will know how to do it (Agbeni market IDI). A mother that understands the importance of the immunization period finally concludes that: I usually don’t want to miss the dates. I make sure it is the exact date that I go for the immunization except if I was not chanced to go on that day. But, I don’t miss it at all, so that it [immunization] can be complete in the body of my children (Gbagi market IDI). Many mothers do not seem to know danger associated with time and vaccine uptake schedule. It is taken like other conventional hospital appointments. Some mothers missed these appointments without rescheduling/or revisiting clinics until after many months. Some for the fear of been scolded by health workers for negligence others for lack of time due to heavy economic burden. Informal working mother’s understanding of the timing and duration of the immunization On the duration of the vaccine, it was observed that there was no uniform period according to the responses of the informal working mothers. While some believe that the immunization period ranges from birth to 9 months, some mothers agreed to a year, yet some others said it is over a year, and even more. One of the women noted that: For my firstborn, I stopped collecting immunization for him at one year and six months, but I am still collecting vitamin A, which they put in his mouth (Agbeni market IDI). It was observed that some groups of working women agreed that immunization starts from birth till 9 months, while some women noted that the duration is between the delivery period and one year. A woman narrated her experience on the immunization period for her children thus: When we were collecting the vaccine for the older ones, the vaccine used to stop at one year, but for the ones that I gave birth to later, it was one year and 6 months, now they say you can receive for 2 years (Bodija market IDI) The uncertainty in the duration of the vaccine also persists as explained by a working mother who missed some vaccinations for one of her children earlier but hopes to complete it for others as she explained that: Ehn, we did not know then, the one that is now 3 years old, if he can still it, I would take him there. The one that is 10 years old, if he can receive it, I would take him there too. There is one that is 8 years old too and one that is 2 years old now, I have said that I would take him to receive it (Bodija market IDI). Children, at times, may miss the immunization period as a result of a lack of experience on the duration of the vaccine as an interviewee simply said: Yes, my child was immunized, but it has been a long that he has been immunized (Bodija market IDI). A woman who was unsure about the timing and duration of the immunization needs to rely on the information given by the health workers: Hmm, they used to tell us a lot about it, but there is little I can remember. Although at birth he took one, I think vitamin K. Also, in the fourth month, he took another one, A month after, he took another one again till the sixth month. I think we took a vaccine that cost seven thousand naira in the third month. In the sixth month, he took vitamin A, which was dropped in his mouth to prevent what he will be eating. After that, we went there but they did not give him any vaccine they just asked questions about his body's reaction to food. We were told he would take another vaccine at nine months (Gbagi market IDI). A woman narrated that the immunization process should be done “Immediately one gives birth to the baby like the second day after birth and getting home, one should go and receive it. In fact, my child had not been named before I started the immunization. I went to the one at nine months yesterday. So, I take it for my child. Then a year and they also said when the child is a year and three months, I should bring him back. They’ve written it on the card (Gbagi market IDI). Mothers lay importance on receiving the first set of childhood immunizations. Discussion The contextual understanding of informal working mothers plays a significant role in childhood immunization uptake in Ibadan. The working mothers in informal spaces represent a unique population that strives to balance multiple needs and tasks including livelihood survival and childcare practices simultaneously ( Oladokun et al. , 2009 ; Omobowale, 2021 ). Mother literacy and religious institution education on immunization are two important factors in achieving optimal childhood immunization in the study population. This corroborates the findings of Ijarotimi et al. (2018) on the immunization status of children and associated demographic factors in Akinyele Local government are of Oyo state, that female literacy and targeting religious institutions may be effective in improving immunization uptake. The majority of mothers in this study were traders, demonstrating that maternal livelihood may also prevent optimal uptake of immunization by children of working mothers in the informal sectors. Many working mothers in the informal space like markets are pressed with demands of sales and profit making in order to sustain their livelihood. In some cases, many of them despite being married, still remained “breadwinners” in their families ( Tade, 2022 ). Some of them are also indebted to serving usury loans especially that of gbomu le lanta . “Usury loans are locally described as owo gb’omulelantan (which literarily means “a loan akin to having one’s breasts on a hot lantern”). In short, a usury loan default worsens the livelihood and economic situation of the loanee” ( Omobowale et al. , 2020 ) and thus may affect their abilities to keep immunization schedules of their ( Oladokun et al. , 2010 ; Omobowale, 2019 ). The report of Obiajunwa & Olaogun (2013) from an urban-rural study on immunization revealed an immunization completion rate of 26.5% (Urban), and 31.7% (Rural) of mothers in our population state their children have completed the age-specific immunization routine at the time of conducting this study. The reason for the marginal difference in the completion rate we reported here could be associated with higher education status and 100% employment status among our study population. We report a completion of 82.6% for BCG, 71.1% for DPT1, 68.4% for DPT2, and 65.7% for DPT3, which were markedly higher than the completion rates reported in a south-eastern population of Nigeria. The 84.3%,75%, 65.9%, 65.6%, and 47.6% completion rates for OPV0, OPV1, OPV2, OPV3, and Measles, respectively, were consistently lower than the reported among the same south-eastern population of Nigeria ( Fatiregun & Okoro, 2012 ). The differential completion rates among the vaccines between the comparison populations are indicative of a yet to be uncovered population-specific reason influencing the vaccine uptake rates in the Nigerian population. The reported completion rate is greater than the reported average for all the geopolitical zones and the national average ( McGavin et al. , 2018 ). This difference can be attributed to the higher education, understanding of childhood immunization, and employment of the women in this population which is higher than the national averages. Also supporting the reports of Hailu et al. (2019) ; Mugada et al. (2017) among others, our study revealed the factors contributing to incomplete immunization rate among mothers, which are the cost of special vaccines, such as Rotavirus, mothers’ forgetfulness of immunization schedule and period, distance to immunization centers and seldom shortage of vaccines. These women, who mostly work in the informal economy, do so without social benefits like pension, health insurance, or sick leave, rather, they seek micro loans ( Omobowale et al. , 2020 ) or develop an ajǫ (a daily/ weekly/ or monthly contributory saving system) system ( Omobowale, 2011 ) to boost their business. Amidst these various survival systems, the informal working mothers must also take cognizance of the health of their children by taking them for immunization, when necessary. Thus, the contextual understanding of these sets of women is germane to the immunization exercise and how such exercise is conceived and practiced. Through the various narratives above, the working mothers, in spite of their various businesses, understand the importance of childhood immunization in the reflection that Immunization is a cost-effective public health policy designed to prevent millions of children from morbidity and mortality ( Ahmad et al. , 2017 ). Childhood immunization is understandably perceived as “prevention” from common childhood diseases such as polio, meningitis, hepatitis, and death, thus, it must be taken seriously. Rather than an exercise, childhood immunization is a culture, which should be preserved through the socialization process and passed down from generation to generation. With such a preservation culture, it is mandatory for all mothers to immunize their child(ren). The contextual understanding of childhood immunization provides detailed information, as well as a broad analysis of how working mothers conceive the immunization process; what immunization is, and how immunization should be done. This is deeper than the awareness and perceived knowledge of mothers on immunization that are mostly examined by scholars. From working a mother’s perspective, the study gives a clearer picture of what immunization means to them [working mothers]. This simply means that it is not enough for working mothers to be aware of and have a knowledge of childhood immunization, which could merely be through information, but how immunization works and functions. In this case, immunization becomes a