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Why immunisation coverage remains low in Nigeria

One of the major reasons Nigeria is committed to the goals of the Global Vaccine Action Plan, GVAP, was not only to ensure that at least 90 per cent of children under the age of 5 are immunised with all the relevant and available vaccines for children but to put to an end or reduce to the barest minimum child killer diseases.

Sadly, with the slow progress being made in immunisation coverage, Nigeria still falls short of the goal it set with only 57 per cent of children immunised in the last five years, according to the 2021 Multiple Indicator Cluster Survey, MICS, and the National Immunisation Coverage Survey, NICS, jointly released by the Nigerian Government, the United Nations Children’s Fund, UNICEF, in partnership with other partners.

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Findings by Good Health Weekly showed that many mothers and caregivers still have reservations about immunisation, leaving Nigeria with only 36 per cent of children aged between 12 and 23 months receiving all recommended vaccines, according to the 2021 MICS.

Even though the benefits of vaccines are fully realised when children receive all recommended vaccine doses promptly, many of these children receive incomplete doses.

A case in point is that of Abdul Abdul. At age 1, Ahmed received only one immunisation which was given to him a few days after his birth at one of the Lagos State Primary Healthcare Centres.

Bola, Abdul’s mother, said he was not himself after the first dose of BCG, which discouraged her from returning for the other immunisations.

“I  was afraid that my child would have more complications if I went back for another immunization. He had a fever for days.  Although I tried to go back for measles the day I went to the PHC, we were told to come back and I have not been able to go back due to time and he is now more than nine months. I lost my first child I don’t want to lose another. ” she said

Like Abdul, many children in Nigeria have either received one or two immunisations and some have not received any at all due to  unsubstantiated reasons.

Today, immunisation coverage in Nigeria is below GVAP goals, putting millions of children at risk of vaccine-preventable diseases all thanks to these unfounded factors.

However, findings by the MICS report, showed that gaps in routine immunisation in Nigeria. It shows that 64 per cent of children aged 12-23 months  did not receive all routine immunisations, 46 per cent did  receive but not all doses, 18 per cent did not receive any one,  and 30 per cent thought the child was fully immunised.

Other reasons found by the survey showed that 51 per cent lack knowledge or information, while 7 per cent complained that the immunisation site was too far and 19 per cent was due to service delivery issues and 11 per cent reported that mothers or caregivers too were busy, 24 per cent lack of time or other family issues, 11 per cent had fear of side reactions and 26 per cent due to mistrust or fears.

According to the report, a fully vaccinated child must have received all 1YL antigens including BCG, OPV0, HepB0, OPV1-3, IPV, Penta1-3, PCV1-3, YF, Meningitis A & MCV1.

Sadly, even though the benefits of vaccines are fully realised when children receive all recommended vaccine doses promptly, only 36 per cent of children aged 12- 23 months received all recommended vaccines in Nigeria.  The report also notes that more children were fully vaccinated in the southern zones compared to the northern zones.

From the survey, nearly 2 of every 4 rural children received Penta3 and children in the richest quintile were more than twice as likely to receive Penta3 as those in the poorest quintile.

 “Immunisation coverage varies dramatically across Nigeria and improvements are needed in nearly every state,” the report stated.

However, the report also found that two states -Ebonyi and Enugu have estimated leads among states with the lowest number of children not vaccinated.

The two states have the highest number of Penta3 coverage above the 90 per cent goal.  Penta3 coverage is notably higher in the southern zones than in the north.

“Children are significantly less likely to have received 3 doses of pentavalent vaccine if they are from poor families or rural families or if the child’s mother is younger than 25 years of age or has a low level of education,” the report revealed.

In the NICS 2021 survey, only 56 per cent of children showed a child health card and the availability of child health cards varied across states, with a high of 98 per cent in Ebonyi and a low of 16 per cent in Sokoto. States with low immunisation coverage also had low card availability. Child health cards are important health records critical for evaluating  immunisation status.

It also found that in 3 of 6 zones there are significant differences in zero dose prevalence between urban and rural households, with rural children more likely to be zero doses. In 4 of 6 zones, there are significant differences across one or more categories of maternal education, with less educated mothers likely to have zero-dose children.  In 5 of 6 zones, there are significant differences between the poorest and richest wealth quintiles, with poorer households more likely to have zero dose children.”

UNICEF’s Chief of Monitoring for Result (M4R), Mr Claes Johanson who traced most deaths of children to lack of immunization, told Good Health Weekly that, although the 2021 immunisation report showed a little improvement from the 44 per cent and now 57 percent, has a huge impact on child mortality. He said women’s education has a huge impact on immunisation.

 Johanson who said the smallest proportions of children who did not receive any vaccinations are found in Enugu with 1 per cent, Ebonyi, 0 per cent and Sokoto with 51 with r cent said the benefits of vaccines are fully realised when children receive all recommended vaccines doses promptly.

Johanson said while there was a little progress, there was room for improvement, adding that, action should be a priority for the Nigerian government.

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