Acceptability and feasibility of measles vaccination, small-quantity lipid-based nutrient supplementation, and their co-delivery among children aged 6–23 months in northern Nigeria: a qualitative study
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Undernutrition and infectious diseases form a vicious cycle that endangers child survival in low-resource settings, including in Northern Nigeria. The NutriVax-Measles trial was designed to evaluate a strategy combining preventive small-quantity lipid-based nutrient supplements (SQ-LNS) distributions with community mobilization and routine immunization services for children aged 6-23 months to improve measles vaccination uptake. To inform future programs co-delivering nutrition supplementation and immunization services at scale, we aimed to assess the feasibility and acceptability of measles vaccination, SQ-LNS distribution, and the NutriVax strategy.
Methods
A qualitative study was conducted at the end of the trial using in-depth interviews (n=53) and focus group discussions (n=8) with key stakeholders: caregivers, health care workers, community health workers, and community representatives. Thematic analysis was guided by multiple conceptual frameworks.
Results
The majority of the participants expressed satisfaction with measles vaccines in both arms, and with SQ-LNS in the NutriVax arm, as they perceived the benefits for their children’s health. In both arms, community awareness sessions and previous experience of outbreaks were key to motivating caregivers to bring their children to healthcare centres. Although distance to health facilities was identified as one of the main barriers to accessing care, SQ-LNS was perceived as an important source of motivation to bring their child to the clinic where they subsequently received vaccination. All stakeholder groups emphasized the importance of community leaders’ support and targeted male sensitization to address the prevailing sociocultural norms. Additionally, improved service organization to reduce waiting time was considered crucial to enhance caregivers’ acceptability of the intervention.
Conclusion
Both measles vaccination and SQ-LNS provision were acceptable and feasible, supporting the NutriVax strategy within primary healthcare settings in fragile health systems. Successful implementation depends on sustained community sensitization, continued engagement of fathers and community leaders, and service delivery decentralized as close as possible to beneficiaries.
KEY MESSAGES
What is already known?
-
Co-delivering small-quantity lipid-based nutrient supplements (SQ-LNS) with routine immunization is an effective strategy to improve vaccination coverage in Northern Nigeria. Yet, evidence on how vaccination and SQ-LNS are perceived, implemented, and experienced by stakeholders at health-care and community levels remains scarce.
What are the new findings?
-
SQ-LNS was an important source of motivation for caregivers to bring their children to health facilities, creating opportunities for vaccination.
-
Persistent barriers to vaccination included socio-cultural misconceptions, gender norms, long waiting time and distance to health facilities.
What do the new findings imply?
-
Sustained community engagement, including targeted male sensitization, is important to improve measles vaccination acceptability.
-
Successful implementation of co-delivery programs also requires well-organized service delivery, with services decentralized to health facilities as close as possible to beneficiaries, particularly to reduce travel distances and waiting times.
