Religious leaders' perspectives on childhood immunization in Bauchi State, Nigeria: A Qualitative Study

IntroductionChildhood immunization is highly cost-effective, yet uptake is shaped by sociocultural and religious influences. In Bauchi State, Nigeria, coverage remains low (Penta3 58.2%; fully vaccinated according to the national schedule 22.5% among children aged 12-23 months; Nigeria Demographic and Health Survey (NDHS) 2024). Religious leaders shape community norms, but their perspectives on immunization in Bauchi are not well characterized. Guided by Omans model of religion/spirituality and health, we explored religious leaders knowledge, beliefs, attitudes, practices and recommendations regarding childhood immunization. MethodsBetween December 2022 and January 2023, semi-structured interviews were conducted with 22 religious leaders purposively sampled across Bauchi State (geographically stratified by local government area). Sampling continued until thematic saturation. Interviews were conducted in Hausa or English, audio-recorded, translated into English where necessary and transcribed. Data were analyzed using Braun and Clarkes thematic analysis in ATLAS.ti. Ethical approval was obtained from the Bauchi State Health Research Ethics Committee, and participants provided verbal informed consent. ResultsMost leaders described immunization as preventive and compatible with religious teachings and reported that observed child health benefits reinforced support. Many described shifts from earlier skepticism to endorsement after lived experience and religious and scientific explanation, while noting persistent misinformation, particularly fertility-related and "population control" narratives. Leaders described three recurring influence practices: Visible role modelling, sermon-based messaging aligned with scripture, and community mobilization through religious gatherings and support during outreach activities. Leaders emphasized that respectful health worker engagement and reliable service delivery were perceived to strengthen trust and support community uptake. ConclusionReligious leaders in Bauchi State may be strategic partners for improving vaccine acceptance. However, this leader-level qualitative study did not measure congregant outcomes. Programs should consider structured engagement with religious leaders, strengthen bidirectional rumor tracking and response, and support frontline health workers to strengthen trust and demand for routine and outreach immunization services, pending evaluation. Future work should include dissenting and more diverse leaders and link engagement to measurable outcomes. SUMMARY BOXO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIChildhood immunization coverage remains low in northern Nigeria, including Bauchi State, and both demand- and supply-side barriers contribute to under-vaccination C_LIO_LIReligious leaders can influence health behaviors and have been engaged in immunization efforts, but their perspectives and practical roles are not consistently described for Bauchi State C_LI What this study addsO_LIMost interviewed religious leaders viewed childhood immunization as preventive and compatible with religious teachings, and many described actively supporting immunization after engagement with immunization programs C_LIO_LILeaders reported persistent community concerns and misinformation, including fertility-related rumors, alongside service delivery constraints such as distance, waiting times, and staff attitudes C_LIO_LILeaders described mobilization practices, including sermon messaging, role modelling, and outreach-related community engagement, and proposed practical program improvements, including house-to-house service delivery and coordination between immunization teams and local religious leaders C_LI How this study might affect research, practice and policyO_LIImmunization programs may benefit from structured partnerships with religious leaders, including timely, credible information and co-developed messaging to address misconceptions C_LIO_LIImprovements in service accessibility and respectful care should accompany demand-generation to maximize impact C_LI