DECENTRALIZED IMMUNIZATION MONITORING: LESSONS LEARNED FROM FOUR STATES - NIGERIA

Area of Science:

• Public Health
• Epidemiology
• Health Services Research

Background:

• Low immunization coverage in Nigeria results in 2.3 million children receiving zero vaccine doses, contributing to increased morbidity and mortality.
• The Nigerian government has prioritized 100 local government areas for interventions to reduce zero-dose children by 15% by 2024.

Purpose of the Study:

• To track immunization performance and identify key indicators.
• To estimate vaccine coverage rates among children.
• To generate evidence for informed decision-making to improve immunization programs.

Main Methods:

• A cross-sectional study was conducted in Kano, Sokoto, Borno, and Bauchi states, involving 4,028 children across 106 wards.
• Validated behavioral and social drivers of immunization (BeSD) and lot quality assurance sampling (LQAs) frameworks were utilized.

Main Results:

• The prevalence of zero-dose children was 30.7%, with caregivers often lacking formal education and income.
• Barriers to vaccination included low intention to vaccinate, distrust in healthcare workers, and affordability challenges, particularly in Bauchi and Sokoto states.
• Despite most caregivers living within a trekkable distance to services, uptake was suboptimal, with only 73% of children receiving at least one antigen.

Conclusions:

• Targeted outreach strategies, including financial aid, education, and community engagement, are essential to increase vaccination rates.
• Improving service delivery, accessibility, and providing clear information on service points are crucial for enhancing immunization uptake.
• Addressing vaccine hesitancy and socioeconomic factors among caregivers is vital for reducing the burden of zero-dose children in Nigeria.