Engaging communities in Anambra State in improving vaccination outcomes: A participatory research approach to enhancing immunization utilization
Keywords:
community engagement, participatory action research, childhood immunization, vaccination uptake, NigeriaAbstract
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 analysed 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.
Downloads
References
Akwataghibe, N. N., Ogunsola, E. A., Popoola, O. A., Agbo, A. I., & Dieleman, M. A. (2021). Using participatory action research to improve immunization utilization in areas with pockets of unimmunized children in Nigeria. Health Research Policy and Systems, 19(Suppl. 2), 88. https://doi.org/10.1186/s12961-021-00719-9 DOI: https://doi.org/10.1186/s12961-021-00719-9
Ariyibi, S. O., Ojuawo, A. I., Ibraheem, R. M., Afolayan, F. M., & Ibrahim, O. R. (2023). Mothers/caregivers' knowledge of routine childhood immunization and vaccination status in children aged 12–23 months in Ilorin, Nigeria. African Health Sciences, 23(4), 582–591. https://doi.org/10.4314/ahs.v23i4.61 DOI: https://doi.org/10.4314/ahs.v23i4.61
Basheer, S. A., Kumar, R., Viwattanakulvanid, P., Yaha, M. B., & Somrongthong, R. (2021). Effect of interpersonal communication training program on child's immunization among mothers living in Kebbi State of Nigeria. Journal of Ayub Medical College Abbottabad, 33(1), 139–144.
Bhandari, P. (2023, June 22). Multistage sampling: Introductory guide & examples. Scribbr.
Blagden, S., Newell, K., Ghazarians, N., Sulaiman, S., Tunn, L., Odumala, M., Isba, R., & Edge, R. (2022). Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people: A scoping review. BMJ Open, 12(8), e061749. https://doi.org/10.1136/bmjopen-2022-061749 DOI: https://doi.org/10.1136/bmjopen-2022-061749
Briggs, N. C. T., Tobin-West, C. I., & Babatunde, O. (2022). Effects of a community volunteer-driven intervention on caregivers' knowledge and practice of childhood immunization in rural communities of Rivers State. The Nigerian Health Journal, 22(3), 250–263. https://doi.org/10.60787/tnhj.v22i3.610
Brotobor, D., Nwadike, I., Edeawe, O. I., Izekor, O. C., & Olowogboye, J. (2021). Determination of the factors that affect mothers' attitude towards immunization in the South-South region of Nigeria. Open Journal of Medical Research, 2(2), 67–74. https://doi.org/10.52417/ojmr.v2i2.233 DOI: https://doi.org/10.52417/ojmr.v2i2.233
Cochran, W. G. (1977). Sampling techniques (3rd ed.). John Wiley & Sons.
Cornfield, J. (1958). [complete citation from thesis source list]
Dathini, H., et al. (2025). Parental SMS reminders and infant immunization coverage and timeliness in Maiduguri, Nigeria. [complete citation from thesis source list]
Dhaliwal, B. K., Chandrashekhar, R., Rattani, A., Seth, R., Closser, S., Jain, A., Bloom, D. E., & Shet, A. (2021). Community perceptions of vaccination among influential stakeholders: Qualitative research in rural India. BMC Public Health, 21, 2122. https://doi.org/10.1186/s12889-021-12188-4 DOI: https://doi.org/10.1186/s12889-021-12188-4
Dubé, È., Ward, J. K., Verger, P., & MacDonald, N. E. (2021). Vaccine hesitancy, acceptance, and anti-vaccination: Trends and future prospects for public health. Annual Review of Public Health, 42, 175–191. https://doi.org/10.1146/annurev-publhealth-090419-102240 DOI: https://doi.org/10.1146/annurev-publhealth-090419-102240
