COVID-19 vaccination implementation in 52 African countries: trajectory and implications for future pandemic preparedness.

INTRODUCTION: To end the COVID-19 pandemic, the WHO set a goal in 2021 to fully vaccinate 70% of the global population by mid-2022. We projected the COVID-19 vaccination trajectory in 52 African countries and compared the projected to the 'actual' or 'observed' coverage as of December 2022. We also estimated the required vaccination speed needed to have attained the WHO 70% coverage target by December 2022. METHODS: We obtained publicly available, country-reported daily COVID-19 vaccination data, covering the initial 9 months following the deployment of vaccines. We used a deterministic compartmental Susceptible-Exposed-Infectious-Recovered-type model and fit the model to the number of COVID-19 cases and vaccination coverage in each African country using a Markov chain Monte Carlo approach within a Bayesian framework. FINDINGS: Only nine of the 52 African countries (Tunisia, Cabo Verde, Lesotho, Mozambique, Rwanda, Seychelles, Morocco, Botswana and Mauritius) were on track to achieve full COVID-19 vaccination coverage rates ranging from 72% to 97% by the end of December 2022, based on their progress after 9 months of vaccine deployment. Of the 52 countries, 26 (50%) achieved 'actual' or 'observed' vaccination coverage rates within ±10 percentage points of their projected vaccination coverage. Among the countries projected to achieve <30% by December 2022, nine of them (Chad, Niger, Nigeria, South Sudan, Tanzania, Somalia, Zambia, Sierra Leone and Côte d'Ivoire) achieved a higher observed coverage than the projected coverage, ranging from 12.3 percentage points in South Sudan to 35.7 percentage points above the projected coverage in Tanzania. Among the 52 countries, 83% (43 out of 52) needed to at least double their vaccination trajectory after 9 months of deployment to reach the 70% target by December 2022. CONCLUSION: Our findings can guide countries in planning strategies for future global health emergencies and learning from each other, especially those that exceeded expectations and made significant progress towards the WHO's 2022 COVID-19 vaccination target despite projected poor coverage rates.

The role of polio emergency operations centers: perspectives for future disease control initiatives in Nigeria.

The Nigeria Polio Emergency Operations Centre (EOC) was established in October 2012 to strengthen coordination, provide strategic direction based on real-time data analysis, and manage all operational aspects of the polio eradication program. The establishment of seven state-level polio EOCs followed. With success achieved in the interruption of wild poliovirus (WPV) transmission as certified in 2020, the future direction of the polio EOC is under consideration. This paper describes the role of the polio EOC in other emergencies and perspectives on future disease control initiatives. A description of the functionality and operations of the polio EOC and a review of documentation of non-polio activities supported by the EOC was done. Key informant insights of national and state-level stakeholders were collected through an electronic questionnaire to determine their perspectives on the polio EOC's contributions and its future role in other public health interventions. The polio EOC structure is based on an incident management system with clear terms of reference and accountability and with full partner coordination. A decline in WPV1 cases was observed from 122 cases in 2012 to 0 in 2015; previously undetected transmission of WPV1 was confirmed in 2016 and all transmission was interrupted under the coordination of the EOCs at national and state levels. During 2014-2019, the polio EOC infrastructure and staff expertise were used to investigate and respond to outbreaks of Ebola, measles, yellow fever, and meningitis and to oversee maternal and neonatal tetanus elimination campaigns. The EOC structure at the national and state levels has contributed to the positive achievements in the polio eradication program in Nigeria and further in the coordination of other disease control and emergency response activities. The transition of the polio EOCs and their capacities to support other non-polio programs will contribute to harnessing the country's capacity for effective coordination of public health initiatives and disease outbreaks.

A qualitative exploration of the contributions of Polio Eradication Initiative to the Nigerian health system: policy implications for polio transition planning.

