Psychological Barrier to Tetanus-Toxoid Vaccination among Nigerian Women

Objectives: We evaluate psychological barrier to and demand for tetanus-toxoid vaccination among women at childbearing age in rural northern Nigeria. Methods: In this individual-level randomized controlled trial, we randomize the condition under which women can receive cash incentives among 1,700 women; Clinic condition (N=822) and Vaccine condition (N=878). Women under Clinic condition could receive cash incentives if they visit assigned clinic, while women under Vaccine condition could receive cash incentives if they visit assigned clinic and get vaccinated at the clinic. Results: 1,268 (74.6%) women visited the clinic (611 [74.3%] of 822 in Clinic condition and 657 [74.8%] of 878 in Vaccine condition), and 1,242 (73.1%) women received the vaccination (585 [71.2%] of 822 in Clinic condition and 657 [74.8%] of 878 in Vaccine condition). There was no statistical difference in clinic attendance between two conditions. Under Clinic condition, 95.7% of women received the vaccination once they visited the clinic, although it was not a requirement for them to receive cash incentives. Conclusion: Psychological barrier is not a major barrier to vaccination among women in northern Nigeria because there is no need of additional incentive for women to receive vaccination once they visit the clinic.