Religious Believe and Vaccine Hesitancy

and Its Wider implications for Public

Health in Nigeria

Blessing Osagie Christopher

October 2022
Table of Contents
Cover Page ............................................................................................... Error! Bookmark not defined.
Table of Contents .................................................................................................................................... 2
Abstract ................................................................................................................................................... 4
Introduction ............................................................................................................................................ 5
Geographic Focus ............................................................................................................................. 7
Brief Overview of Public Health Systems in Nigeria ..................................................................... 7
Vaccination in Nigeria ...................................................................................................................... 8
Justification ........................................................................................................................................ 9
Research Question, Study Goal and Specific Objectives ........................................................... 11
Specific Questions .......................................................................................................................... 11
Study Goal ........................................................................................................................................ 11
Specific Objectives............................................................................................................................ 11
Methodology......................................................................................................................................... 12
Search strategy ................................................................................................................................. 15
Determining the Database ................................................................................................................ 16
Inclusion & exclusion criteria ............................................................................................................ 17
PRISMA Flow ..................................................................................................................................... 18
Prisma Flow Diagram for the Systematic Review ............................................................................. 19
Venn diagram .................................................................................................................................... 19
Data Management ............................................................................................................................ 20
Data analysis ..................................................................................................................................... 22
Ethical considerations ....................................................................................................................... 23
Resources and facilities..................................................................................................................... 24
Review .................................................................................................................................................. 26
Religion and Society .......................................................................................................................... 26
Vaccination and Immunization ..................................................................................................... 29
Religion and Vaccination in Nigeria .................................................................................................. 30
Discussion ............................................................................................................................................ 31
Religious beliefs and vaccination in Nigeria...................................................................................... 32
Does religion impedes on vaccine uptake in Nigeria? ...................................................................... 35
Religious leaders impact on people’s attitude towards vaccination in Nigeria................................ 37
The Wider Implication of Religious Believe and Vaccination on Public Health in Nigeria? .............. 39
Recommendation.................................................................................................................................. 40
Conclusion ............................................................................................................................................. 41
 References ....................................................................................................................................... 42
Appendix 1 – Qualitative critique example........................................................................................... 49
Appendix 3 – Data handling table ......................................................................................................... 50
Abstract
When it comes to public Health, Vaccines have proven to be one of the viable
strategies for propagating and sustaining a healthy society (Malone et al., 2007).

Vaccines are substances or products used to stimulate the production of antibodies

and provide immunity against one or several diseases, they are prepared from the

causative agents of a disease, its products, or a synthetic substitute, treated to act as

an antigen without inducing the disease (Korn et al., 2020).

However, Vaccination has also encountered several challenges that have impacted its

level of impact especially acceptance leading to a major concern known as vaccine

hesitancy, a situation where there is a delay in acceptance or refusal of vaccines despite

the availability of vaccination services

A major factor for vaccine has been linked to religious beliefs, following the influence

of religion today is not uncommon for religious faithful to demonstrate reluctance to

vaccination following the utterances and declaration of its leaders. Yendell et al 2020).

A good example is the misfortune that befell the national polio vaccination campaign
of 2003 when two very influential Islamic groups in the North held a news conference

during which they declared that the vaccine contained anti-fertility substances and was
part of a western conspiracy to reduce the population of the developing world

(Madugba, 2003). The implication of this act was far reaching beyond the shores of
Nigeria into neighbouring Ghana, Chad, Benin Republic slowing down the impact of

the campaign at the time.

This literature review seeks to examine existing reports to determine if religion

constitutes barriers to vaccination in Nigeria and determine its implication for public

health in Nigeria. This literature review adopted a secondary research method which
relies on the review of existing and published literature on the topic as the major data

source for reaching its final findings (Johnston, 2014).

Introduction
Religious and public health institutions work to improve the well-being of their
communities (Idler, 2014). Religion, medicine, and healthcare have been related in one

way or another in all population groups since the beginning of recorded history (Idler,
2014). Only in recent times have these systems of healing been separated, and this

separation has occurred largely in highly developed nations; in many developing

countries like Nigeria, there is little or no such separation (Koenig, 2012). Scholars,

activists and development practitioners working at the very ‘local’ level of aid delivery
note the importance of the role of the religious leaders in international development

(Wilkinson, 2020; Tomalin,2012). This is because faith and religion are key influencing
factors in how communities relate and practice their cultures especially in multicultural

societies like Nigeria (Idler, 2014).

The trust that local religious leaders hold among their followers allows them to
negotiate these communities and cultural intricacies with more ease than other

practitioners (Idler, 2014). During the Ebola and the COVID-19 crisis, religious leaders
also played a key role in sharing accurate fact-based messages, combatting myths, and

offering vital support mechanisms (Idler 2014). Additionally, In the Ebola and AIDS
crises, religious leaders were also key to assisting in social justice roles such as
advocacy for women who required access to healthcare (Epko,2020). Conversely,

religious leaders have also been involved in harmful practices in these settings
(Epko,2020). This can range from stigmatising certain groups and creating barriers in

accessing necessary relief mechanisms as well as spreading misinformation regarding

health issues (Newman and Ranawana, 2021).

When it comes to public Health, Vaccines have proven to be one of the viable

strategies for propagating and sustaining a healthy society (Malone et al., 2007).
Vaccines are substances or products used to stimulate the production of antibodies

and provide immunity against one or several diseases, they are prepared from the
causative agents of a disease, its products, or a synthetic substitute, treated to act as
an antigen without inducing the disease (Korn et al., 2020). Vaccines were first used

some 200years ago when Edward Jenner used vaccines as a prevention for smallpox
in 1796 (Korn et al., 2020). Most vaccines protect both the vaccinated individual and

the society by reducing the transmission of infectious diseases. (Korn et al.,2020).

However, over the years, acceptance and adoption of vaccines has fluctuated due to

many factors including cultural and religious resistance.

The COVID 19 pandemic further established the importance of vaccination in public

health. Evidence shows vaccination help prevent hospitalizations and deaths brought

about by Covid-19 infection (Nauman et al, 2022) and knowledge on the efficacy of
vaccination has also been established with medical and scientific basis (Nauman et al

2022). Vaccines work by allowing the immune system of the body to recognize, fight
and destroy the coronavirus when exposed (Garcia et al 2021). Furthermore, despite

the fact that historical evidence has proven the potency of vaccination as a viable tool
for controlling pandemics and outbreaks, over time we have also learnt that availability

is just one of the many challenges that faces uptake of vaccination (Ophori EA, 2014).
Beliefs and people’s way of life seem to pose even more challenges especially vaccine

hesitancy (Ophori EA, 2014).

Vaccination hesitancy is described as reluctance towards vaccination (Garcia et al

2021). There are a number of factors responsible for this hesitation to vaccination. In
Nigeria where religion and religious leaders represent key determinants of social

behaviours and exalted opinion leaders, it is not uncommon for religion to become a
major hinderance to voluntary vaccine up take (Oyo-Ita et al, 2017). Most religions do

not prohibit vaccinations; however, there are some concerns and in some cases
restrictions regarding vaccination in general (Garcia et al.,2021). These are based on

particular reasons for vaccination, or specific vaccine ingredients. A recent study, “The
role of religiosity in COVID-19 vaccine hesitancy by L. L. Garcia and J. F. C. Yap” found

that even medical students are unwilling to get vaccinated which poses a threat
towards attainment of herd immunity. (Garcia et al., 2021).
Despite the progress made in the last 200 years, vaccine hesitation driven by religious

obligations is increasingly becoming a public health concern and might soon develop
into a major barrier to healthier societies (The Lancet, 2019).

Geographic Focus

Nigeria is a country of black race located in West Africa’s sub-region, with an estimated
population of 200million people (NPC, 2018). Nigeria is easily the most populated

country in Africa. It has over 250 ethnic groups spread across her 36 states and the
Federal Capital Territory. Of the estimated 250 ethnic groups in Nigeria 3 of these are

the major ethnic groups identified with the country, they include the Hausa-Fulanis,
the Yorubas, and the Igbos (Blench & Dendo, 2003), each with their own culture and

traditions, including different languages. These 3 ethnic groups make up about 70%
of the country’s population. It is geographically situated between the Sahel to the

north and the Gulf of Guinea to the south in the Atlantic Ocean. It covers an area of
923,769 square kilometres (356,669 sq mi), Nigeria borders Niger in the north, Chad in

the northeast, Cameroon in the east, and Benin in the west. The country is
predominantly Islamic in the north and Christians in the south in terms of religious

divide although other smaller religious groups including animists do exist within the
country. The two predominant religions are further subdivided into various sects.

Religion has grown to become a determinant factor in every face of the Nigerian life
and thus almost impossible to discuss any social issue without taking into

consideration the religious perspective and the impact it might have on the health care
systems especially public Health.

Brief Overview of Public Health Systems in Nigeria

One of the mainstays of a robust public health system is the presence of a functioning

healthcare system. This starts from the most basic level which is the primary healthcare
system (Alenoghena et al. 2014). While Nigeria has adopted the Alma Ata declaration

on Primary Health Care (PHC) which was made in 1978, the country is yet to reach the
fullest level of public Health efficiency attainable by the declaration (Alenoghena et
al.,2014). The major public health challenges in Nigeria are infectious diseases, vector

control of some diseases, maternal mortality, infant mortality, poor sanitation and
hygiene, disease surveillance, non-communicable diseases and road traffic injuries

etcetera (Muhammad et al.,2017). Nigeria is currently working towards achieving the

Sustainable Development1 Goals but despite the collaborative efforts of both the

Nigerian Government, Donor Agencies and NGOs to provide an efficient and effective
health care delivery in Nigeria, there are still major gaps in Nigeria’s health system

(Muhammad et al., 2017).

