Urban–Rural Disparities in Male Involvement in Birth Preparedness and Childhood Immunization in Rivers State, Nigeria

Abstract

Background: Male involvement in birth preparedness and childhood immunization improves maternal and child health outcomes but remains underutilized in sub-Saharan Africa. Comparative rural‑urban data from Nigeria's South‑south region are scarce. This study compared male involvement in birth preparedness and childhood immunization between rural and urban communities in Rivers State, Nigeria. Methods: This community‑based comparative cross‑sectional study enrolled 450 men (225 urban, 225 rural) with a youngest child aged 0‑24 months. Data were collected using an interviewer‑administered questionnaire adapted from validated tools. Male involvement was assessed using composite scores for birth preparedness and childhood immunization. Data were analyzed using chi-square tests and multivariable logistic regression, with interaction and sensitivity analyses. Results: Men in urban areas had significantly higher good involvement in birth preparedness (60.9% versus 43.8%, p<0.001) and childhood immunization (57.3% versus 40.4%, p=0.001) compared to men in the rural areas. Independent predictors were urban residence (AOR=2.14), tertiary education (AOR=2.67), high income (AOR=1.89), and knowledge of maternal health services (AOR=3.05). Interaction analysis reported that tertiary education was more impactful in urban areas (AOR=3.21), while high income was more important in rural areas (AOR=2.31). Men in the rural areas were more frequently identified as cultural barriers (58.2% viewed maternal and child health as women’s responsibility) and reported a lack of male‑friendly spaces (61.8%). Sensitivity analysis confirmed robustness of findings. Conclusion:  Male involvement is substantially higher in urban than rural Rivers State. Education drives urban engagement; household income is the key modifiable factor in rural areas. Context‑specific interventions should address economic barriers in rural communities and cultural norms across both settings.