prosocial action ( Korn et al. , 2020 ) that benefits working mothers and their children, on the one hand and society, on the other hand. As revealed, although most the working mothers are aware of the functions of childhood immunization, they are ill-informed of the specific functions of the vaccines given to their children. Most working mothers who immunize their child(ren) do so as a result of the general assumption that immunization cures diseases and prevents children from death. The study also shows how mothers, due to a lack of understanding, use supplements to aid the vaccinations received by their children, which could be detrimental to the health of the children Thus, what is lacking is the contextual understanding and interpretation of the functions of the specific vaccines that children receive and the reaction that such vaccines could cause. It is therefore important to also contextualize vaccine names in the indigenous words or phrases as to drive how to establish an in-depth meaning and function of each vaccine. Conclusively, working mothers’ awareness and knowledge about childhood immunization is not contextualize in practice thus leading to incomplete understanding and interpretation of vaccine and vaccination. Similarly, no mention of the strengths and limitations of your work in this manuscript. This study contribute to the discourse on childhood immunization by identifying socio-cultural, socio-economic and day-to-day taken for grantend determinants that affect post-day one immunization among the study population, however, the study is limited in that the sample cannot be generalised for the whole of Nigeria or West Africa and the data that were collected represent western part of Nigeria. The study recommends further National studies. The study recommends further National studies. Furthermore, understanding the duration/timing of immunization and period plays a significant role in the completion of immunization. As shown, many of the mothers gave different responses in the timing and duration of immunization. Although the majority of the mothers agree that it starts from birth, the ending period for the immunization, however, is yet unknown. The understanding of some mothers is that it ends at 9 months, some say 1 year, yet another set of mothers believe that is 1 year and 6 months and some agreed to 2 years. Of course, variations in the timing and period of immunization will affect the completion rate of immunization, particularly, for working mothers who are striving to make ends meet. In addition, some of the mothers do not know the schedule of each vaccine. Thus, understanding the function of each vaccine and the schedule will invariably help in the successful completion of immunization. This study is however, limited in that it was conducted among mothers in a specifically in South west geographical location of Nigeria and may not be generalized for the country. Data availability Underlying data Due to ethical constrains to protect the privacy of the participants, the raw qualitative data containing identifiable information has not been made publicly available. However, access to the data can be made under specific documented request that must confirm that the data will not be made public or misused through the corresponding author. The underlying quantitative data can be found below: Harvard Dataverse: "Standard baseline result for working mothers in Ibadan SHEVACCS", https://doi.org/10.7910/DVN/EHQBQL ( Omobowale, 2024 ). Olukemi Amodu, Mofeyisara Omobowale, Folakemi Amodu, 2024, "Replication Data for: Shevaccs", https://doi.org/10.7910/DVN/D9LADS, Harvard Dataverse, V2, UNF:6:xnmsTYuwFyYysVObLcAYww== [fileUNF] Extended data Harvard Dataverse: "Standard baseline result for working mothers in Ibadan SHEVACCS", https://doi.org/10.7910/DVN/EHQBQL ( Omobowale, 2024 ). This project contains the following extended data: - consent for informal mothers.docx - participants general info page sample.docx Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication). Footnotes 1 Note that childhood immunization in Nigeria now extend till 15 months, but this study examined 0–9 months’ vaccine up-take at the time of data collection. 2 Note that Rota Virus Vaccine as locally called was already listed in the routine vaccine but was not available to mothers, mothers still bought it at the time of this data collection. 3 As at January 2022, a dose of rota virus vaccine is 7500 Naira (18.7$) Faculty Opinions recommended References Abbas K, Procter SR, van Zandvoort K, et al. : Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection. Lancet Glob Health. 2020; 8 (10): e1264–72. PubMed Abstract | Publisher Full Text | Free Full Text Abdullahi S: Factors affecting completion of childhood immunization in north west Nigeria. World J Vaccines. 2018; 4 (4): 175–183. 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Reference Source National Population Commission (NPC) Nigeria and ICF Macro: Nigerian Demographic and Health Survey (NDHS) 2013. 2014. Reference Source Nigeria Population Commission: Nigeria demographic and health survey 2018. NPC, ICF, 2018. Reference Source Obiajunwa PO, Olaogun AA: Childhood immunization coverage in south west Nigeria. Sudanese J Public Health. 2013; 8 (3): 94–98. Reference Source Oladepo O, Dipeolu IO, Oladunni O: Nigerian rural mothers’ knowledge of routine childhood immunizations and attitudes about use of reminder text messages for promoting timely completion. J Public Health Policy. 2019; 40 (4): 459–477. PubMed Abstract | Publisher Full Text | Free Full Text Oladokun RE, Adedokun BO, Lawoyin TO: Children not receiving adequate immunization in Ibadan, Nigeria: what reasons and beliefs do their mothers have? Niger J Clin Pract. 2010; 13 (2): 173–8. PubMed Abstract Oladokun RE, Lawoyin TO, Adedokun BO: Immunization status and its determinants among children of female traders in Ibadan, south-western Nigeria. Afr J Med Med Sci. 2009; 38 (1): 9–15. PubMed Abstract Oleribe O, Kumar V, Awosika-Olumo A, et al. : Individual and socioeconomic factors associated with childhood immunization coverage in Nigeria. Pan Afr Med J. 2017; 26 : 220. PubMed Abstract | Publisher Full Text | Free Full Text Omobowale AO: Social capital and AJỌ system among working class traders in Ibadan, Nigeria. J Labor Soc. 2011; 14 (3): 333–346. Publisher Full Text Omobowale MO: Class, gender, sexuality, and leadership in Bodija market, Ibadan, Nigeria. J Anthropol Res. 2019; 75 (2): 235–251. Publisher Full Text Omobowale MO: "You will not mourn your children": spirituality and child health in Ibadan urban markets. J Relig Health. 2021; 60 (1): 406–419. PubMed Abstract | Publisher Full Text Omobowale MO: Standard baseline result for working mothers in Ibadan SHEVACCS. Harvard Dataverse, V1. [Dataset]. 2024. http://www.doi.org/10.7910/DVN/EHQBQL Omobowale AO, Oyelade OK, Omobowale MO, et al. : Contextual reflections on COVID-19 and informal workers in Nigeria. Int J Sociol Soc Policy. 2020; 40 (9/10): 1041–1057. Publisher Full Text Ophori EA, Tula MY, Azih AV, et al. : Current trends of immunization in Nigeria: prospect and challenges. Trop Med Health. 2014; 42 (2): 67–75. PubMed Abstract | Publisher Full Text | Free Full Text Tade O: ‘My husband is living like a dead person’: explaining women portage labour in Ibadan urban market. African Identities. 2022; 20 (3): 225–236. Publisher Full Text Tagbo BN, Uleanya ND, Nwokoye IC, et al. : Mothers’ knowledge, perception and practice of childhood immunization in Enugu. Niger J Paed. 2012; 39 (3): 90–96. Publisher Full Text World Health Organization Africa (WHO): Seventy seven percent (77%) of children 12 – 23 months in Nigeria did not receive all routine immunization – Survey findings. 2017. Reference Source Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 31 May 2024 ADD YOUR COMMENT Comment Author details Author details 1 Institute of Child Health, University of Ibadan, Ibadan, Oyo, Nigeria 2 Department of Sociology, Lead City University, Ibadan, Oyo, Nigeria Mofeyisara O. Omobowale Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Folakemi A. Amodu Roles: Conceptualization, Investigation, Project Administration, Resources, Supervision, Writing – Review & Editing Olugbenga S. Falase Roles: Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation Taiwo H. Olajide Roles: Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Olukemi K. Amodu Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This work was supported by the Gates Foundation [OPP1217235]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 27 May 2025, 8:48 https://doi.org/10.12688/gatesopenres.15135.2 version 1 Published: 31 May 2024, 8:48 https://doi.org/10.12688/gatesopenres.15135.1 Copyright © 2025 Omobowale MO et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads Gates Open Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Omobowale MO, Amodu FA, Falase OS et al. Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.12688/gatesopenres.15135.