Engaging Communities in Anambra State in Improving Vaccination Outcome: A Participatory Research Approach to Enhancing Immunization Utilization
Helen Simon Nwafor*, Daprim Ogaji and Margaret Inemesit Akpan
ABSTRACT
Background: Childhood immunization coverage in Nigeria remains below the 90% target despite free vaccines. Evidence on participatory community engagement for routine immunization in South-East Nigeria is limited.
Objectives: To (1) determine caregivers’ knowledge of childhood immunization and baseline immunization utilization; (2) identify community-related factors influencing utilization; (3) implement community-based interventions developed with community stakeholders; and (4) determine changes in knowledge and utilization after the interventions.
Methods: A Participatory Action Research design with baseline assessment, participatory planning and implementation, and post intervention evaluation was used in six communities across six Local Government Areas (two per senatorial zone) of Anambra State. Three hundred and sixty-one caregivers of children aged 0–12 months were sampled by multistage sampling at each assessment (sample size computed for a two-proportion comparison, 95% confidence, 80% power, inflated by 10% for attrition). Data were collected with a structured questionnaire (Cronbach’s alpha 0.798 in pilot testing) and child immunization records. Interventions were health education, SMS reminders, telephone calls and supportive supervision. Data were analyzed with descriptive statistics and chi-square tests (p < 0.05).
Results: At baseline, 34.9% of caregivers had good knowledge and 30.5% had high utilization. Distance to facilities, mothers’ time constraints, inconvenient session times and the lack of a reminder system were the community-related factors rated as significant barriers (item means ≥ 3.0). After the interventions, good knowledge rose to 63.2% (poor knowledge fell from 23.8% to 5.3%; χ² = 76.80, df = 2, p < 0.001) and high utilization rose to 58.4% (low utilization fell from 15.2% to 0.6%; χ² = 87.76, df = 2, p < 0.001). Timely completion of immunization rose from 45.4% to 66.8% (p < 0.001), and uptake improved significantly for 13 of 14 individual vaccine doses. Post-intervention utilization did not differ significantly by intervention type (p = 0.41).
Conclusion: Participatory community engagement combining health education, reminders and supportive supervision was associated with better caregiver knowledge and immunization utilization. The single-group design limits causal inference; controlled studies are needed.
