Saheed Dipo Isiaka

Vaccine-preventable diseases (VPDs) remain important causes of morbidity and mortality in sub-Saharan Africa, and evidence on subnational surveillance performance in Nigeria remains limited. We conducted a cross-sectional analytic evaluation of surveillance systems for measles, diphtheria, acute flaccid paralysis (AFP), and cerebrospinal meningitis (CSM) in Niger State, Nigeria. Data were collected from 415 clinicians, community resource persons, and surveillance focal persons across 12 purposively selected Local Government Areas using structured questionnaires adapted from CDC surveillance evaluation guidelines and aligned with IDSR guidance. Surveillance performance was assessed using sensitivity, data quality, and stability. Analyses included descriptive statistics, bivariate tests, and multivariable regression models. Reported suspected case detection was higher for measles and AFP than for CSM and diphtheria, with detection reported by 94.2% and 93.0% of respondents for measles and AFP, respectively, compared with 84.3% for CSM and 81.4% for diphtheria. Transport availability without delays was consistently associated with lower odds of surveillance failure across disease-specific models, including measles sample collection (aOR = 0.12, 95% CI: 0.05–0.28) and case confirmation (aOR = 0.07, 95% CI: 0.02–0.21), diphtheria sample collection (aOR = 0.18, 95% CI: 0.06–0.49) and confirmation (aOR = 0.22, 95% CI: 0.08–0.58), and CSM sample collection (aOR = 0.18, 95% CI: 0.06–0.54) and confirmation (aOR = 0.21, 95% CI: 0.07–0.61). Active guideline use was associated with AFP sample collection (aOR = 4.12, 95% CI: 1.72–9.87). Only 66.5% of respondents reported fully accurate submitted forms, and financial support was associated with lower odds of instability (aOR = 0.74, 95% CI: 0.56–0.97). Strengthening transport, infrastructure, financing, and data quality systems may improve VPD surveillance performance and outbreak preparedness in similar settings.

Background: Adverse events following immunization (AEFI) are any negative medical event that occurs after vaccination but may or may not be causally related to the vaccine. AEFI reporting is the gateway to AEFI surveillance systems at primary healthcare facilities where immunization services are provided. Several studies have highlighted low reporting of AEFI cases, particularly in low-resource settings, yet nothing is known about stakeholders’ perspectives on the factors associated with the AEFI reporting rate in Nigeria. Objective: This study explored the stakeholders’ perspectives (from a baseline assessment) on the barriers to adequately reporting (electronically) AEFI in Nigeria. Methods: The study was conducted using a qualitative approach. Key informant interviews were conducted at the national and sub-national (state) levels, who were purposively selected to acquire information from stakeholders on the challenges facing the e-reporting of AEFI at the national and state levels. All the audio interview files were transcribed into English Language, coded, and presented using a thematic approach. Results: A total of 32 healthcare workers at the national and sub-national levels participated in the study. The study adapted an extant pharmacovigilance thematized framework of reporting the barriers to electronic reporting of the pharmacovigilance system. Therefore, this study categorized the participants’ responses into four main themes, including healthcare workers’ knowledge deficiency and fear, technical infrastructural challenges, poor reporting systems, and inconsistency in government commitment. Conclusion: This study concludes that the AEFI surveillance system in Nigeria requires immediate and thorough attention. This stems from evidence gathered from the study participants, revealing the various challenges that are extant at the national and sub-national levels. While these challenges – healthcare workers’ knowledge deficiency and fear, poor technical infrastructure, poor reporting system, and inconsistency in government commitment – may appear mundane, they are critical to optimizing the AEFI surveillance system and maintaining the drive for an improved disease management system. Recommendation: This study recommends that stakeholders at all levels should take up improved ownership of AEFI reporting (especially electronic) systems in the country.

