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

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

Designing an SMS reminder intervention to improve vaccination uptake in Northern Nigeria: a qualitative study.

BACKGROUND: Penta3 coverage in Nigeria was low at 33 % in 2017. The most reported reason for non-vaccination was lack of knowledge about the immunization place, time, and need. To address knowledge gaps and improve vaccination uptake, we designed an Immunization Reminder and Information SMS System (IRISS) to educate and remind parents/caregivers about immunization using SMS. A formative study was conducted to understand the contextual and behavioural factors that would inform the IRISS intervention design and implementation. METHODS: We conducted the study in four Local Government Areas (LGAs) of Kebbi State Nigeria in October 2018, amongst a diverse selection of participants. Data on social norms about vaccinations, barriers to immunization uptake, mobile phone use, SMS message testing, and willingness to accept SMS reminders were collected from focus group discussions (N = 11), in-depth interviews (N = 12), and key informant interviews (N = 13). In addition, we assessed 33 messages covering schedule reminders, normative, motivational, educational, and informative contents for clarity, comprehensibility, relevance, cultural appropriateness, and ability to motivate action among community members from Argungu and Fakai LGAs. All interviews were analyzed using a thematic analysis approach. RESULTS: We interviewed 135 people, and 90 % were community members. While we found positive perceptions about immunizations among those interviewed, pockets of misconceptions existed among community members. Lack of awareness on the importance of vaccination was a consistent reason for under-vaccination across the LGAs. In addition, most community members do not own phones, could not read SMS messages, and were unaware of how to check/open text messages received. Despite concerns about low literacy levels and phone ownership, community members still saw a role in SMS reminders when phone owners receive messages. For instance, community leaders can disseminate said messages to community members through existing channels such as town announcers and religious gatherings. Therefore, the SMS becomes a source of information, with phone owners acting as a conduit to community dissemination mechanisms. We generally found the tested messages to be relevant, motivating, and culturally acceptable. CONCLUSIONS: SMS reminders have the potential to bridge the information gap in community awareness for vaccination, which can translate to improved immunization uptake. In rural communities with low literacy levels and phone ownership, immunization information can be disseminated when existing community leadership structures are engaged.

ESBL Producing E. coli in Chickens and Poultry Farms Environment in Selangor, Malaysia: A Cross-Sectional Study on Their Occurrence and Associated Risk Factors With Environment and Public Health Importance.

INTRODUCTION: Extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) are widespread multidrug-resistant zoonotic bacteria that threaten animal production, food safety and antimicrobial therapy worldwide including Malaysia. Poultry has been reported as one of the pathways for human exposure to ESBL-EC. There has been little research on the occurrence of ESBL-EC within the Malaysian poultry food chain. Hence, the objectives of the study were to determine the occurrence of ESBL-EC in chickens and to identify the potential risk factors associated with their occurrence in poultry farms. METHODS: A cross-sectional study was conducted on 400 samples, consisting of 240 cloacal swabs from chickens and 160 from poultry farms environments in eight districts in Selangor, Malaysia using culture and disk combination methods and multiple polymerase chain reaction assays. In the determination of possible factors associated with the presence of ESBL-EC at poultry farms, a questionnaire was used to obtain the information and data. RESULTS: The findings demonstrated the wide distribution of ESBL-EC in all the farms with an overall occurrence of 37.2%. Farms in Gombak, Klang and Hulu Selangor had the highest occurrence rates at 62%, 50% and 50%, respectively, followed by farms in Petaling 38%, Sepang at 34%, Kuala Langat at 26% and Kuala Selangor at 24%, and the lowest was in Hulu Langat 14%. Among the study samples, chickens had the highest occurrence rate at 45.4%, followed by chicken house floors at 40% and flies at 30%, while feed and water samples at 17.5% and 12.5%, respectively. The present study indicated the high occurrence and wide dissemination of ESBL-EC in chickens and poultry farms environment. The ESBL-EC occurrence was associated with several factors including imprudent use of antibiotics, poor husbandry, management and biosecurity practices at the farms. CONCLUSIONS: Our study showed the presence and spread of ESBL EC among chickens in the farms and their environment; this may lead to being spread to outside of farm environment by flies, vermins, flying birds, litter and farm wastes and possibly to humans upon contact with the contaminated environment and by poultry meat. Thus, the findings of the study can assist to serve as a piece of useful information to veterinary authority in designing evidence-based mitigation strategies for the control of ESBL-EC in poultry farms.