Etim, E.-O., et al. (2025). Caregivers' and community influencers' perspectives on barriers to childhood immunisation in northern Nigerian states. [complete citation] DOI: https://doi.org/10.1186/s12889-025-22710-7
Fleiss, J. L., Levin, B., & Paik, M. C. (2003). Statistical methods for rates and proportions (3rd ed.). John Wiley & Sons. https://doi.org/10.1002/0471445428 DOI: https://doi.org/10.1002/0471445428
Giubilini, A. (2021). Vaccination ethics. British Medical Bulletin, 137(1), 4–12. https://doi.org/10.1093/bmb/ldaa036 DOI: https://doi.org/10.1093/bmb/ldaa036
Ibraheem, R., Akintola, M., Abdulkadir, M., Ameen, H., Bolarinwa, O., & Adeboye, M. (2021). Effects of call reminders, short message services (SMS) reminders, and SMS immunization facts on childhood routine vaccination timing and completion in Ilorin, Nigeria. African Health Sciences, 21(2), 951–959. https://doi.org/10.4314/ahs.v21i2.57 DOI: https://doi.org/10.4314/ahs.v21i2.57
Jean Baptiste, A. E., Wagai, J., Hahné, S., Adeniran, A., Koko, R. I., de Vos, S., Shibeshi, M., Sanders, E. A. M., Masresha, B., & Hak, E. (2024). High-resolution geospatial mapping of zero-dose and underimmunized children following Nigeria's 2021 Multiple Indicator Cluster Survey/National Immunization Coverage Survey. The Journal of Infectious Diseases, 230(1), e131–e138. DOI: https://doi.org/10.1093/infdis/jiad476
Kaduru, C. C., Mbagwu, G. C., Aadum, D. K., Eshikhena, G., Idim, G. A., Ibe, U. F., Sabenus, T., Jenson, F. G., Egbe, E., Aworabhi-Oki, N., Masa, H., Bekesu, M., & Oyeyemi, A. S. (2023). Using community theater to improve demand for vaccination services in the Niger Delta Region of Nigeria. BMC Proceedings, 17(l7), 6. https://doi.org/10.1186/s12919-023-00263-0 DOI: https://doi.org/10.1186/s12919-023-00263-0
Kagoné, M., Yé, M., Nébié, E., Sié, A., Müller, O., & Beiersmann, C. (2018). Community perception regarding childhood vaccinations and its implications for effectiveness: A qualitative study in rural Burkina Faso. BMC Public Health, 18, 324. https://doi.org/10.1186/s12889-018-5244-9 DOI: https://doi.org/10.1186/s12889-018-5244-9
MacDougall, C., & Smith, [initials]. (2006). [complete citation from thesis source list]
Mahachi, K., Kessels, J., Boateng, K. K., Jean Baptiste Achoribo, A. E., Mitula, P., Ekeman, E., Nic Lochlainn, L., Rosewell, A., Sodha, S. V., Abela-Ridder, B., & Gabrielli, A. F. (2022). Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges. Vaccine, 40(37), 5433–5444. https://doi.org/10.1016/j.vaccine.2022.07.058 DOI: https://doi.org/10.1016/j.vaccine.2022.07.058
Mohammed, Y., Reynolds, H. W., Waziri, H., Attahiru, A., Olowo-Okere, A., Kamateeka, M., Waziri, N. E., Garba, A. M., Corrêa, G. C., Garba, R., Vollmer, N., & Nguku, P. (2024). Exploring the landscape of routine immunization in Nigeria: A scoping review of barriers and facilitators. Vaccine: X, 20, 100563. https://doi.org/10.1016/j.jvacx.2024.100563 DOI: https://doi.org/10.1016/j.jvacx.2024.100563
National Bureau of Statistics & UNICEF. (2022). 2021 Multiple Indicator Cluster Survey/National Immunization Coverage Survey report. National Bureau of Statistics.
