Background: Immunisation drop-out rate measures the effectiveness of the immunisation programme. When drop-outs exceed 10 percent it indicates a problem of utilisation of services. Receipt of vaccines at the recommended ages and intervals will ensure that children are adequately protected from target diseases at all times. Immunisation reminder and recall (RR) systems are cost-effective methods of improving adherence to recommended immunisation schedules. This study, therefore, determined the effect of immunisation reminders and recalls on reducing pentavalent vaccination drop-outs in Abakaliki. Materials and Methods: This is a quasi-experimental study among caregivers of infants in rural health facilities in Abakaliki, Nigeria. Mile-Four and St. Vincent hospitals in Izzi and Ebonyi Local Government Areas (LGA) of Ebonyi State were selected purposively. Mile-Four was assigned the phone reminder/recall intervention group and St. Vincent as a control group. The sample size was determined using the formula for comparing two proportions. Caregiver-child pair was enrolled into the two groups during the infants’ BCG or Pentavalent vaccines 1 immunisation visit and followed till the final scheduled immunisation visit for each child. Data were collected using questionnaire forms, proforma and checklist. Statistical Package for Social Science (SPSS) version 22.0 was used for analysis. Ethical approval was obtained from the Research and Ethics Committee (REC) of the Federal Teaching Hospital Abakaliki (FETHA), Nigeria. Results: The mean age of respondents were 26.6 ±4.9 years and 27.1±4.2 years in the intervention and control groups respectively. Thirty five point seven percent (35.7%) of infants dropped out of pentavalent vaccinnation 3 in pre-intervention phase when compared with 5.5% post-intervention. This difference in their proportions was found statistically significant (p<0.01). In the control group, 47.7% dropped out of pentavalent vaccination 3 at the beginning of the study when compared with 22.1% at the end of the study, a difference that was statistically significant (p=0.02). Out of 145 infants who received pentavalent vaccines 1 in both groups, 137 (94.5%) infants received pentavalent vaccines 3 in the intervention group while 113 (77.9%) infants received pentavalent vaccines 3 in the control group. Far distance to health facility predicted immunisation drop-out in the control group. It is 2.8 times more likely to cause immunisation drop-out than near distance to health facility. No predictor was found in the intervention group. Conclusion: Mobile phone reminders and recall has proven very effective in reducing pentavalent vaccines drop-out rate in Abakaliki. Implementation of immunisation reminders and recall systems are therefore recommended in immunisation clinics in developing countries especially in Nigeria for improved immunisation coverage in order to achieve Sustainable Developmental Goal 3 (SDG 3).
BACKGROUND: The "zero-dose" children are those without any routine vaccination or lacking the first dose of the diphtheria-tetanus-pertussis-containing vaccine. As per 2022 WHO/UNICEF estimates, globally, Nigeria has the highest number of zero-dose with over 2.3 million unvaccinated. METHODS: We used data from the 2021 Nigeria Multiple Indicator Cluster Survey - National Immunisation Coverage Survey to identify zero-dose and under-immunized children. Geospatial modelling techniques were employed to determine the prevalence of zero-dose children and predict risk areas with under-immunized at a high resolution of 1x1 km. RESULTS: Both zero-dose and under-immunized children are more prevalent in socially deprived groups. Univariate and multivariate Bayesian analyses showed positive correlations between the prevalence of zero-dose and under-immunized children with factors like stunting, contraceptive prevalence, and literacy. The prevalence of zero-dose and under-immunized children varies significantly by region and ethnicity, with higher rates observed in the country's northern parts. Significant heterogeneity in the distribution of under-vaccinated children was observed. CONCLUSIONS: Nigeria needs to enhance its immunization system and coverage. Geospatial modelling can help deliver vaccines effectively to underserved communities. By adopting this approach, countries can ensure equitable vaccine access and contribute to global vaccination objectives.
Anne Eudes Jean Baptiste, John Ndegwa Wagai, Susan J.M. Hahné et al.