BACKGROUND: The Nigerian health care system is weak due to lack of coordination, fragmentation of services by donor funding of vertical services, dearth and poor distribution of resources, and inadequate infrastructures. The Global Polio Eradication Initiative has supported the country's health system and provided strategies and skills which need to be documented for use by other health programs attempting disease control or eradication. This study, therefore, explored the contributions of the Polio Eradication Initiative (PEI) activities to the operations of other health programs within the Nigerian health system from the perspectives of frontline workers and managers. METHODS: This cross-sectional qualitative study used key informant interviews (KIIs) and inductive thematic analysis. Twenty-nine KIIs were conducted with individuals who have been involved continuously in PEI activities for at least 12 months since the program's inception. This research was part of a more extensive study, the Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE), conducted in 2018. The KII tool focused on four major themes: work experience in other health programs, similarities and differences between polio programs and other health programs, contributions of polio programs, and missed opportunities for implementing polio lessons. All interviews were transcribed verbatim and analyzed using a thematic framework. RESULTS: The implementation of the PEI has increased health promotion activities and coverage of maternal and child health interventions through the development of tangible and intangible resources, building the capacities of health workers and discovering innovations. The presence of a robust PEI program within a weakened health system of similar programs lacking such extensive support led to a shift in health workers' primary roles. This was perceived to reduce human resources efforts in rural areas with a limited workforce, and to affect other programs' service delivery. CONCLUSION: The PEI has made a notable impact on the Nigerian health system. There should be hastened efforts to transition these resources from the PEI into other programs where there are missed opportunities and future control programs. The primary health care managers should continue integration efforts to ensure that programs leverage opportunities within successful programs to improve the health of the community members.

COVID-19 vaccine hesitancy amongst healthcare workers: An assessment of its magnitude and determinants during the initial phase of national vaccine deployment in Nigeria.

Background: While vaccination plays a critical role in the global response to the COVID-19 pandemic, vaccine rollout remains suboptimal in Nigeria and other Low- and Middle-income countries (LMICs). This study documents the level of hesitancy among health workers (HWs) during the initial COVID-19 vaccine deployment phase in Nigeria and assesses the magnitude and determinants of hesitancy across Nigeria. Methods: A cross sectional study across all States in Nigeria was conducted with over 10,000 HWs interviewed between March and April 2021. Data were cleaned and analyzed with proportions and confidence intervals of hesitancy documented and stratification by HW category. We compared the level of confidence/acceptance to be vaccinated across Nigeria and documented the sources of negative information amongst HWs who refused the vaccine. Findings: Among the 10 184 HWs interviewed, 9 369 [92% (95% CI= 91, 92)] were confident of the COVID-19 vaccines and were already vaccinated at the time of this survey. Compared to HWs who were less than 20 years old, those aged 50 - 59 years were significantly more confident of the COVID-19 vaccines and had been vaccinated (OR=3.8, 95% CI=2.3 - 6.4, p<0.001). Only 858 (8%) of the HWs interviewed reported being hesitant with 57% (479/858) having received negative information, with the commonest source of information from social media (43.4%.). Interpretation: A vast majority of HWs who were offered COVID-19 vaccines as part of the first phase of national vaccine roll out were vaccinated and reported being confident of the COVID-19 vaccines. The reported hesitancy was due mainly to safety issues, and negative information about vaccines from social media. The issues identified remain a significant risk to the success of subsequent phases of the vaccine rollout in Nigeria. Funding: None.

Measles outbreak response immunization during the COVID-19 pandemic: lessons from Borno State, Nigeria.

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.

Tracking the uptake and trajectory of COVID-19 vaccination coverage in 15 West African countries: an interim analysis.

