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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
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Decentralized Immunization Monitoring: Lessons Learnt from a Pilot Implementation in Kumbotso LGA, Kano State,

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Low immunization coverage in Nigeria is linked to caregiver education and rural residence. Targeted interventions are crucial to reduce zero-dose children and improve routine vaccination rates.

Keywords:
immunization surveyslot quality assurance samplingservice deliverysocial determinants of immunizationvaccination coveragevaccine hesitancyzero dose children

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Area of Science:

  • Public Health
  • Vaccinology
  • Health Systems Research

Background:

  • Low immunization coverage in Nigeria necessitates understanding contextual factors influencing vaccine uptake.
  • A pilot study in Kumbotso LGA, Kano State, aimed to identify underperforming wards and barriers to routine immunization (RI).
  • The goal was to reduce unvaccinated children and Zero-Dose (ZD) children, defined as those not receiving their first diphtheria-pertussis-tetanus (DPT) vaccine.

Purpose of the Study:

  • To pilot a Decentralized Immunization Monitoring (DIM) approach using Lot Quality Assurance Sampling (LQAS) and the Behavioural and Social Drivers of Vaccination (BeSD) framework.
  • To identify specific wards with low vaccination rates and analyze the underlying barriers and facilitators.
  • To inform improvements in routine immunization programs to increase vaccine uptake and reduce ZD children.

Main Methods:

  • Cross-sectional study design employing LQAS and the BeSD framework.
  • Study population included caregivers of children aged 0-23 months across 11 wards in Kumbotso District.
  • Segmentation sampling and probability proportionate to size (PPS) sampling were used to select 209 settlements for data collection.

Main Results:

  • Prevalence of delayed vaccination was 21.9% (4.5-11 months) and ZD was 26.8% (12-23 months); 71.4% and 89.1% respectively remained unvaccinated.
  • Lower caregiver education, rural residence, and home births were associated with delayed/ZD status (p < 0.05).
  • Negative vaccine perceptions (50-53.6%) and distrust in health workers (46.4-48.2%) were significant barriers; caregiver intent to vaccinate was protective (OR: 0.27).

Conclusions:

  • LQAS and BeSD effectively identified low-performing wards and immunization gaps in Nigeria.
  • Key barriers included low caregiver education, rural settings, and negative vaccine perceptions; higher education and urban residence were protective.
  • Targeted interventions addressing education, trust, and systemic issues are essential for equitable vaccination and reducing ZD children.