The inadequate programs designed to address the numerous health problems in

Nigeria have led to the little improvement in Nigeria’s health status. Overall life

expectancy at birth is 54 years; infant mortality rate is 86 per 1000 live birth while
maternal mortality ratio is 840 per 100,000 live births (Alenoghena et al., 2014). The

continued neglect of the importance of addressing public health issues would make
matters worse for most citizens of Nigeria, most of who are at the receiving end

(Muhammad et al., 2017).

Vaccination in Nigeria

The National Programme on Immunization was introduced in Nigeria in 1979, the

program was called Expanded Programme on Immunization (EPI) with objective to give

a national outlook to immunization and vaccination programmes in Nigeria (Fawi et

al.,2011). The NPI was created under Decree 12 of August 1997. This is to effectively

control the occurrence of all vaccine preventable diseases through immunization and
provision of vaccine and other consumable. However, the National Programme on

Immunization (NPI) suffers recurrent setbacks due to many factors including ethnicity
and religious beliefs in Nigeria (Tula et al., 2014). The main targets of the NPI are

Children aged ≤11month, all pregnant women and women of reproducing age group
(Fawi et al., 2011).

1
Major Public Health Problems in Nigeria: A reviewhttps://www.banglajol.info› article › viewPDF
by F Muhammad · 2017 · Cited by 79 — 2017 Muhammad et al., publisher and licensee Public Health.
Foundation Bangladesh. ... diseases.5 These diseases with a rising burden in Nigeria.
Immunization rates in Northern Nigeria are some of the lowest in the world (Fawi et

al.,2011). According to the 2003 National Immunization Schedule, the percentage of

fully immunized infants in the States to be targeted was less than 1% in Jigawa, 1.5%

in Yobe, 1.6% in Zamfara and 8.3% in Katsina. As a result, thousands of children are
dying as victims of vaccine preventable diseases (Fawi et al.,2011). Furthermore,

Immunization utilization in Nigeria is also influenced by interlinked community and

health services issues (Akwataghibe et al.,2019). During the Covid 19 pandemic,

resistance, or barriers to vaccination in Nigeria became even more apparent and

despite the desperate need for interventions from vaccines, there is still considerable

apathy and hesitancy around the acceptance and use of the approved vaccines made
available in many places in Africa and especially Nigeria (Kayode et al.,2021).

This apathy has even been proven to still exist among staff and students in a Nigerian

university and it is significantly influenced by the Christian denominational affiliation

(Uzochukwu et al.,2021).

In summary, A number of factors have been listed to be responsible for the widespread

hesitancy to vaccination in Nigeria, but this study focuses on religious related barriers

to vaccination in Nigeria.

Justification
According to the world Fact book, between 1993 and 1999 when Nigeria experienced

chronic economic decline and one of its notable political instabilities coupled with
attendant harsh micro-economic policies, U-5 mortality rate increased from 130- 194

deaths per 1000 live births. All these affected children under five (WHO, 2007; The
World Fact Book, 2010). Compared to records in developed societies, there is high rate

of significant reduction of infant mortality. For instance, in Finland and France it was
reduced from 17.0% to 3-7%) between 1960 and 1985, and 1985 to the present, the

reduction was to 0-6 or 0-7% in these countries. Authors attributed this decline to the
activities of PHC in those countries (Price, 1994).
As proposed by the Alma Ata declaration, PHCs are some of the most important

structures for driving mass vaccination for the masses especially children (Masuda et
al.,2018). The benefits of vaccination are clearly demonstrated by the eradication or

enormous decline in the incidence of many vaccine-preventable diseases, but the

coverage of many highly recommended vaccines is still frequently inadequate, and

children continue to suffer from diseases that could have been prevented (Esposito et
al.,2014). The consistent failure of Nigeria to completely eradicate the wild poliovirus

(WVP) transmission is largely attributed to children (especially in the north) not

sufficiently vaccinated through routine and repeated supplemental vaccination

activities (Pathog Glob Health. 2012).

As an important element of national security, public health not only functions to

provide adequate and timely medical care but also track, monitor, and control disease

outbreak (al., Masuda et al.,2018). The Nigerian health care had suffered several
infectious disease outbreaks year after year. Hence, there is need to tackle the problem,

with immunization remaining one of the most viable options in delivering this
(Akwataghibe et al.,2019). Immunization is aimed at the prevention of infectious

diseases. In Nigeria, the National Programme on Immunization (NPI) suffers recurrent

setbacks due to many factors including ethnicity and religious beliefs. (Trop Med

Health. 2014)

The very heavy religious followership in Nigeria means that if Nigeria must reach

meaningful standards in its public health profile, then vaccination and immunization
will remain a topic that must addressed on the basis of logical and scientific premises

rather than on religious or sentimental basis which often forms the underlying basis
for religious prohibition or restriction to vaccination (Ajaegbu, 2020). As such, it

becomes very necessary to review religious related barriers to vaccination and reach
systematically constructed evidence of the issues so as to inform practical,

programmatic and policy driven solutions to addressing it (Eric Wombwell, 2015).

Research Question, Study Goal and Specific Objectives

The goal of this research is to determine how religion constitutes barriers to

vaccination in Nigeria and the wider implication for public health in Nigeria. Typically,

it focuses on an empirical investigation of religious beliefs and their direct or indirect

impact on religious faithful’s public health related decisions particularly on vaccination.

Research Question

Does religious beliefs constitute barriers to vaccination in Nigeria?

Specific Questions
The specific objectives will be focused on

i. To what extent does religion impedes on voluntary vaccine uptake in Nigeria?

ii. How do religious leaders impact on people’s attitude towards vaccination in

Nigeria?

iii. What are the wider impact of religious believe on vaccination in Nigeria?

Study Goal
The goal of this review is to determine if and how religious beliefs contributes to
vaccine hesitancy in Nigeria and its wider implication for public health management
in Nigeria.

Specific Objectives
The review will attempt to determine

• The extent to which religion hinders vaccine uptake in Nigeria

• To understand how religious leaders influence their follower’s attitude towards
vaccination in Nigeria, and
• To determine the implication of the above on public health issues in Nigeria
Methodology
Research methods are the specific procedures for collecting and analysing data (Shona
McCombes, 2021). This section of this work outlines the methods used for this study.

Research methods include all the processes and steps which have been taken by an

author or a researcher in conducting a research. It also defines the approach a

researcher or a team of researchers have undertaken in responding to a research

question or in addressing a research problem.

Quantitative research methods rely on the countable or numeric quality of a subject in

completing the measurement of that subject. It leverages the volume, value or

countable or quantifiable nature of a specific subject in reaching conclusion about a
given research topic. It focuses on collecting or putting together and analysing the
numeric value of data to determine patterns in outcomes.

Quantitative research methods draw research conclusions using tables, facts, graphs,

charts, etc. it is one of the most common research methods among researchers
especially beginners and those conducting field-based studies. Some of the most

common quantitative research methods include experiments, observations recorded

as numbers, surveys with closed-ended questions and quasi-experiments.

Qualitative research is different from Quantitative because it expresses research

solutions in words in the form of narratives. It gives deeper understanding to concepts

or experiences. Some of the common qualitative research methods include interviews

-these could be Key Informant interviews (KIIs) or a Focus Group Discussion with open-

ended questions, observations recorded in words, and literature reviews that

investigates concepts and theories about a topic. Qualitative research enables the

author and their target audience to gain in-depth understanding of a subject. Most
studies will combine a mixed method of qualitative and quantitative approaches to

their research as they complement each other.

Data collection for both Qualitative and Quantitative research could either be Primary

data collection or secondary data collection. Primary data involves original information
collected for the first time during a study. They are usually collected in response to

questions listed in a questionnaire in the form of surveys, discussions, observations,

and experiments While secondary data are the information gathered from already

completed reports of a study or research. Secondary data relies on the report of other
researchers to generate their own conclusion.

This Literature review adopted a secondary research method which relies on the review

of existing and published literature on the topic as the major data source for reaching
its final findings (Johnston, 2014). This involved carrying out a search of already

completed relevant research work and examining the findings to reach new
conclusions (Smith, 2008, p.4). Relying on existing data meant that the study didn’t

require any form of primary data collection or physical field visits to gather data for
this work.

According to (Preston&Aveyard,2018) literature review is used to determine one or

more research questions that are subsequently answered using a systematic

methodology. More so, a literature review can address research questions with a power
that no single study can match by combining findings and interpretations from a

variety of empirical data, (Snyder,2019). Hence, the methodology for this study aims
to synthesize findings in order to present evidence on a meta-level and to identify

areas where more research needs to be done, which is an essential step in developing
theoretical frameworks and conceptual models, (Snyder,2019). Additionally, the choice

of this method allowed leverage on a key advantage of secondary data which is its
cost effectiveness (O’leary 2017, p.268). The author would have been responsible for

the main cost of the data generated for the reports through primary methods as such
the researcher does not have to commit too much monetary resources to this phase

of the study (O’leary 2017, p.268). In cases where authors must pay to access secondary
data, the cost are usually for less than the cost of generating primary data which usually
include stipends or salaries for enumerators, transportation, and other field related

logistic cost that is usually associated with collecting primary data. (P Joaquim. 2017
p.53).

Secondary methods also comes with lesser challenges and so saves the author time

since the data has already been collected and, in most cases, processed into findings
in the form of reports or briefs usually stored in physical and or electronic format (SMS

Kabir, 2016). Secondary data also allows the author to exercise preference on the time
saved from data collection, instead these become useful resources spent on testing

hypothesis or vetting findings from selected journal articles to determine their

alignment with the objectives of the proposed study and their suitability in responding

to the research question (S Martins, 2018 p. 35).

