Evaluation of an Infant Immunization Encouragement Program in Nigeria
Condition: Tuberculosis; Diphtheria; Tetanus; Pertussis; Hepatitis B; Haemophilus Influenzae Type b Infection; Pneumonia, Bacterial; Measles; Rotavirus Infections; Polio; Yellow Fever
MeSH terms: Infections; Communicable Diseases; Hepatitis B; Tuberculosis; Diphtheria; Yellow Fever; Pneumonia, Bacterial; Rotavirus Infections; Haemophilus Infections
Study type: Interventional

Summary: 
      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 see 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's main
      hypothesis is that New Incentives' program will increase the percentage of children immunized
      with BCG, any PENTA, or Measles 1 by an average increase of at least 7-percentage points
      across all program clinics that share a similar profile to the clinics New Incentives will
      operate in at scale. The study is taking place in Jigawa, Katsina, and Zamfara States between
      August 2017 and January 2020.
    

Detailed description: 
      The study will be structured as a two-arm cluster RCT with clinics catchment areas as
      clusters. One arm will serve as the control (83 clinics) and will operate as the status quo,
      while the other arm will receive New Incentives' full program (84 clinics). This design will
      measure the causal effect of New Incentives' program on the likelihood of an infant receiving
      a vaccine. The unit of treatment and randomization is the clinic catchment, while the unit of
      measurement for the key outcomes is the individual infant.

      Eligible caregivers who bring their infant(s) to a treatment group health facility for
      immunizations are first enrolled in the program by New Incentives staff, who record caregiver
      and infant details. 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.

      Data collection of outcome measures takes place at three points (baseline, midline, and
      endline) using a series of self-reported surveys of caregivers, examination of the child's
      health card (where available) and reviewing clinic records. Baseline was completed between
      August and October 2017, midline is scheduled for March 2019, and endline is planned for
      November 2019 to January 2020. Across all outcome measurements, sampled infants will be aged
      between 12 and 16 months (though baseline surveyed some infants aged up to 24 months to
      increase sample size). These age groups are sampled as they are well beyond the age at which
      children should receive the program vaccinations. (The Nigerian Routine Immunization schedule
      aims to give the program vaccinations between birth and 9 months old.) IDinsight does not
      follow the same infants from baseline to midline to endline but, rather, compares coverage
      rates in the same age group at each point in time. 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.
    

Intervention name(s): All Babies Are Equal Initiative (conditional cash transfer program)
Intervention type(s): Behavioral
Intervention description(s): New Incentives, an NGO, offers cash incentives to caregivers for bringing their child to clinics for the first five visits of the Nigerian Routine Immunization schedule. These small cash transfers can provide some material benefit to new caregivers from poor communities. At a minimum, they help offset time and transport costs. The following vaccines are directly incentivized by the New Incentives' program: tuberculosis (BCG vaccine); diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae Type B (Pentavalent Vaccine), pneumococcal bacteria (PCV vaccine), measles vaccine.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study will be structured as a two-arm cluster RCT. One arm (83 clinics) will serve as the control and will operate as the status quo, while the other arm (84 clinics) will receive New Incentives full program. This design will measure the causal effect of New Incentives' program on the likelihood of an infant receiving a vaccine.
New Incentives, an international non-governmental organization (NGO), is addressing the apparent shortfall in demand for immunization by offering cash incentives to caregivers for bringing their child to clinics for the first five visits of the Nigerian Routine Immunization schedule. To be eligible, the child must reside in the catchment area of the clinic and fall within the age range targeted for the vaccination in question. Infants do not need to have received the previous vaccine in the schedule to be eligible. Incentives are paid in cash by a New Incentives staff member who also ensures the infant meets the eligibility criteria outlined above.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Randomized Controlled Trial; Vaccinations; Nigeria; Conditional Cash Transfers; Cash Incentives; Infants; Impact Evaluation; Immunization