- Print Page
Low vaccination rates continue to be a problem in Nigeria, especially for vulnerable and marginalised populations. Although communities are involved in immunisation programmes, most of the interventions are focused on the provision of information. Providing information to communities may be useful but it may not necessarily empower communities to act.
In Nigeria, traditional and religious leaders (TRL) are respected in their communities as opinion formers and guides in religious, social and family life. They have been used as agents of change to get communities to use health services. This intervention seeks to extend the role of TRLs from merely being informants to being active agents for community participation in vaccination services.
The award has been granted to'Institute of Tropical Disease Research and Prevention, Nigeria.
- What are the effects of a community and health-facility-based multicomponent intervention to improve vaccination coverage, especially among the most vulnerable and marginalised communities?
- What are the mechanisms by which this multicomponent interventions may have worked and for what reasons?
This study will evaluate a multicomponent intervention that involves using TRLs for engaging communities in the planning, implementation, and monitoring of immunisation services. The intervention is targeted at TRLs, communities, health services and ward development committees (WDC).
TRLs are represented in the WDC, which is the main structure in the public health care system. So far the role of TRLs in immunisation services has been limited to mobilisation of the communities for immunisation campaigns. This intervention seeks to strengthen TRLs and WDCs in the following ways:
- The TRLs will undergo a continuous education programme which will include health-related topics and communication approaches;
- TRLs will approach community members and encourage them to be involved in setting up monthly meetings with health service providers and WDC members. In the meetings, community members could share concerns about the delivery of services, brainstorm and plan for remedial action. They could also be involved in organising health camps.
The study will use a two-stage cluster random sampling based on administrative and geographical levels in the Cross River state. There are 18 local government authorities (LGAs) in the state. Half of them will be randomly selected in the first stage. The second stage of random sampling will occur at the ward level. A ward is the smallest unit of political administration in Nigeria. The Cross River State has 196 wards with an average population of 10,000 people per ward. Eligible wards will be coded and kept blind from researchers. Codes of eligible wards will be randomly allocated to intervention and control groups in each selected LGA. The sample size is estimated to be approximately 1,400 children per arm in a total of 58 clusters. Household surveys will be carried out at the beginning, middle and end of the evaluation to assess the vaccination status of children from 12 to 23 months as well as dropout rates. The study will also have a qualitative research component. The degree of community engagement and satisfaction of stakeholders will be assessed through key informant interviews. The interviews will also assess knowledge, beliefs, perceptions and expectations related to vaccinations and the intervention. Focus group discussions will also be carried out in selected sites to understand community perceptions about immunisation and expectations from the intervention.