While the study has benefitted from some of the major advantages of engaging a
secondary method in research, there were some limitations associated with a literature

review as a major research methodology. The research topic also hold potential to
influence the authors reasoning (Lee Jussim 2012 p. 141), considering the sentiments

that is usually associated with religion especially in Nigeria (Dowd, 2016). Following

this, it was necessary for the author to maintain neutrality in investigating the different
resources pulled for this research, all studies were considered with critical attention to

the context, tone and logic that framed their arguments (P Leavy 2017 p. 4), this was
quite similar to conducting a multiverse analysis. Deploying a multiverse analysis

involves identifying all potential analytic choices that could justifiably be made to
address a given research question, implementing them all and reporting the results.

Notably, this method differs from the traditional approach in which findings from only
one analytic method are reported. (J Baldwin 2022).

It was therefore important to be deliberate about emotions and seek ways to limit

sentiments, this can be managed by putting together findings across different studies
and identifying points of similarities and divergent opinions to identify the specific
contribution of the different studies to the research question (J. Baldwin 2022, p.2).

Ascertaining studies with strong alignments to the research question and focusing
more on them was effective and this strategy have benefitted from a deliberately

selected approach in reaching the final search yield ensuring only studies with strong
evidence base were selected for this review (C Hoadley 2004 p.58).

The study also relied on some set of theories; this was to guide what to look for in the

different studies pieced together in this Literature review. Theories are useful in
predicting outcomes of a study and they also help in analysing and interpreting the

data pulled together across different resources (Sutton & Staw 1995). This means
writing critically looks beyond just summarising different theories to explaining how

they guide research design and data interpretation as well as stating any limitations
and how they have been dealt with (Olayinka et al.,2020 p. 105). Where possible,

theoretical perspectives or school of thoughts are key in providing justification for the
choices reached in this investigation (Saunders et al., 2009 p.128).

The key for this investigation was being able to establish what constituted existing

knowledge about the study and what is not yet known, and this allows the author to

understand the current state of knowledge about the research question to ensure
effective linkages with this work and to identify gaps in existing knowledge

(Aveyard,2016). A literature review helps to resolve a debate, establish the need for
additional research, and or define new topics of inquiry. (A Norin 2015 p. 8)

Search strategy
As stated by Aveyard (2014), this study has adopted a search strategy that enabled it
narrow its focus to only studies that related to the research question, this was further

refined to a geographical location limiting interest to studies in Nigeria and Africa at

most. Key consideration in the research strategy included

Key Terminologies and Synonyms: Key terms (figure 1) guided the search for this
study, key terms about the research topic have been used to identify relevant studies
from the selected data base used for this work, they enabled the author narrow in on

publication based on their relevance to the subject matter. (Aveyard et al., 2016, p.67-
68). The adoption of key terminologies and synonyms were strategic to reaching the

final yield by limiting the search to specific topics as well as identifying alternative and
entirely exclusive or excluded topics that could deviate the search. (Aveyard et al. 2016,

p.75)

S/N Key words Synonyms

1 Religion Faith, belief, Creed,

2 Vaccination Jab, Immunization,

Inoculation

3 Public Health Communal Health,

4 Believe systems Spiritual leader

5 Religious Leaders Faith leaders

6 Faith actors Religious Leaders, Religious

groups

Figure 1: Key terms

Determining the Database

A database system is a unified collection of related articles, with details of the

description of the contents. In fundamental terms, the database system is similar to a

computer-based record keeping system used for recording and managing information

or data. (G Bhojaraju 2003). The search strategy included a comprehensive search using
The University of Northampton Electronic Library Search Online (NELSON) which

comprises of: CINAHL, Biomed Central Journals, Wiley Online Library Journals, Medline,
PubMed, SAGE Journals Online, Science Direct, PMC and other web-based and

electronic database system using defined inclusion and exclusion guides to prioritise
the search process. The search used relevant, specific databases to maximise the
identification of appropriate literature (Aveyard et al. 2016, p.72). The table below

presents the list of the databases used to reach the search yield for this investigation.

S/N Database Mode of Storage Area searched

1 Research Gate Web Based Research Methods

2 PDF Drive Web Based Combined Articles

3 Academia Web Based Combined Articles

4 Scientific Research Web Based Social Science and Life

Science

5 PubMed Central Web Based Public Health and

Religion

6 Cambridge University Press Web Based General Research Topics

7 CINAHL

8 Medline

9 Sage journals online

Inclusion & exclusion criteria

The inclusion and exclusion criteria guide are effective for refining the search and

ensuring continuous alignment of data to the objective of the study and most
importantly keeping a focus on reports that are relevant to the research questions

(Aveyard et al. 2016, p.76). They also help investigators describe precise components
of their study objectives as well as contribute to transparency which is a key systematic

review value (Petticrew & Roberts, 2006). The table below present a snapshot of the
inclusion and exclusion criteria for this work.
 S/N Inclusion criteria Exclusion criteria

1 Peer reviewed research Scope of the literature

2 Vaccination campaign Studies older than 10 years

3 Qualitative studies exploring Systematic reviews

voluntary vaccine up-take in

Nigeria

4 Public Health specific religious Online Blogs and Editorials

quotes

5 News item

Figure 2: Inclusion and Exclusion criteria

PRISMA Flow
An important part of a systematic review in research is to note and include a report of
the total number of records or publication collected during the search process of

related scientific literature for a review (Millard T et al. 2019 p325). The PRISMA
statement recommends that literature reviews use a PRISMA flow diagram to show the

flow of report through the different phases of the systematic review (McKenzie M et al
2020). Even though the PRISMA flow diagram is widely used among scholars for

depicting the flow of reports in a systematic review, it is not meant to include the
results of continual searches typically used in literature systematic reviews. This work

has only adopted the PRISMA flow diagram to show the process and of search flow
and how the search yield has been narrowed to the final articles used for this study.
 Prisma Flow Diagram for the Systematic Review
Total number of reports Additional Records from
Identification

identified from database other Sources

search (Total Yield)
(n=5)
(n=39)

Records after extracting duplicate

reports/publications

(n=34)
Screening

Records Screened Records Excluded

(n=28) (n=6)

Full articles assessed for Full text articles excluded

Eligibility

eligibility based on defined exclusion

(n=22) criteria

(n=10)

Exclusion Criteria
Records Included using the
Scope of the literature (3)
defined review inclusion
Studies older than 10 years (2)
criteria for Qualitative analysis Systematic reviews (0)
Included
records

(n= 12) Online Blogs and Editorials (3)

News Item (2)

Venn diagram
The Venn diagram is a popular tool for showing relationships in biomedical studies. (C
Gao, 2021 p. 24). The Venn Diagram is a graphical representation of the distribution of
the key search terms in the final search yield. (B Hur, 2019, p. 58). The Venn Diagram

for contains 3 circle labelled A, B and C. Circle A depicts all research that have been
reviewed for this study (i.e., reports that directly contributes to responding to the

research questions, Circle B for articles that contributed background and context
information and Circle C for articles that contributes to introductory and formatting
related information. The search yield has been rated based on the weight of the key

word contained in them.

Set A = Reports with key terms that directly contributes to responding to the research

questions

Set B = Reports with key terms that contributed to background and context
information

Set C = Reports with key terms that contributes to introductory and formatting related

B
AC
BC

information

Figure 3: Venn diagram (C Gao, 2021)

Data Management
This study adopted a systematic approach to data handling for the reports or

publications selected for this study (Aveyard et al., 2016, p.79). This included a table
chart with headers for key themes of interest in each publication, for this study the

focus was on the Title of the publication, the Author(s), Year of publication, Research
Methodology, relevance among others. The table below shows details of the key
 headers in the data collection tool used for this study. See the annexes for a completed

table with the total search yield.

Title Auth Year Objective Method Participa Critical Themes Outcome Relevanc

or nts appraisal / Findings e

Figure 4: Data handling table headings

As a study carried out using a secondary research method this work prioritised carefully

screening selected publications to gain insight of the strengths, limitations, and

relevance of the selected studies as a criterion for assuring the reliability of the findings

and conclusion reached in them. The study also ensured that methods including data
collection data collection and data analysis tools suits the study and appropriate to

respond to the research question. (Bowling, 2014, p.166). Observation and excerpts
were noted down and reviewed taking note of the citation details and page numbers

where relevant for easy tracking of key findings.

This study adopted the reviewed version of the popular McMaster University

Occupational Therapy Evidence-Based Practice Research Group Critical Review Form.

The guidelines of this tool were critical in enabling the appraisal of the selected articles
for this work, focusing on key study components like Citation, Study Purpose,
Literature, and the entire Study Design (Letts et al., 2007). These tools were originally

designed by the McMaster University Occupational Therapy Evidence-Based Practice

Research Group, they are easy to deploy as they written in basic terms that can be

understood by researchers as well as clinicians and students interested in conducting

critical literature reviews.

The Critical Review Form allowed for a detail review of the study and understanding of

how the author(s) have reached their final findings based on an understanding of the
key study component (McMaster University, 2021). Adopting critical appraisal tools
that allows for effective analysis of the process authors have adopted in the design
and implementation of their studies enhances the confidence in the findings they put

forward as well facilitate easy acceptance among target audience. (Aveyard et al. 2016,
p.109)

Data analysis
This study has reached its findings by analysing relevant data on the impact of religion
on vaccination in Nigeria, it reviewed, critiqued, and synthesized representative

literature on the impact of religion on vaccination in Nigeria to reach new frameworks

and perspectives on the topic of this work. (Arshed, Norin & Danson, Mike. (2015)).

