13,036 Polio Communication Research, The Drum Beat 719

The Drum BeatOpening Access to Polio Communication Research – The Drum Beat 719
September 14 2016

In this issue:

HOW SOCIAL NORMS COME INTO PLAY: Kano State parents, IPV intro in Rwanda
UNDERSTANDING INEQUITABLE ACCESS AND REFUSALS: Underserved in Nigeria, Pakistani refusals
HOW ICTs CAN BE USED IN FIGHTING POLIO: Somali SMS, Nigerian e-lobbyists

This edition of The Drum Beat introduces you to papers published between April and July 2016 as part of a project initiated by The Communication Initiative (The CI) and the United States Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP). The project called on researchers, policymakers, and programme managers to submit papers that address critical issues related to the communication lessons and legacy of the Global Polio Eradication Initiative (GPEI), as well as the relationship between polio and routine immunisation (RI) programmes. The purpose of this project is to increase the number of peer-reviewed papers on RI and polio communication and to ensure that academics from a range of countries – those defined by the GPEI as polio infected, those where MCSP is working, and/or those that USAID has declared high priority – are supported in getting their research peer reviewed, published, and widely disseminated through The CI and the new open access journal Global Health Communication (GHC). For more information on the journal, please see below.

Our thanks go to the many people who helped with initiative – from the group that established the themes listed in the call for papers, to the people who considered the proposals and selected those to be invited for paper submission, to The CI editorial staff who provided support to the authors as they prepared their papers for submission, to the experts who reviewed these papers for the journal, and, of course, to the authors themselves, who took time from their work to write the papers and help share important lessons with others. Please note that the views and opinions expressed in the papers are those of the authors and do not represent those of The CI or the MCSP.

We hope this initiative has been a catalyst for the writing of more papers that help capture the rich experiences and lessons from communication activities in polio eradication and RI efforts. Please consider continuing to build this body of research by submitting your work to the GHC (see below) and/or by alerting us (info@comminit.com) to your publications and projects at any time.

From The Communication Initiative Network – where communication and media are central to social and economic development.
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  • 1. Community Engagement, Routine Immunization, and the Polio Legacy in Northern Nigeria
    by Anne McArthur-Lloyd, Andrew McKenzie, Sally E. Findley, Cathy Green, and Fatima Adamu
    This paper explores the community engagement (CE) component of the Partnership for Reviving Routine Immunization in Northern Nigeria – Maternal, Newborn, and Child Health Initiative (PRRINN-MNCH), suggesting that the lessons learned from this project are relevant to the Polio Eradication Initiative (PEI) when Nigeria reaches polio-free status and community mobilisers are mainstreamed into routine health services. The project’s CE approach aimed to empower communities, work with volunteers, and develop solutions to overcome barriers to health. The PRRINN-MNCH approach balanced addressing social factors and other demand-side constraints behind the low use of health services. PRRINN-MNCH mapped a theory of change to identify barriers and activities to achieve short-, medium- and long-term behaviour change. Application of these principles led to various CE programme components, in which community ownership was deemed essential. Baseline and endline population-based random househ! old surveys conducted in 2009 and 2013 showed improved community knowledge, increased use of antenatal care and immunisation services, and a decrease in maternal, infant, and under-5 mortality. “The transition plan for the Polio Eradication Initiative in Nigeria must give a prominent role to community volunteers. They have and will continue to have a major influence on supporting routine immunization and maintaining trust of the primary health care system at community level.”
  • 2. Evidence-Based Engagement of the Somali Pastoralists of the Horn of Africa in Polio Immunization: Overview of Tracking, Cross-Border, Operations, and Communication Strategies
    by Rustam Haydarov, Saumya Anand, Bram Frouws, Brigitte Toure, Sam Okiror, and Bal Ram Bhui
    Building on the experience of the 2013-2014 wild poliovirus (WPV) outbreak in the Horn of Africa, this study examines applied strategies that helped to engage pastoralists of the Somali cluster (Somalia, Somali Region of Ethiopia, and North-East Kenya) in supplementary immunisation activities (SIAs). Engagement with pastoralist populations required a thorough understanding of: their classification (e.g., nomadic-pastoralists, agro-pastoralists) and power structures; the spatial and temporal dimensions of their movement patterns; their beliefs and values; how to establish trust through respectful dialogue; and the services they found most relevant. On the basis of this deeper knowledge of the Somali pastoralists in the Horn of Africa, GPEI partners rolled out strategies, which are described in the paper. The proportion of children who had never been vaccinated against polio in the overall incidence of children reported with nonpolio acute flaccid paralysis (APF) in Somalia wa! s used as an outcome measure before and after the interventions. Results demonstrate that the proportion of these zero-dose children was reduced from 44.6% to 19.5% between 2014 and 2015. This research provides practical recommendations to public health practitioners who are facing the challenge of reaching pastoralist populations with health services.

