Millions of children in Nigeria are at the risk of measles, polio, diphtheria and other diseases due to disruptions of routine immunisation and other vaccination programmes as a result of the lockdown to contain the spread of COVID-19.
Daily Trust reports that some of the mass immunisation programmes earlier scheduled for the year were cancelled or postponed because of COVID-19. This has heightened fears of more outbreaks of the diseases this year. The disruptions in immunisation schedules by COVID-19 are also threatening the gains Nigeria recorded in the fight against polio.
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The country was certified polio-free by the World Health Organisation (WHO) on Tuesday, August 25, 2020.
WHO, UNICEF, medics express fear of escalation
The World Health Organisation (WHO) and UNICEF had warned of an alarming decline in the number of children receiving life-saving vaccines around the world due to disruptions in the delivery and uptake of immunisation services caused by the COVID-19 pandemic.
According to the two organisations, “Some parents are reluctant to leave home because of restrictions on movement, lack of information or because they fear infection with the COVID-19 virus,” the two organisations said in a statement in July.
“And many health workers are unavailable because of restrictions on travel, or redeployment to COVID response duties, as well as a lack of protective equipment.”
Dr. Aminu Magashi of the Africa Budget Health Network said COVID-19 had taken a toll on vaccination programmes because health workers were afraid of transmission as a result of inadequate provision of Personal Protective Equipment (PPE), delay and inadequate payment of requisite allowances.
He said without vaccination many children would be at risk of getting measles and other diseases.
“Many (children) will come down with pneumonia for instance and it can kill fast. Some will have diarrhoea and vomiting risking dehydration and malnutrition. Some will be exposed to eye infection and earache and the brain of some of them will be affected by a disease called encephalitis.”
We were all of afraid – Mothers
Over the years, mothers are being applauded for the roles they play in containing most of the diseases afflicting children. The situation was the same after polio was conquered.
However, as soon as the coronavirus manifested in the different parts of the world including Nigeria and other Africa countries, the fear of the unknown caught up with parents especially mothers. “When I saw how the COVID-19 was ravaging the world and killing people, I became sceptical of going out of my house,” said Halima Sani, a mother of four in Kano.
“I was afraid of contracting the virus; so I said I would not take the risk of taking my daughter for vaccination. My daughter Surayya missed some doses but I hope we would get a chance to do them now that the lockdown is somehow over,” she said.
Mrs Yinka Banjo said she could not take her child for six months and nine months immunisation for fear of contracting COVID-19 from the health workers and other nursing mothers.
“Now that things are better, I will take my baby to our hospital and explain to them, maybe they will give her that of six months and one year, I really cannot say,” she said.Mrs Funmi Tijjani said she could not take her child for the nine months vaccination due to the lockdown but that she took her for immunisation in June.
Hajja Amina, an IDP from Marte living with relatives in Gwange area of Maiduguri said most health officials in hospitals were also scared of attending to nursing mothers.
“A certain nurse once told me that I was not serious…She said I rather keep my son at home instead of exposing him to danger and since then, I didn’t bother to go to the hospital even when he is feverish. We simply buy him drugs over the counter,” she said.
Ailments associated with killer diseases
Measles is one of the leading causes of deaths and disability among children under five years and if not well managed could lead to deafness, mental retardation, convulsion, and vulnerability to other diseases.
Polio is a viral disease transmitted from person to person, mainly through a faecal-oral route or, less frequently, through contaminated water or food, and multiplies inside the intestines. While there is no cure for polio, the disease can be prevented through the administration of a simple and effective vaccine.
‘COVID-19 denied people access to healthcare’
The Executive Director of the National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib, said COVID-19 affected all primary health care services including immunisation services.
“We experienced a situation where the lockdown prevented people from being able to access primary healthcare centres,” Dr. Shuaib said.
“So, there was a decline in practically all primary health care services,” he said during the recent launch of 456 motorcycles and 456 laptops for routine immunisation officers in low performing states.
Dr. Bassey Bassey Okposen, who is the Director, Disease Control and Immunisation of NPHCDA said there were ongoing efforts by government and partners to sustain and improve the services being delivered at primary health care facilities (PHCs). “Efforts are ongoing to immunise the remaining unimmunised or missed children,” he said.
Speaking on the magnitude of the disruptions, he said, “On the side of the health workers, the lockdowns affected the regular opening of health facilities in some states, disruptions in the implementation of planned outreach sessions and supportive supervision to lower levels, and disruptions in the transportation plan to work. Some of the health workers are also afraid of being infected by patients visiting the health facilities for treatments.
“On the other hand, caregivers and patients are wary of visiting primary health care facilities due to the risk of infection and rumours of the use of experimental vaccines. There has also been the challenge of low turn out to the service delivery points by clients due to restriction of movement, especially during the period of the lockdown,” he said. He said a review of routine immunisation (RI) and other PHC service utilisation data from the national District Health Information Software 2 (DHIS2) data platform confirmed a progressive decline in performance for all the antigens, especially during the months of April and May 2020.
