NIGERIA ROUTINE IMMUNIZATION IN NIGERIA. 31% of children who received the 1st dose of pentavalent vaccine did not get all 3 doses

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Vivian Smith
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MICS/NICS 206/7 NIGERIA 206 207 PROGRESS TOWARD GVAP GOALS Penta3 coverage 00% goal 90% goal States with 80% penta3 coverage NATIONAL IMMUNIZATION COVERAGE SURVEY (NICS): National Brief ROUTINE

Surviving birth cohort: RED Immunization Category 2: Good coverage Access, in Poor Nigeria Utilization is below GVAP goals, putting a substantial number of children at risk of vaccine preventable

BACKGROUND Nigeria conducted a national survey of routine immunization coverage among children 2-23 months of age in 206/7.

IMMUNIZATION COVERAGE ACROSS NIGERIA 3% of children who received the st dose of pentavalent vaccine did not get all 3 doses in 3 children received three doses of pentavalent vaccine 40% of

Nigeria % [95% CI] Africa 3 % First dose of pentavalent vaccine (penta) 49 [46, 5] 83 Third dose of pentavalent vaccine (penta3) 33 [3, 35] 74 Dropout between penta and penta3 dose 2 3 First dose

1 MICS/NICS 206/7 NIGERIA PROGRESS TOWARD GVAP GOALS Penta3 coverage 00% goal 90% goal States with 80% penta3 coverage NATIONAL IMMUNIZATION COVERAGE SURVEY (NICS): National Brief ROUTINE IMMUNIZATION IN NIGERIA 33% 3% Nigeria is committed to the Target: goals of 90% the coverage Global Vaccine all districts Action Plan (GVAP). Surviving birth cohort: RED Immunization Category 2: Good coverage Access, in Poor Nigeria Utilization is below GVAP goals, putting a substantial number of children at risk of vaccine preventable diseases. Immunization coverage varies across Nigeria but improvements are needed in every state. BACKGROUND Nigeria conducted a national survey of routine immunization coverage among children 2-23 months of age in 206/7. This brief summarizes findings from the survey to identify gaps in immunization coverage and guide immunization programs. IMMUNIZATION COVERAGE ACROSS NIGERIA 3% of children who received the st dose of pentavalent vaccine did not get all 3 doses in 3 children received three doses of pentavalent vaccine 40% of children did not receive any vaccines from the health system even though most live close to a health facility NATIONAL IMMUNIZATION COVERAGE INDICATORS Among children aged 2-23 months of age: Nigeria % [95% CI] Africa 3 % First dose of pentavalent vaccine (penta) 49 [46, 5] 83 Third dose of pentavalent vaccine (penta3) 33 [3, 35] 74 Dropout between penta and penta3 dose 2 3 First dose of measles vaccine (MCV) 42 [40, 44] 72 Availability of child health card 29 [27, 3] - Crude coverage based on child health cards or parental recall. Values reported as weighted percentages (%) with two-sided 95% confidence intervals. 2 Dropout defined as percentage of children who received penta but did not complete 3-dose penta series. Dropout calculation for Africa region is not directly comparable to Nigeria estimate. 3 WHO/UNICEF estimates, 206. Penta Coverage Penta3 Coverage Fully Vaccinated

COMPLETENESS OF ROUTINE IMMUNIZATION The benefits of

Substantially more children are fully immunized in South

Lack of awareness is the main reported reason children are

REASONS CHILDREN ARE NOT FULLY VACCINATED 23% thought child

far 42% 25% Lack of awareness % had no faith in immunization

Mistrust or fears Note: Respondents could identify more than

GAPS IN ROUTINE IMMUNIZATION Note: Respondents could

Lack of time or other family issues 77% of children aged

2 COMPLETENESS OF ROUTINE IMMUNIZATION The benefits of vaccines are optimized when children receive all recommended vaccine doses. Only in 4 children received all recommended vaccines. Substantially more children are fully immunized in South South, South West and South East zones. Lack of awareness is the main reported reason children are not fully vaccinated. REASONS CHILDREN ARE NOT FULLY VACCINATED 23% thought child was fully immunized 2% reported immunization site was too far 42% 25% Lack of awareness % had no faith in immunization Service delivery issues 9% reported caretaker too busy 22% Mistrust or fears Note: Respondents could identify more than one reason for incomplete immunization. GAPS IN ROUTINE IMMUNIZATION Note: Respondents could identify more than one reason for incomplete vaccination 8% Lack of time or other family issues 77% of children aged 2-23 months did not receive all routine immunizations 37% received some but not all vaccines from routine immunization 40% did not receive any vaccines from routine immunization Includes BCG, OPV-3, penta-3 & measles vaccine

