Bayero University Kano; Ahmadu Bello University Zaria; National Programme on Immunisation
This study was commissioned by the National Programme on Immunisation (NPI) and looked to examine knowledge, attitude and perceptions regarding vaccination in 11 states in northern Nigeria. Specifically, these parameters included awareness of the protective properties of vaccines; reasons for acceptance of poliomyelitis immunisation; reasons for rejection of polio vaccines; and reasons for poor uptake or rejection of immunisation. Based on their findings, investigators concluded that: the majority of respondents were aware of common childhood illnesses and their preventative measures; the attitude of most mothers/caregivers towards immunisation services is positive and relies on the efficacy of the vaccine to protect against disease; there was a poor attitude towards polio immunisation among respondents who believe that it contains anti-fertility agents; decision-making on immunisation of a child lies predominantly on the father; and, if polio vaccination was rejected it was because of rumours, frequency of rounds, non-payment of charges, and the priority accorded to it in preference to more severe diseases. This data was used to form a comprehensive list of programme recommendations, to guide overall implementation as well as address specific key issues.
The 11 high-risk polio states under consideration in this study included Kano, Katsina, Kaduna, Zamfara, Sokoto, Kebbi, Jigawa, Bauchi, Yoba, Borno and Adamawa. An estimated 68.9 million people reside in this northern part of the country. During the quantitative portion of this study, one urban and two rural local government areas (LGAs) were selected randomly from each state, and a six part-questionnaire was administered to adults from each of these areas. The qualitative assessment focused on mothers, fathers, other caregivers, opinion leaders, traditional and political leaders in three LGAs, and included key informant interviews (KIIs) and focus group discussions (FGDs). A total of six FGDs and six KIIS were conducted per LGA, and 18 per state respectively, for a total of 20,576 respondents who completed the questionnaires.
Most respondents could identify the most common childhood diseases, and attributed their spread to factors such as bad food, bad water, weather conditions, poor environmental sanitation, inadequate childcare, mosquito bites and insufficient food intake. A severe lack of knowledge regarding the causative agent of poliomyelitis was observed, and in many cases respondents attributed this to evil spirits, Inna [a feminine spirit] or other unscientific phenomena.
The proportion of respondents that had heard of childhood immunisation was high, ranging from 86.5% in Kebbi state to 98.9% in Kaduna state. Knowledge related to dosage of polio vaccine varied, ranging from 1.6% in respondents in Bauchi state who believe that children need only one dose of polio vaccine, to 23.3% of their counterparts in Kano state. In Yobe, 52.9% of parents were ignorant of the number of doses of polio vaccine required. A substantial proportion of respondents in all states wrongfully believed that administering more than four doses of polio vaccine is harmful to a child, ranging from 12.6% in Bauchi to 32.2% in Jigawa.
The proportion of respondents that accepted that children should be immunised was high across all states, ranging from 80.2% in Zamfara to 93.8% in Kaduna state. When asked specifically about oral polio vaccine (OPV), those rejecting the vaccine gave reasons such as: children develop polio even after the vaccination; they have a fear of side effects; they have no faith in the vaccine; they believe the vaccine is unnecessary; they believe the vaccine contains HIV or contraceptives; and using the vaccine would be contrary to their religion. The study enumerates actual reasons for poor uptake of immunisation for each state.
Conclusions and Implications for Actions
Based on the findings of the study, a list of fifteen main conclusions were generated, including the following:
- Majority of the caregivers, mothers and other opinion leaders do not believe that immunisation has negative effects except for a few who believe it may cause infertility, paralysis, abscess, and infections like HIV/AIDS.
- Most mothers/caregivers would prefer qualified health workers to administer polio vaccine and other vaccines to their children.
- Rumours surrounding OPV and ignorance about the disease poliomyelitis contribute significantly to the lack of acceptance of the vaccine in the study area.
- There are certain groups that are known for rejecting polio and other vaccines. These include some Muslim communities, the rural Fulanis, Islamic religious leaders, the uneducated or illiterate, Hausas, Januris, Shuwa Arabs and migrants from the Niger Republic.
- Most respondents are not aware of contraindications to immunisation except for fever and age.
- Most mothers, caregivers and opinion leaders were satisfied with immunisation programmes in the study area.
In light of the findings of the survey, recommendations for the improvement of Nigeria’s National Programme on Immunisation were proffered, with a focus on polio vaccination. A few of these are highlighted below:
A. General Recommendations
- There must be an organised programme for the education of the public on the vaccine preventable diseases using appropriate channels of communication.
- Public health education messages should include the causes, risk factors, transmission/spread, preventative strategies, side effects and contraindications to immunisation.
- All components of immunisation should be free, including the cost of needles and syringes.
- The NPI should conduct period health systems research to identify hindrances to the effective delivery of routine immunisation at household and community levels.
B. Specific Recommendations
- Prepare packages on frequently asked questions for all health workers, especially before vaccination campaigns or introduction of new vaccines.
- Keep radio, TV and other media on board.
- The NPI should hold special dialogue on a periodic basis with minority and highly resistant groups with a view to mobilising them to accept immunisation services.
- Schedule Expanded Programme on Immunisation (EPI) campaigns outside the timeframe for family planning or AIDS awareness campaigns.
Other recommendations focused on mechanisms for the intergration of immunisation with primary health care services, and the importance of encouraging a paradigm shift from vaccination campaigns to routine immunisation strategies.
For a copy of the full study, please contact Dr. Mizan
Siddiqi at the address below.