Intervention

FormativestudyonVaccineIndicatorandReminder(VIR)bandtoimprovevaccinationtimelinessandcompletioninNigeria.

AprojectimplementedbyHealthStrategy&DeliveryFoundation(HSDF)andDirectConsultingandLogistics(DCL)Limited,incollaborationwithresearchersfromJohnsHopkinsInternationalVaccineAccessCenter(JHU/IVAC)andPrecisionDevelopmentResearchandAdvocacy.

EvaluationMethod

Outputs

Projectduration:January2016toAugust2018Forfurtherenquiries,contact:LeadInvestigator:Dr.ChizobaWonodicwonodi1@jhu.edu+2348100091910orResearchCoordinator:ChisomObi-Jeffchisom.obi@dclnigeria.com+2348038878844Otherinvestigatorsandteam:Dr.NoorRakshani(Co-LeadInvestigator),Dr.SachiOzawa&Dr.ChikeNwangwu(Co-Investigator),JamilaBelloMalabu&EbubeNwaononiwu.

ProjectSummaryBackground: Despite the significant progress inNigeria’s immunization programs, child mortalityfigures are still unacceptably high. In 2015, anestimated 750,000 children under the age of fivedied in Nigeria. About 30% of these deaths werecaused by a significant proportion of vaccinepreventablediseasessuchaspneumonia,diarrhoea,meningitis,and measles. Interventionsto increasevaccine uptake are important in Nigeria, asimmunization coverage and equity, in particular,timelinessandcompletionofvaccinations,remain achallenge despite remarkable investments in theprogrambygovernmentandpartnersoverthelastfew decades. These investments have focusedmainlyonimprovingvaccinesupply,whiledemand-side interventions such SMS reminders anddefaulter tracking have been implementedunevenly. Tilldate,thereislimitedunderstandingof what works to improve demand for routinevaccinesespecially,inruralandremoteareas.Thus,thereisaneedforevidenceoncommunity-focused,demand-side approaches that work, and are cost-effectiveandeasytoimplementatscale.

Aim:This study aims to assess the feasibility andacceptability of implementing an innovative VIRband to improve immunization timeliness andcompletionamonginfantsinNigeria.

The Innovation: The Vaccine Indicator andReminder (VIR) band is a silicon band and aninnovation that serves as a constant reminder toparents/caregiverson the need tovaccinate theirchildreninatimelymanner.Itconsistsofasealeddyeblisterandatimeindicatorthatisactivatedateachvaccine(BCG,Penta1andPenta2)initiationby pressing theblister, releasing thedye tomovealongamembranebycapillaryactiontoreachtheend point.The ink progression givesavisual clueandservesasareminder toparents/caregivers tovaccinate children in a timely and completemanner. The device has been tested among 346infantsvisitingvaccinationcentersinPakistan,andpreliminary results indicate overwhelmingparental support of the VIR band concept andcompliancewiththedevice.

VIRbanddesignedbyDr.NoorSabahRakhshaniofPrecisionDevelopmentResearchandAdvocacy,Pakistan

StudyObjectives:1. To assess the cultural and practical

acceptabilityamongparentsontheuseofVIRbandontheirchildren.

2. ToevaluatethefeasibilityofincorporatingtheVIRbandsaspartofRIservice.

3. To assess parents’ knowledge, attitude andpracticeaboutchildhoodimmunization.

Findings will contribute to the limited body ofevidence on effective and feasible community-focused, demand side approaches to improvevaccination programs in Nigeria. Additionally, itcould inform decisions on how best to deliverprimary health care interventions/innovations tounderservedcommunities.

Mixedmethodsdesign.Qualitative:7FocusGroupDiscussions,28In-depthinterviews and participant observations will be conducted to assess: 1)community perceptions and attitudes towards vaccination pre- and post-intervention; 2) community acceptance of the VIR band pre- and post-intervention;3)TBAknowledge,attitudes,skills,andexperienceinsensitizingand referringmothers to the health facility for child’s vaccination; and 4)healthcareworkers’adherencetotheVIRbandprotocolandtheirexperiencewith the band. Quantitative: Before and after household surveys amongmothersof infants 0-11months (n=1100), toquantifyandassesschange inknowledge, perceptions and attitudes about the importance of timelyvaccinations; assess change in intention to vaccinate their children, andchangeintimelinessofBCGandPenta3vaccination.Monitoringwithroutinelycollectedfacilityandcommunityservice-deliverydata,totrackadequacyofvaccinesupply,willalsobedone.

This study will be implemented in 3 wards (BunzaMarafa, Maidahini andRaha)inBunzaLocalGovernmentAreaKebbiState,NorthWestNigeria.Theinterventionconsistsof4majorelements:

1. Social mobilization of the community for VIR band andimmunization:Anintensivecommunityengagementexercisecampaignwill be conductedwith community/religious leaders,women’s groupsand men’s group, to inform them of the importance of timely andcompletevaccination,andoftheutilityoftheVIRband.

2. Training TBAsandfacility-basedhealthworkers(HWs):TBAsandHWswillbeenrolledandtrainedontheappropriateuseoftheVIRbandandonimmunizationtimelinessandcompleteness,toenablethemcommunicateeffectivelytoparents.TBAswillbeespeciallytrainedtoeducate mothers on VIR band and discuss the importance ofimmunizationtotheirclients.

3. Sensitization and referral to the health facility by TBA: TrainedTBAswillbeengagedtosensitizeandrefermotherstothehealthfacilityfortheirchild’svaccination.

4. Activation of the VIR band by health workers in the facility:Vaccinatorswillbetrainedontheprotocolfordistributing,activatingand using the VIR band, and on how to respond to deviations fromstandardprotocol.TheVIRbandswillbedistributedinthecommunityandactivatedbyHWsonceaninfant(andchildenrolledinthestudy)withaVIRbandreceivesher/hisfirstdoseofvaccinesinahealthfacilityorinthecommunity.

ThestudyhypothesizesthattheVIRbandcouldactasacuetoactionforparents,aswellasavisiblesignofvaccineacceptance,whichcouldhavecommunitylevelimpact.Specificoutputsinclude:1. Demonstrated positive norms around VIR band and

immunizationinthecommunity.2. DemonstratedparentalunderstandingoftheuseofVIRband,aswell

aswillingnesstoallowtheirchildrenwearthebandasareminderfortheirnextimmunizationsession.

3. Gained knowledge about vaccination timeliness andcompleteness, as well as recognition of the importance of timelyvaccinations and willingness to visit a health facility for child’simmunization.