Community Engagement, Routine Immunization, and the Polio Legacy in Northern Nigeria

Abstract

Northern Nigeria has a history of low use of health services, resistance to immunization programs, and high maternal and child mortality rates. Cultural, physical, and financial barriers prevent many families from accessing health care. The Partnership for Reviving Routine Immunization in Northern Nigeria; Maternal, Newborn, and Child Health Initiative (PRRINN-MNCH) was a project funded by the UK Department of International Development and the Norwegian government that used an integrated approach to strengthen health services and increase community demand for and access to quality health care. The project's community engagement approach aimed to empower communities, work with volunteers, and develop solutions to overcome barriers to health. Simultaneously, PRRINN-MNCH was building primary health care systems, including immunization, and strengthening governance to increase the availability and quality of services. Baseline and endline population-based random household surveys conducted in 2009 and 2013 showed improved community knowledge, increased use of antenatal care and immunization services, and a decrease in maternal, infant, and under-5 mortality. In the project areas, the maternal mortality ratio fell from 1,270 to 1,057; under-5 mortality decreased from 160 to 90.1 per 1,000 live births, and infant mortality decreased from 90 to 46.9 per 1,000 live births. The overall coverage of fully immunized children rose from 2.2% to 19.3%. Many of the PRRINN-MNCH lessons learned about community engagement are relevant to the Polio Eradication Initiative when Nigeria reaches polio-free status and community mobilizers are mainstreamed into routine health services.

Perceptions and experiences of childhood vaccination communication strategies among caregivers and health workers in Nigeria: A qualitative study

“…Community members may, therefore, be more likely to act on information delivered by these leaders compared to those delivered by health workers. Several studies, suggest that involving traditional and religious leaders as part of the immunization programme could improve vaccination communication delivery, may contribute to improving childhood vaccination uptake [ 41 – 45 ]as well as address vaccine refusals [ 46 ]. In order to strengthen the routine immunization programme and consolidate on the gains from the polio programme it might be beneficial that they be actively engaged for routine vaccination services.…”

“…This was also the focus of a recent study from Northern Nigeria where health messages were targeted at respected or influential men in order to enable social approval and encourage the use of service. This strategy was seen to produce positive results and accepted by the men in these settings[ 45 ].…”

Using the COMMVAC taxonomy to map vaccination communication interventions in Mozambique

“…Health workers or town announcers in schools, churches, used printed materials such as posters, banners, and leaflets to remind or recall in Nigeria; and the mass media (radio and television) and announcements or mosques were used to remind or recall in both Nigeria and Cameroon. In these two countries, the range and frequency of communication interventions for routine vaccination is much greater than that observed in Mozambique, perhaps due to the extra resources available for polio eradication as both countries were still reporting wild poliovirus cases at the time of the studies [29,30]. …”

A mixed method approach for the assessment of demand creation intervention strategy for polio eradication on exclusive breast feeding in Northern Nigeria

“…There are two major interventions that are given high priority for improving the health of the Nigerian child. One of it is the eradication of poliomyelitis (NPHCDA, 2016;McArthur-Lloyd et al, 2016;Oyo-Ita et al, 2016;Warigon et al, 2016). The other is promotion of exclusive breastfeeding (EBF) for infants (WHO, 2000).…”