Immunisation services in North-Eastern Nigeria: perspectives of critical stakeholders to improve uptake and service delivery

We investigated the perspectives of parents, health workers (HWs) and traditional medical practitioners (TMPs) on immunisation advocacy, knowledge, attitudes and immuni sation practice and ways of improving immunisation uptake in Borno State, North eastern Nigeria. A cross sectional study analysing quantitative data from the three stakeholders' categories. It was conducted across 18 local government areas of Borno State. A representative sample of 4288 stakeholders (n=1763 parents, n=1707 TMPs, and n=818 HWs aged 20 to 59years, had complete data. The sample has more males: 57.8% (Parents); 71.8% (TMPs) and 57.3% (HWs). The awareness of immunisation schedule among the stakeholders ranged from 87.2 to 93.4%. The study showed that 67.9% of the parent and 57.1% of the health workers had participated in immunisation except the TMPs (27.8%). Across the stake holders' categories, between 61.9 and 72.6% have children who had Adverse Event Following Immunisation (AEFI). The most common AEFI was fever. Safety concerns, preference for herbs and charm, culture and religions, and vaccination perception as a western culture were the major barriers to immunisation uptake. While 63.6 to 95.7% of respondents indicated that community leaders, religious and spiritual leaders and TMPs should be involved in immunisation advo cacy, 56.9 70.4% of them reported that community leaders should be involved in immunisation policy. Upscaling the critical stakeholders' involvement in advocacy, policy devel opment and implementation of immunization activities may improve acceptance, create demand and engender ownership in vulnerable communities of Borno State, Nigeria. AEFI could be detrimental to immunisation access and utilization. Consequently, health education by health workers needs strengthening to minimise vaccine hesitancy.

Seasonal Meningococcal Meningitis Outbreaks in Nigeria: A Need for an Accelerated Introduction of a Conjugated Meningococcal Vaccine into the National Routine Immunization Schedule

Epidemic meningococcal meningitis affects huge populations annually in sub-Saharan Africa with differentially higher death rates among children. Nigeria is one of the twenty-six countries that lie in ‘African meningitis belt’. This paper briefly describes the epidemiology of seasonal recurrent meningococcal meningitis, current efforts to address the epidemics, and then argues for an accelerated introduction of conjugated meningococcal vaccine into routine immunization in Nigeria. This paper also highlights the nature of the epidemics with its attendant impacts on the population; the weaknesses of the current strategies; the emergence of mixed pathogens; the challenges and potential opportunities associated with an introduction of routine vaccination against meningococcal meningitis. The quick introduction of the conjugated meningococcal vaccine into expanded program on immunization (EPI) schedule will mitigate the risk of future massive outbreaks and its attendant morbidity, mortality and larger societal cost. Furthermore, authors suggest the introduction of polyvalent conjugated meningococcal vaccine rather than monovalent (targeting only serotype A), as this will potentially prevent emerging outbreaks of other serotypes such as NmC and W135.

Vaccine hesitancy among medical practitioners

Background: Vaccine hesitancy defined as "delay in acceptance or refusal of vaccination despite availability of vaccination services is a global phenomenon. There have been anecdotal evidence or rather poor documentation of hesitancy or noncompliance among medical practitioners in Northern Nigeria. Objective: We explored the perceptions and perspectives of doctors in Kebbi State, Nigeria, on immunization programs. Materials and Methods: We conducted this cross­sectional study involving 63 medical doctors, whose self­administered questionnaires were analyzed using descriptive statistics. Results: Only 43.55% of the doctors reported having under­five children with complete vaccination, whereas 84% of the doctors surveyed had a child or a relative with a child who had missed routine immunization (RI) previously. Approximately 66.67% and 67.74% of the doctors believed in the quality of the vaccine and capacity of the health workers to effectively deliver polio supplementary immunization activities (PSIAs), respectively. Adequate training of workers (26.23%) and public enlightenment campaigns (23.68%) were suggested as PSIAs enhancers. Collaboration with community and religious leaders (29.2%), education and public sensitization (28.09%), and improved government funding (13.48%) to improve RI were suggested. Others include incentives and fines (8.99%), adequate training of staff (10.11%), house­to­house vaccination (4.49%), and media publicity (5.62%). Conclusion: Vaccine hesitancy among medical doctors could be a threat to sustained polio interruption and efforts toward improving RI in Kebbi State. The state government and development partners should modify the current approaches to attaining polio­free certification standards and strengthen RI in the state. In addition, there is a need to improve sensitization of doctors in the state on vaccines and their safety profiles with a view to reducing vaccine hesitancy among them

