Religious leaders' perspectives on childhood immunization in Bauchi State, Nigeria: A Qualitative Study

Childhood immunization is highly cost-effective, yet uptake is shaped by sociocultural and religious influences. In Bauchi State, Nigeria, coverage remains low (Penta3 58.2%; fully vaccinated 22.5% among children aged 12-23 months). Religious leaders shape community norms, but their perspectives on immunization in Bauchi are not well characterized. Guided by Oman and Syme's religion/spirituality and health model, we explored religious leaders' knowledge, beliefs, attitudes, practices and recommendations regarding childhood immunization.

Between December 2022 and January 2023, we conducted semi-structured interviews with 22 religious leaders (all men; 21 Muslim, 1 Christian) purposively sampled across Bauchi State's Local Government Areas. Interviews were conducted in Hausa or English, audio recorded, translated where necessary and transcribed. Sampling continued until thematic saturation. Data were analyzed using codebook thematic analysis informed by Braun and Clarke's analytic phases and organized according to the pre-specified domains of knowledge, beliefs, attitudes, practices and recommendations. Ethical approval was obtained, and all participants provided verbal informed consent.

Most leaders described immunization as preventive and compatible with religious teachings. Many reported that observed child health benefits reinforced support and that earlier skepticism had shifted after religious and scientific explanation and lived experience. Persistent misinformation was reported, especially fertility-related and population control narratives. Leaders described three recurring influence practices: visible role modelling, sermon-based messaging aligned with scripture, and community mobilization through religious gatherings and support during outreach activities. Respectful health worker engagement and reliable service delivery appeared to strengthen trust and community uptake.

Religious leaders in Bauchi State may be strategic partners for improving vaccine acceptance. Programs should consider structured engagement with religious leaders, bidirectional rumor tracking and response, and support for frontline health workers. Future research should include more diverse leaders and link engagement to measurable outcomes.