The African Union Bureau of Heads of State and Government endorsed the COVID-19 Vaccine Development and Access Strategy to vaccinate at least 60% of each country's population with a safe and efficacious vaccine by 2022, to achieve the population-level immunity needed to bring the pandemic under control. Using publicly available, country-level population estimates and COVID-19 vaccination data, we provide unique insights into the uptake trends of COVID-19 vaccinations in the 15 countries that comprise the Economic Community of West Africa States (ECOWAS). Based on the vaccination rates in the ECOWAS region after three months of commencing COVID-19 vaccinations, we provide a projection of the trajectory and speed of vaccination needed to achieve a COVID-19 vaccination coverage rate of at least 60% of the total ECOWAS population. After three months of the deployment of COVID-19 vaccines across the ECOWAS countries, only 0.27% of the region's total population had been fully vaccinated. If ECOWAS countries follow this trajectory, the sub-region will have less than 1.6% of the total population fully vaccinated after 18 months of vaccine deployment. Our projection shows that to achieve a COVID-19 vaccination coverage of at least 60% of the total population in the ECOWAS sub-region after 9, 12 and 18 months of vaccine deployment; the speed of vaccination must be increased to 10, 7 and 4 times the current trajectory, respectively. West African governments must deploy contextually relevant and culturally acceptable strategies for COVID-19 vaccine procurements, distributions and implementations in order to achieve reasonable coverage and save lives, sooner rather than later.

The resurgence of yellow fever outbreaks in Nigeria: a 2-year review 2017-2019.

BACKGROUND: Yellow fever outbreaks are documented to have a considerable impact not only on the individuals but on the health system with significant economic implications. Efforts to eliminate yellow fever outbreaks globally through the EYE strategy remains important following outbreaks in Africa, Nigeria included. The outbreaks reported in Nigeria, since 2017 and the response efforts provide an opportunity to document and guide interventions for improving future outbreaks in Nigeria and other countries in Africa. METHODS: We reviewed the available yellow fever surveillance and vaccination response data between September 2017 and September 2019 across the 36 states across Nigeria. We described the epidemiology of the difference outbreaks and the periods for all interventions. We also documented the emergency vaccination responses as well as preventive mass vaccinations implemented towards improving population immunity and limiting epidemic potentials in Nigeria. RESULTS: A total of 7894 suspected cases with 287 laboratory-confirmed cases were reported in Nigeria between September 2017 and September 2019 with a mean age of 19 years and a case fatality of 2.7% amongst all reported cases. Outbreaks were confirmed in 55 LGAs with most of the outbreaks across four major epicentres in Kwara/Kogi, Edo, Ebonyi and Bauchi states. In response to these outbreaks, eight reactive vaccination campaigns, supported through ICG applications, were implemented. The duration for responding to the outbreaks ranged from 15 to 132 days (average 68 days) and a total of 45,648,243 persons aged < 45 years vaccinated through reactive and preventive mass campaigns between September 2017 and September 2019. CONCLUSIONS: Nigeria experienced intermediate outbreaks of yellow fever between September 2017 and 2019 with vaccination responses conducted to control these outbreaks. However, there are delays in the timeliness of responses and more efforts required in improving reporting, response times and preparedness to further prevent morbidity and mortality from the yellow fever disease outbreaks. These efforts, including improving routine yellow fever coverage, contribute towards improving population immunity and other activities related to achieving the goals of the EYE strategy.

Adverse events following immunization: Findings from 2017/2018 measles vaccination campaign, Nigeria AEFI reporting in 2017/2018 measles vaccination campaign.

INTRODUCTION: An Adverse event following immunization (AEFI) is an untoward medical occurrence following immunization and which may not have a necessary causal relationship with the usage of a vaccine. The World Health Organization categories AEFI into two; serious and non-serious. An AEFI is considered serious if it is life-threatening, requires inpatient hospitalization or results in death. The measles vaccine is safe and effective however because it is a live-attenuated injectable vaccine it is more prone to AEFI as compared to non-injectable vaccines when given in large numbers over a short period as is the nature of measles mass vaccination campaigns (MVC). This article describes Nigeria's experience on AEFI reporting during the 2017/2018 Measles vaccination campaign (MVC). METHODS: We reviewed various materials which included the Open Data Kit (ODK) which is an open source smartphone-based data collecting tool, operations room reports, measles campaign tally sheets, AEFI line listing forms, the post measles campaign coverage survey report and the report of the AEFI national expert committee review of the 2017/2018 Nigeria measles MVC. RESULTS: A total of 6,214 suspected cases of AEFI were line listed from all 36 states and the Federal Capital Territory(FCT) during the 2017/2018 MVC with Fever(38%) and pain at injection site the (30%)most common reports. Overall, 99.7% AEFIs were reported to be non-serious AEFIs, with almost all cases resolved fully with no long-term sequalae.. The national incidence of suspected AEFI per 100,000 population was 16.3 with subnational incidence highest in Kebbi state (101.3/100,000) and lowest in Bayelsa state (0.8/100,000). CONCLUSION: Adequate AEFI reporting, Investigation and management remains important in managing the risk of a disruption of mass campaigns. The deployment of supervisors during campaign may play an important role in improving the identification and reporting of suspected AEFI. Further inquiries about AEFIs during the post campaign coverage evaluation also played a role in improving AEFI reporting and documentation. The real-time, on the spot, follow up by the national operations team helped with decision making and intervention including AEFI investigations and assessments.