  • Routledge, Taylor and Francis Group has been publishing a growing portfolio of open access titles since 2006. In furthering their commitment to open access, and in partnership with the editorial team of Journal of Health Communication: International Perspectives, they have launched GHC. Published annually, GHC addresses empirical and theoretical health questions using the lens of multiple perspectives, experiences, and cultures. This journal supports the development of a space for the international research community to advance scholarship around the role of communication processes in global public health, policy, and behaviour change. Articles in GHC receive both rigorous peer review and expedited online publication. Authors have the option of publishing their open access article under a Creative Commons Attribution (CC-BY) license.

    Interested in submitting a paper to GHC? Click here to learn how [PDF format].


  • 3. Polio Immunization Social Norms in Kano State, Nigeria: Implications for Designing Polio Immunization Information and Communication Programs for Routine Immunization Services
    by Abdullahi I. Musa
    In light of concerns about the sustainability of acceptance of polio vaccines as a routine exercise to sustain the gains of the GPEI programmes, this study presents a conceptual model of polio immunisation social norms in Kano State, Nigeria. Twenty-six parents in Sumaila Town, Kano State, Nigeria were interviewed using a semi-structured questionnaire. The author used an analytic inductive process to identify 234 narratives explaining polio immunisation social norms. The narratives are organised into 10 recurring topics and further collapsed into 3 emergent categories to explain the polio immunisation social norms. The author states that understanding personal, descriptive, and injunctive norms can inform the design of polio immunisation information and communication programmes for parents that are chronically resistant to polio immunisation in the last remaining polio-endemic areas. For example, there is a need for research to identify “important” individuals in s! ubgroups that have social influence. “This is critical because behaviors and beliefs are influenced by community members through intersubjective discourse with people that the social group regards as important. Most important, there is a need to determine in what way parents’ polio immunization behavior in public (injunctive norm) does/or does not correspond to their private personal belief (pluralistic ignorance).”
  • 4. Looking Back and Planning Ahead: Examining Global Best Practices in Communication for Inactivated Polio Vaccination Introduction in Rwanda
    by Suruchi Sood, Ann Klassen, Carmen Cronin, Philip Massey, and Corinne Shefner-Rogers
    This article combines research from secondary and primary sources on country experiences in polio vaccination and from the polio vaccination programme in Rwanda. As articulated by the GPEI in the Polio Eradication and Endgame Strategic Plan 2013-2018, the next big programmatic push relies on strengthening global RI systems and replacing oral polio vaccination (OPV) with inactivated polio vaccination (IPV). Findings highlight the importance of identifying multichannel and multiaudience approaches to polio eradication that cut across different levels of the social ecological model. The Rwanda data emphasise the use of social network approaches that allow for identification of individuals who can act as message multipliers and motivators within specific communities to help families make a seamless switch from OPV to IPV. Findings further emphasise the importance of evidence-based and audience-centred communication programming. The planned addition of IPV builds on normative beh! aviour across all sectors of society for children to receive full immunisation on schedule. According to the researchers, this provides a specific example of formative research for understanding polio eradication communication approaches that can be considered by other countries for introducing IPV within their RI schedules.

