Effect of Knowledge on Vaccine Take-up in Adamawa State, Northeastern Nigeria

July 11, 2020 updated by: Ryoko Sato, Harvard School of Public Health (HSPH)

Knowledge on Vaccination Schedule and Full Immunization, and Its Effect on Vaccine Take-up in Jada Local Government Area in Adamawa State, Northeastern Nigeria

Child immunization is not a one-time behavior; rather, it is a repeated behavior within a specific timeframe. Not only the low immunization, but also the dropout of immunization and the delayed immunization from the recommended immunization schedule are prevalent and high in Africa. The most common reason for the incomplete vaccination is that caregivers thought the children had already been fully immunized (44.8%), according to Nigeria Multiple Indicator Cluster Survey (MICS) conducted in 2016/2017.

Caregivers' misconception of the complete immunization can be attributed to the complicated immunization schedule. In Nigeria, infants are supposed to receive 9 different types of vaccines at 5 different times within the first year since the births. To make things more complicated, the vaccine schedule changes over time; for example in Nigeria, the new vaccine, inactivated polio vaccine (IPV) was introduced in 2015 to be received at 14 weeks after births, and rotavirus vaccine and meningococcal A vaccine are scheduled for the introduction in 2019.

In this complicated and rapidly-changing environment regarding vaccination schedule, the goal of the study is to improve the understanding of vaccination completion and children's vaccination status among caregivers, which can then lead to the improved rate of full vaccination among children.

Objectives The main objectives of this study are to understand the impact of providing the general and tailored information on the vaccination schedule and vaccination status of women's children on the vaccine take-up. In this study, the investigators focus on women who has a child who is 12 months old or younger.

Hypothesis

The main hypothesis of this proposed study are as follows:

  1. Information on vaccination among caregivers: the general and tailored information on vaccination schedule and child's vaccination status, improves the knowledge on benefit and understanding of vaccination completion, vaccination schedule and the vaccination status of the children among caregivers
  2. Full immunization rate: through the improved knowledge level on the concept of vaccination completion and their children's vaccination status, the proposed study increases the full immunization rate among children

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Background and Objectives Despite the proven benefit of vaccines, the child immunization rate has been stagnant and the rate in African countries lags behind other regions in the world. For example, the global coverage of three doses diphtheria-tetanus-pertussis (DPT3) has been stagnant at 85% since 2015, while DPT3 coverage in Africa remains at 72% since 2010. The distribution of unvaccinated children is unequal; out of about 20 million infants who are not fully vaccinated, more than 20 percent of them reside in three countries, including Nigeria, the proposed study site. Furthermore, Nigeria is one of the few countries where the coverage of DPT3 coverage has decreased over time: 54 percent in 2010 to 42 percent in 2017.

Child immunization is not a one-time behavior; rather, it is a repeated behavior within a specific timeframe. Not only the low immunization, but also the dropout of immunization and the delayed immunization from the recommended immunization schedule are prevalent and high in Africa. The most common reason for the incomplete vaccination is that caregivers thought the children had already been fully immunized (44.8%), according to Nigeria Multiple Indicator Cluster Survey (MICS) conducted in 2016/2017.

Caregivers' misconception of the complete immunization can be attributed to the complicated immunization schedule. Each type and dose of vaccine has its own significance in terms of the type of preventable disease and the achievable efficacy level. In Nigeria, infants are supposed to receive 9 different types of vaccines at 5 different times within the first year since the births. For example, oral poliovirus vaccine (OPV) is to protect infants from contracting polio, a highly contagious disease. At present, Nigeria is one of the three countries in the world, which have not eliminated polio. Infants are scheduled to receive OPV four times; at birth, 6, 10, and 14 weeks. The efficacy of the first dose OPV (oral polio vaccine) is 82%, while the second and the third doses are 90% and 99% or more, respectively. To make things more complicated, the vaccine schedule changes over time; for example in Nigeria, the new vaccine, inactivated polio vaccine (IPV) was introduced in 2015 to be received at 14 weeks after births, and rotavirus vaccine and meningococcal A vaccine are scheduled for the introduction in 2019.

In this complicated and rapidly-changing environment regarding vaccination schedule, the goal of the study is to improve the understanding of vaccination completion and children's vaccination status among caregivers, which can then lead to the improved rate of full vaccination among children.

Objectives The main objectives of this study are to understand the impact of providing the general and tailored information on the vaccination schedule and vaccination status of women's children on the vaccine take-up. This study focuses on women who has a child who is 12 months old or younger.