Knowledge of HPV, HPV-Induced Cancers, and HPV Vaccine among a Sample of Freshmen in a Northwestern Nigeria Monotechnic

Background: Human papillomavirus (HPV) is a notorious virus that is responsible for some cancers in the human body. This study aims to explore the knowledge of a sample of freshmen of the Sultan Abdur-Rahman School of Health Technology, Gwadabawa, Sokoto State, Nigeria, on HPV, HPV-induced cancers and HPV vaccines. Methods: This study surveyed 224 freshmen of the Sultan Abdur-Rahman School of Health Technology, Gwadabawa, on HPV, HPVinduced cancers and HPV vaccines, using a paper questionnaire. Data collected were analyzed using SPSS Version 20 Software. Results: The mean (± SD) age of the surveyed freshmen was 22.04 (± 3.42) years. Only 65 (29.0%) of them had ever heard of HPV and the top three sources of their knowledge of the virus were doctor/nurse (16/65), TV/ radio/magazine (15/65), and parents (9/65). However, the majority of those respondents who claimed awareness of HPV lacked adequate knowledge about the virus and the vaccine. Conclusion: They exists a very low awareness rate of HPV, HPV-induced cancers and HPV vaccines among the surveyed freshmen of the Sultan Abdur-Rahman School of Health Technology, Gwadabawa, Sokoto State, Nigeria.

Do College Freshmen Know about Head and Neck Cancer and its Risk Factors? Experience from Gwadabawa, Nigeria

Background: Head and neck cancer (HNC) is a notorious killer disease. Globally, more than 55,000 people are newly diagnosed to have the disease. Knowledge of disease among the public goes a long way in its prevention in society. Hence, this study aimed to explore the knowledge level of college freshmen on HNC disease and its risk factors. Methods: This study surveyed 224 college freshmen of the Sultan Abdur-Rahaman School of Health Technology, Gwadabawa, Sokoto State, Nigeria, on HNC disease and its risk factors, using an anonymous questionnaire. Data collected were analyzed using the SPSS version 20 software. Results: The mean (± SD) age of the respondents was 22.04 (± 3.42) years. Only one-third (68/224, 30.4%) of the respondents were aware of HNC disease. However, amidst other findings, less than four-tenth of these respondents, who categorically claimed awareness of HNC, actually knew the: risk factors; commonly affected age and gender; commonly affected anatomical site and prognosis of the disease. Conclusion: The surveyed freshmen lacked adequate knowledge of HNC disease. This reveals the urgent need to educate them, and by extension, the entire population on HNC disease. Through effective HNC education programs, the incidence rate of HNC can be brought down to the barest minimum, as more people will be made knowledgeable about how they can prevent the disease from developing.

Hypertension-the Major Cause of Morbidity, Hospitalisation and Mortality among Non-communicable Diseases in the Gambia.

Aim: This study aimed at investigating the major cause of morbidity, hospitalisation and mortality among Non-communicable Diseases (NCDs) in The Gambia, in an effort to raise awareness on the alarming trend and thus stimulating appropriate responses from stakeholders. Method: Descriptive and inferential statistics were used to analyse a nation-wide routine hospital-based data on NCDs in The Gambia. Data were also presented in tables showing the trend of morbidity (in and out-patient case), hospitalisation and mortality between 2008 and 2011. Result: Hypertension as a risk factor for cardiovascular diseases constitutes more than half (55%) of all hospital admissions due to NCDs while cardiovascular diseases as a whole constitute well over 60% of all hospital admissions from NCDs. Of all NCDs studied, morbidity due to hypertension constitutes 80%, nearly responsible for all morbidities due to cardiovascular diseases for the years considered. Seventy percent (70%) of all deaths due to NCDs were caused by cardiovascular diseases, and hypertension was an important factor for NCDs related mortality (47.9% in 2008 to 55.8% in 2011;p-value=0.13). There were increments in morbidity and mortality due to hypertension and cardiovascular diseases between 2008 and 2011. However, there was reduction in hospitalisation due to cardiovascular diseases, but not the case with hypertension (incremental change). The differences in morbidity and hospitalisation were statistically significant for cardiovascular diseases (p<0.0001 and p=0.034 respectively) while only increment in morbidity due to hypertension was statistically significant (p<0.0001). Conclusion: This study shows that hypertension as a risk factor for cardiovascular disease is the greatest cause of morbidity, hospitalisation and mortality among NCDs in The Gambia. Hence, a holistic approach tailored towards preventing the acquisition/onset of the modifiable risk factors (of hypertension and CVD) should be instituted as well as programmes capable of preventing target organ damage among the population already affected.