Obi-Jeff, C., Garcia, C., Onuoha, O., Adewumi, F., David, W., Bamiduro, T., Aliyu, A. B., Labrique, A., & Wonodi, C. (2021). Designing an SMS reminder intervention to improve vaccination uptake in Northern Nigeria: A qualitative study. BMC Health Services Research, 21, 844. https://doi.org/10.1186/s12913-021-06728-2 DOI: https://doi.org/10.1186/s12913-021-06728-2
Oladepo, O., et al. (2021). Effect of reminder SMS on full and timely completion of routine childhood immunization among mothers in rural Nigeria. [complete citation]
Olaniyan, A., Isiguzo, C., Agbomeji, S., Akinlade-Omeni, O., Ifie, B., & Hawk, M. (2022). Barriers, facilitators, and recommendations for childhood immunisation in Nigeria: Perspectives from caregivers, community leaders, and healthcare workers. Pan African Medical Journal, 43, 97. https://doi.org/10.11604/pamj.2022.43.97.35797 DOI: https://doi.org/10.11604/pamj.2022.43.97.35797
Oli, A. N., Ogwaluonye, U. C., Onubogu, C. U., Ozumba, A. F., Agbaenyi, O. H., Okeke, K. N., Onah, S. K., Okoro, J. C., Ifezulike, C. C., & Emechebe, G. O. (2021). Public knowledge and opinion on childhood routine immunizations in two major cities of Anambra State, Nigeria. Journal of Multidisciplinary Healthcare, 14, 247–257. https://doi.org/10.2147/JMDH.S279397 DOI: https://doi.org/10.2147/JMDH.S279397
Oliver-Williams, C., Brown, E., Devereux, S., Fairhead, C., & Holeman, I. (2017). Using mobile phones to improve vaccination uptake in 21 low- and middle-income countries: Systematic review. JMIR mHealth and uHealth, 5(10), e148. https://doi.org/10.2196/mhealth.7792 DOI: https://doi.org/10.2196/mhealth.7792
Oyo-Ita, A., Bosch-Capblanch, X., Ross, A., Oku, A., Esu, E., Ameh, S., Oduwole, O., Arikpo, D., & Meremikwu, M. (2021). Effects of engaging communities in decision-making and action through traditional and religious leaders on vaccination coverage in Cross River State, Nigeria: A cluster-randomised control trial. PLOS ONE, 16(4), e0248236. https://doi.org/10.1371/journal.pone.0248236 DOI: https://doi.org/10.1371/journal.pone.0248236
Oyo-Ita, A., Oduwole, O., Arikpo, D., Effa, E. E., Esu, E. B., Balakrishna, Y., Chibuzor, M. T., Oringanje, C. M., Nwachukwu, C. E., Wiysonge, C. S., & Meremikwu, M. M. (2023). Interventions for improving coverage of childhood immunisation in low- and middle-income countries. Cochrane Database of Systematic Reviews, 2023(12), CD008145. https://doi.org/10.1002/14651858.CD008145 DOI: https://doi.org/10.1002/14651858.CD008145.pub4
Pramanik, S., Ghosh, A., Nanda, R. B., de Rouw, M., Forth, P., & Albert, S. (2018). Impact evaluation of a community engagement intervention in improving childhood immunization coverage: A cluster randomized controlled trial in Assam, India. BMC Public Health, 18, 534. https://doi.org/10.1186/s12889-018-5458-x DOI: https://doi.org/10.1186/s12889-018-5458-x
Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C. W., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A. M., Trotter, C. L., Lindstrand, A., O'Brien, K. L., & Bar-Zeev, N. (2024). Contribution of vaccination to improved survival and health: Modelling 50 years of the Expanded Programme on Immunization. The Lancet, 403(10441), 2307–2316. https://doi.org/10.1016/S0140-6736(24)00850-X DOI: https://doi.org/10.1016/S0140-6736(24)00850-X
Xie, Y. J., Liao, X., Lin, M., Yang, L., Cheung, K., Zhang, Q., Li, Y., Hao, C., Wang, H. H., Gao, Y., Zhang, D., Molassiotis, A., Siu, G. K. H., & Leung, A. Y. M. (2024). Community engagement in vaccination promotion: Systematic review and meta-analysis. JMIR Public Health and Surveillance, 10, e49695. https://doi.org/10.2196/49695 DOI: https://doi.org/10.2196/49695
Yunusa, U., Garba, S. N., MacDonald, S. E., Bello, U. L., Ibrahim, A. H., Abdulrashid, I., Dalhatu, A., & Ladan, M. A. (2024). Utilization of mobile reminders in improving the completeness and timeliness of routine childhood immunization in Kano Metropolis, Nigeria: A randomized controlled trial. Journal of Pediatric Health Care, 38(5), 727–736. https://doi.org/10.1016/j.pedhc.2024.03.002 DOI: https://doi.org/10.1016/j.pedhc.2024.03.002
Published
How to Cite
Issue
Section
Copyright (c) 2026 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
