Peer-reviewed article
Understanding caregivers’ and community influencers’ perspectives on the barriers to childhood immunisation in Northern Nigerian States with public-private partnerships in routine immunisation programme
Eno-Obong E. Etim, Angela Odiachi, Leanne Dougherty, Matthew Ayodele Alabi, Adetayo Adetunji et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined barriers to childhood immunisation in six northern Nigerian states with low vaccination coverage. Researchers conducted 24 focus group discussions with mothers, caregivers, and community influencers to understand what prevents families from vaccinating their children. The study identified barriers at multiple levels: individual factors like limited mobility for women and vaccine side effects; community-level issues including vaccine misconceptions, religious beliefs, and mistrust; and system-level problems such as poor health worker attitudes, weak documentation, long distances to clinics, and vaccine shortages.
Key points
- Individual and interpersonal barriers include limited female mobility and concerns about adverse events after immunisation
- Community-level barriers involve misconceptions and myths about vaccines, religious beliefs and norms, gender discordance between health providers and patients, and mistrust of immunisation
- System-level barriers include poor health worker attitudes, ineffective documentation, distance to health facilities, inadequate staffing, vaccine supply shortages, and lack of incentives
- Recommendations include engaging male caregivers through tailored behaviour change initiatives and capacity building for health workers on vaccine counselling
- Study used socio-ecological framework to examine immunisation barriers across individual, community, and system levels
Limitations
This study captures perspectives through focus group discussions but does not measure actual vaccination coverage outcomes or test interventions to address the identified barriers. The findings reflect community perceptions in six specific northern Nigerian states and may not generalise to other regions or countries with different contexts.
Abstract
BACKGROUND: Despite investments by the Nigerian government and international organisations in childhood immunisation to combat child mortality, coverage in many northern states remains below the national average, thereby increasing the risk of vaccine-preventable diseases. This paper examines the barriers to immunisation in six states in northeast and northwest Nigeria, which have the lowest vaccination coverage rates in the country. METHOD: We conducted 24 focus group discussions (FGDs) with mothers/caregivers and community influencers who collaborate with health workers to provide routine immunisation. The socio-ecological framework informed the design of the FGDs. We thematically analysed inductively and deductively coded data on NVivo version 12. RESULTS: Barriers to immunisation uptake included: Individual and interpersonal level - limited female mobility, adverse events after immunisation; community level - misconceptions and myths about vaccines, religious beliefs and norms, health provider-patient gender discordance, mistrust of immunisation; system level - poor health worker attitude, ineffective documentation of immunisation appointments, distance to health facilities, inadequate human resource capacity at health facilities, vaccine supply shortages, and lack of incentives. CONCLUSION: This study highlights the intricate barriers to immunisation uptake in northern Nigeria. Key recommendations include engaging male caregivers through tailored social and behavioural change initiatives and capacity building for health workers to improve their counselling skills on vaccine side effects. Findings from the study provide valuable insights for policymakers and programme implementers. Implementing these interventions can tackle ongoing challenges and improve routine immunisation in these states.