Acceptability and feasibility of measles vaccination, small-quantity lipid-based nutrient supplementation, and their co-delivery among children aged 6-23 months in northern Nigeria: a qualitative study

Background. Undernutrition and infectious diseases form a vicious cycle that endangers child survival in low-resource settings, including in Northern Nigeria. The NutriVax-Measles trial was designed to evaluate a strategy combining preventive small-quantity lipid-based nutrient supplements (SQ-LNS) distributions with community mobilization and routine immunization services for children aged 6-23 months to improve measles vaccination uptake. To inform future programs co-delivering nutrition supplementation and immunization services at scale, we aimed to assess the feasibility and acceptability of measles vaccination, SQ-LNS distribution, and the NutriVax strategy. Methods. A qualitative study was conducted at the end of the trial using in-depth interviews (n=53) and focus group discussions (n=8) with key stakeholders: caregivers, health care workers, community health workers, and community representatives. Thematic analysis was guided by multiple conceptual frameworks. Results. The majority of the participants expressed satisfaction with measles vaccines in both arms, and with SQ-LNS in the NutriVax arm, as they perceived the benefits for their children health. In both arms, community awareness sessions and previous experience of outbreaks were key to motivating caregivers to bring their children to healthcare centres. Although distance to health facilities was identified as one of the main barriers to accessing care, SQ-LNS was perceived as an important source of motivation to bring their child to the clinic where they subsequently received vaccination. All stakeholder groups emphasized the importance of community leaders support and targeted male sensitization to address the prevailing sociocultural norms. Additionally, improved service organization to reduce waiting time was considered crucial to enhance caregivers acceptability of the intervention. Conclusion. Both measles vaccination and SQ-LNS provision were acceptable and feasible, supporting the NutriVax strategy within primary healthcare settings in fragile health systems. Successful implementation depends on sustained community sensitization, continued engagement of fathers and community leaders, and service delivery decentralized as close as possible to beneficiaries.