Quality of Counselling, Exposure to Vaccination Messages, and Caregivers' Knowledge on the Uptake of Pentavalent Vaccine in Six Northern Nigerian States

"Effective communication strategies are critical to immunization uptake among caregivers because they can enhance their knowledge about the benefits of immunization and correct false impressions or concerns that often prevent caregivers from getting their children immunized."

Studies have identified the influence of individual health-seeking behaviour factors and community-level factors on routine child immunisation uptake in Nigeria. Quality interaction between caregivers and providers and access to appropriate information are associated with healthcare utilisation and acceptance of recommended health behaviours, including vaccination. Coverage for Pentavalent (Penta) vaccine in northern Nigeria remains low. This study examines the quality of counselling (QOC), caregivers' exposure to vaccination messages, and child's uptake of the Penta vaccine.

Previous studies, conducted elsewhere, have attributed the low coverage and low uptake of the first and second doses of the Penta vaccine to high dropout rates among infants who received the first but not the second dose. Dropout has been attributed to factors including lack of satisfaction with service and poor perception of benefits of vaccination among caregivers. These findings suggest the need to encourage mothers to present their children early for the initial vaccination, in addition to addressing behavioural and institutional factors that could impede these caregivers from the timely presentation of their child for vaccination.

The study was conducted in six northern Nigeria states located in the northwest (Kano, Kaduna, and Sokoto) and northeast (Bauchi, Borno, and Yobe) states. These regions have the poorest health indices in the country, including low child vaccination coverage and high childhood mortality. The researchers conducted a cross-sectional study using quantitative data obtained through a survey. Caregivers (n = 561) of children aged 2-24 months accessing child vaccination services who received Penta vaccines at randomly selected health facilities (n = 163) offering routine immunisation (RI) services were surveyed in March-April 2022.

Measures included:
 

• QOC was measured using five indicators: (i) whether the caregiver was told by the provider what vaccine the child received and/or (ii) the date for the next vaccination appointment; (iii) whether the caregiver received information regarding possible side effects or reactions following the vaccination; (iv) whether the provider informed the caregiver on what to do in the event of a side effect; and (v) whether the provider wrote down the date for the next vaccination appointment. To determine the QOC provided, a composite score of all five indicators was generated.
• To determine knowledge, caregivers were asked about when an infant should take the first vaccination dose after birth. Women who reported that a child should receive their first vaccination immediately after birth or within the first week of birth were regarded as having correct knowledge, while those who reported later than 1 week were regarded as having incorrect knowledge.
• Awareness was measured by asking if the caregiver had seen or heard of child vaccination in the last 30 days preceding the survey.
• The level of exposure was measured by the number of channels of information on child vaccination to which a caregiver is exposed.
• Penta uptake was coded as binary (coded "1" if received; otherwise "0").

The study found that, although awareness of child vaccination was high (70%), two-thirds had limited exposure through health communication channels. The top three sources of child vaccination are health workers (67%), radio (41%), and community health workers (CHWs) (28%).

Only 56% of the caregivers studied received quality counselling. However, the study found that low-quality counselling had no significant effect on the uptake of the Penta vaccine. Nonetheless, the researchers argue that quality counselling from providers to caregivers will no doubt help to build mutual trust and address bias, myths, and misconceptions about immunisation, especially in the northern region of the country, where culture and traditions exert a strong influence on people's way of life and acceptance of basic health interventions.

According to the survey, uptake of all three doses of Penta vaccine was 43% among eligble children. Factors associated with Penta uptake include:
 

• Caregivers with correct knowledge of when a child should receive the first vaccination were twice as likely to receive the Penta vaccine (adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI) = 1.01-4.29) for their child.
• Higher odds of Penta vaccine uptake were found among caregivers who received messages about child vaccination from a place of worship (aOR = 2.78, 95% CI = 1.15-6.67, p = 0.022), community leaders (aOR = 2.21, 95% CI = 1.11–4.41, p = 0.023), and CHWs (aOR = 1.95, 95% CI = 1.14–3.34, p = 0.015). On the other hand, lower odds of receiving the Penta vaccine were found when the mother was the primary decision maker on child vaccination (aOR = 0.32, 95% CI = 0.15-0.67, p = 0.002).
• Children of caregivers residing in the northwest region were about three times (aOR = 2.60, 95% CI = 1.51-4.48, p = 0.001) more likely to receive the Penta vaccine relative to their northeast counterparts.

Among the reflections shared in the paper: "The significant effect of traditional and religious leaders on child vaccination uptake is very important because of their positive influence in promoting child vaccination, especially in the northern region of the country. Over the years, traditional and religious leaders have proven to be instrumental in championing child vaccination and shaping norms and behaviour, particularly at the community level, where coverage is usually low..."

In addition to enhancing efforts to engage traditional and religious leaders for Penta vaccine uptake, the results suggest the need for continuous strengthening of the capacity of RI health workers by providing them with requisite skills and strategies to interact with their clients. Capacity building in this area can help build trust, an important component for vaccination uptake, and address issues around vaccine hesitancy.

In conclusion: "Given the low quality of counselling and the positive influence of religious and traditional leaders, interventions that prioritize strengthening patient-provider interaction and community structure are crucial for increasing child vaccination coverage in Nigeria."