Reducing the global burden of maternal morbidity and mortality necessitates focusing on the quality of maternal and newborn care (MNC). This study aimed to assess the quality of MNCs among 25,840 public primary healthcare centers (PHCs) across Nigeria, analyze subnational variations, and determine the influence of contextual variables on the quality of care (QoC) by PHCs. Data from a nationwide PHC assessment conducted in 2022 were utilized to create the composite index of care for PHC facilities in Nigeria. Summary statistics were then generated for the composite of care scores across PHC facilities. Subnational differences in QoC among the 36 states and the Federal Capital Territory and the influence of four contextual variables (Basic Health Care Provision Fund-status of PHC, activity of ward development committees, implementation of quality improvement plan, and activity of facility management committees) on QOC were determined using a one-way analysis of variance and multiple linear regression respectively. PHCs in Nigeria had QoC scores ranging from 0.06-4.0 and a mean QoC score of 2.07. There were significant variations in the mean PHC facility QoC across states, with Katsina and Ondo states having the lowest (1.35) and highest (2.98) QoC, respectively. The regression model showed that the contextual variables analyzed accounted for 31.5% of the variation in QoC, with varying statistically significant relationships with the QoC. The quality of maternal and newborn healthcare in Nigeria’s PHC facilities is unsatisfactory, with noticeable subnational variation in the QoC. To achieve significant improvements in the quality of care provided by PHC facilities in the country, targeted interventions, such as empanelment of more PHCs as BHCPF facilities, strengthening implementation of quality improvement plans and strengthening activities of ward development committees, and facility management committees, are required to improve the quality of maternal and newborn care, and reduce maternal and infant mortality rates.

: The primary goal of program communication in public health is to influence behaviors. It also aims to raise awareness and ultimately improve health outcomes. Under the umbrella of program communication exist three interconnected, interrelated, and mutually supportive communication aspects: advocacy, communication, and social mobilization (ACSM). While advocacy involves promoting political dedication and holding authorities accountable for fulfilling commitments and achieving success, social mobilization brings together various sectors and individuals to raise awareness and demand for a specific program. This study aimed to understand the operationalization and challenges of ACSM activities among health workers addressing COVID-19 and routine immunization in Nigeria. The study used a qualitative study design. In-depth interviews were conducted among health workers in the ACSM unit of the state’s primary health care system, using a two-tier approach. The recorded interviews were transcribed in Microsoft Word format by professional transcribers and coded using Dedoose. A total of 38 health care workers across six states were selected to participate in this study. Our study found that ACSM coordination structures existed across the six states. Routine ACSM activities were either funded by the government or local development partners implementing programs. Lack of technological devices, unavailability of funds, unavailability of data tools, and lack of technological skills are major barriers to ACSM operationalization. This study highlighted the critical role of government and agency funding in sustaining ACSM activities. However, barriers that hinder the effective operationalization of ACSM efforts remain. Therefore, the results support the need for strategic investment in technology, staff capacity building, and appropriate resource allocation to overcome these barriers.

Evidence from literature has established that tracing lost to follow-up clients is an effective strategy for complementing other mechanisms for infectious disease control like human immunodeficiency virus (HIV), tuberculosis, and other diseases such as Ebola. As a long-standing successful public health method of optimizing acceptance and/or adherence to infectious disease treatment tracing lost to follow-up clients is usually carried out by manually investigating individuals who absconded or are absent from treatments designed to manage and/or promote their health status. This study seeks to explore the role of mobile teams in tracing clients lost to follow-up for immunization. This study was premised on a qualitative research approach to elicit information from purposively selected populations across 9 local government areas (LGA) in Ekiti state, Nigeria. Focus group discussions, in-depth interviews, and key informant interviews were the selected methods of data collection on the roles of mobile teams in tracing lost to follow–up clients for the optimization of COVID-19 and routine immunization in Ekiti state. A total of 107 healthcare workers across Ekiti state were selected to participate in this study. Our study found tracing lost to follow-up clients resulted in two major successes for health workers. These are increased awareness of COVID-19 vaccination and routine immunization, and improved vaccination coverage for both categories of vaccinees. Distance between communities, and transportation, were interdependent issues reported by health workers as challenges in the course of their duties. Our study emphasizes the importance of onboarding and/or training health workers across all categories that are involved in the implementation of a public health program, irrespective of the existing knowledge that they may have on the concept. This study recommends that health workers across all levels, in collaboration with key players and stakeholders employ human-centered designed approaches to improve the sensitization of caregivers, and community populace on the values, benefits, and significance of the COVID-19 vaccination and routine immunization uptake.