This study prioritised the relevance of reports from the search yield in responding to
the research questions then proceed to identify data across these studies that related
to the objective of this work and then putting them together to reach the final findings
of this work. The analysis meant that we are able to propose a new argument that

looked entirely different from those you could deduce from reading the different

literature used for this work individually. (H Aveyard, 2014 p. 138-140). The goal is to
‘produce a new and integrative interpretation of findings that is more substantive than

those resulting from individual investigation’ (Finfgeld 2003, p. 894).

This has been completed bearing in mind that literature reviews are usually supposed

to consider the research question, especially in terms of clarity and specificity, the
search strategy, Methodology, presentation of findings and recommendation (H

Aveyard, 2014 p.22). Using existing data has allowed the quick review of existing
opinions and scientific evidence on public health issues focusing on howe religion

facilities or limits voluntary vaccine uptake in Nigeria. It is important that most existing
data sets have been designed to capture belief and behavioural outcomes and their

linkages to religious influences it has become easier to link papers or studies with
similar these and then complete a comparative analysis on the justification for the

conclusion reached across papers and varying authors. (T. P. Vartanian 2011 p. 15)

Putting together the summaries from different articles posed some challenges as a
result of the complexity related to how different authors present information. This
study was interrogative in nature using a research question that has been framed to

be investigative in outlook. (H Aveyard, 2014 p. 28). Literature reviews that uses

interrogative form in framing research question … clarity rather than appearing as

regular statements. In her argument Helen Aveyard believes adopting interrogative

form of research questions helps to keep literature reviews focussed which she also

believes enables the entire work to remain aligned to responding to the questions and
objectives of a study. (H Aveyard, 2014 p. 30). This approach enabled this study to

prioritise data from different articles according to relevance and closeness to the
research question. The subjective nature of most authors and the sentiments that can

arise from dealing with a socially complex topic like religion is further minimised by
continuously focusing on seeking answers to the research questions minimising bias

and emotional deviations, acknowledging that deviations in a process are common,

but noting that what is more important is how and what one does about the deviation

(S. Ostrove 2016)

Ethical considerations
The methodology adopted for this work largely minimized most Research Ethics
related risks, however, this didn’t entirely constitute waiver entirely for ethical

considerations. (Smith, E. 2008, p. 79). This study still made effort to adhere to the
Royal College of Occupational Therapists (RCOT, 2015) direction that all studies and

their authors exercise duty of care to service users, including consent to participate
and capacity to understand the research context (RCOT, 2015, p.19). As such this

research was deliberate about examining studies to be sure they have fulfilled ethical
considerations and requirement for conducting acceptable studies. This means that all

resources included in this study had been conducted with consideration to its costs
and benefits to participants, as well as confidentiality and anonymity (Punch, 2016,

p.25 & 101), in this study anonymity has been prioritised over confidentiality except in
cases where very sensitive information has been noticed in a publication,

understanding how and where a study-related data has been collected was useful in
determining the sensitivity and gravity of any potential ethical concern.
Cresswell and Cresswell’s recommendation on the importance of personal privacy

when engaging internet-based resources (Cresswell and Cresswell 2018, p.88) have
been strictly adhered to in this study. The study has been deliberate in completing

checks for compliance with ethical guides to ensure statements of ethical approvals.

Resources and facilities

Resourcing for data for this study heavily relied on the internet following the
continuously growing dependency on the internet as ready source of information.

There have always been viable alternatives to source for information for different
studies and by different categories of people (Burkell, et al., 2006; Wong and Sam 2010;

Hersberger, 2001; Yusuf 2012; Ukachi, 2007), However, the universality of the Internet
and its ability to deliver information on virtually any topic of interest with simple clicks

of a button at minimal costs has made it a preferred option to physical alternatives in

search for information. The Web has exploded into an information platform of

tremendous importance, with several hundred million users and over a billion Web
pages (Buscher, et al., 2009; Pitkow, et al., 2009).

While this study has relied heavily on internet resources, it also benefitted from other
sources of information and more importantly on guidance from colleagues,

practitioners, professorial supervision among others to ensure alignment to acceptable

research practices (Biggam, 2009, p.27-29).

Below is a table listing the data sources that contributed to this work.

Academic library

Professional project supervisor

Computer

Study space at home

Logbooks

Aid and Development Workers

Review
Religion and Society
Johnston D et al have described Religion as a system of social coherence commonly
understood as a group of beliefs or attitudes concerning an object, person, unseen or

imaginary being, or system of thought considered to be supernatural, sacred, divine

or highest truth, and the moral codes, practices, values, institutions, and rituals

associated with such belief or system of thought. (Johnston, D. et al 1994). It is a

framework within which specific theological doctrines and practices are advocated and

pursued; usually among a community of like-minded believers (Johnston, D. et al

1994).

In the article Socio-cultural factors in onchocerciasis control: a study of rural Southeast

Nigeria, Ajaegbu argues that conceptually religion provides believers (believers in this

case refers to a group of people who believes in the teachings of a given religion) with
a guideline about life and the life-after and thus provides a much-needed incentives

for indulging in productive activities in life. (O O. Ajaegbu, 2020). On this basis Religion
can be considered as a promoter of growth as they direct people on morality issues

including honesty, discipline, hard work, education, thriftiness which can become some
sort of capital for livelihood investment and form the basis for abstaining from harmful

activities (O. O. Ajaegbu, 2020); including looking after the health and wellbeing of
people which provides a subtle linkage to public health objectives.

Johnston et al believes religion brings about beliefs, practices, and rituals related to

the transcendent, where the transcendent is God, Allah, HaShem, or a Higher Power in
Western religious traditions, or to Brahman, manifestations of Brahman, Buddha, Dao

or ultimate truth/reality in Eastern traditions. (Johnston, D. and Sampson, C. Religio

1994). This means that religion becomes a fundamental factor in framing societal

values including a society’s perspective on key issues including how they address their
health problems and this often involves whether people choose to go the mystical or

supernatural path. (Janet K Ruffing, 2012). Religions usually have specific beliefs about
life after death and rules about conduct within a social group including how challenges

are solved.

This means that over time in history religion have found a strong hold on key social
service issues like health. The role of religion and religious institutions has been

scrutinized during major public health challenges in recent history Including HIV/AIDS,
influenza, and Alz-heimer’s disease. (Stephen C. Ko 2014). Each of these diseases

though unique in its epidemiology, pathophysiology, morbidity, and mortality had a

similar theme about them, which is how the society have reacted based on their

religious believe. (Stephen C. Ko 2014). In particular, the complex role of religious

institutions within the history of the HIV/AIDS crisis is well documented (Stephen C. Ko

2014). This includes positive impacts such as the creation of the AIDS National
Interfaith Network along with more nuanced tensions resulting from religious beliefs

that HIV virus is a punishment from God, the consequence of immoral behaviour, or
the result of karma. (Stephen C. Ko 2014)

Besides the above, Religious doctrines have continued to be proven to influence

decisions about health and health behaviours. In the Judeo-Christian scriptures, for

example, there is an emphasis on caring for the physical body as a “Temple of the Holy
Spirit”. (H G. Koenig, 2012). Religious scriptures in other faith traditions also emphasize

the person’s responsibility to care for and nourish their physical body. Behaviours that
have the potential to harm the body are usually discouraged. (H G. Koenig, 2012). This

is reflected in teachings from religious leaders and greatly influences what is

considered appropriate among religious followers. (H G. Koenig 2012). Spirituality is

distinguished from religion and all other things by its connection to that which is
sacred, the transcendent. (H G. Koenig 2012). The transcendent is that which is outside

of the self, and yet also within the self and in Western traditions is called God (H G.
Koenig 2012). These two, (Religion and spirituality) share something in common, and

that is the role of a leader. A religious leader is someone who is associated with a given
religious organization and is authorised to represent the organisation to promote their
teachings or doctrine, they include pastors, a priest, rabbi and imams. Their level of

influence depends on a variety of factors but most commonly by the size of their
followers or popularity of their religious sect

In Nigeria, this group of people are very powerful considering that about 46.9% of the

population identify as Christian and 51.1% as Muslims. That represents 98% of the total
population of Nigeria. The history of religious leaders and their influence in Nigeria

dates back to colonial times when the British conferred so much political powers on
the then chiefs and Emirs who stood as religious leaders, they related with them as

political leaders using their office or position to enforce policies and laws. (M L Yesufu
2016). Today they influence every major sphere of societal life in Nigeria as in most

part of the black continent, their influence have so grown that they are considered
leading opinion makers. There words and teaching is almost becoming laws that

govern how their followers live including how health services is viewed and accessed.

While they have been vital in developing and shaping society especially in areas where
government is struggling with basic service delivery we have seen religious groups

who have the means set up major service delivery centers including thriving

Educational institutions and Hospitals, however, there are also times and situations
where there teachings have impeded on key societal objectives aimed at achieving a

public good including reaching recommended vaccination and immunization levels for
the safety of the public. Does this mean religion constitute a barrier to public health

objectives, is religion suddenly an unexpected hindrance to the health of its believers

and are Religious leaders suddenly a form of blockade to the delivery of public health

service and how. In responding to these we have reviewed the history of immunization
in Nigeria to understand the role of religion and religious leaders and how they have

aided or hindered the attainment of desired goals at different era and public health
scenarios
Vaccination and Immunization
The invention of vaccines has completely revamped the prevention of diseases. (K. M.

