Understanding Attitudes to Immunisation in Northern Nigeria: Research to Support the Polio Endgame and Routine Immunisation Strengthening

This presentation captures the strategies underlying a polio eradication research project that is grounded in the belief that the key to understanding what causes children to be missed by vaccines and continuing suboptimal programme performance (in general and in Nigeria specifically) is to target research at the local level. It opens with slides illustrating the polio situation in Nigeria, one of the few remaining polio-endemic countries. As of this writing, there were 50 cases in 2013 (to date), with 9 states infected. The estimate of missed children at the district level is mapped out as well.

The research approach, as outlined here, focuses on the demand side and systematically investigates influences on vaccine uptake at the settlement and household levels. The specific research technique is called Qualitative Comparative Analysis (QCA), which:

• assesses systematic differences between high- and low-performing households in key Polio Eradication Initiative (PEI) wards/Local Government Areas (LGAs);
• assesses a wide range of household factors (combining quantitative and qualitative aspects), including: household socioeconomic and cultural characteristics; household perceptions of and trust in public services and local governance; and household health, health-seeking behaviour, and attitudes towards immunisation and polio;
• tests which household factors - independently or in combination - correlate with the household's likelihood of having missed children; and
• compares households and settlements in high- and low-performing wards to identify which factors correlate with positive and negative coverage outcomes.

The research process is described here as fully participatory - to be accomplished through semi-structured interviews with key stakeholders in the high-risk states of Kano, Bauchi, and Sokoto. Two questionnaires will be conducted (separately with male head of household and senior female decision-maker) in each of 20 randomly selected households amongst the estimated 1,440 households taking part of the survey. Household interviews will be by structured interview questionnaire.

The survey instrument will collect independent variables in nine "bundles", combining quantitative and qualitative data: household composition, occupation and economic circumstances, religion/ethnicity [sub-ethnicity], educational status and preferences, perceptions of community development priorities, perceptions of support for priority needs, perception of governance systems, perception of reliable sources of information and advice on priority needs (this is a "trust" indicator), and experiences and perceptions of health services, immunisation, and polio.

Click here for the 8-slide PowerPoint presentation.

For more information on this research, which is funded by the United States Agency for International Development (USAID), please see "Related Summaries", below.