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Background: Global health partnerships are increasingly being used to improve coordination, strengthen health systems, and incentivize government commitment for public health programs. From 2012 to 2022, the Bill & Melinda Gates Foundation (BMGF) and Aliko Dangote Foundation (ADF) forged Memorandum of Understanding (MoU) partnership agreements with six northern state governments to strengthen routine immunization (RI) systems and sustainably increase immunization coverage. This mixed methods evaluation describes the RI MoUs contribution to improving program performance, strengthening capacity and government financial commitment as well as towards increasing immunization coverage. Methods: Drawing from stakeholder interviews and a desk review, we describe the MoU inputs and processes and adherence to design. We assess the extent to which the program achieved its objectives as well as the benefits and challenges by drawing from a health facility assessment, client exit interview and qualitative interviews with service providers, community leaders and program participants. Finally, we assess the overall impact of the MoU by evaluating trends in immunization coverage rates. Results: We found the RI MoUs across the six states to be mostly successful in strengthening health systems, improving accountability and coordination, and increasing the utilization of services and financing for RI. Across all six states, pentavalent 3 vaccine coverage increased from 2011 to 2021 and in some states, the gains were substantial. For example, in Yobe, vaccination coverage increased from 10% in 2011 to nearly 60% in 2021. However, in Sokoto, the change was minimal increasing from only 4% in 2011 to nearly 8% in 2021. However, evaluation findings indicate that issues pertaining to human resources for health, insecurity that inhibits supportive supervision and vaccine logistics as well as harmful socio-cultural norms remain a persistent challenge in the states. There is also a need for a rigorous monitoring and evaluation plan with well-defined measures collected prior to and throughout implementation. Conclusion: Introducing a multi-partner approach grounded in a MoU agreement provides a promising approach to addressing health system challenges that confront RI programs. [ABSTRACT FROM AUTHOR]

Introduction: Nigeria adopted the expanded program on immunization (EPI) in 1978, which aimed at offering children under 2 years old routine immunization (RI). Early accomplishments with the program resulted in a decrease in childhood mortality. As of 2018, Nigeria accounted for about 4.3 million out of over 13 million unvaccinated children globally. Therefore, this study revealed the challenges and efforts associated with RI program in Nigeria and the way forward. Methods: In this perspective article, I conducted searches and extracted relevant information from publicly available sources such as Google Scholar, Pubmed, and grey literature. I employed RI, challenges, efforts, and Nigeria as the keywords. Results: The 2021 Multiple Indicator Cluster Survey/National Immunization Coverage Survey reports revealed weaknesses in the program, with a national average coverage of 36%. The primary barrier to EPI across various zones is the challenge of reaching marginalized areas that were cut off from vaccination services due to operational and sociocultural issues. Some of the obstacles, such as restricted access to medical facilities, weak cold chain systems, and COVID‐19 containment strategies had a great impact on the RI program. To scale up the RI program, the Nigerian government, through the National Primary Health Care Development Agency (NPHCDA), collaborated with the World Health Organization (WHO) and Gavi, the Vaccine Alliance, to optimize the "Big Catch‐up campaign" and increase immunization coverage nationwide. By 2028, 80% of the projected zero‐dose populace is expected to be covered, reaching these eligible children with life‐saving vaccines. Conclusion: Nigeria still has a long way to go in making significant progress in the RI program. To further strengthen the immunization coverage, the country needs to maintain data on their achievements, as this will help identify gaps that need to be addressed in the immunization program. [ABSTRACT FROM AUTHOR]

Background "Zero-dose" children are those who are without any routine vaccination or are lacking the first dose of the diphtheria, tetanus, and pertussis–containing vaccine. Based on global estimates from the World Health Organization/United Nations Children's Fund in 2022, Nigeria has the highest number of zero-dose children, with >2.3 million unvaccinated. Methods We used data from the 2021 Nigeria Multiple Indicator Cluster Survey/National Immunization Coverage Survey to identify zero-dose and underimmunized children. Geospatial modeling techniques were employed to determine the prevalence of zero-dose children and predict risk areas with underimmunized children at a high resolution (1 × 1 km). Results Zero-dose and underimmunized children are more prevalent in socially deprived groups. Univariate and multivariate bayesian analyses showed positive correlations between the prevalence of zero-dose and underimmunized children and factors such as stunting, contraceptive prevalence, and literacy. The prevalence of zero-dose and underimmunized children varies significantly by region and ethnicity, with higher rates observed in the country's northern parts. Significant heterogeneity in the distribution of undervaccinated children was observed. Conclusions Nigeria needs to enhance its immunization system and coverage. Geospatial modeling can help deliver vaccines effectively to underserved communities. By adopting this approach, countries can ensure equitable vaccine access and contribute to global vaccination objectives. [ABSTRACT FROM AUTHOR]

The Expanded Programme on Immunization (EPI) and Vaccine Preventable Disease (VPD) Surveillance (VPDS) programs generate multiple data sources (e.g., routine administrative data, VPD case data, and coverage surveys). However, there are challenges with the use of these siloed data for programmatic decision-making, including poor data accessibility and lack of timely analysis, contributing to missed vaccinations, immunity gaps, and, consequently, VPD outbreaks in populations with limited access to immunization and basic healthcare services. Data triangulation, or the integration of multiple data sources, can be used to improve the availability of key indicators for identifying immunization coverage gaps, under-immunized (UI) and un-immunized (zero-dose (ZD)) children, and for assessing program performance at all levels of the healthcare system. Here, we describe the data triangulation processes, prioritization of indicators, and capacity building efforts in Bangladesh, Nigeria, and Rwanda. We also describe the analyses used to generate meaningful data, key indicators used to identify immunization coverage inequities and performance gaps, and key lessons learned. Triangulation processes and lessons learned may be leveraged by other countries, potentially leading to programmatic changes that promote improved access and utilization of vaccination services through the identification of UI and ZD children. [ABSTRACT FROM AUTHOR]

In Nigeria, statistics reveal that there is a high rate of cervical cancer among women and a significant lack of awareness surrounding Human Papillomavirus (HPV), which poses a substantial risk of HPV infection. This cross-sectional survey, conducted at Ibrahim Badamasi Babangida (IBB) University, focuses on adapting and exploring the factors that influence a 20-item scale to measure HPV knowledge, evaluating knowledge-associated patterns and HPV-associated risk factors. We examined HPV vaccination rates, infection awareness, vaccine awareness, and the impact of ethnicity on HPV knowledge. Various validated forms were adapted to measure HPV awareness and knowledge. Non-parametric tests addressed non-normality. Data were presented using median and IQR and categorical data were frequency-based. Bivariate tests (Mann–Witney, Kruskal Wallis) explored knowledge-associated factors, while quantile regression (75th percentile) examined HPV knowledge factors. Variables were considered statistically significant at p < 0.05. The adapted 20-item knowledge scale revealed strong reliability (Cronbach's alpha = 0.913), ensuring internal consistency. The median knowledge score was 0, with an interquartile range (IQR) of 0–5. Our findings revealed a significant lack of awareness and knowledge about HPV; only 34.8% of the population were aware of HPV infection and 25.0% were familiar with HPV vaccination. Furthermore, ethnicity was found to be significantly associated with knowledge of HPV. This study emphasizes the necessity for targeted interventions to enhance HPV awareness, especially within specific ethnic groups. Despite a robust knowledge scale, educational initiatives such as seminars/conferences about HPV and cervical cancer remain crucial in addressing this gap, ultimately reducing HPV infection and cervical cancer risks in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Nigeria has a high proportion of the world's underimmunised children. We estimated the inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and healthcare characteristics among children aged 12–23 months in Nigeria using a social determinants of health perspective. Methods: We conducted a systematic review to identify the social determinants of childhood immunisation associated with inequities in vaccination coverage among low- and middle-income countries. Using the 2018 Nigeria Demographic and Health Survey (DHS), we conducted multiple logistic regression to estimate the association between basic childhood vaccination coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, and 1-dose measles) and socioeconomic, geographic, maternal, child, and healthcare characteristics in Nigeria. Results: From the systematic review, we identified the key determinants of immunisation to be household wealth, religion, and ethnicity for socioeconomic characteristics; region and place of residence for geographic characteristics; maternal age at birth, maternal education, and household head status for maternal characteristics; sex of child and birth order for child characteristics; and antenatal care and birth setting for healthcare characteristics. Based of the 2018 Nigeria DHS analysis of 6,059 children aged 12–23 months, we estimated that basic vaccination coverage was 31% (95% CI: 29–33) among children aged 12–23 months, whilst 19% (95% CI:18–21) of them were zero-dose children who had received none of the basic vaccines. After controlling for background characteristics, there was a significant increase in the odds of basic vaccination by household wealth (AOR: 3.21 (2.06, 5.00), p < 0.001) for the wealthiest quintile compared to the poorest quintile, antenatal care of four or more antenatal care visits compared to no antenatal care (AOR: 2.87 (2.21, 3.72), p < 0.001), delivery in a health facility compared to home births (AOR 1.32 (1.08, 1.61), p = 0.006), relatively older maternal age of 35–49 years compared to 15–19 years (AOR: 2.25 (1.46, 3.49), p < 0.001), and maternal education of secondary or higher education compared to no formal education (AOR: 1.79 (1.39, 2.31), p < 0.001). Children of Fulani ethnicity in comparison to children of Igbo ethnicity had lower odds of receiving basic vaccinations (AOR: 0.51 (0.26, 0.97), p = 0.039). Conclusions: Basic vaccination coverage is below target levels for all groups. Children from the poorest households, of Fulani ethnicity, who were born in home settings, and with young mothers with no formal education nor antenatal care, were associated with lower odds of basic vaccination in Nigeria. We recommend a proportionate universalism approach for addressing the immunisation barriers in the National Programme on Immunization of Nigeria. [ABSTRACT FROM AUTHOR]

