Mobilizing Youths (16-29 Years) through Entertainment-Education for Uptake of MenAfric Vaccination in Niger State, Nigeria

"[T]his study has consistently found that risks of not being vaccinated against meningitis are perceived more negatively since exposure to the hazard is involuntary, they are familiar with the disease and the benefits of vaccination are not immediately apparent...[E]ntertainment-education has succeeded in breaking down some of the bottlenecks posed by these behavioural factors."

The author of this study applied the entertainment-education (EE) approach in Nigeria to mobilise youths aged 16-29 for MenAfric (meningitis) vaccination. As Anthony-Onuekwe notes, following the successful introduction of mass MenAfric vaccination in Burkina Faso, Mali, and Niger Republic, Nigeria started the MenAfriVac campaign in 2011 in an attempt to reach 79.5 million people aged 1-29 years over 3 years covering all the 26 states in the "meningitis belt" (where the largest burden of cerebrospinal meningitis occurs, stretching from Senegal in the west to Ethiopia in the east with a population of about 450 million people. Bacterial meningitis remains a serious threat to health accounting for an estimated 170,000 deaths annually.)<br.
According to the author, vaccination is generally considered to be a risk that is not dreaded (controllable, not fatal, individual, low risk to future generations) but is somewhat unknown (not observable, effect delayed, new risk, risk unknown to science). Therefore, in seeking to influence uptake of meningitis vaccination by those aged 16-29 years, the author recommends an ecological approach, which identifies and addresses the factors influencing behaviours at all levels: micro (personal) factors, meso (social) factors, and macro (environmental) factors.

As detailed here, each campaign was characterised by communication and social mobilisation pre-implementation activities including advocacy, radio announcements, and the development and distribution of information, education, and communication (IEC) materials to impact knowledge, attitude, and acceptance. However, coverage surveys of the campaigns in several states of Nigeria across several phases showed that participants aged 16-29 years recorded low uptake. Communication and community mobilisation activities planned and executed in preparation for the campaign were mostly mass media based: radio announcements, posters, fliers, street banners, and media health correspondent sensitisation, etc. The author suggests that these communication strategies were less effective in mobilising the population at age 16-29 years. Hence, an alternative communication strategy in the format of EE was piloted in the third phase of the campaign in Niger state, Nigeria.

This paper examines the effect of the intensified mobilisation through EE, monitored through the daily call-in data from 4 cities where EE strategies were conducted to attract those aged 16-29 to the vaccination posts for uptake of MenAfric vaccination. By extension, this study also discusses human behaviour change principles and risk perception in order to understand why the uptake of the vaccination exercise for this age group was suboptimal in all the phases of the campaign, including the EE phase, in Nigeria.

As noted here, several research studies conducted in various parts of the world have testified that EE strategies can be effective in creating desired social change in individual and communal behaviours. "These studies include but not limited to Rogers and Singhal's Twende na Wakati studies of family in Tanzania, Singhal, Hurlburt and Vij's (2007) study of Gugar Goje in Nigeria, Penn et al's (2003) study of the effects of a documentary film about schizophrenia on psychiatric stigma, Adegoju's (2010) evaluation of dramatic and persuasive techniques in the dissemination of HIV/AIDs messages in Abule Merin, Southern Nigeria, Onuekwe's (2013) assessment of the impact of polio documentary film on noncompliance parents in Nigeria."

In view of these evidence-based interventions, the strategies adopted in Niger state carried out in October 2013 included: drama; traditional dance and music groups; engagement of motorcycle riders to float a convoy and demonstrate riding skills; and a "mobile music extravaganza to blast popular music especially Nigerian hip-hop around targeted vaccination posts with dancers and entertainers who distributed fliers about the campaign as well as person to person communication about the benefit of MenAfric vaccination."

For example, in Bida Local Government Area (LGA), the exercise was made up of 4 components that worked together to achieve the campaign objectives, namely: attention drawers (float of 20 motorcyclists); informants/educators (mobile public announcement tricycle); entertainers (the traditional dancing troupe); and a special vaccination team. The locations targeted were major streets, markets, schools, Emirs palace, motor packs and other locations where people normally converge for their daily chores. At every popular location, the attention drawers went around the vicinity to distribute fliers, engaging people on one-on-one discussion and pulling a crowd of eligible audiences back to the temporary vaccination post, while the mobile tricycle made announcements about the importance of meningitis vaccination, campaign dates, intended age group, and venues. In Chanchaga and Suleja local government areas (LGAs), the main strategy was basically the same - EE - but, being more metropolitan, traditional dance/music was substituted with recorded Nigerian popular hip-hop music that played while a group of 15 National Youths Service Corps (NYSC) members, dressed in branded T-shirts, distributed the fliers and engaged people on interpersonal discussion on the importance of the MenAfric vaccination.

Results:

• In Chanchaga LGA, daily call-in data (on the third day) showed a marginal increase in uptake of the vaccination by the age group 16-29 years. Hence, the administrative coverage rose from 9% on the third day to 12% by the fourth day and maintained a daily 10% coverage until after the seventh day.
• In Kotangora LGA, the intensified mobilisation exercise took place on the fourth and fifth Days of the campaign. Daily-call-in data showed an increase both in the special teams' and LGA coverage for the age group 16-29 years for the fourth day, and a stable coverage for the fifth, sixth, and seventh days.
• In Suleja, the EE troupe performed on the ninth day of the 10-day campaign. At Day 7, the daily coverage (8%) for age group 16-29 years had started a downward trend but picked up again on Day 9 (11%) which was the day that the intensified mobilisation exercise took place in Suleja LGA.

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