Background: Developing countries have partnered with non-governmental and development organizations to ensure universal health coverage and promote equity in accessing health services. This study was motivated by the timely and relevant collaborative partnership among the National Primary Health Care Development Agency (NPHCDA), Sydani Consulting, and other implementing partners at the sub-national level. There is also no evidence of a study on partnership coordination vis-à-vis COVID-19 vaccine optimization.Objective: This study seeks to examine the influence of partnership coordination in Benue and Niger states for optimized COVID-19 vaccination.Methods: This study adopted a qualitative approach to obtain data from purposively selected participants from Benue and Niger states. Fifty-sox In-depth and Key informant interviews were conducted. The recorded discussions were transcribed and coded (inductively and deductively) using Dedoose software (v9.0). Four themes and seven sub-themes were generated from the participants' responses.Results: Findings from our study revealed that partners played significant roles in providing support to Benue and Niger states toward the optimization of COVID-19 vaccination in the two states. The provided support alleviated several challenges experienced by the states before the advent of partners in the two states. Partners' roles were assessed using the WHO Health Building Blocks Framework.Conclusion: Our study concludes and finds it plausible that partner collaboration can effectively improve health outcomes for the populace, especially in resource-low settings.

Objectives: In Nigeria, modern contraceptive use remains relatively low despite numerous efforts to increase awareness and accessibility. This study examined the geopolitical factors influencing modern contraceptive use in North-central Nigeria Design: Using data from the 2021 Nigeria Multiple Indicator Cluster Survey, this study quantitatively investigated the factors influencing modern contraceptive use among women of reproductive age. The data were analyzed using R studio. Respondents' characteristics were described using frequency and percentage. A logistic regression model was employed to identify factors associated with modern contraceptive usage in the north-central region of Nigeria. Bivariate logistic regression was carried out between the explanatory and response variables. Settings: This study focused specifically on the north-central zone of Nigeria comprising 6 states, namely, Benue, Kogi, Kwara, Nasarawa, Niger, and Plateau states with the Federal Capital Territory (FCT). Results: Nearly one-third (30.1%) of the respondents are above 35 years of age. 3 out of every 5 (61.2%) respondents are currently married. This study found that the average modern contraceptive usage among women of reproductive age in north Central Nigeria is less than 15%. Age, education, childbirth delivery method, number of children, access to media, and state of residence are key drivers of modern contraceptive adoption and utilization among women of reproductive age in north-central Nigeria. Conclusion: This study finds it plausible to increase the awareness and sensitization of modern contraceptives and contraceptive usage in this region. There is a need for health education on the benefits and relevance of modern contraceptive usage.

Background: As part of the fight against coronavirus disease, Nigeria received nearly 4 million doses of the COVID-19 vaccine via the COVID-19 Vaccines Global Access (COVAX) Facility, marking a historic step towards equitable global distribution of COVID-19 vaccines. Although evidence exists on COVID-19 hesitancy in Nigeria, yet, we are unaware of any study on the optimization of COVID-19 vaccination from the lenses of the mobile teams. Objective: This study seeks to explore the perceptions and experiences of mobile teams in selected communities during the implementation of COVID-19 vaccination in Benue and Niger. Methods: An exploratory approach was adopted, and the study was conducted in Niger and Benue states based on poor performance in COVID-19 vaccination. Focus Group Discussions (FDGs) were conducted among 12 mobile vaccination teams from 12 LGAs. The recorded discussions were transcribed and coded (inductively and deductively) using Dedoose software (v9.0). Four themes and seven sub-themes were generated from the participants’ responses. Results: Seventy-two (72) health workers including vaccinators, validators, Electronic Management of Immunization Data (EMID) recorders, social mobilizers, and paper recorders participated in this study. Health workers’ perceptions and experiences were thematized using the health building blocks. The mobilization teams in Benue and Niger states perceived that their mobilization efforts contributed to improved coverage, increased accessibility, and reduced hesitancy among the community dwellers. Challenges reported by the teams were vaccine misconceptions, requests for incentives in exchange for vaccine uptake, poor network services, distance to communities, and vaccine stockout. Conclusion: This study concluded that social mobilizers play key roles in vaccine uptake, especially at the community level. Their roles in creating awareness, sensitization, and bringing the vaccine closer to hard-to-reach communities contributed to the success attained in the fight against COVID-19 in both states.