Malone and A. R. Hinman). Vaccination is the administering of weakened or inactive

parts of a particular organism (antigen) that triggers an immune response within the
body (National Institute of Allergy and Infectious Diseases 2018). Consequently, the

result of this immune response is the production of antibodies specific to the identified
pathogen. An important characteristic of most vaccines is that they provide both

individual and community protection. Most of the diseases against which we vaccinate
are transmitted from person to person. When a sufficiently large proportion of

individuals in a community is immunized, those persons serve as a protective barrier

against the likelihood of transmission of the disease in the community, thus indirectly

protecting those who are not immunized and those who received vaccine but are not
protected (vaccine failures). (K. M. Malone and A. R. Hinman, 2009)

A study conducted among large ethnic groups in Nigeria found that many of the

people's beliefs promoted good health practices and complemented modern health
promotion efforts, including immunization (Adogo Patience Inyamuwa, 2021).

Immunization is considered one of the most cost-effective health interventions,

reducing under-five mortality (WHO 2009). Global immunization coverage from 2010

to 2015 shows that at least 85% of children received three doses of diphtheria-
pertussistetanus (DPT) vaccine (WHO 2016). However, in 2015, the number of children

without routine immunization (RI) was 19.4 million globally (WHO 2016). The majority
(75%) of non-immunized children live in 10 countries, including Nigeria (WHO 2009).

Immunization and vaccination are two of the most important public health
interventions and constitute a cost-effective strategy to reduce both the morbidity and

mortality associated with infectious diseases. (E A Ophori et al 2013). However, a variety

of factors have affected the attainment of complete immunization against most

infectious diseases and religion and religious leaders have been listed in several studies
as constituting barriers to how immunization goals are delivered.
Ophori stated in their report “Variations in the Uptake of Routine Immunization in

Nigeria: Examining Determinants of Inequitable Access’ that the greatest challenge to

the acceptance of immunization in Nigeria is a religious one especially among the

northern Nigerian Muslims. To support this position he analysed the immunization

coverage of different regions in Nigeria from a religious perspective. Generally, the

Muslim north has the lowest immunization coverage in Nigeria, the least being 6%
(northwest) and the highest being 44.6% in the southeast. (E A Ophori et al 2013). This

trend portrays characteristics coherent with scenarios of vaccine hesitancy

Vaccine hesitancy, is defined by WHO as a “delay in acceptance or refusal of vaccines

despite availability of vaccination services”, leading to the adoption of vaccination

mandates in some instances for example like in the case of the recent COVID 19
pandemic. Vaccine mandates can be ethically justified; however, their ethical

justification is contingent upon several conditions and considerations, including the

contexts within which they are implemented

Religion and Vaccination in Nigeria

In 1979, the then Nigerian government introduced the Expanded Programme on

Immunization (EPI) intending to improve children’s health by eradicating six killer

diseases: polio, whooping cough, measles, diphtheria, tuberculosis, and yellow fever.

(Fatiregun AA, 2014). The optimum level was recorded by the early 1990s with the
country achieving a universal childhood immunization coverage of 81.5%. But since

that period of success, Nigeria has witnessed gradual but consistent reduction in
immunization coverage. Ogundipe have worthily noted that this campaign was

resisted from the onset by some religious leaders in the north who described the
exercise as being against Islamic injunctions (Ogundipe, 2001) and rumours of

contamination with the AIDS virus were also widespread (Abuh, 2002).

More recently, in their study ‘COVID-19 vaccine hesitancy among staff and students in

a Nigerian tertiary educational institution’ Ikemefuna Uzochukwu et al tested the

relationship between religious denomination and the willingness to get vaccinated,
their investigation returned that there is a significant association between church

denomination and attitude toward COVID-19 vaccination. The odds ratio value of
0.366 obtained showed that Roman Catholics and Protestants are more likely to accept

the COVID-19 vaccine than the Pentecostals and Sabbaterians. The association of
COVID-19 vaccination and the end of the world (conspiracy theory) by some popular

Pentecostal evangelists on social media may be responsible for the higher hesitancy
among the Pentecostals and Sabbaterians. (I C Uzochukwu et al, 2021)

In the study, ‘The Role of Religious Actors in the COVID-19 Pandemic: a theory-based

empirical analysis with policy recommendations for action’ by Yendell et al, the authors
have argued that it is the role of religious leaders, a position they considered

undisputedly valuable in the circumstance to deal with the important tasks of

convincing their followers to voluntarily take up the COVID 19 vaccine (Yendell et al

2020). They further argued that the global COVID-19 pandemic which has negatively
affected the nations of the World especially the poorest countries like Nigeria is

possibly the first global health crisis since the Spanish flu, whose catastrophic effects
in the wake of World War I resulted in 50 million deaths worldwide and were only really

understood in retrospect. At least, the danger presented by both virus strains may well
be of a similar magnitude, despite the lack of comparability between the basic death

rates and the medical and hygiene standards then and now (Faust et al. 2020). Such is
the magnitude and relevance of religion and belief systems in the world today that

they frame or influence key issues globally and how religious followers respond to
topical issues like public health.

Discussion
From the analysis of data for this review we have seen that religion is deeply rooted

into Nigeria’s national identity with 92% of the population identifying either as
Christian or as Muslims. We have also seen that this magnitude of followership confers

varying degrees of authority on religious leaders depending on the size of their

congregation, it becomes then important how religious leaders conduct themselves
and more importantly what they say considering the impact their words, action or in

some cases body language can have on the choices their followers make.

While most development initiatives have acknowledged and strategically engaged

religious leaders to positive effects, following an effective understanding of power

dynamics within the Nigerian society, government is still not able to fully engage with
and maximise the powers wielded by this hallowed group of leaders to the same level

of positive effects. Yes, there have been some degree of successes in government and
religious leaders relationships, government's engagement of Quranic school teachers

and Muslim clerics in disseminating accurate information to non-compliant and hard

to reach communities where local populations have initially boycotted the polio

vaccine due to fears that it was unsafe during the polio vaccinations in northern Nigeria
in the mid to late 70s easily comes to mind, but there is the more recent disregard or

grudged adherence by religious leaders to government efforts to curb the spread of

the COVID-19 pandemic, then, following government’s declaration of its lockdown

measures in March 2020, several religious leaders and organisations were suspended
for violating the government’s directive that prohibited religious gatherings. They went

ahead with religious services while contending that religious spaces should be
considered an essential service and accorded the same considerations as markets,

banks, and other businesses that were allowed to operate with listed safety measures.

In fact, THISDAY NEWSPAPER issue of the 2nd of April 2020, reported a clash between

worshippers and members of the COVID-19 task force group in Ogun State, this has
since further heighten the debate around the role of religion in Public Health efforts

in Nigeria, is religion an enabler or a barrier to the implementation of public Health

strategies especially vaccination?

Religious beliefs and vaccination in Nigeria

In poorer or less developed nations where the citizens tend to look more towards

religious promises, especially of a kingdom to come where there will be no sufferings

as a source of hope in the face of failing government systems, Religion becomes even
bigger and more influential, as it gets bigger so do religious sects also become bigger,

wielding immense social influence on almost every sphere and topics ranging through
governance, culture and very interestingly how people seek health services. Scholars,

activists and development practitioners working and thinking at the very ‘local’ level
of aid delivery notes the importance of the role of the religious actors in international

development. (Wilkinson 2020, Tomalin 2012). This is because faith and religion are
key influencing factors in how communities relate to change, both behavioural and

structural.

Particularly in countries like Nigeria where religious dynamics are an important cultural,
social and political factor. Local faith actors often operate at national levels and link to

grassroots, and community initiatives. As Tomalin (2020) and others have argued,
religious actors and religious traditions have historically played a major role in

supporting- spiritually, politically and materially- those who were experiencing

poverty, both at the individual level as well as the community level. This importance of

religion has been seen vividly during times of public health crises

The research, ‘Evidence review: Religious marginality and covid-19 vaccination - access

& hesitancy’ by Mariz Tadros recognises the place of religion and recommended that
it is important that any intervention aimed at enhancing voluntary vaccine uptake

prioritises working proactively and inclusively with faith actors to deliver positive
results and recognizing that religious authority is one of many authoritative sources of

knowledge and influence in the community and to capitalize on the existence of

multiple actors who are considered authoritative, for example, health professionals,

women leaders, minority political and community leaders and community volunteers
in dealing with vaccine hesitancy.

In the history of public health in Nigeria, Religious centres and Religious leaders have

been vital in how targets have been achieved or missed. There are records of where
worship centres have been used as mobilization points for the polio vaccines. Religious
leaders have played key roles in pushing for and encouraging their congregation to
get vaccinated but what then is the blurring line between willingness and opposition

to vaccination agenda among religion faithful? In addressing this, Mariz have

cautioned that care be taken not to assume that all religious leaders can be recruited

on a public health awareness campaign highlighting the importance of recognising

counter voices from within.

The paragraph above suggests that there must be clarity of purpose in both

communication and implementation strategy to maximise the potential inherent in

religion followership when engaging in vaccination in Nigeria. The discord experienced

during the COVID-19 pandemic further highlights the need for inclusion in the decision
making spaces taking it a little beyond just communication and choice of

implementation strategy.

In another work, Ayeni et al (1985) found out that utilization of health services among
rural women in Nigeria depended on religious belief, and other factors like awareness

of the services, beliefs in their efficacy, proximity and availability of the services. In a
similar study conducted by Gordis (1993) in Oyo and Bauchi States with respect to

attitudes and practices of women to pregnancy, childbirth and post-partum care, the

data revealed that religious beliefs among other factors often place women at a
disadvantage position from the start of pregnancy. Jegede, (1999), in his study of

socio-cultural factors influencing therapeutic choice also identified religion as a

determinant factor to use of health services among community members.