Background: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic disrupted routine immunisation (RI) services. Reports from low- and middle-income countries remain inconsistent and under-represented. Objective: To evaluate the impact of the COVID-19 pandemic on RI, assess the perspectives of caregivers on service provision and pandemic preparedness in a Nigerian city. Methods: This cross-sectional study was conducted between December 2020 and February 2021 among consecutive mother-child pairs attending four high-volume immunisation clinics: a public primary, a secondary, a tertiary, and a private healthcare facility. Vaccine uptake and caregivers’ experiences were determined, while multivariable logistic regression models were used to predict missed immunisations. Results: A total of 416 mother-child pairs were enrolled. Males were 223 (53.6%), while children aged 7-12 months were 59.6% (248/416). Uptake of Expanded Programme on Immunisation vaccines were as follows: Bacillus Calmette
Babatunde Oluwatosin Ogunbosi, Michael Abel Alao, Joy N Alejoh et al.
Optimal (timely or cumulative age-appropriate) routine childhood immunization coverage (the receipt of every recommended vaccine dose at the recommended age and time-interval between doses) will enhance optimal protection against vaccine-preventable infectious diseases (VPDs) which have been causing significant morbidity and mortality and recurring outbreaks among children younger than five years. This study evaluated optimal routine childhood immunization coverage, and the predictors, in Ebonyi state, Nigeria. This study was a baseline cross-sectional household survey within a cluster-randomised controlled trial and was conducted from July 2 to 16, 2022 among consenting mother-child pairs, in which the children were aged 5-23 months (subdivided into 5-11 and 12-23 months), in 16 randomly selected geographical clusters where the primary health care (PHC) facilities were providing maternal and child health care services including weekly routine childhood immunization. Data was collected using structured interviewer-administered questionnaire in KoBoCollect in android devices. Vaccination data was collected from the vaccination cards of the children. Descriptive analysis and multivariate generalized estimating equations were carried out. Of 1262 children aged 5-11 months, 8.6% had optimal (timely or cumulative age-appropriate) receipt of every recommended birth to 14 weeks vaccine (this was 18.3% of the 596 who had received every recommended vaccine dose) and the median (IQR) receipt timeliness (age-appropriate vaccines receipt) score for the recommended birth to 14 weeks vaccines by these children was 79.3 (64.9-91.7). Of 1166 children aged 12-23 months, 2.9% had optimal receipt of every recommended birth to nine months vaccine (this was 10.6% of the 320 who had received every recommended vaccine dose) and the median receipt timeliness score for the recommended birth to nine months vaccines was 65.0 (45.8-84.4). The most significant predictor of optimal (timely or cumulative age-appropriate) routine childhood immunization coverage of every recommended vaccine was decrease in the travel time to immunization facility. Other predictors were having a mother who completed secondary or higher education, delivery at a health facility, decrease in the age of the husband of the mother, decrease in the birth order of the child, and urban/semi-urban residence. The evidence calls for policy actions and interventions to increase optimal routine childhood immunization coverage, and indicate specific factors to be considered, in the efforts to tackle the recurring outbreaks of VPDs.
Ugwu I. Omale, Cordis O. Ikegwuonu, Glory E. Nkwo et al.
BACKGROUND: The COVID-19 pandemic response diverted health systems resources to COVID-19 activities. Modelling studies and estimates based on administrative data indicate that the number of un- and under-vaccinated children increased during the pandemic, especially in the world's poorest countries. We investigated vaccination coverage and timeliness among children born in rural Guinea-Bissau before and during the pandemic. METHODS: Utilizing Bandim Health Project's nationally representative rural Health and Demographic Surveillance System, 12-month vaccination coverages and vaccination timeliness were assessed for all scheduled vaccines among children born in 2017 and 2020. Furthermore, proportions of fully-immunized children and out-of-sequence Bacillus Calmette-Guérin vaccine (BCG) and measles vaccine (MV) were assessed. Associations between background factors and coverages/out-of-sequence vaccinations were analysed for BCG, Pentavalent vaccine dose 3 (Penta3), and MV using mixed-effects logistic regression models with random effects for village cluster and health area. RESULTS: A total of 6809 children were included (2017: 3495, 2020: 3314). Coverage estimates ranged from 19 % to 99 % in the 2017 cohort and 40 % to 98 % in the 2020 cohort. Only BCG and oral polio vaccine, which were affected by stock-outs, had markedly lower 12-month coverages in the 2020 cohort compared with the 2017 cohort. When excluding vaccines affected by stock-outs, there was no difference in the proportions of fully-immunized children estimates between the two cohorts (66 % and 67 %). Delays were common but timeliness improved from 2017 to 2020 for all vaccines except BCG. Out-of-sequence BCG vaccinations were markedly more prevalent in the 2020 cohort (48 %) than in the 2017 cohort (27 %) while out-of-sequence MV vaccinations were similar across the cohorts. CONCLUSION: There are no indications that the pandemic substantially changed vaccination patterns. Changes in vaccination coverages were likely driven by stock-outs rather than changes in vaccination services or health system access/demand and were not reflected in timeliness of vaccination.
