Nigeria Immunization Plus Days: Observations from One Ward

This report tells the story of Nigerian polio workers Jenny Sequeira, Drs. Femi Oyewole, and Auwal Gajida during a single Immunization Plus Day (IPD) in one local government agency (LGA) ward in Nigeria. Selected communication-related lessons, which appear to illuminate gender-related issues, include:

• "House to house observation: Jenny was able to go into compounds with the vaccination team because of being female and appropriately dressed; Drs. Femi and Gajida were not able to go into the compounds but had informal discussions with some of the men who were outside of the compounds." Some of the communication-relevant findings:
  • Out of the approximately 60 children seen in compounds, no mother/caretaker had an immunisation card; "one mother stated that her husband had locked it away, but all other mothers said they had never had one.
  • "All except one of the mothers (> 15 compounds) noted that they never take children to the HF [health facility] for RI [routine immunisation], and that they only go to the HF when they or children are sick; they cited reasons such as 'why would we go' and 'it is up to our husbands, ask them'; Drs. Femi and Gajida asked fathers the same question of why children are not taken to the HF for RI, to which common responses were 'there is nothing to stop them from taking the children'."
  • "Despite moving with the vaccination team for >2 hours and despite the supervisor's claims to the contrary, Jenny observed that no RI messages were being given during the IPD door to door visits and no parents were encouraged to take their children to the fixed post for RI."
• HF observation: "When asked about why women are not bringing children to the HF for routine services, one HW [health worker] noted that it was because of fear of vaccines containing family planning (although we observed no OPV refusals when going house to house and not even mild 'hesitancy'; mothers knew the vaccinator and were all chatting very amicably), and another staff noted that children are coming for vaccination..."
• LGA health office observation: A short visit to the LGA cold store included brief discussions and looking at what 2 geographic information system (GIS) consultants were doing with electronic mapping of communities/villages. One finding was that, after at least 4 years of IPDs, few children are being taken to the HF for fixed RI sessions, even though their houses are within a 5-minute walk of the HF. One observation that may call for follow-up by LGA and health facility staff as well as community volunteers: "contradictory reasons in feedback of fathers not permitting mothers/caretakers to take children to the HF except when they are sick vs. fathers reporting mothers/caretakers are free to go to the HF at any time." The observers note that "the GPS [global positioning system] endeavor to track new or undiscovered remote villages for IPDs should not overshadow efforts to reach mothers in communities nearby to HFs who are not bringing their children for 'plus' antigens at IPD fixed posts or for RI services in general."

Click here for the 3-page report in PDF format.