Engaging traditional barbers to identify and refer newborns for routine immunization services in Sokoto, Nigeria: a mixed methods evaluation

Leanne Dougherty,Sale Abdu,Yakubu Cherima,Aliyu Ladan,Aliyu Ahmed,Kate E. Gilroy,Folake Olayinka,Masduk Abdulkarim,Bello Kilgori,Sani Garr

doi:10.1007/s00038-020-01518-9

Leanne Dougherty, Sale Abdu

Open Access

https://doi.org/10.1007/s00038-020-01518-9

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Abstract

ObjectivesThis study evaluates the effectiveness of an intervention that engaged traditional barbers to inform parents about the importance of vaccination and then refer newborns for vaccination services.MethodsWe conducted a pre-post quasi-experimental study (n = 2639) to evaluate changes in the coverage of three birth antigens among children aged 0–5 months in response to the intervention. We also conducted in-depth interviews and focus group discussions to assess the enabling factors and challenges associated with implementation.ResultsWe found mothers who received a yellow referral card from a traditional barber were two to three times more likely to vaccinate their children with the three birth antigens. Qualitative findings indicated that the intervention influenced parent’s decision to vaccinate their newborn because the barbers were considered a trusted community advisor. Challenges stemmed from the low levels of literacy among community leaders and barbers that resulted in the need for continuous training, low-literacy training materials and supervision.ConclusionsEfforts to increase vaccine coverage rates in northern Nigeria should consider expanding the role of traditional barbers to encourage parents to accept vaccines.

Highlights

Immunization coverage rates in Nigeria are among the lowest and most inequitable in the world: the 2018 Nigeria Demographic and Health Survey (NDHS) estimates national coverage of children receiving the third dose of the pentavalent vaccine to be around 50% (ICF 2019)
We found mothers who received a yellow referral card from a traditional barber were two to three times more likely to vaccinate their children with the three birth antigens
Efforts to increase vaccine coverage rates in northern Nigeria should consider expanding the role of traditional barbers to encourage parents to accept vaccines

Summary

Introduction

Immunization coverage rates in Nigeria are among the lowest and most inequitable in the world: the 2018 Nigeria Demographic and Health Survey (NDHS) estimates national coverage of children receiving the third dose of the pentavalent vaccine to be around 50% (ICF 2019). In the northern Nigerian state of Sokoto, only 3% of children receive the third dose of pentavalent vaccine by their first birthday ((UNICEF) 2017). Health workers can be effective conduits of information; for example, when mothers receive information during visits to a clinic or are given specially designed immunization cards, they are more likely to vaccinate their children (Brown et al 2016). A data-driven approach that enabled health workers to identify and remind women to vaccinate their children led to improved immunization coverage during the polio eradication effort (Waisbord et al 2010). Targeting influential leaders as conduits of information during the polio eradication campaigns has increased the uptake of polio vaccine in poor-performing areas in northern Nigeria (Warigon et al 2016). Few studies have shown the extent to which community-based volunteers can strengthen demand for RI by improving knowledge and reducing misinformation among parents (Uzondu et al 2015)

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