The challenges of insecurity on implementing vaccination campaign and its effect on measles elimination and control efforts: A case study of 2017/18 measles campaign in Borno state, Nigeria.

Conflict has a negative effect on immunization outcomes leading to epidemics of measles and other vaccine preventable diseases. Borno state, located in the North-Eastern parts of the country, started experiencing insurgency since 2009 by a militant group commonly referred to as "Boko Haram", leading to displacement of numerous persons from their homes. The state government created internally displaced persons (IDPs) camps with an estimated 600,000 persons and over 100,000 children aged 9 - 59 months. We explored the challenges in implementing the measles campaign in 2017 and its effect on measles elimination and control efforts in Borno State. METHODS: We conducted a retrospective review of the measles surveillance data from the Integrated disease surveillance and response (IDSR), the early warning alert and response system (EWARS), Measles SIA implementation strategy reports and the Post campaign evaluation survey data. RESULT: Seven (26%) of the 27 LGAs had security challenges in Borno state in November 2017. Following the measles campaign, 30 EAs were surveyed as part of the post campaign evaluation with a coverage validation of 72%, the lowest reported state level coverage in the country. Reported measles cases in the age cohort <1Year increased in 2018 by 14.3% compared to 2017. CONCLUSION: Despite the security challenges in Borno state, the 2017 measles SIA was conducted with the post campaign evaluation highlighting some areas of suboptimal performance. There remains a need to review the required strategies for successful implementation in Borno and other states affected by security challenges. The reestablishment of holding camps and vaccination posts at all entry points into IDP camps and host communities to ensure new entrants are screened and vaccinated with the measles vaccines, as has been successful in the polio programme in Nigeria will promotes efforts towards Measles control in the state.

A scorecard of progress towards measles elimination in 15 west African countries, 2001-19: a retrospective, multicountry analysis of national immunisation coverage and surveillance data.

BACKGROUND: The WHO Regional Office for the Africa Regional Immunization Technical Advisory Group, in 2011, adopted the measles control and elimination goals for all countries of the African region to achieve in 2015 and 2020 respectively. Our aim was to track the current status of progress towards measles control and elimination milestones across 15 west African countries between 2001 and 2019. METHODS: We did a retrospective multicountry series analysis of national immunisation coverage and case surveillance data from Jan 1, 2001, to Dec 31, 2019. Our analysis focused on the 15 west African countries that constitute the Economic Community of West African States. We tracked progress in the coverage of measles-containing vaccines (MCVs), measles supplementary immunisation activities, and measles incidence rates. We developed a country-level measles summary scorecard using eight indicators to track progress towards measles elimination as of the end of 2019. The summary indicators were tracked against measles control and elimination milestones. FINDINGS: The weighted average regional first-dose MCV coverage in 2019 was 66% compared with 45% in 2001. 73% (11 of 15) of the west African countries had introduced second-dose MCV as of December, 2019. An estimated 4 588 040 children (aged 12-23 months) did not receive first-dose MCV in 2019, the majority (71%) of whom lived in Nigeria. Based on the scorecard, 12 (80%) countries are off-track to achieving measles elimination milestones; however, Cape Verde, The Gambia, and Ghana have made substantial progress. INTERPRETATION: Measles will continue to be endemic in west Africa after 2020. The regional measles incidence rate in 2019 was 33 times the 2020 elimination target of less than 1 case per million population. However, some hope exists as countries can look at the efforts made by Cape Verde, The Gambia, and Ghana and learn from them. FUNDING: None.

