Improving the Timeliness and Completeness of Childhood Vaccination Through Color-coded Bracelets: a Pilot Study Among Fulani Tribe Populations in Nigeria

Overview

Journal J Public Health Afr

Date 2023 Jul 13

PMID 37441119

Authors

Inuwa Barau Yau

Mahmud Zubair Mustapha

Eric Nwaze

Ouedraogo Nobila

Aliyu Maigoro

Adamu Abdullah

Adamu Gamawa

Peter Meissner

Jahn Albrecht

Olaf Muller

Affiliations

Soon will be listed here.

Abstract

Background: Childhood immunization remains one of the most cost-effective public health interventions. Globally, millions of children are not being reached with safe and effective vaccines and Nigeria has the highest number of unprotected children.

Objective: The effects of locally adapted interventions on vaccination timeliness and completeness were studied amongst Fulani populations across 6 health facilities in 2 districts of Bauchi State, Nigeria.

Methods: The intervention group consisted of newborns who received 5-color-coded bracelets representing different immunization contacts, while the control group had no bracelets. Vaccination rates across contacts were followed for 11 months. In addition, mothers of children in the intervention group were voluntarily recruited as peer-to-peer mobilizers (PPM).

Results: In this study, 435 children were studied. Vaccination completeness was higher in the intervention group compared to the control group at all contacts during follow-up. The difference was most noticeable at the fifth contact, with 158/256 (62%) children in the intervention group completing, compared to 73/179 (41%) in the control group (P<0.0001). Vaccination timeliness was better in the intervention group compared to the control one, which reached statistical significance at the second and third vaccination contacts (P<0.05). 68% of women volunteered as PPM and recruited 82 additional children for vaccination.

Conclusion: This study demonstrated the feasibility of a composite intervention (bracelets and PPM) to increase the completeness and timeliness of childhood immunization and provided preliminary evidence for its efficacy among Fulani populations in Nigeria. Findings from this pilot study should be confirmed through a larger cluster randomized controlled trial.

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References

Walton S, Cortina-Borja M, Dezateux C, Griffiths L, Tingay K, Akbari A . Measuring the timeliness of childhood vaccinations: Using cohort data and routine health records to evaluate quality of immunisation services. Vaccine. 2017; 35(51):7166-7173. PMC: 5720480. DOI: 10.1016/j.vaccine.2017.10.085. View

Wakadha H, Chandir S, Were E, Rubin A, Obor D, Levine O . The feasibility of using mobile-phone based SMS reminders and conditional cash transfers to improve timely immunization in rural Kenya. Vaccine. 2012; 31(6):987-93. PMC: 4603391. DOI: 10.1016/j.vaccine.2012.11.093. View

Gidado S, Ohuabunwo C, Nguku P, Ogbuanu I, Waziri N, Biya O . Outreach to underserved communities in northern Nigeria, 2012-2013. J Infect Dis. 2014; 210 Suppl 1:S118-24. PMC: 10546473. DOI: 10.1093/infdis/jiu197. View

Adokiya M, Awoonor-Williams J, Beiersmann C, Muller O . Evaluation of the reporting completeness and timeliness of the integrated disease surveillance and response system in northern Ghana. Ghana Med J. 2016; 50(1):3-8. PMC: 4994486. DOI: 10.4314/gmj.v50i1.1. View

Mosser J, Gagne-Maynard W, Rao P, Osgood-Zimmerman A, Fullman N, Graetz N . Mapping diphtheria-pertussis-tetanus vaccine coverage in Africa, 2000-2016: a spatial and temporal modelling study. Lancet. 2019; 393(10183):1843-1855. PMC: 6497987. DOI: 10.1016/S0140-6736(19)30226-0. View

Abdul Rahman M, Al-Dabbagh S, Al-Habeeb Q . Health education and peer leaders' role in improving low vaccination coverage in Akre district, Kurdistan Region, Iraq. East Mediterr Health J. 2013; 19(2):125-9. View

