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Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service
Kurayi Mahachi1, Joss Kessels2, Kofi Boateng3
1College of Public Health, University of Iowa, Iowa City, Iowa, United States.
Insights
Millions of Nigerian children are unvaccinated due to missed or zero-dose status, facing risks from preventable diseases. Key factors include maternal influences, community disparities, access to care, and immunization awareness, highlighting a need for better routine vaccination strategies.
Area of Science:
- Public Health
- Immunization Science
- Global Health
Background:
- Millions of children globally remain unvaccinated, missing routine immunization schedules ('zero-dose' or 'missed dose').
- Nigeria accounts for a significant proportion of these unvaccinated children, particularly vulnerable due to socioeconomic and health access challenges.
- Understanding the drivers of vaccine hesitancy and access barriers is crucial for improving childhood immunization coverage.
Purpose of the Study:
- To synthesize recent literature on risk factors and interventions for zero-dose and missed-dose children in Nigeria.
- To identify key determinants influencing childhood vaccine uptake within the Nigerian context.
- To highlight evidence gaps in the delivery of effective and sustainable routine immunization programs.
Main Methods:
- A scoping review methodology was employed to systematically search and synthesize relevant literature.
- The review analyzed 127 publications focusing on risk factors, interventions, or recommendations for childhood immunization in Nigeria.
- Data extraction focused on identifying frequently reported factors and intervention types.
Main Results:
- Maternal factors (education, antenatal/perinatal care), community heterogeneity (location, wealth, religion), access to vaccination services (proximity), and awareness of immunization (safety, efficacy, schedule) were the most cited risk factors.
- Literature on interventions was scattered, with a strong emphasis on vaccination campaigns and polio eradication, indicating a gap in routine immunization strategies.
- Significant evidence gaps exist regarding the effective and sustainable delivery of routine childhood immunization.
Conclusions:
- Addressing childhood immunization gaps in Nigeria requires a multi-faceted approach targeting maternal factors, community-specific needs, service accessibility, and public awareness.
- There is a critical need for further research and operationalization of findings to develop robust and sustainable routine immunization interventions.
- Nigeria's vaccination plans should incorporate insights from this review to improve coverage and reduce the burden of vaccine-preventable diseases.
Abstract:
'Zero-dose' refers to a person who does not receive a single dose of any vaccine in the routine national immunization schedule, while 'missed dose' refers to a person who does not complete the schedule. These peopleremain vulnerable to vaccine-preventable diseases, and are often already disadvantaged due to poverty, conflict, and lack of access to basic health services. Globally, more 22.7 million children are estimated to be zero- or missed-dose, of which an estimated 3.1 million (∼14 %) reside in Nigeria.We conducted a scoping review tosynthesize recent literature on risk factors and interventions for zero- and missed-dosechildren in Nigeria. Our search identified 127 papers, including research into risk factors only (n = 66); interventions only (n = 34); both risk factors and interventions (n = 18); and publications that made recommendations only (n = 9). The most frequently reported factors influencing childhood vaccine uptake were maternal factors (n = 77), particularly maternal education (n = 22) and access to ante- and perinatal care (n = 19); heterogeneity between different types of communities - including location, region, wealth, religion, population composition, and other challenges (n = 50); access to vaccination, i.e., proximity of facilities with vaccines and vaccinators (n = 37); and awareness about immunization - including safety, efficacy, importance, and schedules (n = 18).Literature assessing implementation of interventions was more scattered, and heavily skewed towards vaccination campaigns and polio eradication efforts. Major evidence gaps exist in how to deliver effective and sustainable routine childhood immunization. Overall, further work is needed to operationalise the learnings from these studies, e.g. through applying findings to Nigeria's next review of vaccination plans, and using this summary as a basis for further investigation and specific recommendations on effective interventions.
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