Understanding and experience of adverse event following immunization (AEFI) and its consequences among healthcare providers in Kebbi State, Nigeria: a qualitative study

Abstract

Background Vaccines used in the national immunization program are relatively safe and effective. However, no vaccine is perfectly safe. Therefore, adverse reactions may occur. This study aimed to investigate the understanding and experience of Adverse Event Following Immunization (AEFI) among healthcare workers and Routine Immunization (RI) officers. Methods Phenomenological qualitative study was conducted between June and September 2019, using a semi-structured question guide in Kebbi State, Northwest Nigeria. Face-to-face interviews were conducted with 12 RI providers, eight Expanded Program on Immunization (EPI) officers, and eight Disease Surveillance and Notification Officers. Thematic analysis was used to analyze the data. The interviews were transcribed and translated, then manually analyzed thematically. Results The knowledge level of healthcare providers on AEFI definition and classification varied and was suboptimal. Error during vaccination was the study participants' most frequently mentioned possible cause of AEFI. Persistent crying, fever, fainting, and swelling and tenderness at injection sites were the AEFI experienced by the healthcare providers in their careers. Block rejection, lower immunization uptake, loss of confidence in RI, attack on RI providers, discrimination of RI providers and divorce threats among spouses were the consequences of AEFI. Supportive supervision of the RI sessions, refresher training on safe injection for RI providers, and symptomatic treatment of clients with AEFI would prevent AEFI consequences. Also, educating caregivers, community sensitization, and dialogue would minimize the consequences of AEFI. Conclusions Evidence of a sub-optimal understanding of AEFI was established in this study. Hence, policymakers should consider regular refresher training on AEFI to ensure all RI providers have an optimal understanding of AEFI. Health education of caregivers and parents during RI sessions and community engagement should be considered to minimise AEFI consequences on the immunization program and the society.

Optimising reporting of adverse events following immunisation by healthcare workers in Ghana: A qualitative study in four regions

“…Twene and Yawson reported gaps in the knowledge of HCWs with regards to the definition of AEFI, AEFI investigation and conditions that should be reported as AEFIs in some parts of Ghana [21]. Similarly, in Nigeria, Omoleke et al reported varied and suboptimal knowledge levels of healthcare providers on AEFI definitions and classifications [22]. Also, our study showed that many frontline HCWs are not familiar with the AEFI reporting procedures-what to report, who to report to, and how to report.…”

Barriers to optimal AEFI surveillance and documentation in Nigeria: Findings from a qualitative survey

“…To date, LMICs remain challenged by access to life-saving vaccines while uptake and coverage remain sub-optimal due to health system, socio-cultural factors, and geographical disadvantages and poverty [5,8,9]. However, vaccines are not entirely safe; they may cause mild to moderate discomfort and serious adverse events that may warrant hospitalisation or lead to death [10,11]. Indeed, serious adverse events following immunisation (AEFI) caused by vaccines are rare (<1 in 1,000,000 cases).…”

“…Despite this significant safety profile, caregivers and parents sometimes express concern and hesitancy for vaccination. The AEFI or perceived vaccine safety concern is one of the causes of vaccine hesitancy in the form of outright rejection or drop-out in many countries, including Nigeria [11][12][13].…”