Improving the timeliness and completeness of childhood vaccination through color-coded bracelets: a pilot study among Fulani tribe populations in Nigeria

Abstract

Background. Childhood immunization remains one of the most cost-effective public health interventions. Globally, millions of children are not being reached with safe and effective vaccines and Nigeria has the highest number of unprotected children. Objective. The effects of locally adapted intervention on vaccination timeliness and completeness were studied amongst Fulani populations across six health facilities in two districts of Bauchi State, Nigeria. Methods. The intervention group consisted of newborns who received 5-colour-coded bracelets representing different immunization contacts, while the control group has no bracelets. Vaccination rates across contacts were followed for 11 months. In addition, mothers of children in the intervention group were voluntarily recruited as peer to peer mobilizers (PPM). Results. 435 children were studied. Vaccination completeness was higher in the intervention group compared to the control group at all contacts during follow-up. The difference was strongest at the 5th contact, with 158/256 (62%) children in the intervention group completing, compared to 73/179 (41%) in the control group (p<0.0001). Timeliness of vaccination was better in the intervention group compared to the control, which reached statistical significance at 2nd and 3rd vaccination contacts (p<0.05). 68% of women volunteered as PPM and recruited 82 additional children for vaccination. Conclusion. This study has demonstrated the feasibility of a composite intervention (bracelets & PPM) to increase the completeness and timeliness of childhood immunization and provided preliminary evidence for its efficacy amongst Fulani populations in Nigeria. Findings from this pilot study should be confirmed through a larger cluster randomized controlled trial.