Tracking coverage, dropout and multidimensional equity gaps in immunisation systems in West Africa, 2000-2017.

BACKGROUND: Several West African countries are unlikely to achieve the recommended Global Vaccine Action Plan (GVAP) immunisation coverage and dropout targets in a landscape beset with entrenched intra-country equity gaps in immunisation. Our aim was to assess and compare the immunisation coverage, dropout and equity gaps across 15 West African countries between 2000 and 2017. METHODS: We compared Bacille Calmette Guerin (BCG) and the third dose of diphtheria-tetanus-pertussis (DTP3) containing vaccine coverage between 2000 and 2017 using the WHO and Unicef Estimates of National Immunisation Coverage for 15 West African countries. Estimated subregional median and weighted average coverages, and dropout (DTP1-DTP3) were tracked against the GVAP targets of ≥90% coverage (BCG and DTP3), and ≤10% dropouts. Equity gaps in immunisation were assessed using the latest disaggregated national health survey immunisation data. RESULTS: The weighted average subregional BCG coverage was 60.7% in 2000, peaked at 83.2% in 2009 and was 65.7% in 2017. The weighted average DTP3 coverage was 42.3% in 2000, peaked at 70.3% in 2009 and was 61.5% in 2017. As of 2017, 46.7% of countries (7/15) had met the GVAP targets on DTP3 coverage. Average weighted subregional immunisation dropouts consistently reduced from 16.4% in 2000 to 7.4% in 2017, meeting the GVAP target in 2008. In most countries, inequalities in BCG, and DTP3 coverage and dropouts were mainly related to equity gaps of more than 20% points between the wealthiest and the poorest, high coverage regions and low coverage regions, and between children of mothers with at least secondary education and those with no formal education. A child's sex and place of residence (urban or rural) minimally determined equity gaps. CONCLUSIONS: The West African subregion made progress between 2000 and 2017 in ensuring that its children utilised immunisation services, however, wide equity gaps persist.

Routine immunization community surveys as a tool for guiding program implementation in Kaduna state, Nigeria 2015-2016.

BACKGROUND: Routine childhood immunization remains an important strategy for achieving polio eradication and maintaining a polio-free world. To address gaps in reported administrative coverage data, community surveys were conducted to verify coverage, and guide strategic interventions for improved coverage. METHODS: We reviewed the conduct of community surveys by World Health Organization (WHO) field volunteers deployed as part of the surge capacity to Kaduna state and the use of survey results between July 2015 and June 2016. Monthly and quarterly collation and use of these data to guide the deployment of various interventions aimed at strengthening routine immunization in the state. RESULTS: Over 97,000 children aged 0-11 months were surveyed by 138 field volunteers across 237 of the 255 wards in Kaduna state. Fully or appropriately immunized children increased from 67% in the fourth quarter of 2015 to 76% by the end of the second quarter of 2016. Within the period reviewed, the number of local government areas with < 80% coverage reduced from eight to zero. CONCLUSIONS: The routine conduct of community surveys by volunteers to inform interventions has shown an improvement in the vaccination status of children 0-11 months in Kaduna state and remains a useful tool in addressing administrative data quality issues.

Stopping circulatory vaccine-derived poliovirus in Kaduna state by scaling up special interventions in local government areas along rivers of interest- kamacha basin experience, 2013-2015.