Introduction: wide regional variation in immunization coverage still persists in Nigeria. Full Immunization Coverage (FIC) for more than 80% of all states in the northern region is lower than 40% relative to their southern counterpart. Studies focusing on young women in the north remain sparse, despite the high prevalence of early marriage and poor health-seeking behavior. This study examines FIC among young women in northern Nigeria. Methods: we performed a secondary analysis of the 2013 and 2018 Nigeria Demographic and Health Survey on 1,198 women of children aged 12-23 months in 2013 and 405 in the 2018 dataset. Analysis was limited to young women 15-24 years, residing in Northern Nigeria. We used logistics regression to predict factors associated with FIC. Results: the proportion of fully immunized children was low, at 11% in 2013 and 18% in 2018. The coverage for most vaccines was low, except for the oral polio vaccine. The children of mothers who had health card [(aOR=18.1,95% C.I (8.1-40.7)], in 2013 and 2018 [(aOR=12.7, 95% C.I (5.9-27.1)], attended ANC [(aOR=8.6, 95% C.I (2.4-30.9)] in 2013 and had facility delivery [(aOR=2.0, 95% C.I (1.0-4.1)] in 2018 were more likely to be fully immunized. Conclusion: the study found FIC among children of young women in Northern Nigeria was abysmally low. Ownership of health care, antenatal attendance, and facility delivery significantly predicted the odds of FIC. These findings suggest the need for approaches that remove barriers to good health-seeking behavior, especially among young mothers in Northern Nigeria. [ABSTRACT FROM AUTHOR]

Background: This was a cross-sectional community-based survey to study the prevalence of serum antibodies against the severe acute respiratory syndrome coronavirus 1 (SARS-COV-1) and determine possible source of antibodies as to whether from vaccination or from natural infection as well as attempt to compare antibody levels in response to the different four types of vaccines administered in Nigeria. Methods: A cross-sectional community-based study of the prevalence of serum antibodies against all four vaccine types used in Nigeria amongst a representative sample of people aged 18 years and above in the six geopolitical zones of the country using a multistage sampling technique covering 12 states of the country with two states being randomly selected from each geopolitical zone. High-throughput Roche electrochemiluminescence immunoassay system (Elecsys Anti-SARS-COV-1 Cobas) was used for qualitative and quantitative detection of antibodies to SARS-COV-1 in human plasma. Results: There was no statistically significant difference between the proportions with seropositivity for both the vaccinated and the unvaccinated (P = 0.95). The nucleocapsid antibody (anti-Nc) titres were similar in both the vaccinated and the unvaccinated, whereas the Spike protein antibody (anti-S) titres were significantly higher amongst the vaccinated than amongst the unvaccinated. Antibody levels in subjects who received different vaccines were compared to provide information for policy. Conclusion: While only 45.9% of the subjects were reported to have been vaccinated, 98.7% of the subjects had had contact with the SARS-COV-1 as evidenced by the presence of nucleocapsid (NC) antibodies in their plasma. The 1.3% who had not been exposed to the virus, had spike protein antibodies which most likely resulted from vaccination in the absence of NC antibodies. Successive vaccination and booster doses either through heterogeneous or homologous vaccines increased antibody titres, and this stimulation of immune memory may offer greater protection against coronavirus disease 2019. [ABSTRACT FROM AUTHOR]

Background To assess the effectiveness of a wristband for immunization alert (WIA) as a reminder device to caregivers to improve immunization timeliness and reduce drop-outs. Methods Eight health facilities, selected from two local government areas in Kano state, Northwestern Nigeria, were clustered in a two-arm study involving an intervention group and a control group. Only the caregivers (757) from the intervention group received WIA as an immunization reminder device. Immunization timeliness data were then collected from the control and intervention groups for the period of intervention and analyzed using Microsoft Excel and IBM SPSS version 21. Results A cohort analysis of caregivers who received WIA at their second visit showed an increase in immunization timeliness from 10% at the second visit to 86% at the third visit and maintained at 66% for the fifth visit. A difference-in-difference analysis of the effect of WIA on immunization timeliness from baseline to end-line in the control and intervention groups showed a positive 30% increase in immunization timeliness associated with the introduction of WIA. Interpretation Given that immunization timeliness and drop-outs are reported issues of concern in Northwestern Nigeria, the use of the WIA device is a recommended intervention. [ABSTRACT FROM AUTHOR]

The persistence of geographic inequities in vaccination coverage often evidences the presence of zero-dose and missed communities and their vulnerabilities to vaccine-preventable diseases. These inequities were exacerbated in many places during the coronavirus disease 2019 (COVID-19) pandemic, due to severe disruptions to vaccination services. Understanding changes in zero-dose prevalence and its associated risk factors in the context of the COVID-19 pandemic is, therefore, critical to designing effective strategies to reach vulnerable populations. Using data from nationally representative household surveys conducted before the COVID-19 pandemic, in 2018, and during the pandemic, in 2021, in Nigeria, we fitted Bayesian geostatistical models to map the distribution of three vaccination coverage indicators: receipt of the first dose of diphtheria-tetanus-pertussis-containing vaccine (DTP1), the first dose of measles-containing vaccine (MCV1), and any of the four basic vaccines (bacilli Calmette-Guerin (BCG), oral polio vaccine (OPV0), DTP1, and MCV1), and the corresponding zero-dose estimates independently at a 1 × 1 km resolution and the district level during both time periods. We also explored changes in the factors associated with non-vaccination at the national and regional levels using multilevel logistic regression models. Our results revealed no increases in zero-dose prevalence due to the pandemic at the national level, although considerable increases were observed in a few districts. We found substantial subnational heterogeneities in vaccination coverage and zero-dose prevalence both before and during the pandemic, showing broadly similar patterns in both time periods. Areas with relatively higher zero-dose prevalence occurred mostly in the north and a few places in the south in both time periods. We also found consistent areas of low coverage and high zero-dose prevalence using all three zero-dose indicators, revealing the areas in greatest need. At the national level, risk factors related to socioeconomic/demographic status (e.g., maternal education), maternal access to and utilization of health services, and remoteness were strongly associated with the odds of being zero dose in both time periods, while those related to communication were mostly relevant before the pandemic. These associations were also supported at the regional level, but we additionally identified risk factors specific to zero-dose children in each region; for example, communication and cross-border migration in the northwest. Our findings can help guide tailored strategies to reduce zero-dose prevalence and boost coverage levels in Nigeria. [ABSTRACT FROM AUTHOR]

Introduction: Adherence to full vaccination is important in preventing childhood diseases. The aim of this study was to evaluate the level of compliance to full vaccination and identify the socio-cultural factors associated with full vaccination compliance in children. Methodology: The socioeconomic variables associated with each of the four binary dependent variables of whether or not a child is fully vaccinated against tetanus, BCG, measles, and pentavalent were determined using logistic regression. Results: While compliance to full tetanus and BCG vaccinations was > 60% at the national level, less than 50% and 10% full vaccination compliance were recorded for pentavalent and measles vaccinations, respectively. The South East region of Nigeria recorded the overall highest full vaccination compliance while the least performing region was the North West zone. The mother or guardian literacy level, employment status, antenatal care attendance, and internet usage were strong predictors of full vaccination compliance (p < 0.05). Conclusions: The socio-cultural factors associated with achieving full vaccination coverage in Nigeria in this study should drive the implementation of policies that will be best suited to each geopolitical zone of Nigeria. [ABSTRACT FROM AUTHOR]