  • 5. Association of Volunteer Communication Mobilizers’ Polio-Related Knowledge and Job-Related Characteristics with Health Message Delivery Performance in Kano District of Nigeria
    by Rabia Sadat and Abu Mohd Naser
    Although involving the volunteer communication mobilisers (VCMs) was arguably one of the significant interventions for polio eradication in Nigeria, limited data are available on VCM performance. To fill this gap, researchers conducted a study to (ii) assess and compare the knowledge, job-related characteristics, and performance of VCMs in 2 Local Government Areas (LGAs) of Kano state, which is one of the 11 states in northern Nigeria where religious propaganda to boycott OPV occurred, (ii) assess whether VCMs’ knowledge and job-related characteristics were associated with performance, defined as the number of key health messages delivered during last household visit and implementation of community visits as performance variables of VCMs. “Our findings indicate that authorities in Ungogo need to focus on increasing the knowledge of existing VCMs….Although all low-performance problem[s] cannot be solved by providing training solely, it does need to be considered as the! first step of improving low performance when knowledge level is low….Supportive supervision may also increase the knowledge and skills of the health workers.”
  • 6. Redefining Immunization: Not Just a Shot in the Arm
    by Nancy Anderson, Nana Wilson, Tamica Moon, Natalia Kanem, Amad Diop, and Erick Gbodossou
    The project Immunization Advocacy: Saving Lives of Africa’s Children, funded by the Bill and Melinda Gates Foundation, was carried out in Benin, Nigeria, and Senegal with traditional health practitioners (THPs) and other community-based leaders to gain insight into their basic knowledge, attitudes, and perceptions of immunisations, the associated infrastructures, and their overall perceptions of preventive health measures, particularly beliefs and practices that may affect infant well-being. This research paper presents the results from the Senegal study, which surveyed 696 THPs involved in community culture, rites, education, and health. In short: “Effective educational programs that involve THPs in vaccine campaigns from inception, that address their perceptions and integrate their cultural belief systems into vaccine advocacy programs in a culture-centered manner, and that recognise and respect the importance of comprehensive primary health care will be necessary to ! improve essential vaccine coverage in this population.”

  • Polio Will not End Everywhere until Everywhere Ends It: Thirteenth Report of the Independent Monitoring Board of the Global Polio Eradication Initiative

    This report follows the 14th meeting of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI), July 20-21, London, United Kingdom (UK). The report makes an assessment of the progress of the Polio Programme with 6 months to go before the declared GPEI deadline (end of December 2016), by which time transmission of WPV should be interrupted everywhere in the world. One finding: “The IMB’s championship of the people factors and the use of social data are bearing fruit, ranging from valuing and training vaccinators, to really understanding why parents are avoiding having their children immunized, to empowering women as health workers in their communities. As we have described, though, the Polio Programme is paying a heavy price for not listening properly to what the social data are telling it in some key areas.”

    Click here to read The CI’s summary of the report and to access the entire IMB report.


  • 7. Variations in the Uptake of Routine Immunization in Nigeria: Examining Determinants of Inequitable Access
    by Comfort Z. Olorunsaiye and Hannah Degge
    Globally, immunisation prevents an estimated 2-3 million deaths among under-5 children, yet in Nigeria, only 25% of children ages 12-23 months are fully immunised. There are also marked disparities in the uptake of immunisations, largely attributable to the context within which families live and seek health care. The authors assessed the individual and state determinants of child immunisation in Nigeria and used multilevel logistic regression to estimate the odds of full immunisation among 5,561 children. Findings indicate low immunisation coverage rates overall, and there were substantial variations in access to, and use of, immunisation services among states. “These findings call for state-specific targeting to address inequitable access to routine immunization in Nigeria.” The idea is that such findings could contribute to identifying underserved areas, developing appropriate targeted strategies for interventions to improve the utilisation of immunisation servic! es, and providing evidence for the judicious allocation of public health funds for successful structural and individual behaviour change.
  • 8. Polio Eradication and Health Systems in Karachi: Vaccine Refusals in Context
    by Svea Closser, Rashid Jooma, Emma Varley, Naina Qayyum, Sonia Rodrigues, Akasha Sarwar, and Patricia Omidian
    Drawing on research conducted in early 2012, this study focuses on factors affecting parental acceptance of OPV, and health worker motivation to deliver it, in SITE Town, an area of the mega-city of Karachi in Pakistan that in recent years has harboured WPV. In conducting participant observation, interviews, and a document review, the researchers’ aim was not to evaluate the effectiveness of the polio programme but, rather, to qualitatively describe some challenges workers faced and explore why some parents refused polio vaccine (refusals have a negative effect on polio workers’ motivation). In short, in SITE, vaccine acceptance and worker motivation were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Hence, the researchers propose short-term improvements to RI and sanitation in key polio-endemic areas, coupled with a long-term focus on sustainable improvements to RI and broader health services.


