Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015

Abstract

BackgroundDespite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria.MethodsHousehold-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014–2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12–23 months was documented based on vaccination card or caretaker’s recall. District-level coverage estimates were calculated using survey methods.ResultsData from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1–63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%–139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%).ConclusionsSurvey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria.

Progress Toward Poliomyelitis Eradication — Nigeria, January–December 2017

“…The low OPV3 coverage among children aged 12–23 months in the 2016–2017 national vaccination survey reflects persistently poor delivery of routine immunization services, particularly in states in northeast and northwest Nigeria ( 10 ). A National Emergency Routine Immunization Coordinating Center has been commissioned to identify and implement strategies to increase vaccination coverage, starting in the poorest performing states.…”

Factors Influencing Childhood Immunization Uptake in Africa: A Systematic Review

“…Many studies reported factors related to maternal knowledge for instance, knowledge on child immunization [27], knowledge on preventive objective of immunization [24], knowledge on vaccines [57], knowledge on child vaccination schedule which was reported in three studies [29,53,59]. Likewise, awareness on immunization and immunization program was also revealed in three studies [20,32,56].…”

“…In Burkina Faso, mothers with knowledge on preventive objectives of immunization were more likely to have their children compare with mothers without the knowledge [24]. In a household-level cluster survey consisting of 7,815 children, conducted in Nigeria that involved 40 polio high risk districts of Nigeria, lack of maternal knowledge about vaccines was found to be the highest reasons contributing to poor childhood immunization uptake which accounted for 50% reasons for non-vaccination [57].…”

“…For maternal attitude and self-e cacy, three studies reported availability of child immunization record [20,24,43]. Likewise, four studies revealed fear of vaccine side effects [30,57,60,62], wrong beliefs towards childhood immunization uptake [42], good perception of immunization [45] and con dence towards vaccine safety [42].…”

“…Studies showed that mothers who has their child immunization record were more likely to have their children fully immunized compared with mothers without child immunization records [20,24,43]. In Nigeria, poor attitude of mothers accounted for (16%) among the reasons for poor childhood immunization uptake [57]. Among 248 defaulting mothers in Ibadan, Nigeria more than half of the defaulting mothers reported reason for defaulting to be their belief towards childhood immunization where they considered it as waste of time [42].…”