Impact Data - Media Engagement for Supporting Demand Creation for Childhood Immunisation (MERCI)

Similarly to the baseline, most people (88%) knew that polio could be prevented and that it could be prevented by polio drops (79%). However, people who listened to the drama or the radio spots had a more nuanced understanding of polio prevention. Advanced analysis (regression), which controlled for other factors such as education, state, income, gender, age and ethnicity, found the following links with the programmes:

• 58% said prevention of the disease can be done by giving a polio vaccine injection. However, Madubi's regular listeners are significantly more likely to say so (73% compared to 56% of non-listeners). This relationship holds even when controlling for other factors, with Madubi’s regular listeners being on average 1.9 times more likely than non-listeners to mention vaccination by injection.
• Radio spots' listeners were 1.3 times more likely than non-listeners to know that children should be vaccinated at intervals with different vaccines for routine immunisation and 1.5 times more likely than non-listeners to know that there is a national schedule showing the intervals at which the different vaccines are given.

Overall, there is scope to improve knowledge on how the polio virus is transmitted: Only 17.5% of all respondents said a "virus" and 9.5% said "eating with dirty hands" could transmit the disease.

How polio is transmitted and the risks it carries was communicated through the drama. Four out of 5 (80%) Madubi listeners said they had learned about polio from the drama. From a given list, the topics that listeners mentioned most were how polio is transmitted (57%) and the risks of polio and its impact on people (56%). Advanced analysis showed listeners had a deeper understanding of how polio could be transmitted than non-listeners. Madubi regular listeners were twice as likely to know that "contaminated water" and 1.7 times more likely to know that "eating with dirty hands" could transmit the disease. However, the fact that polio is transmitted by a "virus" does not appear to have resonated as strongly with listeners; they were slightly less likely than non-listeners to mention this.

Across all respondents, 72% reported that they intend to have vaccinators give their children polio drops every time they are offered for children under 5. This was an increase from the baseline (60%). Seventy-six percent of Madubi regular listeners reported this intention. This intention was also particularly high in Jigawa (86%), where there have been concerted efforts by the state government to improve polio uptake.

Respondents reported that polio was still the most received vaccination: 93% said this at endline compared with 95% at baseline. However, rates of immunisation against other diseases (BCG, measles, yellow fever, DPT or hepatitis B) remained similar to at baseline, indicating scope for improvement. Audiences of the radio and TV spots showed higher rates of vaccination such as Bacillus Calmette–Guérin (BCG), measles, yellow fever, hepatitis B, or diphtheria, pertussis (whooping cough), and tetanus (DPT). Other factors were not controlled for, so it is not possible to say that higher reported rates of immunisation across other vaccines are linked to exposure.

People who had listened to or watched the spots and been visited by a community leader (encouraging them to vaccinate their children), a volunteer, or a vaccinator/community health worker were more likely to say that they had done something as a result of those visits than non-audiences. Specifically, regression analysis showed that listeners of the radio spots were, on average, twice as likely as non-listeners to say they had done something as a result of those visits, and audiences of the TV spots were 1.3 times more likely, even when controlling for other factors such as age, location (urban/rural), gender, education, income, state, and ethnicity. Actions included: allowing the vaccinators in, asking questions to understand more about the vaccine or the process, and encouraging others such as neighbours to have a vaccination. Thirty-seven percent of Madubi regular listeners and 27% of non-listeners reported having taken action as a result of a visit. This is very different to baseline, where only 14% reported having taken action.

As at baseline, the perception that having one's child vaccinated is an important step in caring for children was high. Most people said their children were immunised (92% compared to 88% at baseline) and the main reason they gave was to protect children from diseases (87%). Overall, the vast majority (90%) felt that responsibility for ensuring children are vaccinated against polio resides with the family rather than with the community or government. This was a large increase from baseline, when 66% thought so. Advanced analysis found that, after controlling for other factors, there were no significant differences between people who had watched or listened to the programmes and those who had not.

