Breaking community barriers to polio vaccination in northern Nigeria: the impact of a grass roots mobilization campaign (Majigi) Sani-Gwarzo Nasiru 1 , Gambo G. Aliyu 2 , Alex Gasasira 3 , Muktar H. Aliyu 4 , Mahmud Zubair 3 , Sunusi U. Mandawari 3 , Hassana Waziri 3 , Abdulsalami Nasidi 1 , Samer S. El-Kamary 5 1 Federal Ministry of Health, Abuja, Nigeria, 2 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA, 3 World Health Organization (WHO) Office, Abuja, Nigeria, 4 Department of Preventive Medicine and Institute for Global Health, Vanderbilt University, Nashville, TN, USA, 5 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA This paper examines the impact of a community-based intervention on the trends in the uptake of polio vaccination following a community mobilization campaign for polio eradication in northern Nigeria. Uptake of polio vaccination in high-risk communities in this region has been considerably low despite routine and supplemental vaccination activities. Large numbers of children are left unvaccinated because of community misconceptions and distrust regarding the cause of the disease and the safety of the polio vaccine. The Majigi polio campaign was initiated in 2008 as a pilot trial in Gezawa, a local council with very low uptake of polio vaccination. The average monthly increase in the number of vaccinated children over the subsequent six months after the pilot trial was 1,047 [95% confidence interval (CI): 647–2045, P50.001]. An increasing trend in uptake of polio vaccination was also evident (P50.001). The outcome was consistent with a decrease or no trend in the detection of children with zero doses. The average monthly decrease in the number of children with zero doses was 6.2 (95% CI: 221 to 24, P50.353). Overall, there was a relative increase of approximately 310% in the polio vaccination uptake and a net reduction of 29% of never vaccinated children. The findings of this pilot test show that polio vaccination uptake can be enhanced by programs like Majigi that promote effective communication with the community. Keywords: Majigi, Polio, Vaccination, Trend, Nigeria Introduction Nigeria is yet to achieve complete interruption of wild polio virus (WPV) transmission, since the inception of the global polio eradication effort more than two decades ago. 1,2 It is also the only country with a polio epidemic driven by a combination of types 1 and 3 WPV, as well as the vaccine-derived poliovirus (VDPV) type 2. 3 Northern Nigeria is one of the world’s largest reservoirs of WPV and accounts for over 80% of the global cases of WPV type 1 reported in 2008. 4,5 This outbreak occurred at the same time that the region struggled with an earlier VDPV type 2 outbreak, the largest and longest vaccine-induced epidemic in the history of the polio eradication campaign. 6,7 Unfortunately, the VDPV is similar to WPV types 1 and 3 in its ability to attack and cause paralytic diseases. 8 The outbreak from this region is linked with the re-emergence of the disease in several polio free countries across Africa, the Middle East and Asia, thereby reversing the global gains achieved previously. 4,9 The consistent failure of Nigeria to completely interrupt WPV transmission is largely attributed to children (especially in the north) not sufficiently vaccinated through routine and repeated supplemental vaccination activities. 3 Over the years, the program’s campaign strategies failed to connect well with the target population in communities worst hit by the disease, in addition to the operational challenges associated with its implementation. 4,5 In some areas in the north, the routine Expanded Program in Immunization is simply non-existent. 3 Where it exists, community acceptance is hampered by mistrust, suspicion, and rejection of the program, due to inadequate social mobilization, improper channels of communication, and lack of program commitment and ownership at the local government level. 3,10 Correspondence to: Gambo G. Aliyu, 725 West Lombard St., N462, Baltimore, MD 21201, USA. Email: algambo@yahoo.com 166 ß W. S. Maney & Son Ltd 2012 DOI 10.1179/2047773212Y.0000000018 Pathogens and Global Health 2012 VOL. 106 NO.3