Hypothesis

The main hypothesis of this proposed study are as follows:

  1. Information on vaccination among caregivers: the general and tailored information on vaccination schedule and child's vaccination status, improves the knowledge on benefit and understanding of vaccination completion, vaccination schedule and the vaccination status of the children among caregivers
  2. Full immunization rate: through the improved knowledge level on the concept of vaccination completion and their children's vaccination status, the proposed study increases the full immunization rate among children

Literature Review Knowledge is powerful in shaping people's health behaviors. In a situation where the health behaviors among the population do not reach the optimal level, one obvious way to attempt to improve the situation is to provide the information to encourage the population for adopting the health behaviors.

In case of vaccination, information provision has a great potential to increase the take-up of vaccination, especially in places where one of the main perceived barriers is the lack of knowledge on the vaccination schedule, as is the case in Adamawa state.

However, the effectiveness of information provision on the vaccine take-up might differ, depending on the type of information provided. One study provided the information on the benefit of tetanus vaccines to caregivers in India and they found the strong effect of the information provision on the vaccine take-up. The effectiveness of gain-framed and loss-framed messaging was statistically identical in their study. On the other hand, salient information, such as fear appeals, might be ineffective or it can even backfire. The investigators found, in the previous project, that in Jada Local Government Area, fear appeals intervention backfired on the tetanus-toxoid vaccine take-up among women who never received the vaccine.

If caregivers are not aware of the vaccination schedule as found in MICS 2016/2017, simply providing the information on the next vaccination schedule can be effective. Recent technological advancement makes it easy and cost-effective to send the reminder through SMS message.

Although SMS (Short Message Service) reminders are found to be effective in affecting one-time vaccine take-up, this intervention should be accompanied with the provision of more fundamental information, which can induce the repeated vaccination behaviors, to make the effect of intervention sustainable. This study proposes to provide fundamental information, which informs respondents the overall vaccination schedule, as well as tailored information, which informs where their children are in the vaccination schedule. The investigators hypothesize that, once respondents understand the overall vaccination schedule, it is easy to comprehend when and how many times more they should visit the clinic, instead of fully relying on the supply-side intervention such as SMS reminders.

Study Type

Interventional

Enrollment (Actual)

400

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Nigeria
    • Adamawa
      • Jada, Adamawa, Nigeria
        • Jada Local Government Primary Health Care Development Agency

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • women with a child 12 months old or younger

Exclusion Criteria:

  • exclude women who do not have a child 12 months or younger

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control
No intervention is implemented among Control
Experimental: Treatment (Educational Information on Vaccination)
Provide general and tailored information on vaccination and vaccination schedule at the end of the baseline survey
Behavioral: Information Provision
Provide the information on the importance of the vaccination and tailored vaccination schedule

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of participants who have the accurate knowledge level of vaccination, as assessed by survey questionnaire
Time Frame: 2 weeks

The investigators will collect the information on respondents' knowledge on vaccination through surveys. The knowledge level is calculated from 5 questions: 1) the number of type of vaccines a child needs to receive before 12 months old, 2) the number of times a child needs to receive Pentavalent vaccine, 3) the last month when a child needs to receive Pentavalent vaccine, 4) the timing when a child needs to receive BCG vaccine, and 5) the number of clinic visits (at minimum) a child needs to make for complete vaccination. For each question, the score is 0 if wrong, or 1 if correct.

The knowledge level scale ranges from 0 to 5, which is the total number of correct answers.
2 weeks
Number of participants who bring their children for the full vaccination, as assessed by the follow-up tracking survey at health clinics
Time Frame: 9 months
The investigators will collect the information on the actual vaccination status among respondents' children
9 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Harvard School of Public Health (HSPH)

Investigators

  • Principal Investigator: Ryoko Sato, Ph.D., Harvard School of Public Health (HSPH)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 15, 2019

Primary Completion (Actual)

February 9, 2020

Study Completion (Actual)

February 9, 2020

Study Registration Dates

First Submitted

July 29, 2019

First Submitted That Met QC Criteria

July 31, 2019

First Posted (Actual)

August 1, 2019

Study Record Updates

Last Update Posted (Actual)

July 14, 2020

Last Update Submitted That Met QC Criteria

July 11, 2020

Last Verified

July 1, 2020

More Information

Terms related to this study

Other Study ID Numbers

  • TBDNA

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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