  • * Although not all of the papers written as part of the MCSP/CI initiative were published in the GHC journal, The CI worked with some of the authors to adapt their papers for publication on The CI website. Here are 2 examples:
  • 9. Use of SMS-Based Platforms for Health Communication and Monitoring in the Context of Polio Outbreak Response
    by Julianne Birungi, Dr. Saumya Anand, Jesse W. Kinyanjui, Anirban Chatterjee, Chaudhary Mohd Parvez Alam, Charles Mutai, and Sahr Kemoh
    This paper presents key findings from an evaluation of a project on the use of mobile phones in the prevention of polio in Somalia with the purpose of highlighting key learning that can be used to design, implement, and scale up similar projects in conflict-affected countries. Implemented by the United Nations Children’s Fund (UNICEF) in partnership with Oxfam GB and a local partner, Hijra, the project was designed in response to a WPV outbreak that paralysed 199 children and young adults in Somalia, 2013-2014. “Overall, the SMS approach did reach a large number of people in a short time compared to conventional methods like interpersonal communication, which in this case would have increased security risks for the community mobilisers.” Among the challenges to using SMS platforms: “Somalia is largely an oral society, meaning that people are accustomed to communicating orally or verbally – news commonly spreads through word of mouth, and people want to talk an! d listen. Texting is therefore not common as an interactive communication approach, and it requires a behaviour shift.”
  • 10. Dynamics and Motivation of Online Pro- and Anti-vaccination Lobbyists in Nigeria: A Qualitative Exploration
    by Dr. Muktar A. Gadanya
    This paper highlights the issue of anti-vaccination lobbyists in Nigeria, who use online networks and discussion groups to spread misinformation about the polio vaccination. The paper seeks to shed some light on the motivations of online vaccine antagonists, and investigates strategies to counter the spread of misinformation and convert online antagonists into pro-vaccination lobbyists. The paper provides a detailed table of factors that influenced an anti-vaccination opinion, such as rumoured anti-fertility effects of vaccines and too much focus on the polio vaccine at the expense of other vaccinations, and outlines the specific knowledge and arguments which led them to change their views on that issue. The paper recommends national and international mapping of online pro- and anti-vaccination lobbyists in order to identify and engage them more effectively. There is also a need to support pro-vaccination lobbyists with information and skills to strengthen their online inter! actions. In addition, steps should be taken to make information that addresses misconceptions about vaccination widely available to the general public, healthcare workers, and academics so they can also be in a position to challenge the views of their peers.
This issue of The Drum Beat was written by Kier Olsen DeVries.
The Drum Beat is the email and web network of The Communication Initiative Partnership.

Full list of the CI Partners:
ANDI, BBC Media Action, Bernard van Leer Foundation, Breakthrough, Citurna TV, Fundación Imaginario, Fundación Nuevo Periodismo Iberoamericano (FNPI), Heartlines,Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Maternal and Child Survival Program (MCSP), MISA, Open Society Foundations, Oxfam Novib, PAHO, The Panos Institute, Puntos de Encuentro, SAfAIDS, Sesame Workshop, Soul City, STEPS International, UNAIDS, UNICEF, Universidad de los Andes, USAID,World Health Organization (WHO), W.K. Kellogg Foundation

The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.

Chair of the Partners Group: Garth Japhet, Founder, Soul City garth@heartlines.org.za

Executive Director: Warren Feek wfeek@comminit.com

The Editor of The Drum Beat is Kier Olsen DeVries.
Please send additional project, evaluation, strategic thinking, and materials information on communication for development at any time. Send to drumbeat@comminit.com

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