Barriers and enablers to childhood immunization in high zero-dose burden communities in Kano and Lagos states, Nigeria

Background: Reducing the number of zero-dose children in Nigeria requires a context-specific understanding of the factors driving under-immunization at individual and community levels. This study identifies barriers and enablers to immunization uptake among caregivers of children under two in high-burden zero-dose communities in Kano and Lagos States, Nigeria.

Methods: We followed a qualitative methods approach, conducting 40 focus group discussions (FGDs) among caregivers in the urban communities of Ungogo and Alimosho in Kano and Lagos states, respectively, peri-urban communities of Gezawa in Kano state and rural communities of Ikorodu in Lagos state. Vignettes, gender analysis, and concept-testing of interventions were integrated into the FGD guides to minimize social desirability and explore gendered factors. FGDs were pretested, translated into local languages, audio-recorded, transcribed, and back-translated into English. Thematic analysis was performed using NVivo software.

Results: We identified high recognition of the importance of childhood immunization among our study communities, despite inadequate immunization uptake. The main barriers to immunization uptake found in this study were gender-skewed decision-making in childhood vaccination between caregivers, prevalent misconceptions about immunization, prioritization of unmet socio-economic needs over immunization, and past negative experiences with immunization and health services. Enablers included effective community mobilization, involvement of religious and traditional leaders, positive attitudes of well-trained health workers, reliable fixed and outreach immunization services, and material incentives for caregivers. Caregivers preferred community-based strategies, especially those engaging community and religious leaders.

Conclusion: While similar barriers and enablers are inherent in global vaccine rejection, two-way community engagement for collective action, vaccination awareness campaigns, and engagement of cultural and traditional leaders, including fathers, offer promising strategies for improving immunization uptake in Nigeria.