Factors affecting poor measles vaccination coverage in sub-Saharan Africa with a special focus on Nigeria: a narrative review.

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.

Building a national framework for multicentre research and clinical trials: experience from the Nigeria Implementation Science Alliance.

There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement sessions, and established a governance structure. Additionally, we selected and trained a core research team, developed criteria for site selection, assessed site readiness for research and obtained ethical approval from a single national institutional review board. We used the Exploration, Preparation, Implementation, Sustainment framework to guide our reporting of the process in the development of this network. The NISA-MIRCs will provide a nationally representative infrastructure to initiate new studies, support collaborative research, inform policy decisions and thereby fill a significant research infrastructure gap in Africa's most populous country.