DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20212997

Assessing the capacity of primary health care centres to provide routine immunization services amidst COVID-19 lockdown in Kaduna state, Nigeria

Auwal G. Suleiman, Abdulhakeem A. Olorukooba, Zaharadeen S. Babandi, Shehu S. Umar, Umar M. Umar

Abstract


Background: The COVID-19 pandemic continues to disrupt health systems across the globe, preventing access to essential health services. Lockdown measures against the virus may impact negatively on immunization services. This study aimed to ascertain the capacity of primary health care centres in Kaduna North senatorial district to provide routine immunization services amidst a state-wide lockdown.

Methods: Cluster sampling was used to select four among eight local Government areas in the district. Facility in-charges and RI focal persons were interviewed using service availability and readiness assessment tool, restricted to immunization tracer items. Paired sample t-test was used to compare the mean number of vaccine doses given in the first quarter of 2020 (pre-lockdown) and the number of doses given in the second quarter (lockdown period).

Results: Forty four PHCs were selected from Zaria (29.6%), Sabon Gari (25.0%), Makarfi (22.7%) and Kudan (22.7%). In addition to well-trained RI focal persons, most facilities had vaccines and commodities available. Shortages were noted for EPI guidelines (46%), Meningitis-A vaccine (36%) and certain cold chain equipment (up to 18%). Tetanus-diphtheria (Td-1) doses given during lockdown period were significantly lower than pre-lockdown doses (Mean difference=-45.58, 95% CI: -74.78 to -16.38, d=0.48). No significant difference exists for infant doses.

Conclusions: Despite widespread availability of PHC facilities, trained personnel, vaccines and commodities, gaps still exist in service delivery, cold chain practices and vaccine supply management. Lockdown measures significantly disrupted immunization services and effective risk communication was key to achieving sustained utilization.


Keywords


Immunization, Lockdown, Primary health care, Kaduna, Nigeria

Full Text:

PDF

References


International conference on primary health care. Available at: https://www.who.int/publications/ almaata_declaration_en.pdf. Accessed on 20 May 2021.

Aregbeshola BS, Khan SM. Primary health care in Nigeria: 24 years after Olikoye Ransome-Kuti’ s Leadership. Front Public Heal. 2017;5(3):7-8.

Aigbiremolen AO, Alenoghena I, Eboreime E, Abejegah C. Primary health care in Nigeria: from conceptualization to implementation. J Med Appl Biosci. 2014;6(2):52-9.

Strengthening the foundation of sustainable primary healthcare in Kaduna State: the “one functional phc centre per ward”. Available at: www.mnch2.com. Accessed on 20 May 2021.

Suleiman AG, Abubakar AS, Tukur MM, Umar SS. COVID-19 Pandemic in Nigeria: A review of the first three months. Int J Public Heal Clin Sci. 2020;7(4): 32-41.

Umeh GC, Madubu DM. Overview of COVID-19 Response in Kaduna State, Nigeria, March-July 2020. Available at: https://osf.io/p8s7x/download. Accessed on 20 May 2021.

Nelson R. COVID-19 disrupts vaccine delivery. Lancet Infect Dis. 2020;20(5):546.

Ogundele OA, Omotoso AA, Fagbemi TA. COVID-19 outbreak: a potential threat to routine vaccination programme activities in Nigeria. Hum Vaccin Immunother. 2021;17(3):661-3.

Chandir S, Siddiqi DA, Setayesh H, Khan AJ. Impact of COVID-19 lockdown on routine immunisation in Karachi, Pakistan. Lancet Glob Heal. 2020;8(9): e1118-20.

Saso A, Skirrow H, Kampmann B. Impact of COVID-19 on immunization services for maternal and infant vaccines: results of a survey conducted by imprint; the immunising pregnant women and infants network. Vaccines. 2020;8(556):1–15.

Kaduna State Bureau of Statistics. Kaduna State Populatiion and Demography 2020. Available at: https://kdbs.ng/. Accessed on 20 May 2021.

Service availability and readiness assessment (SARA): Core instrument. Available at: https://www. who.int./healthinfo/systems/sara_introduction/en. Accessed on 20 May 2021.