BACKGROUND: The Kamacha river is one of the five polio environmental surveillance sites in Kaduna State where 13 circulating vaccine-derived polioviruses (cVDPDs) were isolated between 2014 and 2015. Kamacha river accounted for 5 of all reported cVDPVs in Kaduna State between 2014 and 2015. Poor quality Supplemental Immunization Activities (SIAs) and low population immunity have been reported in the 10 LGAs with tributaries that flow into the river. We described the processes of implementing the various health interventions in these targeted LGAs along the Kamacha River and assessed the effectiveness of the interventions in stopping cVDPV in Kaduna, state, Nigeria. METHODS: Special interventions that had been proven to be functional and effective in reaching unreached children with potent vaccines in the state were scaled up in these targeted 10 LGAs along the Kamacha River. These interventions included revision of house based microplans, scaling up of transit vaccination, scaling up of youth engagement, intensified supportive supervision, scaling up of Directly Observed Polio Vaccination (DOPV) and in-between rounds vaccination activities. We analyzed immunization plus days (IPDs) administrative tally sheet and monitoring data from 10 rounds before and 10 rounds after the special interventions. RESULTS: The number of children immunized increased from 1,862,958 in December 2014 before the intervention to 1,922,940 in March 2016 after the intervention. Lot Quality Assurance Sampling (LQAS) results showed an increase in the proportion of LGAs accepted at coverage > 90% after the interventions, from 67% before intervention to 84% after intervention. The proportion of non-polio AFP children with > 4 doses of oral polio vaccine increased from 2 to 8% before to 93-98% after the interventions.. No new environmental cVDPV has been isolated since the introduction of the interventions in April 2015 until July 2016. CONCLUSION: Scaling up known working interventions in the 10 LGAs with tributaries that drain to Kamacha River environmental sample site may have contributed to improved immunity and interruption of cVDPV in Kaduna state. These interventions should be replicated in LGAs and states with persistent poliovirus isolation.

Assessment of unmet needs to address noncompliant households during polio supplemental immunization activities in Kaduna state, 2014-2016.

BACKGROUND: Despite concerted global efforts being made to eradicate poliomyelitis, the wild poliovirus still circulates in three countries, including Nigeria. In addition, Nigeria experiences occasional outbreaks of the circulating vaccine-derived poliovirus type 2 (cVDPV2). Vaccine rejection by caregivers persists in some parts of northern Nigeria, which compromises the quality of supplemental immunization activities (SIAs). In 2013, the Expert Review Committee (ERC) on polio recommended innovative interventions in all high-risk northern states to improve the quality of SIA rounds through innovative interventions. The study assessed the impact of using unmet needs data to develop effective strategies to address noncompliant households in 13 high-risk Local government areas (LGAs) in Kaduna state, Nigeria. METHODS: A retrospective study was conducted in noncompliant communities using unmet needs data collated from 2014 to 2016. Household-based noncompliance data collated from tally sheets between 2013 and 2016 was also analyzed to assess the impact of unmet needs data in addressing noncompliance households in high-risk communities in Kaduna state. A structured interview was used to interview caregivers by the application of an unmet needs questionnaire, a quantitative study that assesses caregiver perception on immunization and other unmet needs which, if the gaps were addressed, would allow them to accept immunization services. Interventions include siting of temporary health camps in noncompliant communities to provide free medical consultations, treatment of minor ailments, provision of free antimalaria drugs and other essential drugs, and also referral of serious cases; intervention of religious and traditional leaders, youth against polio intervention, and the use of attractive bonuses (sweets, balloons, milk) during SIAs were all innovations applied to reduce noncompliance in households in affected communities as the need for eradication of polio was declared as a state of emergency. Outcomes from the analyses of unmet needs data were used to direct specific interventions to certain areas where they will be more effective in reducing the number of noncompliant households recorded on the tally sheet in each SIA round. Hence, seven immunization parameters were assessed from the unmet needs data. RESULTS: Overall, 54% of the noncompliant caregivers interviewed were ready to support immunization services in their communities. The majority of caregivers were also willing to vaccinate their children publicly following unmet needs interventions that were conducted in noncompliant communities. The trend of noncompliant households decreased by 79% from 16,331 in September 2013 to 3394 in May 2016. CONCLUSIONS: Unmet needs interventions were effective in reducing the number of noncompliant households recorded during SIA rounds in Kaduna State. Hence, unmet needs intervention could be adapted at all levels to address challenges faced in other primary healthcare programs in Nigeria.

Transboundary nomadic population movement: a potential for import-export of poliovirus.