Julie Odgaard Vedel, Oides Furtado, Laerte Lima Almeida et al.
OBJECTIVE: Children from rural households are often deprived of adequate micronutrient intakes either from food or supplementation. The present study examines: (i) the determinants of households' micronutrient-rich food consumption; and (ii) the combined effect of vitamin A supplementation and micronutrient-rich food consumption on child stunting in households with different food allocation patterns. DESIGN: Cross-sectional study. Households' micronutrient-rich food consumption frequency and vitamin A supplementation were used as a proxy measure for child micronutrient intakes. Intra-household food allocation patterns were assessed from caregivers' perception of the disparity in food distribution within the household. Descriptive statistics and logistic regression were employed in analysing the study's objectives. SETTING: Rural communities in Kwara State, Nigeria.ParticipantsIncluded 419 children aged 6-59 months and 413 households. RESULTS: Owning small livestock and a refrigerator, knowledge of micronutrient-rich foods and higher parental education had strong associations with households' micronutrient-rich food consumption. Children from households that consumed micronutrient-rich foods and received more diverse diets were less likely to experience stunting. The combined effect of micronutrient-rich food consumption and vitamin A supplementation was stronger on the likelihood of stunting reduction than the separate effect of each. CONCLUSIONS: Assets ownership, human capital and knowledge of micronutrient-rich foods improve consumption of micronutrient-rich foods among the study population. Micronutrient supplementation to children with poor access to micronutrient-rich foods may not substantially enhance child growth unless reinforced through consumption of micronutrient-rich foods. Fruit and vegetable gardening, livestock holdings and nutrition education to parents should be integral parts of community nutrition programming.
Olusegun Fadare, George Mavrotas, Dare Akerele et al.
Abstract Background Proper nutrition is crucial for enhancing brain function and improving learning. Over time, large evidence has existed to show that childhood undernutrition, marked by stunting, is connected with age-long reduction in cognitive and academic achievement. It is of interest to achieve healthy growth and optimal cognitive development in early childhood. The objective of this study was to examine stunting considered to adversely influence cognitive development among children and therefore of public health importance. Results About two thirds (64.3%) of under-five children attained optimal cognition. Stunted children had 7% reduction in optimal cognitive development, compared with not stunted children (RR = 0.93; 95%CI 0.83, 0.98). Among the covariates, geographical region was significantly associated with optimal cognitive development. In addition, children of Islamic, traditional/other religion, and no religion had significant reduction in optimal cognitive development, compared with children of Christianity belief. Children from mothers who had secondary and tertiary education, listened to radio, and watched television had an increase in optimal cognitive development, compared with children from uneducated mothers. Furthermore, children from mothers who are employed had an 8% increase in optimal cognitive development (RR = 1.08; 95%CI: 1.02, 1.14). Conclusion Due to the adverse impact of stunting on optimal cognitive development, we suggest that government and stakeholders in child welfare should ensure that development programmes combine health and nutrition services with early learning and rely on families as partners to have children’s cognitive development effectively. Early childhood cognitive development programmes should be implemented through families and caregivers, with special focus on disadvantaged children as a poverty reduction strategy, and ensure that all children are adequately nourished.
Michael Ekholuenetale, Amadou Barrow, Charity Ehimwenma Ekholuenetale et al.
