Understanding Attitudes to Immunisation in Northern Nigeria

Research to support the polio endgame and routine immunisation strengthening

Polio Nigeria [GoN, 2012-2013]

• Substantial improvement in programme performance

• Key opportunities in low transmission season, 2013-14

• But polio vaccination is a recurrent negotiation with households that will continue to through 2014 and beyond

• So, better research on household attitudes to polio and routine immunisation supports short-, medium- and long-term goals

• This research follows discussions between NPHCDA (Dr Ado) and USAID (Ellyn Ogden) at the Independent Monitoring Board (IMB) in May in London

Missed children [EMOD, 2013]

• Despite major improvement, data show that gaps [residual groups of missed children] remain

• These gaps are increasingly localised in ‘worst-performing’ areas

• Detailed understanding of localised factors affecting household demand is critical to programme success

Approach of research

• We need a research approach which can ‘drill down’ to micro-level, to systematically investigate influences on vaccine uptake at settlement and household level

• The focus of the research is on the demand-side

• We propose using ‘Qualitative Comparative Analysis’ (QCA) – a new research technique within the global programme

QCA: a localised research strategy

• QCA assesses systematic differences between high- and low-performing households in key PEI wards/LGAs

• It 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, &• Household health, health-seeking behaviour, and attitudes to immunisation and polio

• It tests which household factors – independently or in combination – correlate with the household’s likelihood of having missed children

• It compares households and settlements in high- and low-performing wards to identify which factors correlate with positive and negative coverage outcomes

Process of research

• Selection of focus states and within these, pairs of IPD high/low performing Wards and Settlements• After consultation with all partners, we propose to select Kano, Bauchi and Sokoto

States (all HR States, all include VVHR LGAs, selection covers + and – WPV, and geo-cultural spread of 2 northern ‘zones’)

• Random selection of 20 households per settlement• Survey sample size estimated at a total of 1,440 households (95% CI); 2 questionnaires

will be conducted in each household (separately with male head of household and senior female decision-maker

• Household interviews will be by structured interview questionnaire

• Semi-structured interviews will be conducted with key stakeholders to ensure a fully participatory research process

Survey data: influencing factors

• 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

• ‘Trust’ indicator

• Experiences and perceptions of health services, immunisation and… polio

Research oversight and management