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 27 May 2025 Revised Views 0 Cite How to cite this report: Obohwemu KO. Reviewer Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.17713.r39706 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v2#referee-response-39706 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 23 Jul 2025 Kennedy Oberhiri Obohwemu , Oxford Brookes University, Oxford, England, UK Approved VIEWS 0 https://doi.org/10.21956/gatesopenres.17713.r39706 The authors have written a robust, well-conceptualized mixed-methods study that investigates a critical and understudied public health issue—vaccine drop-off rates beyond initial immunization among informal working mothers in urban Nigeria. The paper is theoretically grounded, methodologically sound, and socio-culturally nuanced. ... Continue reading READ ALL The authors have written a robust, well-conceptualized mixed-methods study that investigates a critical and understudied public health issue—vaccine drop-off rates beyond initial immunization among informal working mothers in urban Nigeria. The paper is theoretically grounded, methodologically sound, and socio-culturally nuanced. Below is a detailed critique evaluating its strengths, limitations, and overall contribution to the field. Strengths of the Study Rich Contextualization and Relevance : The article is commendable for its sociocultural depth. By focusing specifically on informal working mothers in Ibadan—a population structurally disadvantaged yet often underrepresented in immunization research—it unearths a unique set of barriers to vaccine completion. This focus helps bridge the gap between broad immunization statistics and lived maternal experiences. Comprehensive Mixed-Methods Design : The use of both quantitative (n=1,044) and qualitative (n=73) methods allows for a triangulated understanding of immunization behavior. Quantitative data offers generalizable trends, while qualitative narratives expose perceptions, misinterpretations, and coping strategies. The study design is particularly strong due to the explanatory sequential approach, where qualitative findings enrich statistical results. Thematic Depth and Cultural Translation : The research captures how mothers linguistically and conceptually understand vaccines (e.g., polio referred to as “romolapa-romolese”). This enables practical recommendations such as translating medical terms into indigenous languages, a culturally sensitive strategy often lacking in conventional health communication campaigns. Inclusion of Non-NPI Vaccines : The study’s attention to “special vaccines” like Rotavirus and PCV—often missed due to cost or unawareness—highlights systemic inequities between public health offerings and actual community needs. This issue is particularly relevant in low-income settings where public immunization schedules lag behind WHO-recommended comprehensive coverage. Policy and Practice Implications : The article recommends actionable solutions, including improved health education, decentralization of services, and financial subsidies for non-NPI vaccines. These recommendations align well with Nigeria's current efforts to improve immunization uptake and are grounded in empirical evidence from the field. Limitations and Areas for Improvement Limited Generalizability : While the study provides detailed insights into Ibadan’s informal working mothers, the findings may not be representative of all Nigerian or West African contexts. The authors acknowledge this but a clearer delimitation in the abstract and discussion would strengthen interpretive caution. Inconsistent Presentation of Data : While the data are rich, the structure of tables and figures is not consistently integrated into the discussion. For example, the completion rates for various vaccines are compelling but are sometimes buried in narrative instead of clearly tabulated or visually summarized. Overextended Qualitative Quotations : The study would benefit from a tighter synthesis of qualitative data. While the inclusion of participant voices is vital, some quotes are unnecessarily long and repetitive. More concise, thematic presentation (e.g., matrix tables with representative quotes) would increase clarity. Vaccine Knowledge Assessment Lacks Quantification : Although mothers’ knowledge gaps are described vividly, the study could be improved by quantifying these gaps—perhaps via a vaccine knowledge index or score—so that educational deficiencies can be measured and tracked over time. Absence of Health Worker Perspectives : While the study mentions interviews with health workers, their perspectives are not sufficiently integrated into the analysis. Understanding their constraints (e.g., time pressures, vaccine stock-outs) would complement the maternal narratives and provide a more complete view of the service delivery ecosystem. Lack of Analytical Rigor on Causal Factors : Although chi-square and t-tests were used, multivariate logistic regression could have offered more nuanced insights into which variables most strongly predict immunization drop-off. Without this, the interpretation of associations remains largely descriptive. No Formal Strengths and Limitations Section : The study’s discussion informally mentions limitations, but it lacks a clearly delineated section summarizing the methodological constraints and their potential impact. Formalizing this would align the paper more closely with standard reporting guidelines like STROBE or COREQ. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Epidemiology of infectious and non-infectious diseases, Vaccinations, Public health promotion I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Obohwemu KO. Reviewer Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.17713.r39706 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v2#referee-response-39706 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 31 May 2024 Views 0 Cite How to cite this report: Jain M. Reviewer Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.16473.r37382 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v1#referee-response-37382 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Sep 2024 Monica Jain , International Initiative for Impact Evaluation, Washington, District of Columbia, USA Approved with Reservations VIEWS 0 https://doi.org/10.21956/gatesopenres.16473.r37382 The study has an important objective of understanding of informal working mothers of the concept of immunization, vaccines not under the National Program on Immunization (NPI), immunization schedule and period as well as the timing and duration of the immunization. ... Continue reading READ ALL The study has an important objective of understanding of informal working mothers of the concept of immunization, vaccines not under the National Program on Immunization (NPI), immunization schedule and period as well as the timing and duration of the immunization. My main comments are as follows: The paper needs major editing as there is a significant repetition in different sections of the papers and correction in errors leave some sentences hanging and make it difficult to follow authors’ reasoning. Methods - Which software was used for doing the process coding and content analysis? Methods – While authors mention that that markets were randomly selected, they do not mention the criteria of selection of women within the markets. The authors mention – ‘’However, in all the markets, market leaders and significant others of the mothers had earlier been identified, visited, and carried along from the inception of the study.’’ What is the role of the market leaders and significant others in the study design, data and analysis? Statistical analysis – In table 3 – What is general population being referred to? Is it an average of urban and rural population? Statistical analysis - In figure 1 – the number of PCV or OPV vaccination is not visible. It would be useful to provide a rationale for understanding the uptake of ‘’special vaccines’’ not under NPI? Also, what vaccines are under this ‘’special vaccines’’ category? In one part of the paper authors mention ‘’the factors contributing to incomplete immunization rate among mothers, which are the cost of special vaccines, such as Rotavirus.’’ If the vaccines are not part of the national immunization schedule, should they be included in estimation of immunization completion rate? Are these vaccines used in calculating childhood immunization completion rate and drop-off rate in Table 3? If not, then it may be useful to differentiate between the immunization completion rates under the NPI schedule and those with special vaccines. Can the authors shed more light on the ‘’supplements’’ that they have mentioned in the paper? Why are these supplements important to discuss in relation to immunization uptake? The results based on qualitative data contain too many similar quotes. Removing similar quotes will improve readability of the paper. Authors mention – ‘’In some cases, many of them despite being married, still remained “breadwinners” in their families’’. It is not clear what the authors are suggesting about roles of women and their work status and after marriage. Authors mention – ‘’Rather than an exercise, childhood immunization is a culture, which should be preserved through the socialization process and passed down from generation to generation. With such a preservation culture, it is mandatory for all mothers to immunize their child(ren).’’ Are the authors implying that childhood immunization is embedded in the culture so much so that it is mandatory for mothers to immunize their children? Please clarify the argument being made here and its implication. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public health policy with specialization in immunization of children. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Jain M. Reviewer Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.16473.r37382 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v1#referee-response-37382 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ibrahim O. Reviewer Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.16473.r37387 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v1#referee-response-37387 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 22 Jul 2024 Olayinka Ibrahim , University of Ilorin Teaching Hospital,, Ilorin, Nigeria; Pediatrics, University of Global Health Equity, Kigali, Kigali, Rwanda Approved with Reservations VIEWS 0 https://doi.org/10.21956/gatesopenres.16473.r37387 Re: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan Comments Title “Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers ... Continue reading READ ALL Re: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan Comments Title “Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan” This title is too technical for general audience and a bit confusing, what is post day-one childhood immunization? Is after birth? Is first dose irrespective of date vaccine is received? The phrase is unclear? This should be modified. Immunization is an important, and audience go beyond medical personnel's. Also, be specific. add informal working mother: Typical understanding of a working mothers in Nigeria refers to those in formal sector, and also, include country? Not everyone knows Ibadan Globally Abstract Aims: “perceive post-day-one routine immunization” –this manuscript did not access post one day routine immunization but rather mothers’ perception and knowledge of immunization along with other itemized aims. Methods “ working nursing mothers” qualify it further: informal working nursing mothers. Results: Average age (mean) should be presented along the standard deviation. “The mean age of mothers at their first childbirth within the study group was 24.12 years” delete, it is not adding any information Results A “significant majority” of these mothers 95%) are married—delete significant “ livelihood related causes” include the related causes? Though I find it difficult to locate in the manuscript Conclusion “ It is crucial for mothers to possess comprehensive knowledge about the mechanics and operation of immunization” ?difficult to discern this the manuscript Introduction Unduly long with most concept repeated; this should be reduce and preferably about half of the current number of pages. Methods When was this data collected??? “A total of 1,044 (quantitative samples)” ? How is this sample size derived? Provide the details, The qualitative sample is adequate. “Immunization record assessment” how was this done? Provide the details. “Health workers in the selected study sites” were they part of the qualitative vs quantitative? I did see their findings in the results. What informed the sampling of 13 markets? How were the1,044 mothers recruited across these markets? “The dataset was retrieved and analyzed using statistical packages for Social Sciences (SPSS, version 20 windows). Data were represented by numbers, percentages and expressed by mean. Chi-square test was used to observe the difference between the proportions, t-test was applied to observe- the difference between the two means for normally distributed data” I guess this was the quantitative arm of the study, kindly specify Also, this too generic, give details of how each variable was handled. Indeed, there was no a single inferential statistics? Results All the mean should be accompanied with their respective standard deviations “The mean age of mothers enrolled in this study was 31.39 years. The mean age of mothers at first childbirth in the study population is 24.12 years” difficult to understand while the mean age of the mother and mean age at first childbirth? Look more of tautology??? The most important- age of the children of the mothers’ recruited is missing, which will guide in the interpretation of the data? “The majority of mothers (53.8%)” In science 53% is not majority? Rather report as about half of the mothers “The majority of the mothers (95%) in this study were married while only 43 (4.2%) were single. The majority of mothers (82.9%) that had antenatal care during their pregnancy attended health care facilities for their antenatal services, while 13.6% had their antenatal care in faith homes. About 76% and 16.4% of respondents in this population delivered their last child at a healthcare facility and mission house, respectively” These information are incomplete and yet there is no reference Table??? Besides, most of the information was not subjected to statistical analysis? What is there relevance “A higher number of mothers in the urban markets completed the immunization schedule for their children till the 14th week (42.57%) and the ninth month (33.95%)”- you can not use completion rate rate for 14 th week because it is not the end point, similar observation for 9 months- kindly revise and use drop off rate. “Completion rates in Table 3 were visibly lower among children of mothers in the rural market. More than half (53.3%) of the children of mothers in the rural markets dropped off the immunization schedule before they were fully vaccinated” you cannot make this conclusion without inferential statistics,-cursory look is insufficient. Table 1: provide the details of “others” as footnote “Table showing the highest educational attainment by mothers in the study. This table shows 37 of the mothers do not have any form of education, the majority (536) completed secondary school education and 180, making about 18% had tertiary education degrees” Delete…you can not have a prose repetition of a Table “About 48 mothers” humans are countable noun and can not be about? Table 2: Present column one in days for consistency and need for clarity does within first week include day zero, does within second week include preceding days Table 3: Insert n? percent's alone does not convey the true meanings? Delete completion rate, you can specify drop rate at 14 weeks, at 9 months? Nothing like completion rate- it gives impression as if it is satisfactory . Delete the footnote, besides it was a wrong interpretation. Figure 1: Again the completion rate is confusing? This figure should n somewhere? “Post-day-one childhood immunization is an exercise that should be taken seriously. In explaining some of the diseases that post-day-one immunization prevents” ? birth dose vaccines are equally important (hepatitis B, Polio and BCG? “However, in spite of the working mothers’ enlightenment on childhood immunization, some of the mothers do not know the specific vaccines their children receive. Many of them take the vaccines as instructed and on the general assumption that ‘it is good for children’ as adduced by one of the interviewees” It would have been good to also find out why don’t know the names? Are their local names for these vaccines? “supplements’ this term needs to be defined? Supplement may mean different things to different people. Also, I used to hear the advertisement, because they don’t write the name of the vaccine for us, they just write 3 letters, and you know it is only the nurses who know what they mean by that” Partly it is not their faulty, if they were not told ? efforts should be made to teach the mothers the corresponding local names for these vaccines if there is any? iko ahubi (coarse cough)? Am not sure the correct interpretation/translation is coarse cough -rather cough with post-tussive vomiting/pertussis), “Of all the vaccines, the BCG is very important, the PCV, and the Rotavirus. They are all good. For the Rotavirus, if not that it is expensive for most of the parents, it would have been good for everybody to take it for their children (Gbagi IDI)” am not sure when this data was collected but you should discuss with current NPI schedules, Rota Virus is now part of our routine immunization and PCV has already been part of pentavalent. “Rotavirus is very low as shown that only a 7.5% rate had been completed (Table 2).? I can not see this in Table 2??? “ Mothers/caregivers’ knowledge of routine childhood immunization and vaccination status in children aged, 12-23 months in Ilorin, Nigeria ; SO Ariyibi, AI Ojuawo, RM Ibraheem, FM Afolayan, OR Ibrahim African Health Sciences 23 (4), 582-591 Above article may be relevant for your discussion. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly References 1. Ariyibi SO, Ojuawo AI, Ibraheem RM, Afolayan FM, et al.: Mothers/caregivers' knowledge of routine childhood immunization and vaccination status in children aged, 12-23 months in Ilorin, Nigeria. Afr Health Sci . 2023; 23 (4): 582-591 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Pediatric Infectious disease, General Pediatrics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ibrahim O. Reviewer Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.16473.r37387 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v1#referee-response-37387 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Sep 2024 mofeyisara omobowale , Institute of Child Health, University of Ibadan, Ibadan, Nigeria 09 Sep 2024 Author Response Dear Reviewer, Thank you for your insightful review. All suggestions have been examined and used in the improvement of the manuscript. Competing Interests: No competing interests were disclosed. Dear Reviewer, Thank you for your insightful review. All suggestions have been examined and used in the improvement of the manuscript. Dear Reviewer, Thank you for your insightful review. All suggestions have been examined and used in the improvement of the manuscript. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Sep 2024 mofeyisara omobowale , Institute of Child Health, University of Ibadan, Ibadan, Nigeria 09 Sep 2024 Author Response Dear Reviewer, Thank you for your insightful review. All suggestions have been examined and used in the improvement of the manuscript. Competing Interests: No competing interests were disclosed. Dear Reviewer, Thank you for your insightful review. All suggestions have been examined and used in the improvement of the manuscript. Dear Reviewer, Thank you for your insightful review. All suggestions have been examined and used in the improvement of the manuscript. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Olomofe C. Reviewer Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.16473.r37252 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v1#referee-response-37252 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Jul 2024 Charles Olomofe , East Tennessee State University, Johnson City, Tennessee, USA Approved with Reservations VIEWS 0 https://doi.org/10.21956/gatesopenres.16473.r37252 I have a few comments on the research. METHODS SECTION Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the ... Continue reading READ ALL I have a few comments on the research. METHODS SECTION Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the wrong hands, that is a risk! Conducting an interviewer-administered questionnaire for 1,044 persons is huge. Did you make use of research assistants? If yes, you need to mention it here. Moreover, which language was this questionnaire administered? Was Yoruba language employed at any point? If yes, was a back translations done? Can you expound on this (sequential mixed method) more? Any sampling technique used? Any particular reason or justification why only women within markets were considered? Working mothers in the title of your research is a broad group and it would be great to know why you scoped only market women. DISCUSSION SECTION There is no conclusion in this manuscript. What important messages are you leaving your readers with? Similarly, no mention of the strengths and limitations of your work in this manuscript. Are there things you would have done differently had it been the circumstances were different Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Infectious disease epidemiology and vaccine research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Olomofe C. Reviewer Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.16473.r37252 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v1#referee-response-37252 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 Sep 2024 mofeyisara omobowale , Institute of Child Health, University of Ibadan, Ibadan, Nigeria 05 Sep 2024 Author Response Reviewer comment: 1. Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the wrong hands, that ... Continue reading Reviewer comment: 1. Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the wrong hands, that is a risk!: Author response: The participants in this study were not exposed to any serious know risk. The research team employed various means of protection to minimize risk. Reviewer comment: 2. Conducting an interviewer-administered questionnaire for 1,044 persons is huge. Did you make use of research assistants? If yes, you need to mention it here: Author response: Yes. Trained research assistants were employed on the project to assist in data collection. Reviewer comment: 3. Can you expound on this (sequential mixed method) more?: Sequential mixed method here implies timing in collection of the data. The phasing of how data were collected. Any sampling technique used?: Author response: Explanatory Sequential Design detailing two phase design, where quantitative data is collected and analyzed first, then qualitative data were also collected and analyzed based on the quantitative results. Reviewer comment: 4. Any particular reason or justification why only women within markets were considered? Working mothers in the title of your research is a broad group and it would be great to know why you scoped only market women: Author response: Working mothers have limited or no time to attend the available immunization centers because of the time-consuming age-long practices of traditional immunization centers, which can result in loss of time, wages and in some instances source of livelihood for these mothers. These partly culminate to low demand for childhood vaccination in addition, many working mothers in the informal sectors like the local markets miss out on community household’ immunization programmes due to the long hours they spend in the market and also because of the inconvenience of leaving their wares to attend immunization centers, and there are limited studies in Nigeria on mothers on informal economic space and childhood immunization in particular, thus this study was carried out. DISCUSSION SECTION Reviewer comment: 5. There is no conclusion in this manuscript. What important messages are you leaving your readers with?: Author response: Conclusively, working mothers’ awareness and knowledge about childhood immunization is not contextualize in practice thus leading to incomplete understanding and interpretation of vaccine and vaccination. Reviewer comment: 6.Similarly, no mention of the strengths and limitations of your work in this manuscript. Are there things you would have done differently had it been the circumstances were different: Author response: This study contribute to the discourse on childhood immunization by identifying socio-cultural, socio-economic and day-to-day taken for granted determinants that affect post-day one immunization among the study population, however, the study is limited in that the sample cannot be generalized for the whole of Nigeria or West Africa and the data that were collected represent western part of Nigeria. The study recommends further National studies. Reviewer comment: 1. Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the wrong hands, that is a risk!: Author response: The participants in this study were not exposed to any serious know risk. The research team employed various means of protection to minimize risk. Reviewer comment: 2. Conducting an interviewer-administered questionnaire for 1,044 persons is huge. Did you make use of research assistants? If yes, you need to mention it here: Author response: Yes. Trained research assistants were employed on the project to assist in data collection. Reviewer comment: 3. Can you expound on this (sequential mixed method) more?: Sequential mixed method here implies timing in collection of the data. The phasing of how data were collected. Any sampling technique used?: Author response: Explanatory Sequential Design detailing two phase design, where quantitative data is collected and analyzed first, then qualitative data were also collected and analyzed based on the quantitative results. Reviewer comment: 4. Any particular reason or justification why only women within markets were considered? Working mothers in the title of your research is a broad group and it would be great to know why you scoped only market women: Author response: Working mothers have limited or no time to attend the available immunization centers because of the time-consuming age-long practices of traditional immunization centers, which can result in loss of time, wages and in some instances source of livelihood for these mothers. These partly culminate to low demand for childhood vaccination in addition, many working mothers in the informal sectors like the local markets miss out on community household’ immunization programmes due to the long hours they spend in the market and also because of the inconvenience of leaving their wares to attend immunization centers, and there are limited studies in Nigeria on mothers on informal economic space and childhood immunization in particular, thus this study was carried out. DISCUSSION SECTION Reviewer comment: 5. There is no conclusion in this manuscript. What important messages are you leaving your readers with?: Author response: Conclusively, working mothers’ awareness and knowledge about childhood immunization is not contextualize in practice thus leading to incomplete understanding and interpretation of vaccine and vaccination. Reviewer comment: 6.Similarly, no mention of the strengths and limitations of your work in this manuscript. Are there things you would have done differently had it been the circumstances were different: Author response: This study contribute to the discourse on childhood immunization by identifying socio-cultural, socio-economic and day-to-day taken for granted determinants that affect post-day one immunization among the study population, however, the study is limited in that the sample cannot be generalized for the whole of Nigeria or West Africa and the data that were collected represent western part of Nigeria. The study recommends further National studies. Competing Interests: No competing Interest declared Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Sep 2024 mofeyisara omobowale , Institute of Child Health, University of Ibadan, Ibadan, Nigeria 05 Sep 2024 Author Response Reviewer comment: 1. Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the wrong hands, that ... Continue reading Reviewer comment: 1. Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the wrong hands, that is a risk!: Author response: The participants in this study were not exposed to any serious know risk. The research team employed various means of protection to minimize risk. Reviewer comment: 2. Conducting an interviewer-administered questionnaire for 1,044 persons is huge. Did you make use of research assistants? If yes, you need to mention it here: Author response: Yes. Trained research assistants were employed on the project to assist in data collection. Reviewer comment: 3. Can you expound on this (sequential mixed method) more?: Sequential mixed method here implies timing in collection of the data. The phasing of how data were collected. Any sampling technique used?: Author response: Explanatory Sequential Design detailing two phase design, where quantitative data is collected and analyzed first, then qualitative data were also collected and analyzed based on the quantitative results. Reviewer comment: 4. Any particular reason or justification why only women within markets were considered? Working mothers in the title of your research is a broad group and it would be great to know why you scoped only market women: Author response: Working mothers have limited or no time to attend the available immunization centers because of the time-consuming age-long practices of traditional immunization centers, which can result in loss of time, wages and in some instances source of livelihood for these mothers. These partly culminate to low demand for childhood vaccination in addition, many working mothers in the informal sectors like the local markets miss out on community household’ immunization programmes due to the long hours they spend in the market and also because of the inconvenience of leaving their wares to attend immunization centers, and there are limited studies in Nigeria on mothers on informal economic space and childhood immunization in particular, thus this study was carried out. DISCUSSION SECTION Reviewer comment: 5. There is no conclusion in this manuscript. What important messages are you leaving your readers with?: Author response: Conclusively, working mothers’ awareness and knowledge about childhood immunization is not contextualize in practice thus leading to incomplete understanding and interpretation of vaccine and vaccination. Reviewer comment: 6.Similarly, no mention of the strengths and limitations of your work in this manuscript. Are there things you would have done differently had it been the circumstances were different: Author response: This study contribute to the discourse on childhood immunization by identifying socio-cultural, socio-economic and day-to-day taken for granted determinants that affect post-day one immunization among the study population, however, the study is limited in that the sample cannot be generalized for the whole of Nigeria or West Africa and the data that were collected represent western part of Nigeria. The study recommends further National studies. Reviewer comment: 1. Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the wrong hands, that is a risk!: Author response: The participants in this study were not exposed to any serious know risk. The research team employed various means of protection to minimize risk. Reviewer comment: 2. Conducting an interviewer-administered questionnaire for 1,044 persons is huge. Did you make use of research assistants? If yes, you need to mention it here: Author response: Yes. Trained research assistants were employed on the project to assist in data collection. Reviewer comment: 3. Can you expound on this (sequential mixed method) more?: Sequential mixed method here implies timing in collection of the data. The phasing of how data were collected. Any sampling technique used?: Author response: Explanatory Sequential Design detailing two phase design, where quantitative data is collected and analyzed first, then qualitative data were also collected and analyzed based on the quantitative results. Reviewer comment: 4. Any particular reason or justification why only women within markets were considered? Working mothers in the title of your research is a broad group and it would be great to know why you scoped only market women: Author response: Working mothers have limited or no time to attend the available immunization centers because of the time-consuming age-long practices of traditional immunization centers, which can result in loss of time, wages and in some instances source of livelihood for these mothers. These partly culminate to low demand for childhood vaccination in addition, many working mothers in the informal sectors like the local markets miss out on community household’ immunization programmes due to the long hours they spend in the market and also because of the inconvenience of leaving their wares to attend immunization centers, and there are limited studies in Nigeria on mothers on informal economic space and childhood immunization in particular, thus this study was carried out. DISCUSSION SECTION Reviewer comment: 5. There is no conclusion in this manuscript. What important messages are you leaving your readers with?: Author response: Conclusively, working mothers’ awareness and knowledge about childhood immunization is not contextualize in practice thus leading to incomplete understanding and interpretation of vaccine and vaccination. Reviewer comment: 6.Similarly, no mention of the strengths and limitations of your work in this manuscript. Are there things you would have done differently had it been the circumstances were different: Author response: This study contribute to the discourse on childhood immunization by identifying socio-cultural, socio-economic and day-to-day taken for granted determinants that affect post-day one immunization among the study population, however, the study is limited in that the sample cannot be generalized for the whole of Nigeria or West Africa and the data that were collected represent western part of Nigeria. The study recommends further National studies. Competing Interests: No competing Interest declared Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 31 May 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 Version 2 (revision) 27 May 25 read Version 1 31 May 24 read read read Charles Olomofe , East Tennessee State University, Johnson City, USA Olayinka Ibrahim , University of Ilorin Teaching Hospital,, Ilorin, Nigeria; University of Global Health Equity, Kigali, Rwanda Monica Jain , International Initiative for Impact Evaluation, Washington, USA Kennedy Oberhiri Obohwemu , Oxford Brookes University, Oxford, UK Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Obohwemu K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Jul 2025 | for Version 2 Kennedy Oberhiri Obohwemu , Oxford Brookes University, Oxford, England, UK 0 Views copyright © 2025 Obohwemu K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have written a robust, well-conceptualized mixed-methods study that investigates a critical and understudied public health issue—vaccine drop-off rates beyond initial immunization among informal working mothers in urban Nigeria. The paper is theoretically grounded, methodologically sound, and socio-culturally nuanced. Below is a detailed critique evaluating its strengths, limitations, and overall contribution to the field. Strengths of the Study Rich Contextualization and Relevance : The article is commendable for its sociocultural depth. By focusing specifically on informal working mothers in Ibadan—a population structurally disadvantaged yet often underrepresented in immunization research—it unearths a unique set of barriers to vaccine completion. This focus helps bridge the gap between broad immunization statistics and lived maternal experiences. Comprehensive Mixed-Methods Design : The use of both quantitative (n=1,044) and qualitative (n=73) methods allows for a triangulated understanding of immunization behavior. Quantitative data offers generalizable trends, while qualitative narratives expose perceptions, misinterpretations, and coping strategies. The study design is particularly strong due to the explanatory sequential approach, where qualitative findings enrich statistical results. Thematic Depth and Cultural Translation : The research captures how mothers linguistically and conceptually understand vaccines (e.g., polio referred to as “romolapa-romolese”). This enables practical recommendations such as translating medical terms into indigenous languages, a culturally sensitive strategy often lacking in conventional health communication campaigns. Inclusion of Non-NPI Vaccines : The study’s attention to “special vaccines” like Rotavirus and PCV—often missed due to cost or unawareness—highlights systemic inequities between public health offerings and actual community needs. This issue is particularly relevant in low-income settings where public immunization schedules lag behind WHO-recommended comprehensive coverage. Policy and Practice Implications : The article recommends actionable solutions, including improved health education, decentralization of services, and financial subsidies for non-NPI vaccines. These recommendations align well with Nigeria's current efforts to improve immunization uptake and are grounded in empirical evidence from the field. Limitations and Areas for Improvement Limited Generalizability : While the study provides detailed insights into Ibadan’s informal working mothers, the findings may not be representative of all Nigerian or West African contexts. The authors acknowledge this but a clearer delimitation in the abstract and discussion would strengthen interpretive caution. Inconsistent Presentation of Data : While the data are rich, the structure of tables and figures is not consistently integrated into the discussion. For example, the completion rates for various vaccines are compelling but are sometimes buried in narrative instead of clearly tabulated or visually summarized. Overextended Qualitative Quotations : The study would benefit from a tighter synthesis of qualitative data. While the inclusion of participant voices is vital, some quotes are unnecessarily long and repetitive. More concise, thematic presentation (e.g., matrix tables with representative quotes) would increase clarity. Vaccine Knowledge Assessment Lacks Quantification : Although mothers’ knowledge gaps are described vividly, the study could be improved by quantifying these gaps—perhaps via a vaccine knowledge index or score—so that educational deficiencies can be measured and tracked over time. Absence of Health Worker Perspectives : While the study mentions interviews with health workers, their perspectives are not sufficiently integrated into the analysis. Understanding their constraints (e.g., time pressures, vaccine stock-outs) would complement the maternal narratives and provide a more complete view of the service delivery ecosystem. Lack of Analytical Rigor on Causal Factors : Although chi-square and t-tests were used, multivariate logistic regression could have offered more nuanced insights into which variables most strongly predict immunization drop-off. Without this, the interpretation of associations remains largely descriptive. No Formal Strengths and Limitations Section : The study’s discussion informally mentions limitations, but it lacks a clearly delineated section summarizing the methodological constraints and their potential impact. Formalizing this would align the paper more closely with standard reporting guidelines like STROBE or COREQ. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Epidemiology of infectious and non-infectious diseases, Vaccinations, Public health promotion I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Obohwemu KO. Peer Review Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.17713.r39706) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v2#referee-response-39706 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Jain M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Sep 2024 | for Version 1 Monica Jain , International Initiative for Impact Evaluation, Washington, District of Columbia, USA 0 Views copyright © 2024 Jain M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The study has an important objective of understanding of informal working mothers of the concept of immunization, vaccines not under the National Program on Immunization (NPI), immunization schedule and period as well as the timing and duration of the immunization. My main comments are as follows: The paper needs major editing as there is a significant repetition in different sections of the papers and correction in errors leave some sentences hanging and make it difficult to follow authors’ reasoning. Methods - Which software was used for doing the process coding and content analysis? Methods – While authors mention that that markets were randomly selected, they do not mention the criteria of selection of women within the markets. The authors mention – ‘’However, in all the markets, market leaders and significant others of the mothers had earlier been identified, visited, and carried along from the inception of the study.’’ What is the role of the market leaders and significant others in the study design, data and analysis? Statistical analysis – In table 3 – What is general population being referred to? Is it an average of urban and rural population? Statistical analysis - In figure 1 – the number of PCV or OPV vaccination is not visible. It would be useful to provide a rationale for understanding the uptake of ‘’special vaccines’’ not under NPI? Also, what vaccines are under this ‘’special vaccines’’ category? In one part of the paper authors mention ‘’the factors contributing to incomplete immunization rate among mothers, which are the cost of special vaccines, such as Rotavirus.’’ If the vaccines are not part of the national immunization schedule, should they be included in estimation of immunization completion rate? Are these vaccines used in calculating childhood immunization completion rate and drop-off rate in Table 3? If not, then it may be useful to differentiate between the immunization completion rates under the NPI schedule and those with special vaccines. Can the authors shed more light on the ‘’supplements’’ that they have mentioned in the paper? Why are these supplements important to discuss in relation to immunization uptake? The results based on qualitative data contain too many similar quotes. Removing similar quotes will improve readability of the paper. Authors mention – ‘’In some cases, many of them despite being married, still remained “breadwinners” in their families’’. It is not clear what the authors are suggesting about roles of women and their work status and after marriage. Authors mention – ‘’Rather than an exercise, childhood immunization is a culture, which should be preserved through the socialization process and passed down from generation to generation. With such a preservation culture, it is mandatory for all mothers to immunize their child(ren).’’ Are the authors implying that childhood immunization is embedded in the culture so much so that it is mandatory for mothers to immunize their children? Please clarify the argument being made here and its implication. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Public health policy with specialization in immunization of children. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Jain M. Peer Review Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.16473.r37382) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v1#referee-response-37382 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Ibrahim O. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 22 Jul 2024 | for Version 1 Olayinka Ibrahim , University of Ilorin Teaching Hospital,, Ilorin, Nigeria; Pediatrics, University of Global Health Equity, Kigali, Kigali, Rwanda 0 Views copyright © 2024 Ibrahim O. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Re: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan Comments Title “Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan” This title is too technical for general audience and a bit confusing, what is post day-one childhood immunization? Is after birth? Is first dose irrespective of date vaccine is received? The phrase is unclear? This should be modified. Immunization is an important, and audience go beyond medical personnel's. Also, be specific. add informal working mother: Typical understanding of a working mothers in Nigeria refers to those in formal sector, and also, include country? Not everyone knows Ibadan Globally Abstract Aims: “perceive post-day-one routine immunization” –this manuscript did not access post one day routine immunization but rather mothers’ perception and knowledge of immunization along with other itemized aims. Methods “ working nursing mothers” qualify it further: informal working nursing mothers. Results: Average age (mean) should be presented along the standard deviation. “The mean age of mothers at their first childbirth within the study group was 24.12 years” delete, it is not adding any information Results A “significant majority” of these mothers 95%) are married—delete significant “ livelihood related causes” include the related causes? Though I find it difficult to locate in the manuscript Conclusion “ It is crucial for mothers to possess comprehensive knowledge about the mechanics and operation of immunization” ?difficult to discern this the manuscript Introduction Unduly long with most concept repeated; this should be reduce and preferably about half of the current number of pages. Methods When was this data collected??? “A total of 1,044 (quantitative samples)” ? How is this sample size derived? Provide the details, The qualitative sample is adequate. “Immunization record assessment” how was this done? Provide the details. “Health workers in the selected study sites” were they part of the qualitative vs quantitative? I did see their findings in the results. What informed the sampling of 13 markets? How were the1,044 mothers recruited across these markets? “The dataset was retrieved and analyzed using statistical packages for Social Sciences (SPSS, version 20 windows). Data were represented by numbers, percentages and expressed by mean. Chi-square test was used to observe the difference between the proportions, t-test was applied to observe- the difference between the two means for normally distributed data” I guess this was the quantitative arm of the study, kindly specify Also, this too generic, give details of how each variable was handled. Indeed, there was no a single inferential statistics? Results All the mean should be accompanied with their respective standard deviations “The mean age of mothers enrolled in this study was 31.39 years. The mean age of mothers at first childbirth in the study population is 24.12 years” difficult to understand while the mean age of the mother and mean age at first childbirth? Look more of tautology??? The most important- age of the children of the mothers’ recruited is missing, which will guide in the interpretation of the data? “The majority of mothers (53.8%)” In science 53% is not majority? Rather report as about half of the mothers “The majority of the mothers (95%) in this study were married while only 43 (4.2%) were single. The majority of mothers (82.9%) that had antenatal care during their pregnancy attended health care facilities for their antenatal services, while 13.6% had their antenatal care in faith homes. About 76% and 16.4% of respondents in this population delivered their last child at a healthcare facility and mission house, respectively” These information are incomplete and yet there is no reference Table??? Besides, most of the information was not subjected to statistical analysis? What is there relevance “A higher number of mothers in the urban markets completed the immunization schedule for their children till the 14th week (42.57%) and the ninth month (33.95%)”- you can not use completion rate rate for 14 th week because it is not the end point, similar