However, he added that following implementation of innovative strategies by NPHCDA, significant improvements have been noticed for all the antigens since the months of June and July 2020. Asked how many children were targeted, he said from the DHIS2 platform, about 74% of the 85% children targeted for pneta3, OPV3 and 1PV as at end of July 2020 have been immunised, and that efforts were on to immunise those missed. The Director of the South-South zonal office of the agency, Dr. Avuwa Joseph Oteri, who served as Director, Special Duties till March 2020, said some supplemental immunisation activities could not be done as a result of COVID-19.
“Before the COVID-19 disruption, we planned an integrated measles and meningitis A vaccination campaigns for Niger and Kogi states, and integrated meningitis and yellow fever vaccination campaign for Anambra State and meningitis A vaccination campaigns for Cross River, Oyo and Ebonyi states. These supplemental immunisation activities could not be done,” he said.
Situation in states
A study on the impact of COVID-19 on routine immunisation (RI) services in Niger, Kano, Kaduna and Lagos states conducted by the Partnership for Advocacy in Child and Family Health at Scale (PACFaH@Scale) and obtained by Daily Trust showed that provision of routine health services was greatly affected in Nigeria due to the initial lockdown restricting the movement of health workers and caregivers, and rumours, myths, and misinformation on COVID-19.
In Lagos State, the PACFaH findings revealed that routine immunisation performance summary for June 2020 showed a general improvement across the board in all indices compared to May 2020 and April of the last quarter. However, in comparison to the same period in 2019, the programme showed a decline, which was due to the negative impact of COVID-19 on routine immunisation program.
“In June 2020, only 32% of planned RI outreach sessions were conducted in Badagry LGA, and Mushin LGA did not plan nor conduct any RI outreach session. This is due to the impact of COVID-19 in these LGAs, as they refused to release health workers.
“There is a drop of more than 50% of immunisation attendance at two specialists facilities assessed (Murtala Specialists Hospital and Hasiya Bayero Pediatric Hospital). With clients for BCG, Penta 1,2,3 and measles vaccines services declining throughout the months of the pandemic.”
The Permanent Secretary of the Lagos Primary Healthcare Board, Dr. Olugbemiga Aina, said COVID-19 only affected immunisation in the state during the lockdown.“There were no cancelled immunisation sessions in any PHCs except for those that were shut down due to probable or confirmed COVID-19 cases. Over 90 percent of planned sessions were conducted between April and June. However, patronage was low between April and May because of the lockdown restrictions.”
The PACFaH survey revealed that in Niger State, “In the last 27 weeks, less than half of the health facilities reported that they are providing fixed routine immunisation sessions.”
The study quoted the Deputy Programme Manager of Niger State Emergency Routine Immunisation Coordination Centre (SERICC), Pharmacist Daniel Jiya, as saying COVID-19 impacted on routine immunisation services through a decline in service delivery such as a decline in supportive supervision visits from the state to the LGAs, and from the LGAs to the health facilities; and increase in stock out of antigens such as Pentavalent vaccines during fixed and outreach sessions conducted, among others.
About 10 LGAs including Tofa, Tarauni and Nasarawa performed low in their RI indicators from analysis of data by the PACFaH study.
“There is a drop of more than 50% of immunisation attendance at two specialists’ facilities assessed (Murtala Specialists Hospital and Hasiya Bayero Pediatric hospital). With clients for BCG, Penta 1,2,3 and measles vaccines services declining throughout the months of the pandemic,” the survey showed.
There were reported cases of vaccine rejection by communities in Anguwan Malamai, and this was not so pre-COVID-19 pandemic according to the PACFaH research in Kaduna state.
Other findings include reported cases of service disruption due to the COVID-19 lockdown and security issues in the state and effect on data quality especially on SMS reporting from 40 health facilities of 18 LGAs, among others.
The Executive Secretary of the Sokoto State Primary Health Care Development Agency, Adamu Romo, told our reporter that house-to-house vaccination against polio was the only immunisation disrupted by the pandemic as there was no immunisation against polio since the outbreak of coronavirus in the country.
“Because polio immunisation requires a large number of people, which would not be feasible now because of COVID-19,” he said.
The Public Relations Officer of the Anambra State Ministry of Health, Chukwudi Nwauba said the state government would commence the immunisation programmes disrupted by COVID-19 immediately things get normal.
In Katsina, the state Primary Healthcare Development Agency said despite the COVID-19 pandemic immunisation and vaccination programmes were successfully carried out.
The Executive Secretary, Dr Shamsuddeen Yahaya said the state just conducted a reactive vaccination for measles in 584 health facilities across 32 local government that targeted 337,899 children under the five.
Measures to mitigate the challenges
Dr. Okposen said efforts put in place by the agency to mitigate the challenges include supporting PHC workers with adequate PPEs and other essentials items needed at health facilities, public service announcements on TV and radio to enlighten parents to take their children for routine immunisation and other PHC services, and circulation of materials on how to prevent COVID-19 infection and control to the states and LGAs.
With contributions by Abubakar Auwal (Sokoto) Titus Eleweke (Awka) Habibu Umar Aminu ( Katsina) Risikat Ramoni (Lagos)