Use of an adapted participatory learning and action cycle to increase knowledge and uptake of child vaccination in internally displaced persons camps (IVACS): A cluster-randomised controlled trial

Andrew J. Seal, Hodan Abdullahi Mohamed, Ronald Stokes-Walter, Sadik Mohamed, Amina Mohamed Abdille, Ellyn Yakowenko, Mohamed Sheikh Omar, and Mohamed Jelle

Vaccine, Volume 41, Issue 19 (2023), Pages 3038-3046


This article presents the results of a randomized cluster trial in internally IDP camps in Somalia to estimate the effects of an adapted Participatory Learning and Action (PLA) approach on knowledge and uptake of child vaccinations. The PLA approach is based on social empowerment to address health issues, whereby teachers and students exchange ideas and experiences, and implement a cycle of learning, action, and reflection.  

The trial took place in IDP camps on the outskirts of Mogadishu, Somalia. The adapted PLA approach was implemented through traditional women’s groups, known as Abaay Abaay groups in five IDP camps, randomly selected from 10 identified IDP camps that met the study criteria. The intervention entailed weekly facilitated meetings of Abaay Abaay groups for a period of two months, with an average of 38 members attending each meeting. The meetings were led by an external facilitator who guided participants through a four-phase PLA cycle focused on identification, prevention and control of child health problems, and evaluation of the group’s activities. Five other IDP camps with Abaay Abaay groups were allocated to a control group. Within each IDP camp, all households with young children (aged below 5) were included in the study (n = 658), as well as all young children (n = 1269) and their mothers/caregivers (n = 663). Data was collected at the household and individual level at baseline (June/July 2021) and endline (October 2021). 

Within the 10 IDP camps included in the trial there were 3 international and 2 local NGOs supplying health services, which were responsive to requests from the Abaay Abaay groups to attend stakeholder meetings and to requests to expand their mobile vaccination teams. 

The baseline survey found that: 

  • Most households were male headed and the average household had seven members. 
  • Almost all households had access to piped water.  
  • Households had a high consumption of food assistance from humanitarian organizations in the seven days prior to the survey.  
  • Mothers/caregivers were on average 30 years of age and over 90 percent of them had received no formal education. 
  • One in ten children slept under a mosquito net on the night before the survey and one in ten had been ill in the four weeks prior to the survey. 

 Main empirical findings: 

  • The adapted PLA intervention improved the adjusted maternal/caregiver knowledge score from 8 to 16 points (out of a maximum score of 21) compared to the control group. Educational status, having received a vaccination (both as a child and during pregnancy), and age were all positively associated with a higher maternal knowledge score at baseline. 
  • Coverage of both measles vaccination (MCV1) and completion of the pentavalent vaccination series improved. However, there was no impact on achieving timely vaccination. 
  • Caregiver preference for getting young children vaccinated was greater than 95 percent at baseline and did not change.  
  • Possession of a home-based child health record card increased in the intervention arm from 18 to 35 percent. 

The authors conclude that an adapted PLA approach, run in partnership with indigenous social groups, can increase maternal knowledge and improve child vaccination coverage within a 3-month period. The presence and willingness of health actors to respond to group requests was important in achieving a rapid and successful intervention.