Based on the influence of religion In Nigeria, the greatest challenge to the acceptance

of immunization very much seems to be a religious one especially among the northern
Nigerian Muslims, there have also been some positives as we have seen. While this

seems bold to state, the figures also suggest so. For instance, the lowest immunization
and vaccination coverage in Nigeria are recorded in the Muslim dominant north with

the least being 6% for the northwest region and the highest being 44.6% in the
southeast. If we become more location specific, we see that in Ekiti state, a southwest
state, the northeast and western part of the state with a stronger Islamic influence also
records low immunization coverage and poor educational attainment. Christians have

24.2% immunization coverage as compared to only 8.8% for Muslims (Babalola S.

2011) Ophori EA et al 2013. From the above discussion it seems safe to say that religion

holds a massive influence in the history of vaccination in Nigeria but how this influence
is engaged goes a long way to determine if it becomes an enabler or a barrier to

reaching vaccination goals

Does religion impedes on vaccine uptake in Nigeria?

Most faith-based denominations do not have specific scriptural or canonical objections

to the use of vaccines. (Grabenstein JD. 2013). In Islam, theology generally supports
immunization through Islamic law (hukm), however, there are prohibitions where

certain materials considered to be forbidden (haram) has been used in producing the
vaccine, and example includes the use of materials such as Porcine-derived products.

There are also exceptions made for the “law of necessity” when no alternatives are

available. Biblical support for immunization includes Christian service to humanity

(being one’s Brother’s keeper, loving your neighbour as yourself. (Grabenstein JD.

2013).

Religious leaders and local faith actors are also universally recognized as influential
people in driving Immunization uptake and coverage (Berkeley Centre for Religion),

However, there must be an a deliberate effort to ensure their participation in the

decision through listening and dialoguing with them as a critical part to finding

theologically-acceptable solutions to vaccine processes. So it becomes hard to tell if

vaccine hesitancy has any correlation with faith or if faith-related objections are a

convenient cover for more complex, intersectional, sociocultural, and political issues.

Religion has always been used as a basis for defining the truth (Gaskell, et al., 2010), in
Nigeria, opposition to vaccination is associated with knowledge, religiosity, trust in

institutions and persons, and attitudes to science (Falade 2014). Falade has through

his work on Religiosity and Vaccination argued that there exists an association
between religion and opposition to vaccination in Nigeria but that there are no
sufficient evidence to help draw conclusions that objections or uptake of vaccine

among religious groups are solely based on their faith. For instance, there are findings
that lower immunization rates among certain religious groups are more linked with

factors such as limited access to social programs, marginalization, limited knowledge

and perceptions of illness rather than as a result of their religious belief. (Hum

Vaccinthatnother 2012 p. 239).

Just as in Nigeria, this review has also found that the Muslim religion has been
identified as a potential barrier to immunization coverage elsewhere in Ethiopia (Feleke

A et al 2014) and Chad (Abakar MF et al 2018), two countries which along with Nigeria
are identified with high proportions of unvaccinated Muslim children. Nevertheless, it

has been argued that scepticism towards immunization by religious leaders is rooted
less in faith-based beliefs than in health-related concerns that spread across social

networks within religious communities (Larson HJ, et al 2016 p. 295). Islamic groups in
other countries also have concerns that some vaccines are not halal, and therefore

could not be administered (Ahmed A et al. 2018 p. 153). On the other hand, a multi-
country study on vaccine confidence showed that the Muslim faith itself is not always

linked to low coverage, taking a look at Saudi Arabia as an example, where 100% of a
study’s respondents were Muslim and there were few objections to vaccines ((Larson

HJ, et al 2016). In fact, the involvement of Islamic and Christian leaders in the
promotion of child survival interventions in Sierra Leone was linked to a marked

increase in vaccine coverage in the 1980s.

This means that religion does not openly impedes vaccination nor are they solely

responsible for low vaccine coverage in Nigeria. However, vaccination hesitancy or

resistance is often hidden under the guise of “religion,” without a theologically-

grounded objection. Religious objections to vaccination seems to only serve as a cover

for other concerns about the safety of the vaccine, social norms, socio-cultural issues,

political, and economic factors (Sara M. 2021)

Religious leaders impact on people’s attitude towards vaccination in Nigeria

Following their influence, religious leaders are publicly idolized and revered in Nigeria.

In fact, many Nigerians are more likely to listen and believe in the words of their
religious leaders than government leaders given the general lack of trust between

citizens and the political elite. The local community recognizes a religious leader as a
trusted leader (Marshall 2017). This is especially true in Nigeria where the religious

actor is more often also a community representative or mobiliser.

In the review of the study ‘Vaccination Resistance, Religion and Attitudes to Science in
Nigeria’ by Falade, we see that following the rampant nature of the polio epidemic in

1996 African leaders had launched the polio eradication campaign tagged “Kick Polio
out of Africa.” However, by 2002 even though most countries, including several states

in Southern Nigeria, were declared free of the disease, there were still major concerns
in Northern Nigeria (WHO, 2005). Ogundipe have worthily noted that the “Kick Polio

out of Africa” campaign was resisted from the beginning by some religious leaders in
the north. The crisis was worsened in 2003, when in the midst of the campaign, two

very influential Islamic groups in the North: the Supreme Council for Shari’ah in Nigeria
(SCSN) and the Kaduna State Council of Imams and Ulamas held a news conference

through which they declared that the vaccine contained anti-fertility substances and

was part of a western conspiracy to reduce the population of the developing world
(Madugba, 2003).

Ordinarily these statements shouldn’t bring too much worry but given the revered

status of the two groups among Muslims, the stage was set for a major revolt. This
antagonistic action of some Muslim religious leaders in Northern Nigeria climaxed with

a number of states in Northern Nigeria placing a ban on the use of the Oral poliovirus
vaccines on the controversial argument that it contained substances that had

potentials to sterilize the male reproductive abilities of recipients (Sabiu and Shobayo,
2003). As expected that ban impeded on the gains already reached, by 2005 world-
wide fears of the reversal of the gains already made by the “Kick Polio out of Africa.”
campaign was widespread as there were a rise in re-infection rates of most previously

declared polio free countries (UNICEF, 2009).

In some positive reflection religious leaders in Nigeria have also facilitated the uptake
of contraceptives and have been at the forefront of shaping opinions and influencing

behaviours in the fight against infant and maternal mortality through awareness
campaigns. Thus, deploying religious leaders as change agents was crucial to

increasing family planning adoption and promoting family health in Nigeria.

The empirical analysis carried out on the role of religious actors during the COVID-19
pandemic also shows that there is need for further research. This is an exciting and

complex subject area, from which important insights for further, probably unavoidable
(health) crises can be gained. At the time this study was drawn up, research on the

COVID-19 pandemic, focussing specifically on the religious phenomenon, had only just
begun. This report can, therefore, serve as a basis and an incentive for further research,

especially for more in-depth, country- and region-based studies or case studies of
individual religious communities

Yes Religious leaders are influential in vaccine uptake as well as can hinder it, not by
compulsion on their followers but through words based on the reverence they enjoy.

As reported by Sara in her review of the influence of Religious leaders on vaccination,

sometimes religious leaders will find verses and passages of scripture to shut down

your mouth from questioning their stand, putting you in a place where all you can do
is accept their interpretation of the scriptures, such prophets thrive on partial truths

she argued, and have scientific schizophrenia, rejecting some science but accepting
the parts they like. (Sara M. 2021)

In some Christian communities in Nigeria, there are a few sects that hold to the

doctrine of the non-use of drugs, relying only on one’s faith for healing in all
circumstances. This is often extended to the immunization of children. However, these

sects do not have a wide following in the Southern part of Nigeria dominated by
Christianity. High literacy levels and information dissemination through access to
media platforms in these areas has limited the influence and spread of such doctrines.

(Oluwadare C 2009).

The boycott of the polio vaccine in 2003 is perhaps the best known and longest
boycott driven by the influence of religious leaders using the umbrella of the Supreme

Council for Sharia in Nigeria (SCSN) to make strong declaration that the ‘Kick Polio out
of Africa’ Campaign being implemented then in Nigeria was part of a western plot to

reduce Muslim populations. The impact of this statement was almost instant, delaying
the immunization of children resulting in the spread of new polio infections within

Nigeria and allegedly to other parts of western and central Africa. Impeding on
previous achievements of the global campaign. Conspiracy theories like these linking

vaccination and fertility control have been propounded and promoted by religious
leaders, particularly in the North including in States with the least immunization

coverage rates. This is one too much evidence of the influence of religious leaders and
how they can impede vaccination objectives where Religious leaders are not properly

integrated into the process of deploying a vaccination project.

