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Communication strategies to promote the uptake of childhood vaccination in Nigeria: a systematic map

Tuesday, 15th of March 2016

Communication strategies to promote the uptake of childhood vaccination in Nigeria: a systematic map

Afiong Oku^1*, Angela Oyo-Ita¹, Claire Glenton², Atle Fretheim^2,3, Heather Ames², Artur Muloliwa⁴, Jessica Kaufman⁵, Sophie Hill⁵, Julie Cliff⁶, Yuri Cartier⁷, Xavier Bosch-Capblanch^8,9, Gabriel Rada¹⁰ and Simon Lewin^2,11

 

¹Community Medicine Department, University of Calabar, Calabar, Nigeria; ²Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway; ³Institute of Health and Society, University of Oslo, Oslo, Norway; ⁴Departamento de Saúde, Direcção Provincial de Saúde de Nampula, Nampula, Mozambique; ⁵Department of Human Biosciences, Centre for Health Communication and Participation, College of Science, Health and Engineering La Trobe University, Melbourne, Australia; ⁶Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; ⁷International Union for Health Promotion and Education, Cedex, France; ⁸Swiss Tropical and Public Health Institute, Basel, Switzerland; ⁹University of Basel, Basel, Switzerland; ¹⁰Evidence-based Healthcare Program, Pontificia Universidad Católica de Chile, Santiago, Chile; ¹¹Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa

 

excerpts below; full text is at http://www.globalhealthaction.net/index.php/gha/article/view/30337/0

ABSTRACT

Background: Effective communication is a critical component in ensuring that children are fully vaccinated. Although numerous communication interventions have been proposed and implemented in various parts of Nigeria, the range of communication strategies used has not yet been mapped systematically. This study forms part of the ´Communicate to vaccinate´ (COMMVAC) project, an initiative aimed at building research evidence for improving communication with parents and communities about childhood vaccinations in low- and middle-income countries.

Objective: This study aims to: 1) identify the communication strategies used in two states in Nigeria; 2) map these strategies against the existing COMMVAC taxonomy, a global taxonomy of vaccination communication interventions; 3) create a specific Nigerian country map of interventions organised by purpose and target; and 4) analyse gaps between the COMMVAC taxonomy and the Nigerian map.

Design: We conducted the study in two Nigerian states: Bauchi State in Northern Nigeria and Cross River State in Southern Nigeria. We identified vaccination communication interventions through interviews carried out among purposively selected stakeholders in the health services and relevant agencies involved in vaccination information delivery; through observations and through relevant documents. We used the COMMVAC taxonomy to organise the interventions we identified based on the intended purpose of the communication and the group to which the intervention was targeted.

Results: The Nigerian map revealed that most of the communication strategies identified aimed to inform and educate and remind or recall. Few aimed to teach skills, enhance community ownership, and enable communication. We did not identify any intervention that aimed to provide support or facilitate decision-making. Many interventions had more than one purpose. The main targets for most interventions were caregivers and community members, with few interventions directed at health workers. Most interventions identified were used in the context of campaigns rather than routine immunisation programmes.

Conclusions: The identification and development of the Nigerian vaccination communication interventions map could assist programme managers to identify gaps in vaccination communication. The map may be a useful tool as part of efforts to address vaccine hesitancy and improve vaccination coverage in Nigeria and similar settings.

Keywords: communication interventions; childhood vaccination; Nigeria

To access the supplementary material for this article, please see Supplementary files under ´Article Tools´

INTRODUCTION

Vaccination has been described as one of the greatest public health achievements of the twentieth century and is widely seen as a worthwhile and cost-effective public health measure (1). More than 3 million child deaths worldwide are said to be prevented each year through vaccination (2, 3). Despite these huge benefits, childhood vaccination programmes face numerous challenges including low and stagnant coverage levels, underutilisation of vaccine services, inadequate sustainable financing, and misleading information on vaccination and its effects (4, 5).

Nigeria has one of the highest rates of under-5 mortality in the world and vaccine-preventable diseases account for approximately 22% of child deaths in the country (6). Though vaccination rates have increased in Nigeria in the last decade, only 52% of eligible children in Southern Nigeria were fully vaccinated in 2013 (7), and in the North, even fewer children (10–27%) were fully vaccinated. These low rates have been attributed partly to vaccine hesitancy, a behaviour influenced by a number of factors, including a lack of trust in the vaccine or the provider, people not perceiving a need for or not valuing the vaccine, poor access, lack of knowledge, rumours, religious beliefs, illiteracy, and other social and political factors (5, 8). Effective communication strategies can address some of these issues by making more people aware of the benefits of immunisation; correcting false beliefs, rumours, or concerns that prevent people from getting immunised; and informing people where and when to get immunised, thereby potentially increasing vaccination rates (9–12).

We define a communication intervention as a purposeful, structured, repeatable, and adaptable strategy to inform and influence community decisions to personal and public health participation, disease prevention and promotion, policy making, service improvement, and research (11, 13). Communication interventions are believed to have contributed to the successes recorded in the polio eradication initiative in Nigeria (14). The country´s National Social Mobilisation Working Group, headed by UNICEF, is responsible for developing and coordinating communication strategies for all childhood vaccinations. At state and local levels, social mobilisation committees coordinate these activities which tend to focus on the following three objectives: advocacy, social mobilisation and behavioural change communication (15).

Currently, a wide range of communication interventions are being used in Nigeria. Most of the interventions used are developed at the national level and then implemented locally (16, 17) which may result in inadequate community involvement in their planning and implementation (18). To improve communication, it is important to identify what interventions are being used, where, and for which purposes (19, 20); which communication interventions are effective (12, 19, 21); and how people want to be communicated with (22). To better understand some of these issues, we have developed a global taxonomy of communication interventions. This taxonomy aims to map the communication strategies that are used in a way that identifies the key purposes of each strategy, thereby helping to ensure that these strategies address the most relevant determinants of vaccine hesitancy (20).

This study of childhood vaccination communication in Nigeria forms part of the ´Communicate to vaccinate 2´ (COMMVAC) project – an international project exploring how to integrate evidence-based communication strategies that are adapted for local conditions into vaccination programmes in selected low- and middle-income countries.