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Effect of Yellow Fever Education on Yellow Fever Vaccination Uptake among Adults in Nigeria

Abstract

Yellow fever is a vaccine-preventable viral disease that remains an important public health concern in areas where suitable mosquito vectors and susceptible populations exist. Vaccination is the most effective preventive measure against yellow fever, while public awareness and access to vaccination services are important for achieving adequate population protection. Yellow fever education provides adults with information about yellow fever transmission, signs and symptoms, risk factors, complications, the protective benefits of vaccination, vaccine eligibility and availability, vaccination schedules and requirements, possible minor adverse reactions, and the locations of available vaccination services. Yellow fever vaccination uptake refers to the extent to which eligible adults receive the recommended yellow fever vaccine through appropriate vaccination services. In Nigeria, suboptimal vaccination uptake may be associated with inadequate knowledge, misconceptions about yellow fever and its vaccine, concerns about vaccine safety, limited awareness of vaccination requirements, low perceived risk, inadequate access to vaccination services, financial and transportation barriers, and limited exposure to reliable health information. Effective yellow fever education may improve adults' knowledge, confidence, risk perception, and willingness to utilize available vaccination services. Against this background, this study investigates the effect of yellow fever education on yellow fever vaccination uptake among adults in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Knowledge-Attitude-Practice framework. The Health Belief Model provides a framework for understanding adults' yellow fever vaccination decisions through perceived susceptibility, perceived severity, perceived benefits of vaccination, perceived barriers, and cues to action. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, and environmental conditions in shaping vaccination-related behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how yellow fever education may improve adults' knowledge and attitudes and influence vaccination uptake. Collectively, these theoretical perspectives provide a suitable framework for explaining how yellow fever education may influence vaccination uptake among adults in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from eligible adults in selected communities, public and private healthcare facilities, vaccination centres, and community health programmes in Nigeria using a structured interviewer-administered questionnaire, yellow fever knowledge assessment, and vaccination uptake assessment tool. A multistage sampling technique will be employed to select states, local government areas, communities, healthcare facilities, and eligible adult participants. Where feasible, selected communities, healthcare facilities, or participant groups will be assigned to intervention and comparison groups. Adults in the intervention group will receive structured yellow fever education covering disease transmission, signs and symptoms, risk factors, complications, the protective benefits of vaccination, vaccine eligibility, vaccination requirements, possible minor adverse reactions, vaccine availability, and locations of appropriate vaccination services. Yellow fever vaccination uptake will be assessed using indicators such as vaccination status, receipt of the recommended vaccine, possession of valid vaccination documentation where applicable, and utilization of available vaccination services. Where feasible, self-reported vaccination status will be verified using vaccination cards, certificates, healthcare records, or facility documentation. Descriptive statistics will be used to summarize participants' sociodemographic characteristics, previous yellow fever education, knowledge, vaccination history, and vaccination uptake. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic regression analysis, will be used to determine the effect of yellow fever education on vaccination uptake. Where appropriate, vaccination uptake before and after the intervention will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that yellow fever education has a significant positive effect on yellow fever vaccination uptake among adults in Nigeria. Adults exposed to structured yellow fever education are expected to demonstrate improved knowledge of disease transmission, symptoms, risks, complications, vaccine benefits, and vaccination requirements. Education may improve adults' perception of their susceptibility to yellow fever and increase their willingness to seek and receive vaccination through appropriate health services. Clear information from trusted healthcare professionals may also reduce misconceptions and concerns regarding vaccine safety and encourage informed vaccination decisions. However, education alone may not guarantee vaccination uptake because adults may continue to experience barriers such as limited availability of vaccination services, transportation difficulties, financial constraints, low perceived risk, misinformation, and inconvenient service locations or schedules. Consequently, yellow fever education is expected to be most effective when supported by accessible vaccination services, adequate vaccine availability, trained healthcare professionals, effective community mobilization, reliable vaccination information, and appropriate follow-up systems. The study is expected to contribute to the literature on yellow fever prevention, adult vaccination, vaccine uptake, health education, infectious disease prevention, epidemiology, community health, and public health in Nigeria by providing empirical evidence on the effect of yellow fever education on yellow fever vaccination uptake among adults. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, vaccination centres, community health workers, immunization programmes, development partners, and policymakers regarding strategies for improving adult vaccination coverage. The study will also provide evidence-based recommendations for strengthening yellow fever education, integrating adult vaccination education into community health programmes, improving community awareness of yellow fever risk, addressing vaccine misinformation and safety concerns, increasing access to vaccination services, strengthening vaccination documentation and follow-up systems, and promoting timely uptake of recommended yellow fever vaccination among adults in Nigeria.

Keywords: Yellow fever education, yellow fever vaccination uptake, adults, Nigeria, yellow fever prevention, adult vaccination, vaccine uptake, health education, infectious disease prevention, vaccine confidence, community health, epidemiology, immunization, public health.