Assessing the impact of social networks on mothers' childhood immunization decisions in northern Nigeria

Background: Over the past decade, there has been increased attention to examining the relationship between social networks and health. Up to this point, however, no research has investigated the linkage between social networks and immunization use. This study contributes to the social networks literature by analyzing the relationship between social networks and immunization use in northern Nigeria. Methodology: This study was conducted in a Health and Demographic Surveillance System (HDSS) site in northern Nigeria in 2011. 550 mothers and 128 opinion leaders (traditional health providers and religious and political leaders) living across 22 neighborhoods were included. The 22 neighborhoods were selected using a matching procedure. Mothers were selected from the HDSS using pre-defined eligibility criteria. Opinion leaders mentioned by the mothers during their interviews were also interviewed. Results: Analyses show that opinion leader support and peer support for immunizations are associated with higher levels of childhood immunization use. The relationship between opinion leader support for immunizations significantly increases when mothers' peers also support immunizations. The relationship between opinion leader support for immunizations and immunization use significantly increases when mothers have more contact with their opinion leaders. The relationship between peer support for immunizations and immunization use significantly increases when mothers are more socially integrated and they have a more cohesive social network. Conclusions: The results have important implications for understanding how social networks influence immunization uptake and generating evidence-based strategies for mobilizing social networks to increase childhood immunization use in areas suffering from dangerously low levels of coverage.