A qualitative midline study, conducted in February 2016, had shown that Madubi had helped listeners to understand the importance of immunisation by portraying immunised children as healthier than non-immunised children and by including health professionals in the drama. 68% of all respondents thought that community members "very much" supported polio immunisation; this perception is 11 percentage points lower compared to baseline (79%). Overall, social norm measures remained stable since baseline; on each measure (e.g., "most" or "all" other people they know will encourage polio vaccination), at least 60% feel that people they know will exhibit appropriate prevention behaviours. Perceptions of parents who immunise their children are more commonly reported as positive at endline compared to baseline. There were no differences between listeners and non listeners.

Overall, levels of discussion around immunisation in the household were reported to be much lower at endline (40% compared to 62% at baseline). This could be due to polio being less controversial after Nigeria was officially removed from the list of polio-endemic countries by the World Health Organization, or WHO (although the 2 new cases were known 2 months before fieldwork).

Nonetheless, advanced analysis showed that, even after controlling for other factors, listeners of all BBC Media Action's programmes were more likely than non-listeners to report discussing plans for immunisation with people at home. Specifically: Madubi regular listeners were on average 1.4 times more likely than non-listeners to discuss plans; listeners of the radio spots were on average 1.9 times more likely than non-listeners to discuss plans; and listeners of the TV spots were on average 1.6 times more likely than non-listeners to discuss plans. Thirty-eight percent of Madubi's audience reported they had discussed the programme with someone in their household or community. Of those: 86% reported having discussed it with their spouse, 80% reported having discussed the characters in the drama, and 53% reported having discussed the importance of the lessons from the drama.

Overall, participation in community discussions on immunisation was lower at endline (23%) than at baseline (27%). However, advanced analysis showed that people who had listened to or watched the spots were more likely than those who had not to say they had participated in a community discussion in the last 2 months on immunisation. (Listeners of the radio spots were on average 1.8 times more likely than non-listeners to say that they ever participated in any community discussion on immunisation in the last 2 months; those who had seen the TV spots were on average 1.7 times more likely). While 34% of Madubi regular listeners had taken part in a community discussion, when other factors were controlled for, there was no association with the drama.

The drama reportedly appealed to listeners; they felt it was educational, entertaining and encouraged polio vaccination. They also liked the cultural dances and the acting.

The role of religious leaders in promoting immunisation remains important among respondents. Thirty-seven percent said that religious leaders promote immunisation, compared to 21% at baseline. Seventy-two percent said they would be more likely to get their child immunised if their religious leaders told them that polio immunisation is approved by their religion, compared to 81% at baseline.

• 73% of non-listeners say this compared to 68% of listeners.
• 74% of men say this compared to 70% of women.
• 72% of Muslims are likely to say this compared to 69% of Christians.

The top 4 reasons respondents gave for being encouraged to immunise the next time immunisation is offered were:

• The vaccinators came to their house (89%) - vs. 71% at baseline
• The vaccinators explained satisfactorily the benefits (49%) - vs. 25% at baseline
• Family members convinced them of the benefits (18%) - vs. 15% at baseline
• Their community supports immunisation (14%) - vs. 16% at baseline

All respondents were asked what would be a reason they would not immunise their children (even if they had):

• 51% mentioned fear of side effects as a reason why they would not routinely immunise their children (41% mentioned side effects at baseline)
• 22% mentioned refusal by husbands (13% mentioned this at baseline)
• 15% mentioned "too many rounds" of immunisation (vs. 5% at baseline)
• 15% mentioned the location of immunisation centres (vs. 2% at baseline)
• 13% mentioned religion or traditional beliefs (vs. 17% at baseline)
• 11% mentioned doubts about the effectiveness of the vaccine (vs. 15% at baseline)

When the small group who do not immunise against polio were asked for their reasons, a lack of faith in immunisation was the most common reason given (56%).

The midline qualitative study found that caregivers reported acquiring knowledge of the importance of immunisation from radio programmes such as Madubi and other discussion programmes that feature health professionals. The presence of health professionals in the drama was identified as an important factor contributing to knowledge acquisition. In addition, caregivers mentioned receiving information on polio vaccination from: religious leaders at mosques, town criers, community leaders, health workers, friends, neighbours, and relatives. Fathers also reported learning from their wives, as they said that women receive this information from health workers. All these information sources appear to combine in reinforcing the importance of immunisation to the communities under study.