Missed opportunities for vaccination among children aged 0-23 months visiting health facilities in a southwest State of Nigeria, December 2019.

BACKGROUND: Despite efforts to improve childhood immunization coverage in Nigeria, coverage has remained below the national acceptable level. In December 2019, we conducted an assessment of Missed Opportunities for Vaccination (MOV) in Ondo State, in Southwest Nigeria. The objectives were to determine the magnitude of, explore the reasons for, as well as possible solutions for reducing MOV in the State. METHODS: This was a cross-sectional study using a mixed-methods approach. We purposively selected 66 health facilities in three local government authorities, with a non-probabilistic sampling of caregivers of children 0-23 months for exit interviews, and health workers for knowledge, attitudes, and practices (KAP) surveys. Data collection was complemented with focus group discussions and in-depth interviews with caregivers and health workers. The proportion of MOV among children with documented vaccination histories were determined and thematic analysis of the qualitative data was carried out. RESULTS: 984 caregivers with children aged 0-23 months were interviewed, of which 869 were eligible for inclusion in our analysis. The prevalence of MOV was 32.8%. MOV occurred among 90.8% of children during non-vaccination visits, and 7.3% during vaccination visits. Vaccine doses recommended later in the immunization series were given in a less timely manner. Among 41.0% of health workers, they reported their vaccination knowledge was insufficient. Additionally, 57.5% were concerned about and feared adverse events following immunization. Caregivers were found to have a low awareness about vaccination, and issues related to the organization of the health system were found to contribute towards MOV. CONCLUSIONS: One in three children experienced a MOV during a health service encounter. Potential interventions to reduce MOV include training of health workers about immunization policies and practices, improving caregivers' engagement and screening of vaccination documentation by health workers during every health service encounter.

Confidential enquiries into maternal deaths in Ondo State, Nigeria - a comparative analysis.

BACKGROUND: Paucity of data on state-wide maternal mortality in Nigeria hampers planning, monitoring and evaluation of the impact of interventions. The Confidential Enquiry into Maternal Deaths in Ondo State was initiated to overcome this problem. This study aimed to compare trends of maternal mortality ratios, causes of deaths, geographical distribution and other associated factors in 12-monthly reports of the Confidential Enquiry into Maternal Deaths in Ondo State. METHODS: Notification forms were distributed throughout the State to focal persons and medical records officers at community and facility levels, respectively. Maternal deaths, as defined in the International Classification of Diseases 10th version, were recorded prospectively over 3 years from 1st June 2012 to 30th May, 2015. Forms were submitted, collated and data analysed by a multidisciplinary review committee. RESULTS: Reported numbers of maternal deaths (and maternal mortality ratios) were 114 (253 per 100,000 births), 89 (192) and 81 (170), respectively per year, indicating a 33% reduction in maternal mortality ratio over the course of the study period. Assuming that the confidential enquiry process was the only intervention at the time aimed at reducing maternal mortality, simple linear regression with a correlation coefficient of 0.9314, showed a relationship though the difference in the values were not statistically significant (95% CI = - 184.55 to 101.55, p = 0.169). Postpartum haemorrhage and eclampsia were the leading causes of deaths. CONCLUSION: There was a trend of reduction in maternal mortality ratio during the period of study with postpartum haemorrhage as the major cause of death. The positive association between the confidential enquiry reports and maternal mortality ratios make us recommend that our model be adopted in other states and at the federal level.