Randomized evaluation of All Babies Are Equal - a conditional cash transfer for routine childhood immunization in north-west Nigeria

Plain English summary of protocol

Background and study aims
North West Nigeria has one of the highest fertility rates (6.7 births per woman (Demographic and Health Survey 2013)) and lowest vaccination rates in the world (UNICEF 2017). The most recent National Immunization Coverage Survey in 2011 found that only about 1 in 20 12- to 23-month-olds in the North West states of Katsina and Zamfara, respectively, had received all recommended childhood vaccines. Low immunization rates contribute to Nigeria’s high death rate in children aged under 5 years (104 deaths per 1,000 live births). Two in five of deaths in this age group in Nigeria are from diseases that are preventable through vaccination. The region of North West Nigeria has particularly low levels of vaccination and has had frequent measles outbreaks. It is also one of the world’s last locations where polio has not been eliminated.
Aid organizations have improved the infrastructure for routine immunization, but vaccination rates remain low. The World Health Organization's global immunization coverage target is 9 out of 10 children. Over half of people who either never vaccinated their children or skipped certain vaccinations said 'lack of knowledge' or 'ambivalence' (not knowing whether it was positive or negative) was the main reason for not vaccinating their children. For those who skipped one or more routine vaccinations, access and service delivery issues were a barrier. People who did vaccinate their child at least once were likely to say that health concerns were the main reason for doing so. People who had their child fully immunized said it was because they wanted to prevent illness, disease or death, rather than because of influence from community leaders or family members.
Previous studies have shown that a small incentive can have a large impact on health behaviors like vaccinating children. New Incentives, an international non-governmental organization (NGO), aims to boost demand for immunization by offering cash incentives to caregivers who have their child vaccinated at a program clinic. In collaboration with New Incentives, IDinsight is conducting a study to whether this approach will increase immunization in North West Nigeria. This study aims to investigate whether giving cash to caregivers in North West Nigeria who bring their infants to receive vaccination against common infections (tuberculosis, diphtheria, tetanus, pertussis, hepatitis B virus (HBV) infection, Haemophilus influenzae Type B (Hib), pneumococcal bacteria, measles, rotavirus, polio, yellow fever) increases the proportion of children who are immunized. The study is taking place in Jigawa, Katsina, and Zamfara States between August 2017 and January 2020.

Who can participate?
Children aged 0 to 16 months living in the catchment areas of the clinics taking part in the study.

What does the study involve?
Eligible caregivers who bring their infant(s) to the health facility for immunizations are first enrolled in the program by New Incentives staff, who record caregiver and infant details. To be eligible for the program, infants must have received one of the routine vaccinations at the clinic – this is checked against the child’s health card. If the child has received the vaccination, the caregiver receives the cash incentive, and instructions on when to return for the next vaccination and incentive payment. From the perspective of the participant, taking part in the study involves receiving a researcher into their home, providing informed consent, and answering a 1-hour survey.

What are the possible benefits and risks of participating?
Those who participate in the trial and are in the New Incentives arm will benefit from the cash payments. All data is anonymized and stored securely. The children will benefit from being protected from common infectious diseases, but might experience soreness at the injection site. There is a risk that by paying carregivers to vaccinate children, there might be a reduction in their motivation to get the children vaccinated for health reasons. The study will investigate this by asking caregivers for their attitudes towards vaccination at the start and end of the trial. They will also be asked if they would still vaccinate children if there was no incentive.

Where is the study run from?
IDInsight West Africa (Senegal)

When is the study starting and how long is it expected to run for?
June 2017 to June 2020

Who is funding the study?
GiveWell (USA)

Who is the main contact?
1. Zack Devlin-Foltz (public contact)
zack.devlinfoltz@idinsight.org
2. Alison Connor (public contact)
alison.connor@idinsight.org

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• Nigeria

Study participating centre

Sponsor information

Funders

Funder type

Charity

Results and Publications

Study outputs

Additional files

ISRCTN10808433_SAP_16Nov2018.pdf

Uploaded 11/02/2019

ISRCTN10808433_SAP__29Nov2019.pdf

Uploaded 29/11/2019

Editorial Notes

26/07/2021: Funder report added.
13/03/2020: The total final enrolment number has been added.
12/03/2020: The following changes have been made:
1. The recruitment end date has been changed from 01/12/2019 to 20/02/2020.
2. The intention to publish date has been changed from 01/06/2020 to 01/07/2020.
12/12/2019: The following changes were made to the trial record:
1. Ethics approval details added.
2. Primary and secondary outcome measures and study hypothesis were updated.
3. The recruitment end date was changed from 01/11/2018 to 01/12/2019.
4. The overall trial end date was changed from 01/11/2019 to 30/06/2020.
29/11/2019: Uploaded updated statistical analysis plan.
11/02/2019: Uploaded statistical analysis plan.