BACKGROUND: Nomadic populations have a considerably higher risk of contracting a number of diseases but, despite the magnitude of the public health risks involved, they are mostly underserved with few health policies or plans to target them. Nomadic population movements are shown to be a niche for the transmission of diseases, including poliomyelitis. The nomadic routes traverse the northern states of Nigeria to other countries in the Lake Chad subregion. As part of the February 2016 polio supplemental immunization activity (SIA) plans in Bauchi state, a review of nomadic routes and populations identified a nomadic population who originated from outside the international borders of Nigeria. This study describes the engagement process for a transboundary nomadic population and the interventions provided to improve population immunity among them while traversing through Nigeria. METHODS: This was an intervention study which involved a cross-sectional mixed-method (quantitative and qualitative) survey. Information was collected on the nomadic pastoralists entry and exit points, resting points, and health-seeking behavior using key informant interviews and semistructured questionnaire. Transit vaccination teams targeted the groups with oral polio vaccines (OPVs) and other routine antigens along identified routes during the months of February to April 2016. Mobile health teams provided immunization and other child and maternal health survival interventions. RESULTS: A total of 2015 children aged under 5 years were vaccinated with OPV, of which 264 (13.1%) were zero-dose during the February 2016 SIAs while, in the March immunization plus days (IPDs), 1864 were immunized of which 211 (11.0%) were zero-dose. A total of 296 children aged under 1 year old were given the first dose of pentavalent vaccine (penta 1), while 119 received the third dose (penta 3), giving a dropout rate of 59.8%. CONCLUSIONS: Nomadic pastoralists move across international borders and there is a need for transboundary policies among the countries in the Lake Chad region to improve population immunity and disease surveillance through a holistic approach using the One-health concept.

Acute flaccid paralysis (AFP) surveillance intensification for polio certification in Kaduna state, Nigeria: lessons learnt, 2015-2016.

BACKGROUND: Nigeria has made remarkable progress in its current efforts to interrupt wild poliovirus transmission despite the re-emergence of wild poliovirus in 2016. The gains made in Nigeria have been achieved through concerted efforts by governments at all levels, traditional leaders, health workers, caregivers, and development partners. The efforts have involved an elaborate plan, coordination, and effective implementation of routine immunization services, supplemental immunization activities, and acute flaccid paralysis (AFP) surveillance. METHODS: We conducted the following activities to strengthen AFP surveillance in Kaduna state: a monetary reward for all AFP cases reported by health workers or community informants and verified as "true" AFP by a World Health Organization (WHO) cluster coordinator; training and sensitization of surveillance officers, clinicians, and community informants; recruitment of more personnel and expansion of the surveillance network; and the involvement of special populations (nomadic, hard-to-reach, and border communities) and caregivers in stool sample collection. The paired t test was used to evaluate the impact of the different initiatives implemented in Kaduna state to intensify AFP surveillance in 2016. RESULTS: There was increased annualized non-polio AFP rate (ANPAFPR) in 21 out of 23 Local Government Areas (LGAs) of Kaduna state 6 months after implementation of different initiatives to intensify AFP surveillance. The AFP reported by the special population increased in 15 out of 23 LGAs. Statistical analyses of mean scores of ANPAFPR before and after the interventions using the paired t test revealed a significant difference in mean scores: mean = 19.7 (standard deviation (SD) = 16.1) per 100,000 < 15 years old in July-December 2015, compared with 38.0 (SD = 21.6) per 100,000 < 15 years old in January-June 2016 (p < 0.05). Likewise, analysis of silent wards using the paired t test showed a significant difference in mean scores: mean = 4.0 (SD = 2.1) in July-December 2015 compared with 2.4 (SD = 1.8) in January-June 2016 (p < 0.05). CONCLUSION: The different initiatives implemented in 23 LGAs of Kaduna state to intensify AFP surveillance may be responsible for the significant improvement in the AFP surveillance performance indicators in 2016.

Micro-planning for immunization in Kaduna State, Nigeria: Lessons learnt, 2017.