The Lancet . Looking beyond the Decade of Vaccines. Lancet. 2018; 392(10160):2139. DOI: 10.1016/S0140-6736(18)32862-9. View

Alrowaili G, Dar U, Bandy A . May we improve vaccine timeliness among children? A cross sectional survey in northern Saudi Arabia. J Family Community Med. 2019; 26(2):113-117. PMC: 6515760. DOI: 10.4103/jfcm.JFCM_153_18. View

Oyo-Ita A, Wiysonge C, Oringanje C, Nwachukwu C, Oduwole O, Meremikwu M . Interventions for improving coverage of childhood immunisation in low- and middle-income countries. Cochrane Database Syst Rev. 2016; 7:CD008145. PMC: 4981642. DOI: 10.1002/14651858.CD008145.pub3. View

10.

Ozawa S, Clark S, Portnoy A, Grewal S, Stack M, Sinha A . Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001-2020. Bull World Health Organ. 2017; 95(9):629-638. PMC: 5578376. DOI: 10.2471/BLT.16.178475. View

11.

Hotez P . Immunizations and vaccines: a decade of successes and reversals, and a call for 'vaccine diplomacy'. Int Health. 2019; 11(5):331-333. DOI: 10.1093/inthealth/ihz024. View

12.

Das A, George B, Ranebennur V, Parthasarathy M, Shreenivas G, Todankar P . Getting to the First 90: Incentivized Peer Mobilizers Promote HIV Testing Services to Men Who Have Sex With Men Using Social Media in Mumbai, India. Glob Health Sci Pract. 2019; 7(3):469-477. PMC: 6816816. DOI: 10.9745/GHSP-D-19-00094. View

13.

Medley A, Kennedy C, OReilly K, Sweat M . Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Educ Prev. 2009; 21(3):181-206. PMC: 3927325. DOI: 10.1521/aeap.2009.21.3.181. View

14.

Ozawa S, Stack M, Bishai D, Mirelman A, Friberg I, Niessen L . During the 'decade of vaccines,' the lives of 6.4 million children valued at $231 billion could be saved. Health Aff (Millwood). 2011; 30(6):1010-20. DOI: 10.1377/hlthaff.2011.0381. View

15.

Vora S, Verber L, Potts S, Dozier T, Daum R . Effect of a novel birth intervention and reminder-recall on on-time immunization compliance in high-risk children. Hum Vaccin. 2008; 5(6):395-402. DOI: 10.4161/hv.5.6.7282. View

16.

Siddiqi D, Munir M, Shah M, Khan A, Chandir S . Effect of vaccine reminder and tracker bracelets on routine childhood immunization coverage and timeliness in urban Pakistan: protocol for a randomized controlled trial. BMC Public Health. 2019; 19(1):1421. PMC: 6820929. DOI: 10.1186/s12889-019-7667-3. View

17.

. Polio field census and vaccination of underserved populations--northern Nigeria, 2012-2013. MMWR Morb Mortal Wkly Rep. 2013; 62(33):663-5. PMC: 4604797. View

18.

Hofstetter A, duRivage N, Vargas C, Camargo S, Vawdrey D, Fisher A . Text message reminders for timely routine MMR vaccination: A randomized controlled trial. Vaccine. 2015; 33(43):5741-5746. PMC: 5863911. DOI: 10.1016/j.vaccine.2015.09.042. View

19.

Gibson D, Ochieng B, Kagucia E, Were J, Hayford K, Moulton L . Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial. Lancet Glob Health. 2017; 5(4):e428-e438. PMC: 5348605. DOI: 10.1016/S2214-109X(17)30072-4. View

20.

Wariri O, Edem B, Nkereuwem E, Nkereuwem O, Umeh G, Clark E . Tracking coverage, dropout and multidimensional equity gaps in immunisation systems in West Africa, 2000-2017. BMJ Glob Health. 2019; 4(5):e001713. PMC: 6747924. DOI: 10.1136/bmjgh-2019-001713. View