Shawon SR, Adhikary G, Ali W, Ahmed S, Alam N, Shackelford KA, et al. General service and child immunization- specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh. BMC Health Serv Res. 2018;5:1-11.

Victoria BB, Oluwatosin AO, Ogundeji OM. Impact of training intervention on immunization providers’ knowledge and practice of routine immunization in Ibadan, south-western Nigeria: a primary health care experience. Pan Afr Med J. 2017;26(216):11545.

Ameen HA, Salaudeen AG, Bolarinwa OA, Uthman MMB, Aderibigbe SA, Ameen K, et al. The effect of training on knowledge and practices of vaccine management among primary health care (PHC) workers in static immunization facilities in Ilorin, Nigeria. Trop J Heal Sci. 2016;23(2):4-10.

Nicol E, Turawa E, Bonsu G. Pre- and in-service training of health care workers on immunization data management in LMICs: a scoping review. BMC Hum Resour Heal. 2019;17(92):1-14.

Tadesse T, Gelaw B, Haile Y, Bisrat F, Kidanne L, Asres M, et al. Immunization service availability and readiness in primary health care in pastoral and semi-pastoral CGPP Ethiopia implementation districts. Ethiop J Heal Dev. 2019;33:1-7.

Aftab A, Hasan M, Bari R, Hossain MD, Hasan M, Azad AK, et al. Facility assessment for maternal and child health services in bangladesh using service availability and readiness assessment (SARA) tool: a cross-sectional pilot study. Public Heal Indones. 2017;3:77-88.

Nwankwo B, Shuaibu JJ, Olorukooba AA, Lawal A, Onoja-Alexander MO, Hamza KL. Knowledge, attitude, and practice of cold chain management among primary health care workers in Giwa, Northwestern Nigeria. Arch Med Surg. 2018;3(2):71-6.

Mavimbe JC, Bjune G. Cold chain management: Knowledge and practices in primary health care facilities in Niassa, Mozambique. Ethiop J Heal Dev. 2007;21(2):130-5.

Yakum MN, Ateudjieu J, Walter EA, Watcho P. Vaccine storage and cold chain monitoring in the North West region of Cameroon: a cross sectional study. BMC Res Notes. 2015;8:145.

Bogale HA, Amhare AF, Bogale AA. Assessment of factors affecting vaccine cold chain management practice in public health institutions in east Gojam zone of Amhara region. BMC Public Health. 2019; 19(1433):1-6.

Ophori EA, Tula MY, Azih A V, Okojie R, Ikpo PE. Current Trends of Immunization in Nigeria: Prospect and Challenges. Trop Med Health. 2014;42(2):67-75.

Gooding E, Spiliotopoulou E, Yadav P. Impact of vaccine stockouts on immunization coverage in Nigeria. Vaccine. 2019;37(35):5104-10.

Sato R, Thompson A, Sani I, Metiboba L, Giwa A, Femi-ojo O, et al. Effect of vaccine direct delivery (vdd) on vaccine stockouts and number of vaccinations: case study from Bauchi State, Nigeria. Vaccine. 2021;39(9):1445-51.

Sato R. Vaccine stockouts and vaccination rate: examination of unique administrative data from Nigeria. Int Health. 2020;12:170-6.

Agrawal AD, Gupta G, Bhasin A, Singh A, Rathi A. Impact of COVID-19 pandemic on routine childhood immunisation services post lockdown in a tertiary care centre in Meerut district of western U.P. Int J Contemp Pediatr. 2021;8(2):219-24.

Olasupo A. Lockdown in Kaduna as government imposes 24- hour curfew. Guardian Nigeria. 2020 Mar 26;1-5.

Aliyu AA, Dahiru T. Predictors of delayed antenatal care (anc) visits in nigeria: secondary analysis of 2013 Nigeria demographic and health survey (NDHS). Pan Afr Med J. 2017;26(124):1-13.

Nwaneri AC, Ndubuisi I, Okoronkwo IL, Ezike O, Nkiruka U. Determinants of late booking for antenatal care among pregnant women in selected hospitals in South East Nigeria. Int J Nurs Midwifery. 2018;10(7): 74-80.