Background: Globally, child mortality and morbidity remain a serious health challenge and infectious diseases are the leading causes. The use of count models together with spatial analysis of the number of doses of childhood vaccines taken is limited in the literature. We used a Bayesian zero-inflated Poisson regression model with spatio-temporal components to assess the number of doses of childhood vaccines taken among children aged 12–23 months and their associated factors. Methods: Data of 19,564 children from 2003, 2008, 2013 and 2018 population-based cross-sectional Nigeria Demographic and Health Survey were used. The childhood vaccines include one dose of Bacillus-Calmette-Guérin; three doses of Diphtheria-Pertussis-Tetanus; three doses of Polio and one dose of Measles. Uptake of all nine vaccines was regarded as full vaccination. We examined the multilevel factors associated with the number of doses of childhood vaccines taken using descriptive, bivariable and multivariable Bayesian models. Analysis was conducted in Stata version 16 and R statistical packages, and visualization in ArcGIS. Results: The prevalence of full vaccination was 6.5% in 2003, 14.8% in 2008, 21.8% in 2013 and 23.3% in 2018. Full vaccination coverage ranged from 1.7% in Sokoto to 51.9% in Anambra. Factors associated with the number of doses of childhood vaccines taken include maternal age (adjusted Incidence "risk" Ratio (aIRR) = 1.05; 95% Credible Interval (CrI) = 1.03–1.07) for 25–34 years and (aIRR = 1.07; 95% CrI = 1.05–1.10) for 35–49 years and education: (aIRR = 1.11, 95% CrI = 1.09–1.14) for primary and (aIRR = 1.16; 95% CrI = 1.13–1.19) for secondary/tertiary education. Other significant factors are wealth status, antenatal care attendance, working status, use of skilled birth attendants, religion, mother's desire for the child, community poverty rate, community illiteracy, and community unemployment. Conclusion: Although full vaccination has remained low, there have been improvements over the years with wide disparities across the states. Improving the uptake of vaccines by educating women on the benefits of hospital delivery and vaccines through radio jingles and posters should be embraced, and state-specific efforts should be made to address inequality in access to routine vaccination in Nigeria. [ABSTRACT FROM AUTHOR]

Introduction: measles outbreak remains a recurring episode and continues to be responsible for millions of deaths globally every year. This study examines measles immunization coverage and uncovers barriers and enablers to effective provision and uptake of measles immunization services from the supply end and provider's perspective in a developing nation's context. Methods: the study employed a mixed-method approach to explore trends and patterns of measles immunization uptake in Ekiti State-a state in the southwestern region of Nigeria-utilizing DHIS 2014 - 2019 data of 789,518 under 1-year children and complemented the quantitative study with key informant interviews from appointed Immunization Officers in the state. Using deductive methods, we thematically analyzed the interview data using NVivo version 12 while STATA 16 was used to analyze the quantitative data. Results: the annualized measles immunization coverage ranged between 49% and 86% from 2014 to 2019, which is below the WHO set threshold for measles infection prevention. Caregiver, geographical, human, and infrastructural factors were elicited as barriers, while potential enablers include increased public engagement and enhanced media involvement. Conclusion: while programmatic efforts are being improved nationally to drive up the uptake, this study provides baseline information for benchmarking the subsequent level of efforts and recommends improved collaboration across contextually similar states to promote program efficiency. The results can inform policy and program development, execution and direct future research on measles immunization to address uptake challenges at both local and central administration levels, especially in the aspect of surveillance and monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Vaccine stockout is a severe problem in Africa, including Nigeria, which could have an adverse effect on vaccination coverage and even health outcomes among the population. The Vaccine Direct Delivery (VDD) program was introduced to manage vaccine stockouts using eHealth technology. This study conducts a cost analysis of the VDD program and calculates the incremental costs of reaching an additional child for vaccination through the VDD program. Methods: We used the expense reports from eHealth Africa, an NGO which implemented the VDD program, to calculate the VDD program's overall operating costs. We also used the findings from the literature to translate the effect of VDD on the reduction of vaccine stockouts into its effect on the increase in vaccination coverage. We calculated the incremental costs of reaching an additional child for vaccination through the VDD program. Results: We calculated that implementing the VDD program cost USD10,555 monthly for the 42 months that the VDD program was operating in Bauchi state. This figure translates to an incremental cost of USD20.6 to reach one additional child for vaccination. Discussion/Conclusions: Our study is one of the first to conduct a cost analysis of eHealth technology in Africa. The incremental cost of USD20.6 was within the range of other interventions that intended to increase vaccine uptake in low- and middle-income countries. The VDD program is a promising technology to substantially reduce vaccine stockout, leading to a reduction of over 55% at a reasonable cost, representing 26% of the total budget for routine immunization activities in Bauchi state. However, there is no comparable costing study that evaluates the cost of a supply chain strengthening intervention. Future studies should investigate further the feasibility of eHealth technology, as well as how to minimize its costs of implementation while keeping the efficacy of the program. [ABSTRACT FROM AUTHOR]

Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first- and third-dose diphtheria-tetanus-pertussis vaccine coverage in Borno state, Nigeria, using a spatiotemporal MBG modelling approach, then compared these to estimates from recent conflict-affected, household-based surveys. We compared sampling cluster locations from recent household-based surveys to geolocated data on conflict locations and modelled spatial coverage estimates, while also investigating the importance of reliable population estimates when assessing coverage in conflict settings. These results demonstrate that geospatially-modelled coverage estimates can be a valuable additional tool to understand coverage in locations where conflict prevents representative sampling. [ABSTRACT FROM AUTHOR]

Introduction: Despite abundant evidence showing immunization as a lifesaving public health measure, a large proportion of Nigerian children are still not or fully vaccinated. Lack of awareness and distrust of the immunization process by caregivers are some of the reasons for poor immunization coverage which need to be addressed. This study aimed at improving vaccination demand, acceptance and uptake in Bayelsa and Rivers State, both in the Niger Delta Region (NDR) of Nigeria through a human-centered process of trust building, education and social support. Methods: A quasi-experimental intervention christened Community Theater for Immunization (CT4I) was deployed in 18 selected communities between November 2019 and May 2021 in the two states. In the intervention localities, relevant stakeholders including the leadership of the health system, community leaders, health workers and community members were engaged and actively involved in the design and performance of the theaters. The content for the theater showcased real stories, using a human-centered design (HCD) of ideation, co-creation, rapid prototyping, feedback collection and iteration. Pre- and post-intervention data on the demand and utilization of vaccination services were collected using a mixed method. Results: In the two states, 56 immunization managers and 59 traditional and religious leaders were engaged. Four broad themes implicating user and provider factors emerged from the 18 focus group discussions as responsible for low immunization uptake in the communities. Of the 217 caregivers trained on routine immunization and theater performances, 72% demonstrated a knowledge increase at the post-test. A total of 29 performances attended by 2,258 women were staged with 84.2% of the attendees feeling satisfied. At the performances, 270 children received vaccine shots (23% were zero-dose). There was a 38% increase in the proportion of fully immunized children in the communities and 9% decline in the proportion of zero-dose children from baseline. Conclusion: Both demand- and supply-side factors were identified as responsible for poor vaccination in the intervention communities. Our intervention demonstrates that caregivers will demand immunization services if they are engaged through community theater using a human-centered design (HCD). We recommend a scaling up of HCD to address the challenge of vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Background: Yellow fever (YF) outbreaks continue to occur in Nigeria with a high mortality rate despite a wellestablished mode of transmission and the availability of a potent vaccine. This review is aimed at describing the epidemiology, determinants, and public health responses of yellow fever outbreaks in Nigeria from 1864 to 2020. Methodology: The guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review from November 2020 to April 2021. PubMed database, WHO library databases, and Google Scholar were used to search for relevant published materials including original and reviewed articles, conference papers and case reports from 1864 to 2020. Results: Forty - eight articles and reports were included in the final reviews. Twenty - three outbreaks were described involving 33,830 suspected, presumptive, or confirmed cases of yellow fever and 8,355 deaths. The outbreaks occurred in every state of Nigeria including the Federal Capital Territory mostly during the rainy season. Low immunity in the population or low vaccination coverage, poor vector control, rainforest or savanna vegetation, rural-urban migration, and imported virus by travelers were common determinants noted. Public health responses have been through, centrally coordinated laboratory support, case management, emergency immunization, vector control, and surveillance. Conclusion: Yellow fever outbreaks have increased in frequency and geographical spread with associated mortality rates. To stem the tide, mass immunization with 17D vaccines is encouraged, planned urbanization with adequate vector control measures enforced, effective case definition, vector surveillance, and effective awareness campaigns should be emphasized. [ABSTRACT FROM AUTHOR]

