Improving Hepatitis B Vaccination uptake in Bassan Jiwa Community of the FCT.
- Over 19.3 million new cases of cancer with 9.5 million deaths occurred globally in 2020. With the highest burden in Low- and Middle-income countries like Nigeria. Cases are expected to rise by 70% in the next two decades.
An estimated 115,950 new cancer cases and 70,327 deaths occur in Sub-Saharan African and in Nigeria, liver cancers and cervical cancers are among the top five cancers among men and women.
Nigeria is a high-risk location for hepatitis B infection and liver cancer with 9.5% prevalence of HBV infection. Only 52% of children born in Nigeria receive a timely dose of HBV on the day of their birth (2019). Hepatitis B infection may progress to liver cirrhosis and cancer of the liver.
Bassan Jiwa is a community of about 132,000 people in the FCT, located along the airport road, is documented to have a low coverage of Hepatitis B vaccine (<2%). Health workers here have also been part of recurrent health worker strikes and industrial action. The PHC workers reported that transportation to the communities with low vaccine coverage for outreaches was a challenge.
- The Nigerian Government through the National Primary Health Care Development Agency (NPHCDA) provides vaccines for children 0-14 months at no cost to them. However, for several reasons the uptake remains very low. Sometimes, the people reject vaccination believing in myths that it will affect fertility and undermine population growth. Some are denied vaccination due to incessant health worker strikes, poor attitude of health workers, insecurity, long distance to the health facility, previous bad experiences with vaccination. Some other socio-cultural or religious reasons are also commonly at play.
With my team members, I intend to study and understand these socio-cultural and religious reasons for rejection or low uptake in Bassan Jiwa community together with my colleagues who come from different disciplines – medical doctors, nurses, biomedical sciences, physiology and public health and with several years of community work and research experience. We will conduct qualitative research including focus group discussions with mothers of children less than one year and key informant interviews with the health workers, to understand the myths and other reasons for the low uptake of vaccination in the community and their perceptions about cancer. We will also conduct quantitative survey using well structured and pre tested questionnaires in this research for other socio-demographic metrics as well as the knowledge and practices with relation to vaccination in the community. The cultural and language context including existing structures like health facilities and religious places of worship will be factored into the context of this community. The PEN 3 model will form the framework for this study, so that the community is engaged in the study from planning to implementation and final dissemination of the findings.
- The use of implementation strategies “that are appropriately aligned with the culture, values, and resource realities of the setting.
The innovative intervention that I believe will form the basis for improved uptake is a health camp integrated with vaccination services. This is relatively cheap and easy to undertake by the community and using available resources such as the health workers in the community. This will significantly improve the uptake of hepatitis B vaccination along with boosting other vaccine coverage generally. We will conduct sensitization/health education activities with the relevant stakeholders in the community including the women, men, traditional and religious leaders as well as the youths, prior to the health camp.
The Health camp/ vaccination outreaches will be conducted at the Chief’s palace or other acceptable venue and other health products like deworming tablets, multivitamins, anti – malarial for children, LLIN etc will be provided by the researchers.
Customized T-shirts, face caps, banners, posters and flyers with relevant messages on hepatitis vaccination (#Hepatitis B is a Killer disease #Vaccinate children against Hepatitis B #Stop Cancer of the Liver) will be distributed to the community to serve as reminders. Mothers of new-born babies will also receive baby diapers after vaccination.
The records/data of children vaccinated at the health camp/outreaches will be used to assess hepatitis vaccine uptake especially among the new-born.
- The health facility will be supported with transportation to continue the outreaches to vaccinate the community, building trust and sustain the vaccination uptake while encouraging utilization of health services at the health facility over time. We will partner with the FCT Primary Health Care Board, Local Government Chairman and LG health authorities. The WHO and UNICEF, other health NGOs, CSO in the community will also be part of the partnership so as to sustain the intervention
- Dissemination of findings to the Bassan Jiwa community, stakeholders, partners and the Policy makers will facilitate the sustainability and adoption of this strategy in other communities with low vaccine uptake by policy makers.
The expected Output/outcome:
- Increased hepatitis vaccine uptake among new-borns in the Bassan Jiwa community.
- Improved knowledge about importance of Hepatitis vaccination and prevention against liver cancer in the Bassan Jiwa community.