observation for 9 months- kindly revise and use drop off rate. “Completion rates in Table 3 were visibly lower among children of mothers in the rural market. More than half (53.3%) of the children of mothers in the rural markets dropped off the immunization schedule before they were fully vaccinated” you cannot make this conclusion without inferential statistics,-cursory look is insufficient. Table 1: provide the details of “others” as footnote “Table showing the highest educational attainment by mothers in the study. This table shows 37 of the mothers do not have any form of education, the majority (536) completed secondary school education and 180, making about 18% had tertiary education degrees” Delete…you can not have a prose repetition of a Table “About 48 mothers” humans are countable noun and can not be about? Table 2: Present column one in days for consistency and need for clarity does within first week include day zero, does within second week include preceding days Table 3: Insert n? percent's alone does not convey the true meanings? Delete completion rate, you can specify drop rate at 14 weeks, at 9 months? Nothing like completion rate- it gives impression as if it is satisfactory . Delete the footnote, besides it was a wrong interpretation. Figure 1: Again the completion rate is confusing? This figure should n somewhere? “Post-day-one childhood immunization is an exercise that should be taken seriously. In explaining some of the diseases that post-day-one immunization prevents” ? birth dose vaccines are equally important (hepatitis B, Polio and BCG? “However, in spite of the working mothers’ enlightenment on childhood immunization, some of the mothers do not know the specific vaccines their children receive. Many of them take the vaccines as instructed and on the general assumption that ‘it is good for children’ as adduced by one of the interviewees” It would have been good to also find out why don’t know the names? Are their local names for these vaccines? “supplements’ this term needs to be defined? Supplement may mean different things to different people. Also, I used to hear the advertisement, because they don’t write the name of the vaccine for us, they just write 3 letters, and you know it is only the nurses who know what they mean by that” Partly it is not their faulty, if they were not told ? efforts should be made to teach the mothers the corresponding local names for these vaccines if there is any? iko ahubi (coarse cough)? Am not sure the correct interpretation/translation is coarse cough -rather cough with post-tussive vomiting/pertussis), “Of all the vaccines, the BCG is very important, the PCV, and the Rotavirus. They are all good. For the Rotavirus, if not that it is expensive for most of the parents, it would have been good for everybody to take it for their children (Gbagi IDI)” am not sure when this data was collected but you should discuss with current NPI schedules, Rota Virus is now part of our routine immunization and PCV has already been part of pentavalent. “Rotavirus is very low as shown that only a 7.5% rate had been completed (Table 2).? I can not see this in Table 2??? “ Mothers/caregivers’ knowledge of routine childhood immunization and vaccination status in children aged, 12-23 months in Ilorin, Nigeria ; SO Ariyibi, AI Ojuawo, RM Ibraheem, FM Afolayan, OR Ibrahim African Health Sciences 23 (4), 582-591 Above article may be relevant for your discussion. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly References 1. Ariyibi SO, Ojuawo AI, Ibraheem RM, Afolayan FM, et al.: Mothers/caregivers' knowledge of routine childhood immunization and vaccination status in children aged, 12-23 months in Ilorin, Nigeria. Afr Health Sci . 2023; 23 (4): 582-591 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Pediatric Infectious disease, General Pediatrics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 09 Sep 2024 mofeyisara omobowale, Institute of Child Health, University of Ibadan, Ibadan, Nigeria Dear Reviewer, Thank you for your insightful review. All suggestions have been examined and used in the improvement of the manuscript. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Ibrahim O. Peer Review Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.16473.r37387) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v1#referee-response-37387 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Olomofe C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Jul 2024 | for Version 1 Charles Olomofe , East Tennessee State University, Johnson City, Tennessee, USA 0 Views copyright © 2024 Olomofe C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I have a few comments on the research. METHODS SECTION Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the wrong hands, that is a risk! Conducting an interviewer-administered questionnaire for 1,044 persons is huge. Did you make use of research assistants? If yes, you need to mention it here. Moreover, which language was this questionnaire administered? Was Yoruba language employed at any point? If yes, was a back translations done? Can you expound on this (sequential mixed method) more? Any sampling technique used? Any particular reason or justification why only women within markets were considered? Working mothers in the title of your research is a broad group and it would be great to know why you scoped only market women. DISCUSSION SECTION There is no conclusion in this manuscript. What important messages are you leaving your readers with? Similarly, no mention of the strengths and limitations of your work in this manuscript. Are there things you would have done differently had it been the circumstances were different Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Infectious disease epidemiology and vaccine research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 05 Sep 2024 mofeyisara omobowale, Institute of Child Health, University of Ibadan, Ibadan, Nigeria Reviewer comment: 1. Every research carries risk. I would rather say the risk is minimal. What about the data that was collected? If it gets into the wrong hands, that is a risk!: Author response: The participants in this study were not exposed to any serious know risk. The research team employed various means of protection to minimize risk. Reviewer comment: 2. Conducting an interviewer-administered questionnaire for 1,044 persons is huge. Did you make use of research assistants? If yes, you need to mention it here: Author response: Yes. Trained research assistants were employed on the project to assist in data collection. Reviewer comment: 3. Can you expound on this (sequential mixed method) more?: Sequential mixed method here implies timing in collection of the data. The phasing of how data were collected. Any sampling technique used?: Author response: Explanatory Sequential Design detailing two phase design, where quantitative data is collected and analyzed first, then qualitative data were also collected and analyzed based on the quantitative results. Reviewer comment: 4. Any particular reason or justification why only women within markets were considered? Working mothers in the title of your research is a broad group and it would be great to know why you scoped only market women: Author response: Working mothers have limited or no time to attend the available immunization centers because of the time-consuming age-long practices of traditional immunization centers, which can result in loss of time, wages and in some instances source of livelihood for these mothers. These partly culminate to low demand for childhood vaccination in addition, many working mothers in the informal sectors like the local markets miss out on community household’ immunization programmes due to the long hours they spend in the market and also because of the inconvenience of leaving their wares to attend immunization centers, and there are limited studies in Nigeria on mothers on informal economic space and childhood immunization in particular, thus this study was carried out. DISCUSSION SECTION Reviewer comment: 5. There is no conclusion in this manuscript. What important messages are you leaving your readers with?: Author response: Conclusively, working mothers’ awareness and knowledge about childhood immunization is not contextualize in practice thus leading to incomplete understanding and interpretation of vaccine and vaccination. Reviewer comment: 6.Similarly, no mention of the strengths and limitations of your work in this manuscript. Are there things you would have done differently had it been the circumstances were different: Author response: This study contribute to the discourse on childhood immunization by identifying socio-cultural, socio-economic and day-to-day taken for granted determinants that affect post-day one immunization among the study population, however, the study is limited in that the sample cannot be generalized for the whole of Nigeria or West Africa and the data that were collected represent western part of Nigeria. The study recommends further National studies. View more View less Competing Interests No competing Interest declared reply Respond Report a concern Olomofe C. Peer Review Report For: Contextualizing post day-one childhood immunization in-take drop-off rate in Nigeria: An assessment of working mothers in Ibadan [version 2; peer review: 1 approved, 3 approved with reservations] . Gates Open Res 2025, 8 :48 ( https://doi.org/10.21956/gatesopenres.16473.r37252) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-48/v1#referee-response-37252 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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