Background: Effective integration, one of the seven strategic priorities of the Immunization Agenda 2030, can contribute to increasing vaccination coverage and efficiency. The objective of the study is to measure and compare input costs of "non-selective" measles vaccination campaign as a stand-alone strategy and when integrated with another vaccination campaign. Methods: We conducted a cost-minimization study using a matched design and data from five states of Nigeria. We carried-out our analysis in 3 states that integrated measles vaccination with Meningitis A and the 2 states that implemented a stand-alone measles campaign. The operational costs (e.g., costs of personnel, training, supervision etc.) were extracted from the budgeted costs, the financial and technical reports. We further used the results of the coverage surveys to demonstrate that the strategies have similar health outputs. Results: The analysis of the impact on campaign budget (currency year: 2019) estimated that savings were up to 420,000 United States Dollar (USD) with the integrated strategies; Over 200 USD per 1,000 children in the target population for measles vaccination (0.2 USD per children) was saved in the studied states. The savings on the coverage survey components were accrued by lower costs in the integration of trainings, and through reduced field work and quality assurance measures costs. Conclusions: Integration translated to greater value in improving access and efficiency, as through sharing of costs, more life-saving interventions are made accessible to the communities. Important considerations for integration are resource needs, micro-planning adjustments, and health systems delivery platforms. [ABSTRACT FROM AUTHOR]

Pneumococcal conjugate vaccines (PCVs) protect against invasive pneumococcal disease (IPD) among vaccinees. However, at population level, this protection is driven by indirect effects. PCVs prevent nasopharyngeal acquisition of vaccine-serotype (VT) pneumococci, reducing onward transmission. Each disease episode is preceded by infection from a carrier, so vaccine impacts on carriage provide a minimum estimate of disease reduction in settings lacking expensive IPD surveillance. We documented carriage prevalence and vaccine coverage in two settings in Nigeria annually (2016–2020) following PCV10 introduction in 2016. Among 4,684 rural participants, VT carriage prevalence fell from 21 to 12% as childhood (<5 years) vaccine coverage rose from 7 to 84%. Among 2,135 urban participants, VT carriage prevalence fell from 16 to 9% as uptake rose from 15 to 94%. Within these ranges, carriage prevalence declined with uptake. Increasing PCV10 coverage reduced pneumococcal infection at all ages, implying at least a comparable reduction in IPD. Nigeria has the highest incidence of pneumococcal disease in Africa and introduced the 10-valent pneumococcal vaccine for infants between 2014 and 2016. Here, the authors conduct repeated cross-sectional surveys to analyse the impact of the vaccination campaign on pneumococcal carriage and serotype distribution. [ABSTRACT FROM AUTHOR]

By May 30, 2022, there were 526,182,662 confirmed COVID-19 cases and 6,286,057 deaths globally; of which Nigeria had recorded 256,028 confirmed cases and 3143 deaths. By the same time, Nigeria had received a total of 93.9 million doses of the COVID-19 vaccine, enough to vaccinate 25% of the population; however, only 27.4 million people (13.3% of the population) had received at least one dose of the vaccine. This article examines available evidence on COVID-19 vaccine hesitancy in Nigeria and makes recommendations for improving its uptake. Major causes of COVID-19 vaccine hesitancy identified in Nigeria were concerns around vaccine efficacy and safety, disbelief in the existence and severity of the disease, and distrust of the government. To reduce COVID-19 vaccine hesitancy and improve vaccine coverage in Nigeria, mapping vaccine acceptance and hesitancy across geographies and demographics is needed, as well as increased stakeholder communication, and effective community engagement. [ABSTRACT FROM AUTHOR]

Background: COVID-19 testing coverage is limited in Nigeria. Access to rapid SARS-CoV-2 antigen-detection self-testing kits may help improve the detection of asymptomatic and mildly symptomatic cases and increase the country's low rate of SARS-CoV-2 testing. Before implementing self-testing in Nigeria, assessing the population's perceptions regarding this approach is imperative. In mid-2021, an exploratory cross-sectional qualitative research was conducted to investigate stakeholders' values and preferences for SARS-CoV-2 self-testing in Nigeria. Methods: In-person and online semi-structured interviews and focus group discussions with healthcare workers, representatives of civil society, and potential implementors of self-testing delivery programs were used to explore values and perceptions around access to conventional provider-initiated COVID-19 testing. Topics included the public's values in relation to SARS-CoV-2 self-testing, the safe and effective use of SARS-CoV-2 self-testing, and likely actions upon receiving a positive SARS-CoV-2 self-test result. A thematic analysis approach was applied. Results: The 58 informants (29 female) reported that Nigeria has limited availability of conventional provider-delivered SARS-CoV-2 testing. While just a few informants were familiar with SARS-CoV-2 self-testing, they generally supported using self-testing as an approach that they felt could assist with early case detection and improve access to testing. Concerns relating to the use of self-testing mainly related to the ability of low-literate individuals to use and interpret the self-tests, the affordability of self-tests, equity of access, and the availability of healthcare system support for those who self-test positive. Conclusion: Although the Nigerian public perceive multiple benefits associated with access to SARS-CoV-2 self-testing, the perceived inefficiency of the national health service delivery system may limit the access of users of the kits to psychosocial and clinical support. Nevertheless, in Nigeria, where COVID-19 vaccine coverage is low and the risk of further waves of COVID-19 is high, self-testing may assist in the prompt detection of cases and contribute to halting the spread of the virus. [ABSTRACT FROM AUTHOR]

Africa bears the brunt of diarrheal mortality globally. Rotavirus vaccination rates are high across the continent and demonstrate impact on diarrheal disease reduction. Nevertheless, there is room for significant improvement in managing rotavirus vaccine coverage, in access to recognized public services such as appropriate medical care, including oral rehydration therapy and improved water and sanitation. [ABSTRACT FROM AUTHOR]

Serological surveys provide an objective biological measure of population immunity, and tetanus serological surveys can also assess vaccination coverage. We undertook a national assessment of immunity to tetanus and diphtheria among Nigerian children aged <15 years using stored specimens collected during the 2018 Nigeria HIV/AIDS Indicator and Impact Survey, a national cross-sectional household-based survey. We used a validated multiplex bead assay to test for tetanus and diphtheria toxoid-antibodies. In total, 31,456 specimens were tested. Overall, 70.9% and 84.3% of children aged <15 years had at least minimal seroprotection (≥0.01 IU/mL) against tetanus and diphtheria, respectively. Seroprotection was lowest in the north west and north east zones. Factors associated with increased tetanus seroprotection included living in the southern geopolitical zones, urban residence, and higher wealth quintiles (p < 0.001). Full seroprotection (≥0.1 IU/mL) was the same for tetanus (42.2%) and diphtheria (41.7%), while long-term seroprotection (≥1 IU/mL) was 15.1% for tetanus and 6.0% for diphtheria. Full- and long-term seroprotection were higher in boys compared to girls (p < 0.001). Achieving high infant vaccination coverage by targeting specific geographic areas and socio-economic groups and introducing tetanus and diphtheria booster doses in childhood and adolescence are needed to achieve lifelong protection against tetanus and diphtheria and prevent maternal and neonatal tetanus. [ABSTRACT FROM AUTHOR]

