Vaccine Perception among Acceptors and Non-Acceptors in Sokoto State, Nigeria

"[M]en in the community should be the target for sensitization, [as] they are the ones that determine whether a child gets vaccinated or not."

In the context of sub-optimal immunisation uptake in Africa - in particular, of the oral polio vaccine (OPV), which has led Nigeria to be one of the few remaining polio-endemic countries - this paper shares the results of a study exploring vaccine perceptions among acceptors and non-acceptors in 2 local government areas (Wurnoand Wammako) in Sokoto State, Nigeria.

Noting that the effectiveness of health interventions, especially immunisation, relies on a range of factors, such as the attitudes and behaviours of intended groups, the researchers note that, for some Nigerian parents, immunisation "has been seen as [an] unnecessary or even possibly dangerous undertaking for infants and children who are not experiencing health problems, regardless of impending epidemics. For these parents, prayer is not only sufficient, but is the only real protection against disease, which ultimately comes from God. Terms such as kariya Allah, translated as natural immunity, have a distinctive meaning in this context. In this case, natural immunity refers to the special protection (kariya) given by Allah, rather than to the responses of the immune system exposed to a particular virus (as opposed to immunity derived from vaccines)."

To explore these and other factors, researchers carried out in-depth interviews with 72 caregivers, using an interview guide that assessed vaccine acceptance, social and personality factors, and health belief model (HBM) categories in relation to OPV (perceived susceptibility, severity, cost barriers, general barriers, benefits, knowledge, and engagement in preventative health behaviours). Women constituted 66% the respondents. Overall, approximately half of the respondents were acceptors.

Results showed that the HBM framework, which holds that levels of susceptibility and severity of infection are associated with perception of the benefits of interventions, was found to be appropriate for identifying and distinguishing vaccine acceptors and non-acceptors. In addition, the HBM categories of benefits and susceptibility were found to influence OPV acceptance. Those who perceived the severity of polio and their susceptibility accepted the OPV during campaigns. A majority of the acceptors presented their children for vaccination because they have been told to do so. Most of the female respondents indicated authority of the husband as the main reason for acceptance. Other motivations included advice by a neighbour or community leader. One respondent said: "the healthworkers and government people who know better than we do told us that OPV is very effective against this disease that affects the legs". Lack of information, fear of side effects, and lack of trust in the immunisation programme were among the reasons cited for non-acceptors. Also, to echo the context provided above, one of the respondents noted: "In Islam, we have a practice where quranic verses are recited to invoke divine protection against all diseases when a child is brought into the world. After the recitation, the words are written on a slate, washed and the water given to the child. This is a very serious and effective immunization against diseases and ill health."

"In light of these findings it could be seen that there is the need for more programmes that will enlighten caregivers on benefits of immunization." As the quotation above notes, the focus should particularly be on reaching men, as they tend to have a strong voice in decision-making in the Nigerian family context, according to these researchers.