Understanding Attitudes to Immunisation in Northern Nigeria

1. Understanding Attitudes to Immunisation in Northern Nigeria Research to support the polio endgame and routine immunisation strengthening

2. Polio Nigeria [GoN, 2012-2013] • Substantial improvement in programme performance • Key opportunities in low transmission season, 2013-14 • But polio vaccination is a recurrent negotiation with households that will continue to through 2014 and beyond • So, better research on household attitudes to polio and routine immunisation supports short-, medium- and long-term goals • This research follows discussions between NPHCDA (Dr Ado) and USAID (Ellyn Ogden) at the Independent Monitoring Board (IMB) in May in London

3. Missed children [EMOD, 2013] • Despite major improvement, data show that gaps [residual groups of missed children] remain • These gaps are increasingly localised in ‘worst-performing’ areas • Detailed understanding of localised factors affecting household demand is critical to programme success

4. Approach of research • We need a research approach which can ‘drill down’ to micro-level, to systematically investigate influences on vaccine uptake at settlement and household level • The focus of the research is on the demand-side • We propose using ‘Qualitative Comparative Analysis’ (QCA) – a new research technique within the global programme

5. QCA: a localised research strategy • QCA assesses systematic differences between high- and low-performing households in key PEI wards/LGAs • It assesses a wide range of household factors (combining quantitative and qualitative aspects) including: • Household socioeconomic and cultural characteristics • Household perceptions of, and trust in public services and local governance, & • Household health, health-seeking behaviour, and attitudes to immunisation and polio • It tests which household factors – independently or in combination – correlate with the household’s likelihood of having missed children • It compares households and settlements in high- and low-performing wards to identify which factors correlate with positive and negative coverage outcomes

6. Process of research • Selection of focus states and within these, pairs of IPD high/low performing Wards and Settlements • After consultation with all partners, we propose to select Kano, Bauchi and Sokoto States (all HR States, all include VVHR LGAs, selection covers + and – WPV, and geo-cultural spread of 2 northern ‘zones’) • Random selection of 20 households per settlement • Survey sample size estimated at a total of 1,440 households (95% CI); 2 questionnaires will be conducted in each household (separately with male head of household and senior female decision-maker • Household interviews will be by structured interview questionnaire • Semi-structured interviews will be conducted with key stakeholders to ensure a fully participatory research process

7. Survey data: influencing factors • The survey instrument will collect independent variables in nine ‘bundles’, combining quantitative and qualitative data: • Household composition • Occupation and economic circumstances • Religion/ethnicity [sub-ethnicity] • Educational status and preferences • Perceptions of community development priorities • Perceptions of support for priority needs • Perception of governance systems • Perception of reliable sources of information and advice on priority needs • ‘Trust’ indicator • Experiences and perceptions of health services, immunisation and… polio

8. Research oversight and management