• In 2018, about 8,883,931 and 12,566,478 children aged under 5 years old in Nigeria had not received routine DTP1 and MCV1, respectively. • MCV and DTP zero-dose prevalence shared similar patterns, with highest prevalence districts concentrated in the northeast and northwest but also found elsewhere. • Measles incidence, though mitigated by campaigns, is related to subnational routine MCV1 coverage. • Residual zero-dose prevalence following vaccination campaigns should be analysed and reported. • Targeted campaigns or routine immunization interventions in higher zero-dose prevalence districts are needed to reduce disease risk. Geographically precise identification and targeting of populations at risk of vaccine-preventable diseases has gained renewed attention within the global health community over the last few years. District level estimates of vaccination coverage and corresponding zero-dose prevalence constitute a potentially useful evidence base to evaluate the performance of vaccination strategies. These estimates are also valuable for identifying missed communities, hence enabling targeted interventions and better resource allocation. Here, we fit Bayesian geostatistical models to map the routine coverage of the first doses of diphtheria-tetanus-pertussis vaccine (DTP1) and measles-containing vaccine (MCV1) and corresponding zero-dose estimates in Nigeria at 1x1 km resolution and the district level using geospatial data sets. We also map MCV1 coverage before and after the 2019 measles vaccination campaign in the northern states to further explore variations in routine vaccine coverage and to evaluate the effectiveness of both routine immunization (RI) and campaigns in reaching zero-dose children. Additionally, we map the spatial distributions of reported measles cases during 2018 to 2020 and explore their relationships with MCV zero-dose prevalence to highlight the public health implications of varying performance of vaccination strategies across the country. Our analysis revealed strong similarities between the spatial distributions of DTP and MCV zero dose prevalence, with districts with the highest prevalence concentrated mostly in the northwest and the northeast, but also in other areas such as Lagos state and the Federal Capital Territory. Although the 2019 campaign reduced MCV zero-dose prevalence substantially in the north, pockets of vulnerabilities remained in areas that had among the highest prevalence prior to the campaign. Importantly, we found strong correlations between measles case counts and MCV RI zero-dose estimates, which provides a strong indication that measles incidence in the country is mostly affected by RI coverage. Our analyses reveal an urgent and highly significant need to strengthen the country's RI program as a longer-term measure for disease control, whilst ensuring effective campaigns in the short term. [ABSTRACT FROM AUTHOR]

Introduction: This study analyzes the trend of prevalence of, and factors contributing to, children with incomplete vaccination status, namely zero-dose, under-immunized, and dropout children, over time from 2003 to 2018 in Nigeria, one of the countries with the highest number of children with incomplete vaccination. Methods: Nigeria Demographic and Health Survey data from 2003 to 2018 were analyzed to calculate the prevalence of children with incomplete vaccination status by geographical zone over time and to investigate the factors contributing to the change in the prevalence of such children over time based on the Blinder–Oaxaca decomposition analysis. Results: The prevalence of children with incomplete vaccination status substantially decreased from 2003 to 2018 in most of zones in Nigeria. Rural areas and the northern zones had consistently higher prevalence of children with incomplete vaccination status than urban areas and the southern zones. It was identified that mothers' education and the household wealth level explained the reduction in the prevalence of zero-dose and under-immunized children, but the degree of contribution of each factor varied by zone and place of residence, i.e., urban or rural. Both the mother's education and household wealth level only weakly contributed to the reduction in the number of dropout children. Discussions and conclusion: Future studies should explore further how to improve the vaccination coverage in Nigeria over time. Examples of topics for future study include other contributing factors beyond education and wealth level, differential factors influencing the reduction in the number of children with incomplete vaccination status by area of residence (urban vs. rural), why the reduction in the number of dropout children is not explained by either education or wealth, and the significant contributors to the reduction in the number of such children. [ABSTRACT FROM AUTHOR]

Background: Short Message Service (SMS) reminders have improved vaccine uptake in low- and middle-income countries (LMICs). However, the limited use of SMS reminders in LMICs requires evaluating the intervention's internal and external validity to improve adoption and sustainability. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we qualitatively assessed the impact of a SMS reminder intervention implemented in Kebbi State, Northwest Nigeria between May 20, 2019 and May 31, 2020. This will guide and inform future SMS reminder interventions to improve childhood immunization uptake in LMICs. Methods: In June 2020, we conducted 14 focus group discussions, 13 in-depth interviews, and 20 key informant interviews among 144 purposively selected participants from five local government areas of Kebbi State. For analysis, we used a deductive approach to develop preliminary codes based on the RE-AIM framework and the inductive approach to generate themes that emerged from the interviews. Results: The perceived importance and impact of the SMS reminder in improving demand and uptake for vaccinations were the consistent contributing factors that encouraged participants' participation. Other facilitators included the involvement of health workers in supporting SMS reminder registration and community gatekeepers using existing structures to convey messages on scheduled immunization services. Policymakers adopted the intervention because it aligns with the state's priority to improve immunization coverage. Similarly, the SMS reminder appealed to health workers and program managers because it reduced their workload and served as a performance monitoring tool to track immunization and intervention defaulters. Despite these, low mobile phone ownership and the inability to read text messages due to the low literacy level were the main barriers during implementation. Finally, data availability on cost-effectiveness and the intervention's impact on improving coverage was critical for scalability. Conclusions: Our study demonstrated that SMS reminders in local languages could improve vaccination demand and uptake in resource-constrained settings due to their perceived importance and impact. Addressing the cited implementation barriers and promoting the facilitators is critical to its adoption and sustainability. Costing and impact data are needed to collaborate findings on the effectiveness of the SMS reminder to improve childhood vaccination uptake. [ABSTRACT FROM AUTHOR]

The number of confirmed cases of COVID-19 globally is well over 400 million, however, the number of cases is showing a downward trend especially in developed countries largely as a result of effective vaccination against COVID-19. In developing countries, vaccination coverage is still very low as a result of vaccine hesitancy, which could be attributed to misconceptions about COVID-19 itself and its newly developed vaccines. This study assessed COVID-19 vaccine acceptance and perception amongst the adult population in Sokoto state, Nigeria. A cross-sectional study was conducted in Sokoto state among 854 respondents selected via a multi-stage sampling technique. Data was collected electronically using a set of structured questionnaire and analysis was done using IBM SPSS version 25. Respondents' perception was assessed using a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Respondents having a score of 3 and below were graded as having poor perception and those having scores above 3 were graded as having good perception. Respondents' ages ranged from 17 to 76 years, with a mean of 34.8±12.07; more than half [474(53.7%)] of the respondents were males, 667(75.5%) were married and 539(61.0%) had formal education. The majority [839(95.0%)] of the respondents had a good perception of COVID -19 vaccine; 49.9% agreed enough research would be required on the safety of the vaccine. The majority, (72.4%) expressed their willingness to accept the COVID- 19 vaccine (male 38.4% vs. female 34.0%); 410(47.4%) said they can spend more than one hour to get the vaccine. Significant predictors of willingness to accept COVID 19 vaccine include age (p = 0.006; aOR = 0.223; 95% CI = 0.077–0.645), education (p<0.001; aOR = 1.720; 95% CI = 1.274–2.321) and perception of COVID 19 vaccine (p<0.001; aOR = 0.020; 95% CI = 0.009–0.044). The majority of the respondents had a good perception of COVID- 19 vaccine and more than two-thirds were willing to be vaccinated with the vaccine. Government should make the vaccine available for vaccination since a significant proportion of the respondents expressed their willingness to accept the vaccine [ABSTRACT FROM AUTHOR]

Background Immunization is a cost-effective public health strategy to reduce vaccine preventable disease, especially in childhood. Methods This paper reports the philosophy, service delivery, achievements and lessons learned from an immunization program in rural Nigeria privately financed via a corporate social responsibility initiative from GlaxoSmithKline Biologicals. Results The immunization program served the community for a 16-y period extending from 1998 until 2015, resulting in an increase in age-appropriate immunization coverage from 43% to 78%. Conclusion In its success, this immunization program exemplified the importance of early and sustained community engagement, integration of strategies to optimize implementation outcomes and effective team building well before some of these principles were accepted and codified in the literature. The project also underscores the important role that the private sector can bring to achieving critical immunization goals, especially among underserved populations and provides a model for successful public-private partnership. [ABSTRACT FROM AUTHOR]

Introduction: While recent years have observed a substantial improvement in vaccination coverage among children in developing countries, many children are still left out and remain unvaccinated. This study analyzes the trend of the prevalence and characteristics of zero-dose children in Nigeria over time. Methods: Using data from the Demographic and Health Survey in Nigeria from 2003 to 2018, I analyzed the prevalence and determinants of zero-dose children who had not received any DTP vaccine by geographical zone and over time. In addition, I conducted Blinder–Oaxaca decomposition analysis to evaluate the reasons for the change in the prevalence of zero-dose children over time. Results: The overall prevalence of zero-dose children reduced from over 60% in 2003 to 40% in 2018 in Nigeria. Rural areas had a higher prevalence of zero-dose children than urban areas and the gap was consistent over time. Southern zones consistently had a lower prevalence of zero-dose children, but northern zones observed more reductions in the prevalence of zero-dose children. The mother's education and wealth level in a household are strongly associated with a lower likelihood of having zero-dose children. In both urban and rural areas, an improvement in the mother's education level strongly explained the reduction in zero-dose children over time, while an increase in the wealth level also explained the reduction in zero-dose children in rural areas. Conclusions: While Nigeria has observed a substantial reduction in the prevalence of zero-dose children in the 15 years since 2003, the pattern of and explanatory factors for the reduction differ by geographical region. This analysis can be useful for identifying a targeting strategy to further reduce the prevalence of zero-dose children in Nigeria in the future. [ABSTRACT FROM AUTHOR]