In Nigeria, the low status of women and inflexible gender gaps contribute to weak dietary diversity and chronic child malnutrition. Child malnutrition is persistent,despite several interventions which fail to capture the need to empower women to improve the menace. In this study, the influence of women empowerment on child nutrition in rural Nigeria was therefore examined. Secondary data were sourced from General Household Survey Panel 2015-2016. Data were analyzed using the descriptive statistics, Modified Women Empowerment Index, Ordinary Least Square regression and Instrumental Variables techniques to correct for potential endogeneity. The result shows that majority (over 90%) of the households consumed cereals, vegetables, oils and fat, and spices, condiments and beverages while the least consumed food groups were milk and milk products (36%) and eggs (11%). It was also found that on average, women had less than two empowerment indicators implying low empowerment among women. Meanwhile, women empowerment significantly increased the household dietary diversity and consequently reduces the probability of child stunting. Therefore, the findings from this study lend support to the claims that woman empowerment remains a pathway out of cycle of weak dietary diversity and consistence child malnutrition in rural Nigeria.
Mutiat Bukola Salawu, Abubakar Rufai, K. K. Salman et al.
Child nutrition and health indicators are crucial for monitoring child growth and predicting health outcomes. Poor health in early childhood can negatively affect cognitive abilities and academic achievement, while poor nutritional indicators have been linked to lower academic performance in children. This study was aimed at assessing child nutrition and health indicators as predictors of academic performance among primary school children in Binduri District, Ghana. Overall, 460 children from 63 schools were studied to assess the relationship between child nutrition, health indicators, socioeconomic status and academic performance. Data was collected through questionnaires, height/weight measurements, and academic records. Statistical methods such as Chi-squared tests and binary regression were used to determine associations with a 95% confidence level and 5% precision. Overall, stunting (cOR =2.44, 95% CI: 1.17-5.11, p=0.018) and thinness (a OR=11.75, 95% CI: 3.99-34.60, p<0.0001) were significantly associated with poor academic performance, while wasting and overweight were not. Second intermittent preventive treatment in infants is strongly associated with poor academic performance (a OR=6.50, 95% CI: 2.02-20.89, p=0.002), while yellow fever vaccination at 9 months is negatively associated with poor academic performance (c OR=0.21, 95% CI: 0.05-0.88, p=0.032). Children aged 11-14 years (OR=0.40, 95% CI: 0.22-0.71, p=0.002), Muslim children (a OR=2.14, 95% CI: 1.04-4.41, p=0.039), public school attendees (a OR=6.58, 95% CI: 2.13-20.32, p=0.001) children with separated or divorced parents (a OR=7.22, 95% CI: 2.85-18.31, p<0.0001) all had significant associations with poor academic performance. This study highlights the association between child nutrition, health indicators and academic performance in primary school children in Ghana’s Binduri District. Interventions to reduce stunting and thinness and increase access to yellow fever vaccination should be prioritized. School policies should also consider demographic factors affecting academic performance to provide targeted support to at-risk students.
Alfred Apubuos Azure, Faith Agbozo, Francis Bruno Zotor
This study examined factors and teacher practices that foster compassion in Ghanaian kindergarten classrooms. Situated within the sociocultural theory, the study sought to understand how compassion is enacted and nurtured by teachers in early childhood education settings. Data were collected from eight public Kindergarten teachers in the Cape Coast Metropolis through semi- structured interviews, allowing for in-depth exploration of teachers‘ perspectives and classroom practices. The data were analysed thematically to identify recurring patterns. The findings revealed that compassion is socio culturally entrenched and shaped by broader societal values, norms and religious teachings that emphasise care, reciprocity and love. Teachers drew on these cultural and moral elements to cultivate compassionate disposition among young children. Pedagogical strategies such as storytelling, guided peer interactions, role modelling and the creation of learning centres within the kindergarten classroom also emerged as key teacher practices for fostering compassionate behaviour. In addition, teachers organised community visits that allowed children to observe and experience compassion in action in real-life situations, while parental involvement and support further reinforced children’ s learning and behaviour beyond the classroom environment, highlighting the interconnected roles of school, home and community. Together, these findings call for the need for policy and pedagogical shifts that embed compassion within teacher education, curriculum design, and school culture. Such integration would ensure that compassion becomes a lived educational outcome rather than a peripheral moral and social outcome.
