Breaking community barriers to polio vaccination in northern Nigeria: the impact of a grass roots mobilization campaign (Majigi)

Abstract

This paper examines the impact of a community-based intervention on the trends in the uptake of polio vaccination following a community mobilization campaign for polio eradication in northern Nigeria. Uptake of polio vaccination in high-risk communities in this region has been considerably low despite routine and supplemental vaccination activities. Large numbers of children are left unvaccinated because of community misconceptions and distrust regarding the cause of the disease and the safety of the polio vaccine. The Majigi polio campaign was initiated in 2008 as a pilot trial in Gezawa, a local council with very low uptake of polio vaccination. The average monthly increase in the number of vaccinated children over the subsequent six months after the pilot trial was 1,047 [95% confidence interval (CI): 647-2045, P50.001]. An increasing trend in uptake of polio vaccination was also evident (P50.001). The outcome was consistent with a decrease or no trend in the detection of children with zero doses. The average monthly decrease in the number of children with zero doses was 6.2 (95% CI: 221 to 24, P50.353). Overall, there was a relative increase of approximately 310% in the polio vaccination uptake and a net reduction of 29% of never vaccinated children. The findings of this pilot test show that polio vaccination uptake can be enhanced by programs like Majigi that promote effective communication with the community.

Strategies intended to address vaccine hesitancy: Review of published reviews

“…Determinants of hesitancy in mass campaigns vary and include convenience, confidence and complacency factors, as also seen with routine programmes [62]. While neither the systematic review of strategies [63] nor the reviews examined in this article have focused on interventional research in the context of mass campaigns, the Working Group did note that successful mass campaigns had a number of common features; these include the polio elimination campaign in India [64] (although the reaction to the mass polio campaign approach has also provoked distrust in some countries), [65] polio virus containment in Israel in 2013, [66] meningococcal A campaigns in several countries in the African meningitis belt [67,68] and meningococcal C outbreak control campaigns in high-income countries, [69]. In each case, the vaccine-preventable disease was well known and feared.…”

Public trust and vaccine acceptance-international perspectives

“…One example is a successful grass roots mobilization campaign in Nigeria that actively engaged political, traditional and religious leaders to participate in the vaccination campaign by showing road side films on polio from mobile vans in communities. 41 Such successful interventions need to be replicated and sustained for longer periods of time, engaging all stakeholders in the development and dissemination of effective messages around vaccines. Community engagement in these interventions can also help foster partnerships between those who develop and implement immunization programs and those who influence community beliefs.…”

Strategies to Overcome Vaccine Hesitancy: A Systematic Review

“…Among the evaluated peer-reviewed literature, nine were related to community health trainings theme, [11][12][13][14][15][16][17][18][19][20] five were related to incentive-based approach, [21][22][23][24] eight were related to technology-based health literacy, [14,20,[28][29][30][31][32][33][34][35][36][37][38] and eleven were related to media engagement (Tables 1 and 2). [12,[36][37][38][39] vaccine. Lack of knowledge, negative parental attitude, and misconceptions were the foremost encountered causes for vaccine hesitancy that were addressed predominantly by health workers/medical interns.…”

“…[11,12,14,15,20] Home visits and information campaigns were the most common types of community training modalities except for the two studies that had personally controlled health management systems (PCHMS) and community-level nutrition information system for action (COLNISA) as community health training strategies that led to an overall 21% to 33% rise in vaccine coverage. [37,38,41,42] Community activity for systematic engagement of parents and home visits by community health workers and medical interns significantly improved program acceptance and utilization of immunization services (Table 2).…”