Analysis of the impact of COVID-19 pandemic and response on routine childhood vaccination coverage and equity in Northern Nigeria: a mixed methods study

Abstract

BackgroundBased on 2021 data, Nigeria had the second largest number of zero-dose children globally estimated at over 2.25 million, concentrated in the northern part of the country due to factors some of which are sociocultural. This study analysed the impact of the COVID-19 pandemic and response on childhood vaccination in Northern Nigeria.MethodsUsing a mixed methods sequential study design in the most populous northern states of Kaduna and Kano, quantitative routine immunisation data for the period 2018–2021 and qualitative data collected through 16 focus group discussions and 40 key informant interviews were used. An adaptation of the socioecological model was used as a conceptual framework. Mean vaccination coverages and test of statistical difference in childhood vaccination data were computed. Qualitative data were coded and analysed thematically.ResultsMean Penta 1 coverage declined in Kaduna from 69.88% (SD=21.02) in 2018 to 59.54% (SD=19.14%) by 2021, contrasting with Kano where mean Penta 1 coverage increased from 51.87% (SD=12.61) to 56.32% (SD=17.62%) over the same period. Outreaches and vaccination in urban areas declined for Kaduna state by 10% over the pandemic period in contrast to Kano state where it showed a marginal increase. The two states combined had an estimated 25% of the country’s zero-dose burden in 2021. Lockdowns, lack of transport and no outreaches which varied across the states were some of the factors mentioned by participants to have negatively impacted childhood vaccination. Special vaccination outreaches were among the recommendations for ensuring continued vaccination through a future pandemic.ConclusionWhile further interrogating the accuracy of denominator estimates for the urban population, incorporating findings into pandemic preparedness and response will ensure uninterrupted childhood vaccination during emergencies. Addressing the identified issues will be critical to achieving and sustaining universal childhood vaccination in Nigeria.

The evolution of household forgone essential care and its determinants during the COVID-19 pandemic in Nigeria: A longitudinal analysis

“…Our study has demonstrated that childhood vaccination was the most affected during the pandemic. This aligns with numerous findings from various parts of the world [ 6 ], and is consistent with other studies which have shown significant declines in childhood vaccination coverage in Nigeria [ 42 , 43 ]. The pandemic-induced mobility restrictions and healthcare disruption were the primary cause of this decline, as evidenced by the fact that hard-to-reach rural and security-prone areas were most affected [ 42 – 44 ].…”

“…This aligns with numerous findings from various parts of the world [ 6 ], and is consistent with other studies which have shown significant declines in childhood vaccination coverage in Nigeria [ 42 , 43 ]. The pandemic-induced mobility restrictions and healthcare disruption were the primary cause of this decline, as evidenced by the fact that hard-to-reach rural and security-prone areas were most affected [ 42 – 44 ]. This has serious implications for the fight against vaccine-preventable diseases, particularly in the most disadvantaged areas of the country.…”

“…A substantial household pre-pandemic financial susceptibility is plausible, with about 40% of Nigerians below poverty and high catastrophic OOP health spending [ 41 , 42 ]. High OOP has been associated with increased forgone care during the pandemic in Europe [ 57 ].…”

Key Learnings from the Development and Early Use of Global Guidance on the Integration of COVID-19 Vaccination into Broader Health Systems

“…While the guidance was developed as a ‘living document’ in 2022, it remains relevant for the present and the future [ 15 , 29 , 30 ]. The COVID-19 vaccination effort did not end with the standing down of the PHEIC in May 2023.…”

“…Mass vaccination campaigns were used as a main delivery approach to reach target populations quickly and widely. This approach put a strain on essential immunization and other programs [ 5 , 6 , 7 , 8 , 10 , 12 , 15 ]. Health workers and resources were diverted away from the provision of essential health services.…”