Improving Timeliness and Completion of Infant Vaccination among Infants in Nigerian Urban Slums through Older Women's Participation

"[T]he involvement of trained older women caregivers in infant vaccination improved both the timeliness and completion of infants' vaccination in urban slum."

Nigerian urban slums have a high population of infants with suboptimal vaccination despite previous interventions. Older women traditionally play supervisory roles in infant care in Nigeria, but their influence is untapped in infant vaccination. This randomised experimental community study sought to determine if training of older women (35 years and above) in urban slum communities in Ibadan, Southwest Nigeria, and involving them in infant vaccination would improve infant vaccination timeliness and completion.

Pregnant women (n=198) in their third trimester residing in 7 urban slum communities were randomised using their antenatal clinics (ANCs) into intervention (6 ANCs) and control groups (6 ANCs). Women in the intervention group (n=105) were asked to bring the potential older woman caregiver (n=96) for their unborn babies to the clinic for 7 training sessions on the importance of infant vaccination timeliness and completion. The training manual was developed based on findings from focus group discussions among women of similar age group from these communities. Participatory learning methods were used during the training sessions, each of which lasted 90-120 minutes. Each older woman had at least 2 sessions of training before the infants (n=202: 109 in intervention group and 93 controls) were born. The pregnant women in the control arm (n=93) had their infant vaccination as usual. The vaccination of all the infants were monitored from birth till 9 months and 2 weeks of age, when all infant vaccination were expected to have been completed.

Infants in the intervention group (67.9%) significantly had both timely and complete vaccinations compared with those in the control group (36.6%). Vaccines given at birth were the least timely in both groups. More infants whose older women caregiver were married had timely and complete vaccinations. Also, a higher proportion of male infants, low birthweight babies, and infants with older women caregiver with at most two children had timely and completed vaccinations, but these associations were not statistically significant.

The researchers note that timeliness and completeness of vaccination in this study was consistent all through the age of the infants among the intervention group, which is in contrast with the typical pattern of gradual reduction in the timeliness and uptake of infant vaccination as the age of infants progresses in sub-Saharan Africa. This fact may be a reflection of the improved knowledge and efforts of the older women caregiver, who ensured timely uptake of each vaccine by the infants. Distraction of the mother by other responsibilities looks like a plausible explanation for this reduction in timeliness and completion as the infant grows. The training and involvement of older women infant caregivers (where this set up exist) may be used to address this decline, with resultant improvement in infant vaccination timeliness and completion.

Based on the study's findings, the researchers suggest that the intervention tested here "gives hope for the improvement of infant vaccination timeliness and completion in disadvantaged communities and has some edge over earlier interventions that were designed to achieve the same. The odds of its acceptance in other similar settings are high because it was built on an existing and respected cultural set up which community members could identify with. The focus here was on training older women caregivers who are influential and respected...[, which] will reduce the resources required for the intervention. The skills that these women acquired can be transferred to others in their social network, broadening the impact. This will open the window for sustainability of the model as it will be easy for the communities to take ownership of the program."