3 COVERAGE OF 3 rd DOSE OF PENTAVALENT VACCINE BY STATE Note: Crude coverage for 3rd dose of pentavalent vaccine by state. Initials (LA) represent coverage estimate and bars represent 95% confidence interval. Penta3 coverage estimate represented in brackets [%] next to state name. National average is 33% [95% CI: 3, 35]. DISPARITIES IN IMMUNIZATION COVERAGE yrs Penta3 Coverage (%) Note: Penta3 crude coverage (%) represented by circles. Bars represent upper and lower bounds of two-sided 95% confidence interval. Wealth index quintile shows the poorest 20% and richest 20% of population. Immunization coverage varies dramatically across Nigeria but improvements are needed in every state. All states fall below the global goal of 90% coverage for 3 doses of pentavalent vaccine. Immunization performance is weakest in North East or North West zones where every state falls below 50% penta3 coverage. Children in rural areas are half as likely to be vaccinated as those is urban areas. in 4 children in rural areas receive 3 pentavalent doses in 0 children of poorest families receive all 3 pentavalent doses Children of younger and less educated caretakers are at greatest risk.

AVAILABILITY OF CHILD HEALTH CARDS Child health cards are an important part of a child s health records and critical

In Nigeria, only in every 3 children had a child health card.

States with low immunization coverage also had low card availability rates.

caretaker showed a child health card at the time of the survey.

health system among children aged 2-23 months. Planning for NICS began in early 205.

NICS was conducted among children who were aged 2-23 months by August 206 - January 207.

How were the field workers trained? Field staff were trained for one month. Who conducted the survey?

National Bureau of Statistics (NBS) in cooperation with state Bureau of Statistics in Kano and Lagos.

4 AVAILABILITY OF CHILD HEALTH CARDS Child health cards are an important part of a child s health records and critical for evaluating whether children have received their vaccinations. In Nigeria, only in every 3 children had a child health card. Availability of child health cards varied across Nigeria. States with low immunization coverage also had low card availability rates. AVAILABILITY OF CHILD HEALTH CARDS BY STATE Note: State initials (LA) represent percentage of children whose caretaker showed a child health card at the time of the survey. Bars represent upper and lower 95% confidence intervals. National average is 29% [95% CI: 27, 3]. ABOUT THE SURVEY What is NICS? An immunization coverage survey conducted in Nigeria to assess coverage of vaccine antigens provided through the health system among children aged 2-23 months. Planning for NICS began in early 205. Field work was conducted August January 207. Which cohort of children was evaluated in NICS? NICS was conducted among children who were aged 2-23 months by August January 207. These children should have received their vaccines between August 204 and December 206. How were the field workers trained? Field staff were trained for one month. Who conducted the survey? The survey was commissioned by the National Primary Healthcare Development Agency (NPHCDA) and conducted by the National Bureau of Statistics (NBS) in cooperation with state Bureau of Statistics in Kano and Lagos. Experienced field workers, primarily females, were selected from each state to facilitate communication with mothers of children. Where was NICS conducted? NICS was conducted in all 36 states and FCT, Abuja. Approximately 40,000 households were selected and 6,268 children were enrolled. The results provide valid national and state level immunization coverage for children aged 2-23 months, while in Kano and Lagos, estimates are provided at the state and senatorial district level. In Yobe and Borno, <80% of selected clusters could be accessed and results are representative of areas where the survey could be conducted.

5 BCG Hep B at birth Percentage (%) of children aged 2-23 months who received: Polio at birth Polio Penta Yellow fever Measles Card MCV Full 2 seen Children age 2-23 mo. NIGERIA ,268 North Central FCT-Abuja Benue Kogi Kwara Nasarawa Niger Plateau North East ,346 Adamawa Bauchi Borno Gombe Taraba Yobe North West ,468 Jigawa Kaduna Kano Katsina Kebbi Sokoto Zamfara South East Abia Anambra Ebonyi Enugu Imo South South Akwa Ibom Bayelsa Cross River Delta Edo Rivers South West Ekiti Lagos Ogun Ondo Osun Oyo Does not include vaccines administered through campaigns. 2 BCG, OPV-3, penta-3 & measles from health system.

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