The project was implemented in Imo State, which is situated in the South Eastern part of Nigeria within longitude 5˚29'06"N and latitude 7˚02'06"E occupying an area between the lower river Niger and the upper and middle Imo River .It occupies an area of 5289 square kilometre with a total population of 3·93million (2·03 million males and 1·9million females) according to the 2006 census with an annual growth rate of 3·2% .The State is delineated into 27 Local Government Areas and 305 registrations areas (communities) within three senatorial geopolitical zones; Owerri, Orlu and Okigwe with varying social development, cultural and traditional beliefs.
Study Population/Sample size
The study population comprise traditional birth attendants practising within the three senatorial geopolitical zones of Imo State. The minimum sample size per zone for a two tailed paired sample T test analysis was calculated using G Power software version 3·1·9·4 where the estimated effect size of 0·5 based on a previous study ,α value of 0·05 and a power of 80% was assumed. The minimum sample size calculated was 26 which was increased to 30 to accommodate incomplete or non-responses. A total study sample of 90 participants was enrolled (30 participants per senatorial geopolitical zone).
Study design /Sampling technique/Selection criteria
The study was a repeated measures design where convenience sampling technique was used to select 90 TBAs. All TBAs practising within the State were invited and as they arrived, were enrolled according to their respective zones of practice until each zone attained a maximum of 30 participants. However, those that had received any formal medical training were excluded and replaced. The TBAs that arrived after enrolment had closed, were registered according to their zones but not enrolled. They formed the pool of TBAs from where replacements were randomly picked in cases of drop out or exclusion. TBAs were also randomly selected from the pool to participate in the pre-testing of the questionnaire.
The project commenced 7th January 2020 and was for a duration of 3 months. The workshop activities comprised content communication, health facility linkages and workshop evaluation. Workshop content was communicated through audio visual presentations comprising slide shows on the clinical effects of non-immunization and a drama production depicting the role of TBAs in the promotion of immunization uptake. The audio-visual content was developed by the project team and structured for the target audience by taking into consideration their level of literacy, language barriers, customs and traditions. Health facility linkages were achieved through health-linkage sensitization talks given by health facility immunization focal persons. The accessible health facilities that conduct immunization activities within the three geopolitical zones of the State were identified. Immunization focal persons from these facilities were invited and through health-linkage sensitization talks were engaged with the TBAs. The intention was to establish sustainable communication channels after the programme. The workshop evaluation involved the administration of a semi-structured questionnaire pre and post workshop. The questionnaire was developed by the project team and pretested among the pool of TBAs not enrolled to participate in the workshop. The content validity was established and a reliability coefficient (alpha) of 0·83 was calculated.
Data was collected using a pretested semi-structured interviewer-administered questionnaire. Research assistants were trained on the questionnaire administration and on the appropriate translations in the native language (Igbo). The questionnaire comprised 4 sections: one on socio-demographic characteristics; two on knowledge of maternal and neonatal immunizations; three on attitude towards maternal and neonatal immunizations and four on practices with respect to willingness to encourage clients on immunization uptake.
The level of knowledge was determined by scoring the questions that assessed knowledge.
A correct answer was scored 2 and incorrect answer was scored 0. The aggregate knowledge scores for each respondent was assessed against a scale of ≤30 for poor, 31-38 for moderate and 39-46 for good knowledge of immunization. In assessing the level of attitude, an answer connoting a positive attitude was scored 2 and a negative attitude was scored 0 and a “no opinion” attitude was scored 1.The aggregate attitude scores for each respondent was assessed against a scale of ≤8 for poor, 9-10 for moderate and 11-12 for good attitude towards immunization.
Data was cleaned and validated manually then analysed using Software Package for Social Sciences (IBM-SPSS) version 22. Descriptive statistics (frequency tables and summary indices) were generated. Chi square test was done to determine any significant association with the zone of practice. Paired sample t-test analysis was done to determine any significant change in knowledge and attitude towards immunization. A Level of significance was set at p ≤ ·05 with 95% confidence interval.
Role of the funding source
The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. ICA, UKA, OUR, DC and NE had full access to all the data in the study. All authors had final responsibility for the decision to submit for publication.