Caregivers Qualitative Insights on Trust, Resilience and Vaccine Hesitancy Shaping Child Health in Conflict-affected Northeast Nigeria

Background: The northeast of Nigeria, particularly the conflict-affected states of Borno, Yobe and Adamawa, has some of the highest under-five mortality rates in the world. Armed conflict, damaged health infrastructure and systemic poverty have significantly reduced access to healthcare. This study explores the intersection of health-seeking behaviour among caregivers of children under five with trust in health systems, exposure to violence, and vaccine hesitancy. Methods: A qualitative study was conducted using nine focus group discussions (FGDs) with 72 caregivers living in conflict-affected communities. Participants were purposively selected, and the discussions explored the following topics: barriers to accessing healthcare; trust in health systems; the impact of conflict on health-seeking behaviour; and perceptions of childhood vaccinations. Data were analysed thematically using content analysis. Results: Health-seeking behaviour was found to be shaped by a complex interplay of poverty, dysfunctional health infrastructure and deep-seated mistrust of governmental institutions, all of which were exacerbated by prolonged exposure to violence. Patriarchal norms played a central role in decision-making processes, often limiting women's autonomy when it came to accessing care. Vaccine hesitancy was influenced by misinformation, knowledge gaps and limited community engagement. However, caregivers with access to reliable information sources, such as community networks and local media, showed more positive attitudes towards immunisation. Conclusions: Efforts to improve maternal and child health in conflict-affected regions must prioritise trust-building, strengthening the health system in a culturally sensitive way, and implementing targeted communication strategies. Community engagement and resilience must be leveraged to reduce barriers to care and address vaccine hesitancy in fragile contexts.