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Impact of Childhood Diphtheria Vaccination Campaigns on Diphtheria Vaccine Uptake among Children in Nigeria

Abstract

Diphtheria remains an important vaccine-preventable public health concern in Nigeria because infection can cause severe respiratory illness, complications, disability, and death, particularly among children who are inadequately vaccinated. Although diphtheria-containing vaccines are included in routine childhood immunization programmes, some children may remain unprotected because of missed vaccination opportunities, delayed immunization, limited caregiver awareness, vaccine misinformation, access barriers, and inadequate follow-up of children who miss scheduled doses. Childhood diphtheria vaccination campaigns provide an opportunity to increase awareness, reach children who have missed routine vaccination, address caregiver concerns, and improve access to vaccination services. Effective vaccination campaigns may therefore strengthen protection against diphtheria and reduce the number of susceptible children. Against this background, this study investigates the impact of childhood diphtheria vaccination campaigns on diphtheria vaccine uptake among children in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Social Ecological Model. The Health Belief Model explains how parents' and caregivers' perceptions of children's susceptibility to diphtheria, perceived severity of the disease, perceived benefits of vaccination, perceived barriers, and cues to action may influence acceptance of diphtheria vaccination. The Theory of Planned Behavior emphasizes caregivers' attitudes, subjective norms, perceived behavioural control, and vaccination intentions as determinants of vaccination behaviour. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare, and environmental factors on childhood immunization. Collectively, these theoretical perspectives provide a suitable framework for explaining how childhood diphtheria vaccination campaigns may influence diphtheria vaccine uptake among children in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise children within the applicable childhood immunization age range and their parents or primary caregivers residing in selected communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, healthcare facilities, and eligible child-caregiver pairs. Childhood diphtheria vaccination campaigns will be assessed using indicators such as campaign frequency and duration, geographical coverage, community mobilization, caregiver sensitization, household visits, vaccination-point accessibility, availability of trained vaccination personnel, vaccine availability, reminder activities, involvement of community leaders, identification of unimmunized or under-immunized children, and follow-up mechanisms. Diphtheria vaccine uptake will be assessed using indicators such as receipt of diphtheria-containing vaccine doses, vaccination status verified through immunization cards or programme records where available, participation in campaign activities, completion of applicable recommended doses, timeliness of vaccination, and vaccination of previously missed or under-immunized children. Data will be collected using structured questionnaires, child immunization cards, vaccination registers, campaign attendance records, household vaccination records, healthcare-facility records, and relevant immunization programme documents. Descriptive statistics will be used to summarize caregivers' characteristics, campaign exposure, vaccination knowledge, and children's vaccination status. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of childhood diphtheria vaccination campaigns on diphtheria vaccine uptake. Where a quasi-experimental design is adopted, vaccination uptake before and after implementation of the campaign may be compared with that of a comparison community or group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that childhood diphtheria vaccination campaigns have a significant positive impact on diphtheria vaccine uptake among children in Nigeria. Children exposed to well-organized vaccination campaigns are expected to have higher rates of diphtheria-containing vaccine uptake than children with limited access to campaign activities. Campaigns may increase caregiver awareness of diphtheria, its symptoms, severity, transmission, and the protective benefits of vaccination. Community-based vaccination activities may also reduce geographical and financial barriers by bringing vaccination services closer to households and providing additional opportunities for children who missed routine immunization. Engagement of community health workers, traditional leaders, religious leaders, and other trusted community representatives may help address misinformation and improve caregiver acceptance. However, vaccine hesitancy, misinformation, limited vaccine availability, inadequate campaign coverage, transportation difficulties, population mobility, insecurity in some communities, and weak follow-up systems may reduce campaign effectiveness. The study therefore expects accessible, well-coordinated, evidence-based, and community-supported diphtheria vaccination campaigns to contribute significantly to improved diphtheria vaccine uptake among children in Nigeria. The study is expected to contribute to the literature on diphtheria prevention, childhood vaccination, immunization campaigns, vaccine uptake, vaccine-preventable diseases, community mobilization, child health, infectious disease prevention, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state primary healthcare boards, local government health authorities, primary healthcare centres, community health workers, schools, traditional and religious leaders, development partners, and policymakers regarding strategies for improving childhood immunization coverage. The study will also provide evidence-based recommendations for strengthening diphtheria vaccination campaigns, improving identification of unimmunized and under-immunized children, increasing caregiver education, addressing vaccine misinformation, strengthening community mobilization, improving vaccination accessibility, enhancing follow-up systems, and integrating campaign activities with routine childhood immunization services across Nigeria.

Keywords: Childhood diphtheria vaccination campaigns, diphtheria vaccine uptake, diphtheria prevention, childhood immunization, vaccine uptake, vaccine-preventable diseases, community mobilization, child health, routine immunization, Nigeria, public health.