So we see that Religious leaders are a potential force that must be used for, instead of

against routine immunization. Engagement with them, should be considered a must,

even as considering the sensitivity to religious differences in opinions that exists in

Nigeria. Integrating religious leaders into efforts to improve Nigeria’s routine

immunization uptake rates is the best way to go (Ben C. A 2014)

The Wider Implication of Religious Believe and Vaccination on Public Health in

Nigeria?
Reluctance to accept vaccination against a pandemic poses a significant public health
risk among the population especially in poor countries like Nigeria where citizens are

faced with weak health service delivery systems. This also has a multi-determined
phenomenon on the total wellbeing of a society. The introduction of safe and effective

vaccines that protect against major pathogens like the virus that can causes major
pandemics has the potential to bring the pandemic under control. Unfortunately, a
substantial number of the population are either hesitant to be vaccinated or say they
will absolutely not receive one of the vaccines under any circumstances often times

citing religious reasons among other justification for their position. Vaccine hesitancy
and refusal threaten the ability to establish community immunity and thereby posing

a significant risk to public health objectives

Vaccines are considered as one of the greatest achievements in attaining community

and global health objectives. It represents one of basic public health strategies for

mitigating against severe epidemiological and economic burden generated by

communicable diseases, beyond the protection it affords individuals who key into the

process to protect themselves against specific pathogens, vaccination can have a

broader more societal-wide benefits at varying levels of society. These benefits could

include improved access to education, increased productivity and positive fiscal

impact, limitation of gender inequalities, and control and prevention of antibiotic-

resistant pathogens. The alternative to vaccination are usually characterised by forced

measures including Vaccine mandates and at the extreme forced lock down measures

that usually comes with hard social and economic implications.

In this review, the benefits listed in the paragraph above are concise, the implications

could be far reaching beyond just access to basic services and means of livelihood, but
they could also represent a measure for enhancing scientific development in the health

sector, just the manufacturing of the COVID-19 vaccines has contributed to a further
growth in the field of epidemiology and vaccination. The broad benefits of

immunization if maximised could lead to improved communication about the impact

of vaccination and could form part of developmental programs for future healthcare

workers, however, all these benefits and worse still the implication of not properly
curbing a pandemic could be lost in societies where religion interfere with the

objectives of public health programmes like vaccinations.

Recommendation
Inclusion and Participation: The theme from this review seems to largely agree with
the fact that globally and more locally that religion and religious leaders could be very
influential and can have massive impact on vaccination goals. However, we strongly

recommend a deliberate effort to include all key stakeholders including and especially
Religious leaders. As we have seen in history religious leaders have been a useful

influence in reaching vaccination objectives when effectively engaged.

Effective Communication: The level of awareness among a community can also help in
minimising to what extent they can be misled by doctrines and misguided religious

actors. The government through public Health instruments and other social awareness
and education agencies can facilitate mass sensitization interventions to enhance the

level of enlightenment among the population. The high level of vaccination successes
recorded in extreme religious societies like in Saudi Arabia also suggests that poverty

and ignorance could constitute more limiting factors hindering vaccination objective
than religion does.

Conclusion
As we have noticed in this review, Nigeria is a highly religious society with religious

leaders wielding various degree of influence largely based on the size of their
followership. There is also some misleading interpretation of scripture related quotes

across religion in Nigeria mostly propagated by religious leaders. These go a long way
in framing the belief systems and attitude of religious followers. These attitudes can in
turn prove to become a barrier in implementing certain policies that have wide

reaching societal implications like the case in vaccination against certain pandemic.
The COVID 19 pandemic and the associated hesitancy toward the COVID vaccine

provides a recent

There is evidence that religious constitute major barriers to vaccination in Nigeria even
though religion have at times also served as leverage for the delivery of effective

vaccine campaigns. The

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Appendix 1 – Qualitative critique example
Critical Review Form - Qualitative Studies (Version 2.0)

© Letts, L., Wilkins, S., Law, M., Stewart, D., Bosch, J., & Westmorland, M., 2007

McMaster University
 Appendix 3 – Data handling table
Final key articles for critique