Measles is a highly contagious infection that can cause severe illness in children. Vaccination is the primary means of controlling the infection, with elimination a possibility. However, the measles-containing vaccine coverage in sub-Saharan Africa (SSA) is 70% while that for Nigeria is 54% according to official estimates and 64.7% from household surveys. This review aims to identify factors that contribute to the poor coverage rate and proposes appropriate recommendations to address these factors. We conducted a comprehensive search of five databases (MEDLINE, Embase, Global Health, CINAHL Plus and PubMed) using the PICOTS (population, intervention, comparison, outcome, timing, study type) framework. The search was conducted in September 2017 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and inclusion criteria were studies conducted in SSA, that evaluated measles vaccine coverage gaps, evaluated strategies for improving measles vaccination coverage and were published in English. The database search yielded 23 publications. Several different factors influencing measles vaccine coverage were identified and were grouped into four main areas: immunization system, information and communication, family characteristics and parental attitudes and knowledge. Fears and misconceptions were common reasons for non-vaccination. Activities to improve vaccination coverage were identified, including structural reforms such as siting health centres within or proximal to target communities, improving female literacy and conducting measles vaccination campaigns. Multiple reasons for poor measles vaccination coverage were identified. Factors influencing the immunization system and information and communication factors can be fixed at the country level, but challenges relating to family characteristics and parental attitudes and knowledge require solutions adapted to the community of concern. However, vaccination campaigns are an effective means of improving vaccination coverage and they reduce geographic and socio-economic inequities. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 has been impacting our lives globally, including in Nigeria. While the COVID-19 vaccine is available free of charge, vaccination coverage remains low. This study evaluates the relationship between trust in government and COVID-19 vaccine hesitancy. Methods: We used an Afrobarometer survey for data on trust in government and the COVID-19 National Longitudinal Phone Survey (NLPS) for data on COVID-19 vaccine hesitancy, merged by strata (states and urban/rural). The simple correlation was evaluated using Ordinary Least Squares (OLS) regression. Results: Distrust in government was strongly associated with COVID-19 vaccine hesitancy as well as with perceptions that the vaccine was not safe, and concerns about side effects were given as reasons for vaccine refusal. Discussion/Conclusion: Distrust of government is an important predictor of vaccine hesitancy in Nigeria. This result is consistent with findings in the literature, especially in developed countries. Vaccine refusers, who distrust the government, refuse vaccines because they think that vaccines do them harm. Policy makers should be cautious when it comes to strategizing for COVID-19 vaccine distribution, especially in places where trust in government is weak. [ABSTRACT FROM AUTHOR]

High childhood disease prevalence and under-five mortality rates have been consistently reported in Nigeria. Vaccination is a cost-effective preventive strategy against childhood diseases. Therefore, this study aimed to identify the determinants of Incomplete Vaccination (IV) among children aged 12-23 months in Nigeria. This cross-sectional design study utilized the 2018 Nigeria Demographic and Health Survey (NDHS) dataset. A two-stage cluster sampling technique was used to select women of reproductive age who have children (n = 5475) aged 12-23 months. The outcome variable was IV of children against childhood diseases. Data were analyzed using Integrated Nested Laplace Approximation and Bayesian binary regression models (α 0.05 ). Visualization of incomplete vaccination was produced using the ArcGIS software. Children's mean age was 15.1 ± 3.2 months and the median number of vaccines received was four. Northern regions contributed largely to the IV. The likelihood of IV was lower among women aged 25-34 years (aOR = 0.67, 95% CI = 0.54-0.82, p < 0.05) and 35-49 years (aOR = 0.59, 95%CI = 0.46-0.77, p < 0.05) compared to younger women in the age group 15-24 years. An increasing level of education reduces the risk of odds of IV. Other predictors of IV were delivery at the health facility (aOR = 0.64, 95% CI = 053-0.76, p < 0.05), and media exposure (aOR = 0.63, 95%CI = 0.54-0.79, p < 0.05). Mothers' characteristics explained most of the variability in the IV, relatively to smaller overall contributions from the community and state-level factors (p < 0.05). The level of IV against childhood diseases was high in Nigeria. However, disparities exist across the regions and other socioeconomic segments of the population. More efforts are required to improve vaccination sensitization programs and campaigns in Nigeria., (© 2024. The Author(s).)

Measles remains an important cause of childhood mortality in many resource-limited countries. With Sustainable Development Goals (SDG), there has been increasing emphasis on measles vaccination as a key strategy to remarkably improve child survival. While progress has been made towards measles vaccination coverage due to SDG in some settings, there has been no prior study evaluating its impact in Nigeria. To assess the effectiveness of SDG policy implementation on measles vaccination coverage, we examined the changes in first dose of measles vaccination coverage rates among children aged 9–15 months following the implementation of SDG, and changes in spatial patterns of measles vaccination from 2014 to 2019 in Ekiti State, Southwest Nigeria. Using state and local government area-level District Health Information data from January 2014 to December 2019, we conducted interrupted time series (ITS) and spatiotemporal analyses. The ITS evaluated the immediate and continuous effects of SDG policy implementation on the monthly childhood measles vaccination coverage by comparing longitudinal changes in rates between pre-intervention period (January 2014-December 2015) and during-intervention period (January 2016-December 2019). The low and high coverage clusters across the years were detected with spatial cluster analysis. The average state-level measles vaccination coverage rates from 2014 to 2019 was 70.67%. In 2019, coverage rate was 49%—a 35.53% decline from 76% in 2014 and a state-level gap of 46%. The geographical distribution of measles vaccination varied considerably across the local government areas from 2014 to 2019. There was an initial acceleration of vaccination rates (β ^ = 24.07, p-value = 0.012), but a significant decrease in coverage rates after implementation of SDG policy in Ekiti State (β ^ = −1.08, p-value < 0.001). No local government area had accelerated monthly coverage rates following SDG-implementation. Evidence suggests immediate acceleration in coverage rates which could not be sustained during SDG-era and calls for a rethink measles immunization coverage strategy in the state and other resource-limited jurisdictions to ensure vaccination scale-up. [ABSTRACT FROM AUTHOR]

Vaccines are one of the most effective and successful strategies employed to date to prevent and increase the population's immunity against several viral diseases. However, vaccine hesitancy among populations poses a potential danger to global health. This study focused on determining the vaccine acceptance rate and associated key determinants among veterinarians. A cross-sectional study using a web-based survey among veterinarians was conducted in the month of April 2021. A multivariate logistic regression model was performed to identify key predictors for vaccine acceptance among veterinarians. A total of 305 veterinarians participated in this survey, of whom 39 respondents (12.8%) had received the COVID-19 vaccine. The vaccine acceptance rate among respondents was 38.3% (excluding those that have taken the vaccine). Only 37.0 % of the respondents were confident about the safety and efficacy of the Oxford-AstraZeneca vaccine in circulation in the country. Major perceived drivers for vaccine acceptability were safety (91.8%), possible adverse reactions (85.6%) and global acceptability (75.7%). The adjusted odds ratio (aOR) of vaccine acceptance increased by 2.3 times among male veterinarians than females (95% CI: 1.358-3.900; p = 0.002) in the multivariate model. In Nigeria, little is known about COVID-19 vaccine acceptance (VA) and predictors among animal healthcare providers, including veterinarians. The study found gender as a key sociodemographic predictor for VA. There is a need to address the sociodemographic determinants of vaccine hesitancy through public health efforts and increase COVID-19 vaccine acceptance and coverage in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed. Methods: Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months. Results: Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome. Conclusion: Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has resulted in millions of human deaths, prompting the rapid development and regulatory approval of several vaccines. Although Nigeria implemented a COVID-19 vaccination program on 15 March 2021, low vaccine acceptance remains a major challenge. To provide insight on factors associated with COVID-19 vaccine hesitancy (VH), we conducted a national survey among healthcare workers, academics, and tertiary students, between 1 September 2021 and 31 December 2021. We fitted a logistic regression model to the data and examined factors associated with VH to support targeted health awareness campaigns to address public concerns and improve vaccination rates on par with global efforts. A total of 1525 respondents took part in the survey, composed of healthcare-workers (24.5%, 373/1525), academics (26.9%, 410/1525), and students (48.7%, 742/1525). Only 29% (446/1525) of the respondents were vaccinated at the time of this study. Of the 446 vaccinated respondents, 35.7% (159/446), 61.4% (274/446) and 2.9% (13/446) had one, two and three or more doses, respectively. Reasons for VH included: difficulty in the vaccination request/registration protocols (21.3%, 633/1079); bad feelings towards the vaccines due to negative social media reports/rumours (21.3%, 633/1079); personal ideology/religious beliefs against vaccination (16.7%, 495/1079); and poor confidence that preventive measures were enough to protect against COVID-19 (11%, 323/1079). Some health concerns that deterred unvaccinated respondents were: innate immunity issues (27.7%, 345/1079); allergic reaction concerns (24.6%, 307/1079); and blood clot problems in women (21.4%, 266/1079). In the multivariable model, location of respondents/geopolitical zones, level of education, testing for COVID-19, occupation/job description and religion were significantly associated with VH. Findings from this study underscore the need for targeted awareness creation to increase COVID-19 vaccination coverage in Nigeria and elsewhere. Besides professionals, similar studies are recommended in the general population to develop appropriate public health interventions to improve COVID-19 vaccine uptake. [ABSTRACT FROM AUTHOR]

