Impact of COVID-19 pandemic on immunization services in Nigeria; A preliminary report by Paediatric Association of Nigeria (PAN)

Background: Since the onset of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic also known as Coronavirus disease 2019 (COVID-19) beginning in Wuhan, China in December 2019 and spreading to Nigeria in February 2020 (as well as the rest of the world), there have been enormous resultant impact on health, social, emotional and economic aspects lives and services. The disease as well as its mitigation measures have negatively affected other aspects of lives and health services. This paper aims to assess the preliminary effects on immunization services, blow the whistle and suggest measures to limit these effects. Methods: Data was obtained by interviews and use of a structured proforma from Immunization Field Experts/Consultants working with national and international agencies in four states, heads of immunization units, officers in charge of immunization centres and facility immunization records from seven sites across Nigeria. Results: There were disrupted immunization services with total absence of outreach services and campaigns, limited fixed sessions, disease outbreaks, general drop in number of immunized children. These were thought to be due to the lockdown effects, fears, rumours and panic among others. Outright routine vaccines amongst rejections were also reported. Conclusion: Reports suggest that the pandemic and its mitigation measures are affecting immunization services in terms of demand/ access (physical and economic), services and logistics with overall drop in coverage and rise in dropout rates. The effects are still unfolding. It does not appear that health facilities are monitoring and interrogating their data with a view to making specific response action plans. All stakeholders in immunization (Government, non- governmental and professional organizations, the media, traditional / religious institutions) should work to flood the mainstream / social media with positive messages on immunization; monitor immunization progress by ongoing data collection, collation, analysis, interpretation and action; actively counter rumours and anti- vaccine messages and plan for post COVID 19 intensification/ catch- up

Rotavirus diarrhoea hospitalizations among children under 5 years of age in Nigeria, 2011-2016.

BACKGROUND: The high burden of rotavirus acute gastroenteritis (AGE) is well documented among children under 5 years of age, with the majority of mortality occurring in developing countries. Nigeria ranked second worldwide in the number of rotavirus deaths in 2013. As Nigeria plans to introduce rotavirus vaccine soon, a pre-vaccine documentation of rotavirus disease burden is necessary to determine vaccine impact. METHODS: Routine rotavirus surveillance was conducted during 2011-2016 in 3 sentinel sites in Nigeria using the standard WHO protocol. Children under 5 years of age hospitalized for acute gastroenteritis were enrolled and demographic, clinical and outcome data were collected. A stool sample was subsequently obtained and tested for human rotavirus antigen using the Enzyme-linked immunosorbent assay (ELISA). RESULTS: 2694 children with acute gastroenteritis were enrolled during January 2011 to December 2016; of these, 1242 (46%) tested positive for rotavirus. Among the rotavirus positive cases, 66% and 94% were younger than 12 months and 24 months respectively. Marked peaks in rotavirus positivity were seen in January of each year. Vomiting, and use of oral and intravenous fluids occurred more often in rotavirus positive cases as compared to rotavirus negative cases. CONCLUSION: The high prevalence of rotavirus disease highlights the need for urgent introduction of rotavirus vaccine in Nigeria. Additionally, this study provides pre-vaccine introduction disease-burden data that will serve as a baseline for rotavirus vaccine impact-assessment once vaccine has been introduced in the national immunization program.

Evaluation of the School Environment of Public and Private Schools in Enugu to Ensure Child Health Promotion.

OBJECTIVES: Poor maintenance of school environment can cause or worsen illnesses among schoolchildren. The objective of this study was to assess the healthfulness of school environments of primary schools in Enugu East, Nigeria, and to compare the difference if any between public and private schools. STUDY DESIGN: This was a cross-sectional noninterventional study of the school environments in Enugu East, Nigeria. METHODS: Multistage sampling method was used to select the sample population. The participating schools were inspected and their head teachers were interviewed using a questionnaire. Scores were awarded using the School Health Program Evaluation scale. Results: Thirty-three schools were studied. The most common source of water for most schools was well. Eleven schools dump refuse openly. Three public schools only had functional toilets. All public schools were adequately ventilated and lit. One private school had a foodservice area. Ten schools did not have a play field, while three public schools had soaps for handwashing. The mean scores for public and private schools were 33.00 and 37.86, respectively. Three schools only attained the minimum score of 57 of a maximum of 66. CONCLUSION: The environment of primary schools in Enugu east, Nigeria, is unhealthy and unfriendly and currently cannot promote and protect the health of the schoolchildren.