© Kamla-Raj 2009 Ethno-Med, 3(1): 49-56 (2009) The Social Determinants of Routine Immunisation in Ekiti State of Nigeria Christopher Oluwadare Department of Sociology, University of Ado Ekiti, P.M.B.5363, Ado Ekiti, Nigeria E- mail: ctoluwadare@yahoo.co.uk KEYWORDS Health. Poverty. Factors. Infant. Child Mortality ABSTRACT The greatest challenge to child health in sub Saharan Africa is poor immunization service for major child illnesses. The World Health Organisation’s (WHO) review of the health systems of the World, looking at various health indicators including child mortality, in the year 2003 placed Nigeria in 187 th position among 191 countries, and little has been achieved since then. This paper is an overview of routine immunization in Ekiti State of Nigeria. The State serves as a case for understanding the prospects and challenges of child health care in South Nigeria. The study used qualitative data derived from focus group discussions and key informants and secondary data of state and national surveys. The findings identify factors that account for the relative poor immunization coverage. The salient issues include ignorance and social cost of access to the service. Also the quality of the immunization service: availability to the remote areas, health personnel commitment, and consistent availability account for low coverage. It is concluded and recommended that there is a need for improvement in the supply side of immunization service especially taken the service to the physically and socially marginalized areas and also extend the campaigns for immunizations beyond the current emphasis on Polio vaccination to incorporate other antigens. INTRODUCTION Nigeria has a very high under –five and infant mortality rates of 201 and 100 respectively. This is one of the highest in the world. Most of the childhood deaths are due to malaria, diarrhoea, pneumonia, measles and malnutrition. Also due to the significant population size of the country, childhood mortality accounts for a significant percentage of deaths nationally (Nigeria Demographic and Health Survey (NDHS), 2003). This situation is directly related to the worsening condition of health care services which include the Maternal and Child Health (MCH) programmes. One global health intervention to improve child health is the Extended Programme of Immunisation (EPI). Generally the whole Nigerian health system is facing great challenges. It is noted that more than half of child deliveries take place outside of the modern health facility and the use of child preventive health service is low. (Oral rehydration therapy, treated bed nets, breastfeeding and immunisation) (Dada 2005). The Extended Programme on immunisation, introduced in 1979 with the aim of providing routine immunisation to children less than the age of two years, recorded initial but intermittent successes. The optimum level was recorded by early 1990s with the country achieving universal childhood immunisation of 81.5 percent coverage. But since that period of success, Nigeria has witnessed gradual but consistent reduction in immunisation coverage. By 1996, the national coverage data showed less than 30% coverage for the entire antigens, by the 1999 NDHS, this has reduced to 16.8% for all antigens and by 2003, it was 12.9% (Babalola and Olabisi 2004). This figure is consistent with the 2003 National Immunisation coverage survey figure. This current national figure is among the lowest in the world and explains the poor health status of children in the country; the worst in the west African sub region, only better than Sierra Leone. For instance the Polio epidemic in Nigeria is the worst in the African region also constituting a threat to other nations (Green 2004). This epidemic is a reflection of the growing concern for the worsening human development index of the country, the millennium development goals of reducing child mortality and improving survival by 2015 is frustrated by the poor immu- nisation service. There is therefore the urgent need to address specifically and concretely the problem facing immunisation activities in the country. Most data available is not aggregated to ethnic, state and social conditions of the population and health interventions have also been generic. These produce little return for the