Peer-reviewed article
Assessment of Childhood Immunisation Services in Kano and Lagos States, Nigeria: A Mixed-methods Study
AdekunleGaniyu Salaudeen, Oladimeji Akeem Bolarinwa, Catherine R. McGowan, Drichi Daniel, Mervat Alhaffar et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at how well childhood vaccination services work in Kano and Lagos States, Nigeria. Researchers talked to caregivers and health workers and watched vaccination sessions to understand why many children are not fully vaccinated or receive no vaccines at all. They found that while many caregivers were satisfied with the services, there were problems with staffing, facilities, and how programmes are planned and delivered. The study suggests these problems are linked together and that fixing them could improve vaccination rates.
Key points
- About a third of children aged 12-23 months in Nigeria receive all basic recommended vaccines, and about 18% get none (zero-dose).
- Caregivers reported high satisfaction with vaccination services in exit interviews despite identified problems.
- Staffing issues included too few staff, poor communication with caregivers, and sometimes unfriendly attitudes.
- Facilities were often unwelcoming or uncomfortable, and vaccine shortages occurred occasionally.
- Programme design problems included poor planning, lack of service integration, and insufficient resources for outreach and transport.
Limitations
The study describes problems in service delivery but does not test or measure the effect of any specific solution or intervention.
Abstract
Background Recent evidence suggests that just over a third of children aged 12–23 months in Nigeria have received basic antigens as recommended by the expanded programme on immunisation schedule; just over a quarter have received all first year antigens. Approximately 18% of children in Nigeria are classified as ‘zero-dose’. We assessed the status of immunisation services in Kano and Lagos States of Nigeria to inform the design of interventions to address high numbers of zero-dose and under-immunised children in these states. Methods We used a mixed-methods study design. We collected information from caregivers (including female and male caregivers; and caregivers of zero-dose, under-immunised, and immunised children), and healthcare workers. We conducted focus groups and key informant interviews amongst caregivers of zero-dose and non-zero-dose children. We interviewed caregivers and observed vaccination sessions. We carried out facility observation of vaccination sessions. Data collection tools were adapted from the WHO expanded programme on immunisation review guidelines. Results Whilst we identified many positive practices - and exit interviews suggested high satisfaction with vaccination services - we identified important areas for improving services. Specific challenges related to the: 1) staff (including insufficient staff to operate vaccination activities, poor information exchange with caregivers, low planning capacity, sub-optimal health and safety practices, and abrasive healthcare worker attitudes); 2) facility (including unwelcoming and uncomfortable facility environments and occasional vaccine shortages), and 3) programme design/delivery (including poor planning/service integration, and insufficient resources for transportation/outreach services). Conclusion We suspect that many of the identified challenges are interrelated (e.g. insufficient staff numbers, and an uncomfortable facility environment, may contribute to poor interaction between healthcare workers and caregivers) and that addressing some of these challenges may have cascading effect on vaccination coverage. A better understanding of improving service design and delivery to incentivise visits to vaccination services is needed.