Background Hepatitis B birth dose (HepB-BD) vaccination coverage remains suboptimal in Nigeria. While evidence suggests that institutional delivery is associated with the uptake of HepB-BD vaccine, little is known about how the uptake differs by facility ownership (public or private). This study examined the HepB-BD vaccination coverage by place of delivery in Nigeria. Methods This study is a secondary analysis of data on 6143 children aged 12–23 mo obtained from the 2018 Nigeria Demographic and Health Survey. We assessed the association between HepB-BD vaccination and the place of delivery using logistic regression models. Results About 53% of the children received the HepB-BD vaccine. Approximately 77, 83 and 33% of those delivered at a public health facility, private health facility and at home received the HepB-BD vaccine, respectively. After controlling for child- and maternal-level factors, the odds of receiving HepB-BD vaccine were significantly lower in children delivered at a private health facility (adjusted OR [aOR]=0.77, 95% CI 0.59 to 0.99) or at home (aOR=0.48, 95% CI 0.36 to 0.63). Wealth index and region of residence were significantly associated with the receipt of HepB-BD vaccination in all three places of delivery. Conclusions Children are less likely to receive the HepB-BD vaccine if they are delivered at a private health facility or at home. There is a need for private health sector engagement for immunization service delivery and innovative community-based interventions to reach the children delivered at home. [ABSTRACT FROM AUTHOR]

Introduction: the COVID-19 outbreak was declared a public health emergency of international concern by the WHO on the 30th January 2020. The occurrence of measles outbreaks in the context of COVID-19, both highly infectious respiratory illnesses, impacts additional challenges to the health system in a state with an ongoing humanitarian crisis. This article documents the implementation of an outbreak response immunization (ORI) during the COVID-19 pandemic and the implementation of global guidelines for mass vaccination. Methods: a retrospective review of the response to measles outbreak implemented in Borno state across six local government areas (LGAs) in 2019 was conducted. This review assessed the utilization of the World Health Organization (WHO) decision making framework, measles and COVID-19 epidemiological reports and the measle's vaccination response data. Results: an outbreak response immunization was implemented in six LGAs in Borno State, with a validated post campaign coverage of 96.3% (95% CI: 93.0 - 98.1). In total, 181,634 children aged 9 months-9 years were vaccinated with 27,961 (15.4%) receiving the measles vaccine for the first time. Prior to the interventions, 20 COVID-19 cases were reported in the six LGAs while only seven suspected cases were reported with only two cases confirmed in one of the six LGAs four weeks after the ORI. Conclusion: the WHO decision-making framework for implementing mass vaccinations in the context of the COVID-19 Pandemic was utilized for the outbreak response immunization in Borno State, Nigeria with 181,634 children aged 9 Months-9 years vaccinated with the measles vaccine. The use of the WHO decision-making framework to assess risk benefits of initiating mass vaccination campaigns remains a very important practical tool. These types of responses in Nigeria and other low and middle income countries (LMICs), with hitherto suboptimal immunization coverage and weak health systems and other settings, affected by humanitarian emergencies is essential in the achievement of the regional measle's elimination targets. [ABSTRACT FROM AUTHOR]

All WHO regions have set measles elimination objective for 2020. To address the specific needs of achieving measles elimination, Nigeria is using a strategy focusing on improving vaccination coverage with the first routine dose of (monovalent) measles (MCV1) at 9 months, providing measles vaccine through supplemental immunization activities (children 9–59 months), and intensified measles case-based surveillance system. We reviewed measles immunization coverage from population-based surveys conducted in 2010, 2013 and 2017–18. Additionally, we analyzed measles case-based surveillance reports from 2008–2018 to determine annual, regional and age-specific incidence rates. Survey results indicated low MCV1 coverage (54.0% in 2018); with lower coverage in the North (mean 45.5%). Of the 153,097 confirmed cases reported over the studied period, 85.5% (130,871) were from the North. Moreover, 70.8% (108,310) of the confirmed cases were unvaccinated. Annual measles incidence varied from a high of 320.39 per 1,000,000 population in 2013 to a low of 9.80 per 1,000,000 in 2009. The incidence rate is higher among the 9–11 months (524.0 per million) and 12–59 months (376.0 per million). Between 2008 and 2018, the incidence rate had showed geographical variation, with higher incidence in the North (70.6 per million) compare to the South (17.8 per million). The aim of this study was to provide a descriptive analysis of measles vaccine coverage and incidence in Nigeria from 2008 to 2018 to assess country progress towards measles elimination. Although the total numbers of confirmed measles cases had decreased over the time period, measles routine coverage remains sub-optimal, and the incidence rates are critically high. The high burden of measles in the North highlight the need for region-specific interventions. The measles program relies heavily on polio resources. As the polio program winds down, strong commitments will be required to achieve elimination goals. [ABSTRACT FROM AUTHOR]

This article discusses the importance of ensuring equitable vaccination coverage to prevent bacterial meningitis among school children in Nigeria. Bacterial meningitis is a severe infection that can lead to complications such as brain damage and death. However, there are challenges to achieving equitable immunization coverage in Nigeria, including limited access to vaccines, lack of infrastructure and resources, and cultural beliefs. To address these challenges, strategies such as educating parents and caregivers, providing vaccinations in accessible locations, and involving communities in vaccination campaigns can be implemented. By targeting high-risk populations and tracking progress, public health officials can increase vaccination coverage and reduce the incidence of bacterial meningitis among school children in Nigeria. [Extracted from the article]

Introduction: Adverse Events Following Immunization (AEFI) are one of the main reasons for inadequate immunization coverage in Kaduna State, and AEFI underreporting serves as a barrier to achieving goals of global pharmaco-vigilance for vaccine. The purpose of this study is to estimate the completeness of variables in the AEFI line-listing forms, calculate AEFI reporting rates by Local Government Areas & vaccine type and profile the reported cases according to their reactions. Methods: we conducted a descriptive, cross-sectional, retrospective study of primary surveillance records. We calculated AEFI reporting rates in the State and Local Government areas and AEFI Vaccine reaction rates to the various antigens. We used Binary logistic regression to determine the association between gender and vaccine reactions. Results: seven thousand eight hundred and twenty-four (7,824) AEFI cases were reported. The completeness of variables on the filled AEFI line-list varied from 21% to 100%. The State had a high AEFI reporting rate of 9.09 per 10,000 administered doses. Fever (<38°C) was the main AEFI reaction. Severe AEFI cases accounted for only 0.89% of the total reported cases. Pentavalent vaccine was the suspect antigen responsible for the highest number of AEFI cases, with a vaccine reaction rate of 44.77 per 10,000 doses. The Zaria Local Government area had the highest AEFI reporting rate, while the Sanga Local Government area had the lowest AEFI reporting rate in the State. The difference between genders in the number of reported AEFI cases was not statistically significant (p>0.05). There were 35% higher odds of occurrence of bleeding among males than among females (aOR: 1.354; P-value: p=.012; 95% CI: 1.070-1.715; Nagelkerke-R²-: 0.003). The other reactions were not significantly related to gender. Conclusion: our study shows a higher occurrence of severe AEFI in subjects undergoing pentavalent vaccine. Thiscaused the highest incidence of AEFI. There was no significant association between gender and AEFI reactions. [ABSTRACT FROM AUTHOR]

