Effect of cash incentives on tetanus toxoid vaccination among rural Nigerian women: a randomized controlled trial

ABSTRACT

Tetanus toxoid vaccination is freely available for most women in developing countries, yet maternal and neonatal tetanus are still prevalent in 13 countries, 9 of which are in sub-Saharan Africa. We evaluated whether providing cash incentives increases the uptake of tetanus toxoid vaccination among women of childbearing age in rural northern Nigeria. We randomized amounts of cash incentives to women in three groups: 5 Nigerian naira (C5), 300 naira (C300), and 800 naira (C800) (150 naira = 1 U.S. dollar). Overall, of 2,482 women from 80 villages, 1,803 (72.6%) women successfully received the vaccination (419 of 765 [54.8%] women in C5, 643 of 850 [75.7%] women in C300, and 741 of 867 [85.5%] women in C800). Women in C300 and C800 were significantly more likely to receive the vaccine than women in C5. We further found that transportation costs are one of the significant barriers that prevent women from receiving vaccination at clinics, and that cash incentives compensate for transportation costs unless such costs are large.

KEYWORDS:

• Cash incentives
• tetanus toxoid vaccine
• transportation
• northern Nigeria

Acknowledgments

I am grateful to Abdullahi Belel and the Adamawa State Primary Health Care Development Agency for their cooperation and support throughout the project implementation. We give special thanks to the field team who devoted themselves to the project. We appreciate Raj Arunachalam, Abhijit Banerjee, Hoyt Bleakley, Anne Fitzpatrick, Susan Godlonton, David Lam, Edward Norton, Hitoshi Shigeoka, and Rebecca Thornton for their valuable comments. This paper also benefited from feedback from seminar participants at the Informal Development Seminar at the University of Michigan, the Population Association of America, and the University of Tsukuba.

Authors’ Contributions

RS conceived of the research design, collected data, analyzed the data, and wrote the manuscript. BF supervised the data collection. All authors provided critical feedback and helped shape the research, analysis and manuscript.

Disclosure of potential conflicts of interest

The author declares that she has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethics approval

Ethics approval was obtained on November 2012 from University of Michigan Health Sciences and Behavioral Sciences Institutional Review Board (HUM00063832). Oral and written informed consents were obtained from all the respondents prior to their participation in the study.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. In this study, our interviewers approached women within each village without the census list of eligible women, because of the high probability of misreporting of eligible women in the list, as well as the small size of each village. The study lacks information on the refusal to participate in the baseline survey among women who were approached by our interviewers. As there were no follow-up visits to respondents in this study, there was no attrition.

2. Transportation costs were self-reported costs to visit the assigned health clinic using the mode of transport the respondent would typically use.

3. While the Nigerian DHS sampled women aged 15 to 49, we restricted the DHS sample to women aged 15 to 35 to compare with our sample. In the DHS sample, over half of the women were Muslim (57.3%), about half (49.6%) had never received any education, 14% were pregnant, and 62% engaged in paid work. Distinct from our sample, only a very small proportion of women in the DHS sample were single (2%), and most of them (96.3%) had at least one child. In the DHS sample, 31.8% of women had received a tetanus vaccination. The means of most variables in the DHS sample are not statistically different from those in our sample (results not shown).

Additional information

Funding

This project was supported with research grants from the Institute for Research on Women & Gender, the Rackham Graduate School, the Department of Afroamerican and African Studies, the Department of Economics, and the Center for the Education of Women at the University of Michigan; the Japan Society for the Promotion of Science (22223003); and Yamada Scholarship Foundation. Funders support the study financially; they support data-collection activities in the field.