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Rural-urban disparities in maternal immunization knowledge and childhood health-seeking behavior in Nigeria: a mixed method study Okafor, Ifeoma P; Dolapo, Duro C; Onigbogi, Modupe O & Iloabuchi, Iruoma G Abstract Background: Immunization and appropriate health-seeking behavior are effective strategies to reduce child deaths. Objectives: To compare maternal knowledge about immunization, use of growth chart and childhood health-seeking behavior in rural and urban areas. Methods: A cross-sectional comparative study done in Lagos, Nigeria. Questionnaire survey and focus group discussions were done. 300 respondents were selected by multi-stage sampling while discussants were purposively selected. Results: Awareness of immunization was high but knowledge of vaccine preventable diseases (VPDs) was poor in both areas. Urban women utilized preventive services more; growth monitoring (p<0.001) and immunization (p<0.001) while higher proportions of rural women utilized nutritional counseling (p=0.005) and treatment of illness (p<0.001). Growth chart utilization was better in the urban areas (p<0.001). Increasing maternal education increased use of growth chart in both areas. Both groups of women use multiple treatment sources for children (more in urban), determined by cost, time, perceived severity of illness and type of ailment (urban) and peculiarity of illness (rural). There is a preference for orthodox care in the rural area. Conclusions: Knowledge of VPDs was poor and multiple treatment sources were common among rural and urban women. Education is vital to improve immunization knowledge and health-seeking behavior in both areas. Keywords Immunization; growth chart; health-seeking behavior; child health; Nigeria

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