Abstract

The Federal Ministry of Health, Nigeria introduced incentives such as sachets milk powder to increase demand for oral polio vaccine (OPV). This study assessed whether the milk encourages the use of breast milk substitutes thereby dis-incentivising exclusive breastfeeding (EBF) in children during the first six months of life. A cross sectional design with mixed method was used for collecting quantitative and qualitative data in Borno and Kaduna states. Questionnaire was administered to 808 caregivers. There were focus group discussions, in-depth interviews and observations of an ongoing OPV+ intervention campaign. Quantitative and qualitative data were analysed using STATA 10 and MAXQDA, respectively. Milk was an infrequent component of the incentive package and accounting for only 4.6 and 1.5% in the 3 most recent immunisation campaigns. The high EBF awareness (82.4%) was associated with the demand creation campaign which the health service providers used to reinforce EBF messages. Breastfeeding decisions were mainly influenced by family and group norms and not by the sachet of milk powder that was given during the OPV+. There were no indications of inappropriate promotion of foods or any of the incentives. The inclusion of sachet milk in OPV+ kit did not compromise EBF but further enhanced it since the same service providers were responsible for all health interventions in the local government. Using milk powder and other incentives are effective for increasing participation and compliance with uptake of OPV in both states.

Key words: Polio eradication, incentive, exclusive breastfeeding, demand creation.

Abbreviation

EBF, Exclusive breastfeeding; FGD, focus group discussion; FMOH, Federal Ministry of Health; LGA, Local Government Area; MMC, Maiduguri Metropolitan Council; NPEEP, National Polio Eradication Emergency Plan; NREC, National Research Ethics Committee; OPV, oral polio vaccine; SIA, supplementary immunization activities; U5, child(ren) less than five years old; UNICEF, United Nations Children’s Emergency Fund; WHO, World Health Organisation.