• Modeling survey stratification and clustering improves coverage estimation. • High-resolution coverage maps based on survey data often have large uncertainties. • Visualizing posterior distributions of coverage estimates help reveal uncertainties. • A new presentation method is proposed to compare and control overall map precision. It is becoming increasingly popular to produce high-resolution maps of vaccination coverage by fitting Bayesian geostatistical models to data from household surveys. Usually, the surveys adopt a stratified cluster sampling design. We discuss a number of crucial choices with respect to two key aspects of the map production process: the acknowledgement of the survey design in modeling, and the appropriate presentation of estimates and their uncertainties. Specifically, we consider the importance of accounting for urban/rural stratification and cluster-level non-spatial excess variation in survey outcomes, when fitting geostatistical models. We also discuss the trade-off between the geographical scale and precision of model-based estimates, and demonstrate visualization methods for mapping and ranking that emphasize the probabilistic interpretation of results. A novel approach to coverage map presentation is proposed to allow comparison and control of the overall map uncertainty. We use measles vaccination coverage in Nigeria as a motivating example and illustrate the different issues using data from the 2018 Nigeria Demographic and Health Survey. [ABSTRACT FROM AUTHOR]

Background: Vaccination coverage levels fall short of the Global Vaccine and Action Plan 90% target in low- and middle- income countries (LMICs). Having identified traditional and religious leaders (TRLs) as potential public health change agents, this study aimed at assessing the effect of training them to support routine immunisation for the purpose of improving uptake of childhood vaccines in Cross River State, Nigeria. Methods: A cluster-randomised controlled study was conducted between 2016 and 2019. Of the 18 Local Government Areas (LGA) in Cross River State, eight (four urban and four rural LGAs) were randomized into the intervention and control study arms. A multi-component intervention involving the training of traditional and religious leaders was implemented in the four intervention LGAs. Baseline, midline and endline surveys collected information on children aged 0–23 months. The effect of the intervention on outcomes including the proportion fully up-to-date with vaccination, timely vaccination for pentavalent and measles vaccines, and pentavalent 1–3 dropout rates were estimated using logistic regression models using random effects to account for the clustered data. Results: A total of 2598 children at baseline, 2570 at midline, and 2550 at endline were included. The intervention was effective in increasing the proportion with at least one vaccine (OR 12.13 95% CI 6.03–24.41p<0.001). However, there was no evidence of an impact on the proportion of children up-to-date with vaccination (p = 0.69). It was effective in improving timeliness of Pentavalent 3 (OR 1.55; 95% CI: 1.14, 2.12; p = 0.005) and Measles (OR 2.81; 96% CI: 1.93–4.1; p<0.001) vaccination. The odds of completing Pentavalent vaccination increased (OR = 1.66 95% CI: 1.08,2.55). Conclusion: Informal training to enhance the traditional and religious leaders' knowledge of vaccination and their leadership role can empower them to be good influencers for childhood vaccination. They constitute untapped resources in the community to boost routine immunisation. Pan African Clinical Trial Registry (PACTR) PACTR202008784222254. [ABSTRACT FROM AUTHOR]

In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software (named the Vaccination Coverage Quality Indicators—VCQI) to calculate them.–The current WHO vaccination coverage survey manual was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria–one to assess routine immunization and one to measure post-measles campaign coverage. The primary analysis for both surveys was conducted using VCQI. In this paper, we describe those surveys and highlight some of the analyses that are facilitated by the new resources. In addition to calculating coverage of each vaccine-dose by age group, VCQI analyses provide insight into several indicators of program quality such as crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and, where relevant, vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. We show that routine coverage of all vaccines is far below targets in Nigeria and especially low in northeast and northwest zones, which also have highest rates of dropout and missed opportunities for vaccination. Coverage in the 2017 measles campaign was higher and showed less geospatial variation than routine coverage. Nonetheless, substantial improvement in both routine program performance and campaign implementation will be needed to achieve disease control goals. [ABSTRACT FROM AUTHOR]

Dog-mediated human rabies remains a major public health threat in Nigeria. The availability of reliable dog population estimates is the key in planning control strategies for canine rabies in developing countries. This study was conducted to evaluate the demography of dogs in Umuahia, Abia State, Nigeria. A cross sectional study was carried out in Umuahia North and Umuahia south, Local Government areas (LGA) Abia state, Nigeria, between September and November 2019. A total of 132 compounds in Umuahia North and 186 compounds in Umuahia South were randomly selected for administration of questionnaires. A total of 159 questionnaires were distributed for compound dog count. Information obtained included household information such as numbers of dogs in the premises, housing and control of dog movement. Others were history of dog bites and individual dog information such as breed, sex, age, source of dog, source of food and vaccination status. Two hundred and fifty-seven (257) dogs were counted which comprised 126 (49%) males and 131 (51%) females. Also, 46.3% of the dogs were confined. The dog vaccination coverage in the dog population surveyed was 47.9%. Majority of the respondents (83.3%) stated that no member of their family has been bitten by a dog. The findings of this study show female: male ratio of dog to be 1.04:1. There was negligent dog ownership as a good number of dogs were left to roam. There was a low anti-rabies vaccination coverage in Umuahia North and Umuahia South LGAs which falls below recommendation of 70-80% vaccination coverage by the World Health Organization to achieve herd immunity. [ABSTRACT FROM AUTHOR]

The role of the health care personnel in the delivery of immunization services is very important in achieving the target of immunization coverage of 90% given by the world Health Organisation (WHO). The objective of the study was to determine the challenges affecting healthcare worker's implementation of immunization services in Primary Healthcare Care (PHC) centres in Edo State, Nigeria. A descriptive cross-sectional study design, with a mixed method of data collection approach (incorporating quantitative and qualitative methods) using an interviewer administered questionnaire among 295 respondents (comprised of 270 health care providers, 7 key informants and 18 supervisors) of immunization activities in the various health care facilities for the Focus Group Discussion (FGD) guide. Ethical clearance for the study was obtained from the Ethics Committee of the University of Benin Teaching Hospital. Quantitative data collected was analyzed using the International Business Machine statistical package for Social Science (IBM) version 21.0 while themes occurring in the qualitative data were analyzed using ATLAS.ti software. Logistic regression was calculated to determine odds ratio and level of significance was set at <0.05. This study showed that good knowledge of immunization. age, training on the implementation of immunization, and designation affected their knowledge of immunization, and some of the challenges encountered were insufficient workers and transport for outreach activities, funding and impress, lack of motivation. Health worker's knowledge of immunization was good, majority were trained on implementation on immunization services but there were still numerous challenges such as insufficient workers and transportation which must be addressed to strengthen and improve immunization service delivery. [ABSTRACT FROM AUTHOR]

For more than 6 decades, snakebite has been recognized as an important global public health problem. Such bites can be complicated by mortality and various forms of morbidities including tetanus. Tetanus as a complication of snakebite is rare, more so among children. We present a case of a 13-year-old adolescent male rural dweller with lockjaw and spasms a week following snakebite. He had no immunization in infancy and was not administered tetanus toxoid after the incidence. Important findings at presentation were healed ulcer on the left big toe, board-like rigidity of the anterior abdominal wall, and spasms. He was managed for tetanus complicating snakebite and discharged home after a total of 26 days of hospitalization. The case demonstrates the need to strengthen immunization coverage in rural communities while improving health-seeking behaviors through health education. Victims of snakebites should be encouraged to seek orthodox care and be administered intramuscular tetanus toxoid. [ABSTRACT FROM AUTHOR]

Introduction: wide regional variation in immunization coverage still persists in Nigeria. Full Immunization Coverage (FIC) for more than 80% of all states in the northern region is lower than 40% relative to their southern counterpart. Studies focusing on young women in the north remain sparse, despite the high prevalence of early marriage and poor health-seeking behavior. This study examines FIC among young women in northern Nigeria., Methods: we performed a secondary analysis of the 2013 and 2018 Nigeria Demographic and Health Survey on 1,198 women of children aged 12-23 months in 2013 and 405 in the 2018 dataset. Analysis was limited to young women 15-24 years, residing in Northern Nigeria. We used logistics regression to predict factors associated with FIC., Results: the proportion of fully immunized children was low, at 11% in 2013 and 18% in 2018. The coverage for most vaccines was low, except for the oral polio vaccine. The children of mothers who had health card [(aOR=18.1,95% C.I (8.1-40.7)], in 2013 and 2018 [(aOR=12.7, 95% C.I (5.9-27.1)], attended ANC [(aOR=8.6, 95% C.I (2.4-30.9)] in 2013 and had facility delivery [(aOR=2.0, 95% C.I (1.0-4.1)] in 2018 were more likely to be fully immunized., Conclusion: the study found FIC among children of young women in Northern Nigeria was abysmally low. Ownership of health care, antenatal attendance, and facility delivery significantly predicted the odds of FIC. These findings suggest the need for approaches that remove barriers to good health-seeking behavior, especially among young mothers in Northern Nigeria., Competing Interests: The authors declare no competing interests., (Copyright: Matthew Ayodele Alabi et al.)