"Everything created by a white man is for pagans": Understanding the Barriers to Childhood Immunization in North-Eastern and North-Western Nigeria.

BackgroundDespite investments by the Nigerian government and international organizations in childhood immunization to combat child mortality, coverage in many northern states remains below the national average, thereby increasing the risk of vaccine-preventable diseases. This study describes the barriers to immunization in six states in Northeast and Northwest Nigeria, which have the lowest vaccination coverage rates in the country. MethodThe socioecological framework informed the design of focus group discussions that we conducted with 93 caregivers and 91 community influencers from March to July 2022 to understand their perceptions of the barriers to immunization uptake. We thematically analyzed data that were inductively and deductively coded in NVivo version 12 software. ResultsSupply-side service delivery challenges were the main systems-level barriers to vaccine uptake. These included poor provider attitude, shortage of health workers, vaccine stock-out, long wait-times, and inequitable service delivery. Other barriers were, rumors, misconceptions, vaccine distrust, socio-cultural and religious norms at the community level, and spousal and family disapproval at the interpersonal level. Limited autonomy and mobility, poor vaccine knowledge and awareness of immunization benefits, and concerns about side effects were important individual-level barriers. ConclusionStrategies for improving immunization uptake should include intensifying community sensitization, improving the numbers and quality of the health workforce, involving men and traditional institutions through context-appropriate channels, and addressing socio-cultural norms and concerns about adverse events after immunization