MIDTERM FEEDBACK ON EFFECTS OF ENGAGING COMMUNITIES IN DECISION MAKING AND ACTION THROUGH TRADITIONAL AND RELIGIOUS LEADERS ON VACCINATION RATES :  A CLUSTER RANDOMIZED TRIAL

Angela Oyo-Ita, Xavier Bosch-Capblanch, Amanda Ross, Afiong Oku, Ekpereone Esu, Soter Ameh, Olabisi Oduwole,  Kanu Okpo, Elemi Agbor, Dachi Arikpo, Edet Edet, Moriam Chibuzor, Friday Odey, Ekong Udo, Okokon Enembe, Martin Meremikwu

WHAT WAS THE RESEARCH ABOUT?

Low childhood vaccination rates continue to be a problem in Nigeria. This has partially been linked with weak routine immunization services (Ophori, 2014). One of the ways to strengthen routine immunization is mobilising people to generate demand through community and caretakers engagement. Traditional and religious leaders (TRL) are influential and 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 (Nwaeze & Mohammed, 2013). We believe that engaging the TRLs and the Ward Development Committee (WDC) members will improve their capacity to communicate information on vaccination to their community members and thereby mobilise them towards increased demand and timeliness of vaccination and consequently improve facility utilization.

WHY THE RESEARCH WAS DONE

The aim of this research was to determine the efficacy of a multi-component intervention to strengthen the capacity of traditional and religious leaders (TRL) as a means to improving uptake of immunization in selected communities in Cross River State, Southern Nigeria.

OBJECTIVES

To assess the effect of the intervention on:

  • The proportion of children aged 0 to 23 months who are fully vaccinated
  • The proportion of children vaccinated on time for Penta and Measles
  • The proportion of children who have Penta 1 and Penta 3 on time
  • The incidence of measles disease in young children using passive case detection
  • Utilisation of Antenatal Care (ANC), delivery and out-patient attendance for minor treatment
  • Costs and cost effectiveness of the intervention

WHERE WAS THE RESEARCH DONE?

Eight local government areas were randomly selected from the north, central and southern senatorial districts of Cross River State. Four LGAs (Abi, Odukpani, Ogoja, and Calabar Municipality) were randomly allocated to the control arm and four LGAs (Etung, Biase, Obudu, and Ikom) to the intervention arm.

HOW WAS THE RESEARCH IMPLEMENTED?

The control LGAs had routine services while the intervention LGAs had routine services in addition to the trial interventions which are as follows:

  1. TRL Training: Five training sessions were held with TRL in the intervention LGAs between May and November 2017. The sessions were on vaccines and vaccine preventable diseases, how vaccines work, influential leadership and communication approaches to promote vaccination uptake and roles of Ward Development Committees.
  2. Community Engagement: trained community leaders educated members of the community during routine community meetings such as meetings of women, youth groups and religious meetings.
  3. Training of Health Workers: health workers were trained on root cause analysis, data summarization and presentation, and use of defaulters register to improve tracking of defaulters.
  4. Strengthening of the WDCs: Six WDCs were revitalized in Akpet/Abini, Abijang, Mkpot, Abayong, Ipong, and Utugwang wards.

WHEN WAS THE RESEARCH DONE?

Baseline assessment was in Dec, 2016 and midterm evaluation in Feb, 2018 after 9 months of intervention.

WHAT AND WHO WAS EVALUATED?

Uptake of vaccination among children aged 0—23 months in the control (n=1,268) and intervention (n= 1,302) LGAs .

ETHICAL CLEARANCE

Ethical approval for the research was obtained from the Cross River State Research Ethics Committee.

RESULTS OF THE RESEARCH

Proportion of children aged 0 to 23 months who are fully vaccinated.

Using a logistic regression with random effects for LGA, ward, and village levels, the proportion of unvaccinated children dropped significantly from 7% to 2%  (p=0.001) in the intervention arm. However, there was no significant difference in up-to-date vaccinations between the intervention areas and controls.

Proportion of children vaccinated on time for Penta and Measles

Two percentage drop in proportion of children that received Penta 1 at 6 to 8 weeks in the control LGAs but 9% increase in the intervention LGAs was reported. Similarly there was a 1% increase in timely measles vaccination in control LGAs and a 10% increase in the intervention LGAs. The observed differences were not statistically significant.

Proportion of children who received Penta 1 and Penta 3 on time

More children received Penta 1 on schedule than they did for Penta 3 in both arms.

Dropout rate for Penta 3

The intervention arm showed a steeper drop for Penta 3 than the control arm. This difference was not statistically significant.

Conclusions and policy implications

  1. The intervention may promote reduction of the proportion of unvaccinated children
  2. The failure to impact on timely and up-to-date vaccination may be linked to the weak health system.

Reference: 

Ophori  EA, et al,. 2014. Current trends  of immunization in Nigeria; propects and challenges. Trop Med Int Health, 42(2), pp. 67–75.

Nwaze, E. and Mohammed, A. (2013). An impact evaluation of the engagement of traditional and religious leaders in the Nigerian polio eradication initiative. Scholarly J Med3, pp. 53-63.

ACKNOWLEDGEMENTS: 

Traditional and Religious Leaders and survey participants in the study areas, Felicia Undelikwu, Christiana Bassey, Oqua Edim, Arit Ekpenyong, Friday Odey, Benson Obu, Nuria Nwachukwu.

With grant from the International Initiative for Impact Evaluation (3ie)