Only articles used in this review have been included in this table

Title Author Year Objective Method Participan Critical Themes Outcome / Relevance
ts appraisal Findings
The Effect Adamu 2018 This paper Mixed Health weak Religion, The cholera Low
of Nuhu, focuses on Method Workers, Methodolo Violent outbreak in
Religious MBBS, studying (Primary IDP Camp gy Conflicts 2018 is a
Conflicts MBA the and Managers, description, and major
in resultant Secondar IDPs poor access to public
Northern large y data) presentatio Public health
Nigeria on numbers of n of Health event with
Public IDPs from findings Services deleterious
Health the religious impacts on
Outcomes conflicts sociocultur
: A Case and the al and
Study of impact on economic
Cholera specific activities;
Outbreak public and
health indicative
that
attaining
the global
strategic
goals,
especially in
relation to
cholera-
related
deaths,
While there
is evidence
on the risk
factors for
cholera
infection
including
inadequate
WASH
interventio
ns The
religious
conflicts
limited
access to
health
services
which could
 have
positively
impacted
on the
number of
causality.
Religion Ellen L. 2014 Exploring Qualitativ NA A detailed Religion, The High
as a Social Idler the e and book on Policy, objective of
Determin intersection Secondar Religious Public public
ant of between y data intersection Health health is to
Public religious ality with conduct
Health institutions Public research
and Public Health and act on
Health issues. it to
institutions. improve the
health of
society; it is
an ethical
imperative
to include
religious
communitie
s as
fundament
al parts of
social life.
Religion Okech 2020 Examining Secondar NA Weak Religion the Medium
and ukwu the y Method description and relationship
National O. influence of of Relevance between
Developm Ajaegb religion on methodolo of religion and
ent in u. the gy, Poor Religion developme
Nigeria developme result to Social nt is likely
nt of presentatio Service to be
Nigeria. n and complemen
Developm tary as long
ent as religious
beliefs and
practices
promote
‘moderatio
n’ rather
than
‘extremes’.
A peaceful
coexistence
of various
religious
groups (or
sects) in a
country and
various
nations
 with
different
religious
affiliations
within the
global
community
is a
prerequisite
for growth
and
prosperity
in today’s
highly
interconnec
ted world
Major Faisal 2017 To review qualitativ NA Detailed Public Nigeria is High
Public Muha the e study, Good Health currently
Health mmad implication approach result challenge working
Problems of public presentatio s, The towards
in Nigeria: health n, strong impact of achieving
A review service on literature health the
maternal review and service on Millennium
mortality in analysis Maternal- Developme
Nigeria Mortality nt Goals. To
reach the
targets for
the
reduction
of child
mortality,
which form
MDG 4,
Nigeria
should
reduce
under-five
deaths per
1,000 live
births to 71,
and
increase
measles
immunizati
on to 100
per cent by
2015.
Religion Chatte 2000 Literature NA Good result Spiritualit to provide High
and rs, L. M review presentatio y, Religion high-
Health: n, strong and Public quality care,
Public description Health and simply
Health of common
Research methodolo sense, all
and gy underscore
Practice the need to
integrate
spirituality
into patient
care
Religion, Harold 2012 To provide a Literature NA Good result Spiritualit to provide High
Spiritualit G. comprehen review presentatio y, Religion high-
y, and Koenig sive review n, strong and Public quality care,
Health: of research description Health and simply
The on of common
Research religion/spir methodolo sense, all
and ituality (R/S) gy underscore
Clinical and both the need to
Implicatio mental integrate
ns health and spirituality
physical into patient
health. care
Nigeria’s C Dan- 2020 A review of Mixed NA Detailed A rapid, Medium
public Nwafo Nigeria’s Method study but holistic,
health r Preparedne weak cohesive,
response ss and methodolo whole-of-
to the Response to gical governmen
COVID-19 the COVID- emphasis, t approach
pandemic: 19 Good result that
pandemic presentatio encompass
n, strong es civil
literature society and
review and local-
analysis communitie
s in the
response
will be
absolutely
critical to
combating
the COVID-
19
pandemic
in Nigeria
The Iulia O. 2011 provides a Mixed Patients, Detailed Religion religion High
influence Basu- briefly Method Health study and seems to be
of religion Zharku discuss Service Health a psycho-
on health concerning providers Good result service social factor
the bond presentatio and the
between n, biological
health and benefit in
religiosity in Strong the
the cure literature recovery of
process and review and physical
analysis and mental
 diseases diseases.
treatment Independen
t of the
possible
mechanism
s, if
individuals
receive
health
profits by
religion;
those
should be
motivated,
respecting
the faith
individualit
y of each
one
The Socio- Joyce 2013 Assessing Mixed Communi Detailed Religion, In order to High
Cultural Rumun The Socio- method ty study Public combat the
Factors Cultural of Primary members, Health, problem of
Influencin Factors and Health Good Maternal maternal
g the Influencing Secondar care Result Health and child
Utilization The y data providers presentatio care mortality
of Utilization n and
Maternal of Maternal morbidity,
and Child and Child Good the
Healthcar Healthcare analysis standard of
e Services Services living ofthe
in kwande including Nigerian
Local vaccination populace
Governm in Nigeria must be
ent Area raised.
of Benue Extreme
State, poverty and
Nigeria religion are
not only the
source of
disease and
mortality,
but it is also
one of the
chief causes
of
bottleneck
in public
health
delivery in
Nigeria
Enablers Paul F 2021 This Primary Adults, Detailed Vaccinatio indicates High
and Burke research Research living in methodolo n, Belief, that various
barriers examines Method Australia gical Public cohorts
to COVID- individuals’ using an (39%), the description HEalth based on
19 psychologic online United age,
vaccine al beliefs survey States Good result employmen
uptake: that may act (21%), presentatio t, and flu
An as enablers Canada n vaccination
internatio and barriers (16%), uptake, will
nal study to England Clear differ in
of vaccination (12%) conclusions their
perceptio intentions orNew participatio
ns and Zealand n in a
intentions (11%) COVID-19
vaccination
pro-gram.
The results
also show
rates of
intentions
for
vaccination
uptake, as
well as the
levels and
effects of
various
drivers of
uptake
significantly
differ across
the
countries
sampled.
Examinin Alicia L 2019 This study Primary college Detailed Vaccinati sexual High
g the Best examined Research women mythologi on and activity is
Influence the role of Method cal Religion the main
of religious/sp factor
narrative,
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and beliefs on with HPV
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HPV among presentati activity fully
Vaccine college on mediates
Uptake women the
Among relationship
College between
Women religious/sp
iritual
beliefs and
HPV
vaccination
Barriers Oliver 2019 The Mixed Farmers, Detailed Vaccinatio Immunizati High
to Ombe objectives Method fishermen study n/Immuni on services
effective va of this study and local zation in Hoima
uptake Malan were to caregivers Good District
and de et al evaluate the Result require
provision state of presentatio urgent
of immunizati n improveme
immuniza on services nt in the
tion in a and to Good following
rural identify the analysis areas:
district in gaps in
Uganda immunizati vaccine
on health supply,
systems expanding
that service
contribute delivery
to low points,
uptake and more health
completion workers,
of transport
immunizati and tailored
on mechanism
schedules in s to ensure
Hoima adequate
District communica
tion
between
health
workers
and
caretakers
Barriers Moreni 2015 To assess Primary Parents, Detailed Vaccine High High
to uptake ke the Barriers Method Care study Belief and pricing and
of human Oluwat to the givers, human low health
papilloma oyin voluntary Health Good papilloma insurance
virus Folaya uptake of workers, Result virus coverage
vaccine in n human Religious presentatio vaccine limit access
Nigeria: A papillomavi faithfulls n to this
populatio rus vaccine essential
n in need in Nigeria Good potentially
analysis life-saving
vaccine
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experienc and communit and vaccination
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childhood of Result cation more than
vaccinatio caregivers presentatio the
n and health n message
communi workers in but is also
cation Nigeria on Good influenced
strategies vaccination analysis by the
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caregivers tion t and the
and strategies attitudes
health implemente and beliefs
workers d in their of the
in Nigeria: settings deliverer
A and
qualitativ receiver. It
e study is pertinent
for health
policy
makers and
programme
managers
to
understand
these
factors so
as to
effectively
implement
communica
tion
approaches
Exploring gozi 2019 This study Mixed Children Detailed Immuniza Immunizati Medium
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g factors in s Good was
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tion North presentatio by
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intervention n
approaches approaches
to tackle should
barriers to ensure that
immunizati communitie
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actors at
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involved
and
strategies
are
adjusted to
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The John 2021 Highlightin NA NA Weak Religious Religious High
Pervasive Campb g the Methodolo Leaders, leaders can
Influence ell influence of gical Vaccinatio be a force
of religious reference n for good,
Nigeria's leaders on they can
Religious social issues Good also
Leaders Result undermine
presentatio public
n health and
human
Good rights
analysis initiatives.
The role Wilhel 2013 To assess Primary Religious Good Religious Religious High
of mina L the role of Research Leaders Methodolo Leaders leaders’
religious M religious gical attitudes
leaders in Ruijs leaders in reference Vaccinatio towards
promotin promoting n vaccination
g acceptance Good vary from
acceptanc or refusal of Result full
e of vaccination presentatio acceptance
vaccinatio within an n to clear
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minority Protestant Good According
group: a minority analysis to orthodox
qualitativ group with Protestant
e study low church
vaccination order, local
coverage in congregati
The on
Netherlands members
appoint
their
religious
leaders
themselves.
Obviously
they choose
leaders
whose
views are
compatible
with the
views of the
congregati
on
members.
Moreover,
the
positions of
orthodox
 Protestant
religious
leaders on
vaccination
will not
change
easily, as
their
objections
to
vaccination
are rooted
in religious
doctrine
and they
owe their
authority to
their
interpretati
on and
application
of this
doctrine.
Insights John 2021 To review Literature NA Weak Religion conservativ High
on H. the role of Review Methodolo e
Vaccine Evans Religion in gical Science Protestants
Hesitancy challenging reference were less
from scientific Health likely than
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People’s health Discussion think that
View of manageme and analysis scientists
Science nt of themes were
working for
Weak result the good of
presentatio humanity,
n and more
likely to
think they
were
serving
their own
narrow
interests. It
is this
perceived
moral
conflict that
is the
problem.
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Influencin F reasons for Method s with Methodolo n soft
g Vaccine vaccine children gy techniques
Hesitancy hesitancy Qualitativ under 5 Vaccine in social
and and refusal e data years Good Hesitancy and
Immuniza and identify Discussion behavioural
tion barriers and Local and analysis Religion change,
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in to uptake of Vaccinatio communica
Zimbabw vaccination Health Good result n tion
e among workers presentatio interventio
socio- n ns are
cultural and crucial in
religious improving
groups in knowledge
Masvingo of
and vaccination,
Manicaland interperson
Provinces in al
Zimbabwe relationship
in order to between
strengthen health
evidence- workers
based and
communica caregivers
tion and and key
programmi social
ng influencers
strategies to like
improve religious
vaccination leaders
adherence,
utilization
of routine
vaccination
services,
and MNCH
services.
Determin Astaw 2022 This study Primary NA Good Vaccinatio The number High
ants of us aimed to Research Discussion n of people
COVID-19 Alema assess Method and analysis vaccinated
vaccine yehu, determinan of themes COVID 19 was higher
uptake M. ts of vaccine among 50–
and Yusuf uptake and Good result 60 age
barriers barriers to presentatio groups than
to being being n those who
vaccinate vaccinated are >60
d among among first- years. Being
first- round female,
round eligibles for being a
eligible coronavirus person with
for disease no
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vaccinatio in Harar, being a
n in eastern merchant,
Eastern Ethiopia. being a
Ethiopia: farmer, and
A having low
communit coronavirus
y based disease
cross- prevention
sectional practice
study was found
to be
significantly
associated
with
coronavirus
disease
vaccination.
Religious Retna 2019 This study Primary Religious Detailed Religion This study High
and Siwi aimed to Research leaders Methodolo highlights
communit Padma explore the gy Religious the need for
y leaders’ wati views of Communi Leaders better
acceptanc religious ty Good stakeholder
e of and represent Discussion Vaccinatio engagemen
rotavirus community atives and analysis n t prior to
vaccine leaders of themes vaccine
introducti regarding availability
on in the Good result and the
Yogyakart rotavirus presentatio potentially
a, vaccine to n important
Indonesia inform role of
: a future religious
qualitativ communica and
e study tion community
strategies leaders in
rotavirus
vaccine
acceptabilit
y in the
majority
Muslim
community
of
Yogyakarta,
Indonesia.
The Momo 2016 This study Secondar NA Detailed Religion The impact Medium
Impact of h explores the y Methodolo of religion
Religion Lawani impact of Research/ gy Developm in a secular
on a Yesufu religion on Literature ent state seems
Secular certain Review Good History to have
State: The aspects of Discussion played out
Nigerian Nigerians negatively
Experienc living within and analysis Politics in Nigeria,
e a secular of themes and as politics
state Policies and religion
Good result are mixed in
presentatio the attempt
n to gain
political
hold on the
population.
For a very
long time,
religion has
been used
by the
(Nigerian)
oligarchy as
its main
weapon to
hold on to
power
(Kukah
1993)
Positive Willia 2019 To provide a Qualitativ NA Detailed Religion Culture, High
and m H. thoughtful e/Second Methodolo religion,
Negative Foege, account of ary gy Culture and
Influences MD, how research tradition
of MPH religion, Good Public changes
Religion, culture, and Discussion Health over time.
Culture, tradition and analysis At one time,
and can provide of themes there were
Tradition positive and religious
in Public negative Good result objections
Health influences presentatio to women
on public n voting,
health. holding
power, or
preaching.
This is
changing.
At one time,
religious
groups
accepted
slavery.
Even now,
the
acceptance
of poverty
by religious
groups is in
need of
change.
Religious D.N. 2010 The study Qualitativ NA Detailed Religion These High
leaders' Uchea highlights e Method Methodolo findings
response ga differences gy HIV AIDS indicate
to AIDS in in messages that
Nigeria between Good Public religious
mainstream Discussion Health organisatio
and and analysis ns are
Pentecostal of themes already
Christians playing a
and Good result role in HIV
Muslims in presentatio prevention,
Combating n but their
HIV AIDs in responses
Nigeria are not
uniform.
Public
health
organisatio
ns and
policymake
rs should be
aware of
these
denominati
onal
differences
as they
engage
with
religious
institutions
and leaders
in HIV
prevention
and care
An John O 2010 This study Qualitativ Parents Detailed Religion It is High
Assessme Umoh examines e study Methodolo important
nt of the the using Religious gy Health to note that
Relevance relevance Primary Leaders Service even with
of and/or role Data Good delivery the
Religion of religion Health Discussion indifference
to Health in modern workers and analysis Governme shown by
Care health care of themes nt health the
Delivery delivery in policies governmen
in Nigeria: Nigeria. It Good result t and her
Case of uses presentatio agencies on
Akwa Christianity n the
Ibom as its contributio
State reference n of religion
point. to health
care
delivery, it
 remains
relevant to
Nigeria’s
health care
system.
Patients
and health
care
providers
still resort
to the
miracle of
healing.
Vaccinati Falade 2014 This Primary Strong Vaccine Science and High
on , research is Method Methodolo Resistanc technology
Resistanc Bankol about gical e, are crucial
e, Religion e common reference to Nigeria’s
and Adeba sense Religion, growth and
Attitudes yo making; Good developme
to Science how a new Discussion Science in nt and
in Nigeria phenomeno and analysis Nigeria some
n is of themes respondent
absorbed s are of the
into our Strong and view that
existing detailed they may
pictures of result also be
the world presentatio instrumenta
drawn n l to its
through stability.
personal However,
and shared this is an
experiences, area that
conversatio needs more
n, writing research
and other
forms of
communica
tion.