BACKGROUND: The OPV 3 coverage for Kaduna State, 12-23 months old children was 34.4%. The low OPV 3 coverage, due mainly to weak demand for routine antigens and the need to rapidly boost population immunity against the disabling Wild Polio Virus (WPV), led the Global Polio Eradication Initiatives (GPEI) to increase supplemental OPV campaigns in Kaduna State, despite the huge cost and great burden on personnel. The OPV campaigns, especially in high risk (low vaccine uptake, <80% OPV 3 coverage and high vaccines refusal rate) states of northern Nigeria with poliovirus transmission has resulted in overestimated denominators or target population, as the highest ever vaccinated is used to set OPV campaign targets. METHODS: We utilized a cross-sectional study that assessed the impacts and possible solutions to the challenges of overestimated denominators in immunization services planning, delivery and performance evaluation in Kaduna State, Nigeria. We used both descriptive and quantitative approaches. We enumerated households and obtained the target populations for routine immunization (<1 year), polio campaign (<5 years) and acute flaccid paralysis surveillance (<15 years). RESULTS: We found a significant difference in mean scores between the micro-planning and supplemental vaccination data on a number of <5 years (M = 102967, SD = 62405, micro-planning compared to M = 157716, SD = 72212, supplemental vaccination, p < 0.05). We also found a significant difference in mean scores between the micro-planning and projected census data on a number of <1 year (M = 26128, SD = 16828, micro-planning compared to M = 14154, SD = 4894, census, p < 0.05). CONCLUSION: Periodic household-based micro-planning, aided with the use of technology for validation remains a useful tool in addressing gaps in immunization planning, delivery and performance evaluation in developing countries, such as Nigeria with overestimated denominators.

Attitude and subjective wellbeing of non-compliant mothers to childhood oral polio vaccine supplemental immunization in Northern Nigeria.

BACKGROUND: Attitude and subjective well-being are important factors in mothers accepting or rejecting Oral Polio Vaccine (OPV) supplemental immunization. The purpose of the study was to determine the role of mothers' attitude and subjective wellbeing on non-compliance to OPV supplemental immunization in Northern Nigeria. METHODS: The study utilized a cross-sectional design to assess attitude and subjective well-being of mothers using previously validated VACSATC (Vaccine Safety, Attitudes, Training and Communication-10 items) & SUBI (Subjective Well-being Inventory-40 items) measures. A total of 396 participants (equal number of non-compliant and compliant mothers) from 94 non-compliant settlements were interviewed, after informed consent. T-test was run to assess difference in mean scores between the non-compliant and compliant mothers on VACSATC and SUBI measures. RESULTS: The research showed a significant difference in mean scores between the non-compliant and compliant groups on VACSATC measure of mothers' attitude (M = 18.9 non-compliant, compared to 26.5 compliant; p < 0.05). On subjective well-being, the study showed there was no significant difference in the mean scores of the SUBI measure (M = 77.4 non-compliant, compared to 78.0 compliant; p > 0.05). CONCLUSION: The research has shown that negative attitude is more commonly present in non-compliant mothers and may be a factor in vaccine refusal in Northern Nigeria.

Diagnosis of malaria in children's outpatient departments in Abuja, Nigeria.

Over-diagnosis of malaria has previously been described, especially in East Africa. Abuja is the capital of the most populous country in Africa. Over-prescription of artemisinin-based combination therapy (ACT) antimalarials in Nigeria on the scale reported from other countries will result in substantial unnecessary use of this class of drug. In a study of 1000 children seen in the outpatient paediatric clinics of four district hospitals in Abuja, 669 had history of fever, of whom 616 (92%) were diagnosed with malaria. Only 24 (3.8%) where confirmed by positive malaria slides. Of 82 malaria tests requested, 32 (40%) were not available when clinicians wrote their prescriptions. Of 256 children prescribed an ACT, 11 (4.4%) were test negative, eight (3.1%) test positive, in 11 (4.3%) the test was not available and the test was not requested for 219 (86%). The proportion of available negative slides for patients treated with an antimalarial was 23/26 (88%), which was similar to the 22/24 (91%) treated with an antimalarial who were test positive. Testing for malaria made almost no impact on ACT prescription or on all other antimalarials and antibiotics. Based on these findings there is high possibility of massive over prescription of antimalarials.