Characteristics of Persons Refusing Oral Polio Vaccine during the Immunization Plus Days - Sokoto, Nigeria 2011

"The traditional leaders were the most successful in positively influencing the decision to vaccinate."

This paper describes research undertaken to understand the reasons for refusal of the oral polio vaccine (OPV) during Immunization Plus Days (IPD) in 2011 in Sokoto state, Nigeria, the only African country endemic for wild poliovirus (WPV). Researchers conducted an unmatched case-control study amongst 65 heads of households refusing OPV and 65 accepting it. Noncompliant households were defined as households refusing OPV vaccination in last 3 rounds of IPDs; compliant households were those accepting vaccination in the last 3 rounds. Interviewers administered a questionnaire to the heads of households to obtain information on socio-demographics, media habits, and knowledge of IPD.

Here are selected communication-related findings from the 121 valid questionnaires (60 noncompliant households and 61 compliant households):

• Noncompliant heads of households were more likely to lack tertiary education (OR = 3.7) compared to compliant heads of households (see Table 2). Noncompliant heads of households were more likely to lack knowledge of the benefit of immunisation (OR = 35) and to lack knowledge of the global effort to eradicate polio (OR = 19).
• Noncompliant heads of household were more likely to "source" information concerning IPD from town announcers (OR = 3.9) and lack access to a functional radio (OR = 4.4) and television (OR = 9.4) (see Table 3). The most frequent reason given for vaccine refusal among the noncompliant heads of households was "no felt need" (see Figure 1).
• Of the 61 compliant heads of household, 27 (44%) had never refused OPV in the past while 34 (56%) refused OPV at least once prior to last 3 rounds of IPD in 2011. Of the 34 who had previously refused OPV, 21 (62%) were convinced to start accepting OPV by traditional rulers and five (15%) by religious leaders.

The discussion section of the paper offers reflects on the findings, such as the fact that lacking a tertiary education was associated with noncompliant households, which is a challenge in a country with an adult literacy rate of "about 57% and much lower (25-50%) for northern Nigeria". Other factors, as reflected in the findings, are: lack of knowledge of the importance of immuninising against polio as part of a global effort to eradicate the disease, a negative attitude towards OPV (e.g., worries that it might not be safe and that it may cause infertility), "no felt need", and/or exhaustion from too many rounds. Considering that the interviewees get information about OPV from town announcers (because they lack access to functional radio and television), it is suggested that town announcers be trained on key communication messages - with evaluation to follow as to the efficacy of these messages. Furthermore, the researchers recommend community dialogue preceding every round of IPD, with refined key messages such as "polio eradication is a global effort" and messages stressing the need for several rounds of OPV vaccination and the benefits of immunisation. This could involve the use of alternative methods of communications such as mobile text messages and village street theatre. The researchers also recommend offering mosquito nets, de-worming tablets, and other child survival strategies that were supposed to be bundled with OPV when IPD was being scaled up.