Barriers to Childhood Immunisation in Nigeria: A Scoping Review of Recent Empirical Studies
Main Article Content
Abstract
The aim of this review is to determine barriers to childhood immunisation in Nigeria. This review is a scoping review of recent empirical studies. The data sources for this scoping review of recent empirical studies were: PubMed, Scopus and African Journal Online [AJOL]. The search was conducted between 11th to the 18th of April, 2024. The search results into these databases after setting of the predefined limiters yielded a total of 3589 articles. Additionally grey literatures were searcTABLE OF hed through reference list and Google search. Quality appraisal was done using Mixed Methods Appraisal Tool (MMAT), version 2018. A total of 26 articles were found to have met the eligibility criteria and were therefore included. Result indicates that vaccine safety concern was identified as the major vaccine related barrier to childhood immunisation. Civil unrest and lack of political will were the governance related barriers. With regards to health system related barrier to childhood immunisation, hard to reach facilities was identified. Additionally, poverty and vaccine misconception were the most reported caregivers barriers to immunisation while negative healthcare workers attitude was the healthcare worker barrier to childhood immunisation in Nigeria. Government and all critical stakeholders should vigorously get involve in designing specific education program based on the identified barriers. This review brings to light barriers to immunisation in Nigeria. This would help immunisation stakeholders plan strategies of overcoming barriers and ensure optimal immunisation coverage.
Downloads
Article Details
References
Simegn W, Diress M, Gela YY, et al. Childhood vaccination practices and associated factors among mothers/caregivers in Debre Tabor town, Northwest Ethiopia: A cross-sectional study. Frontiers in Pediatrics. 2023;11. doi:10.3389/fped.2023.1070722
Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health. 2020;20(1). doi:10.1186/s12889-020-09169-4
Touray E, Barrow A, Kinteh B, et al. Childhood vaccination uptake and associated factors among children 12–23 months in rural settings of the Gambia: a community-based cross-sectional study. BMC Public Health. 2021;21(1). doi:10.1186/s12889-021-11810-9
Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health. 2021;21(1). doi:10.1186/s12889-021-11466-5
WHO. Nigeria crisis. Published April 12, 2024. Accessed May 20, 2024. https://www.who.int/emergencies/situations/nigeria-crisis
Nandi A, Shet A. Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Human Vaccines & Immunotherapeutics. 2020;16(8):1900-1904. doi:10.1080/21645515.2019.1708669
Williams SV, Akande T, Abbas K. Systematic review of social determinants of childhood immunisation in low- and middle-income countries and equity impact analysis of childhood vaccination coverage in Nigeria. PloS One. 2024;19(3):e0297326. doi:10.1371/journal.pone.0297326
Adesina MA, Olufadewa II, Oladele RI, Solagbade A, Olaoyo C. Determinants of childhood immunization among rural mothers in Nigeria. Population Medicine. 2023;5(September):1-7. doi:10.18332/popmed/171542
WHO. WHO partners government for Big-Catch-up campaign to close immunization coverage gaps | WHO | Regional Office for Africa. WHO | Regional Office for Africa. Published May 5, 2023. Accessed May 20, 2024. https://www.afro.who.int/countries/nigeria/news/who-partners-government-big-catch-campaign-close-immunization-coverage-gaps
UNICEF. The State of the World’s Children 2023. UNICEF. Published April 1, 2023. Accessed May 20, 2024. https://www.unicef.org/reports/state-worlds-children-2023
Obanewa OA, Newell ML. The role of place of residency in childhood immunisation coverage in Nigeria: analysis of data from three DHS rounds 2003–2013. BMC Public Health. 2020;20(1). doi:10.1186/s12889-020-8170-6
Eze P, Agu UJ, Aniebo CL, Agu SA, Lawani LO, Acharya Y. Factors associated with incomplete immunisation in children aged 12–23 months at subnational level, Nigeria: a cross-sectional study. BMJ Open. 2021;11(6):e047445. doi:10.1136/bmjopen-2020-047445
Mahachi K, Kessels J, Boateng K, et al. Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges. Vaccine. 2022;40(37):5433-5444. doi:10.1016/j.vaccine.2022.07.058
Olaniyan A, Isiguzo C, Agbomeji S, Akinlade-Omeni O, Ifie B, Hawk M. Barriers, facilitators, and recommendations for childhood immunisation in Nigeria: perspectives from caregivers, community leaders, and healthcare workers. the Pan African Medical Journal. 2022;43. doi:10.11604/pamj.2022.43.97.35797
Akwataghibe NN, Ogunsola EA, Broerse JEW, Popoola OA, Agbo AI, Dieleman MA. Exploring factors influencing immunization utilization in Nigeria—A mixed methods study. Frontiers in Public Health. 2019;7. doi:10.3389/fpubh.2019.00392
Akinyemi OO, Adebayo A, Bassey C, et al. Assessing community engagement in Nigeria polio eradication initiative: application of the Consolidated Framework for Implementation Research. BMJ Open. 2021;11(8):e048694. doi:10.1136/bmjopen-2021-048694
Omoleke SA, Omotara BA, Oyeyemi AL, Beida O, Etatuvie SO. Immunisation Services in North-Eastern Nigeria: Perspectives of Critical Stakeholders to improve Uptake and Service Delivery. Journal of Public Health in Africa. Published online January 2, 2024. doi:10.4081/jphia.2023.1807
Ogbuabor D, Ghasi N, Nwangwu N, Okenwa U, Ezenwaka U, Onwujekwe O. Stakeholders’ perspectives on internal accountability within a sub-national immunization program: A qualitative study in Enugu State, South-East Nigeria. Nigerian Journal of Clinical Practice. 2022;25(12):2030. doi:10.4103/njcp.njcp_522_22
UNICEF. UNICEF IMMUNIZATION ROADMAP 2018-2030. Published 2018. Accessed April 6, 2024. https://www.unicef.org/sites/default/files/2019-01/UNICEF_Immunization_Roadmap_2018.pdf
Abad N, Uba BV, Patel P, et al. A rapid qualitative assessment of barriers associated with demand and uptake of health facility-based childhood immunizations and recommendations to improve immunization service delivery in Sokoto State, Northwest Nigeria, 2017. PubMed. 2021;40(Suppl 1):10. doi:10.11604/pamj.supp.2021.40.1.23793
Hong QN, Fàbregues S, Bartlett G, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information. 2018;34(4):285-291. doi:10.3233/efi-180221
Ilesanmi M, Olujobi B, Ilesanmi O, Umaefulam V. Exploring data trends and providers’ insights on measles immunization uptake in south-west Nigeria. the Pan African Medical Journal. 2023;46. doi:10.11604/pamj.2023.46.28.37572
Etokidem A, Nkpoyen F, Ekanem C, Mpama E, Isika A. Potential barriers to and facilitators of civil society organization engagement in increasing immunization coverage in Odukpani Local Government Area of Cross River State, Nigeria: an implementation research. Health Research Policy and Systems. 2021;19(S2). doi:10.1186/s12961-021-00697-y
Salako J, Bakare D, Uchendu OC, Bakare AA, Graham H, Falade AG. Factors associated with immunization status among children aged 12-59 months in Lagelu Local Government Area, Ibadan: a cross-sectional study. the Pan African Medical Journal. 2024;47. doi:10.11604/pamj.2024.47.35.37013
Adedire EB. Perception and barriers to Routine Immunisation Uptake: A Qualitative Study in Rural areas of Osun State, Nigeria. Texila International Journal of Public Health. 2020;8(2):134-141.doi:10.21522/tijph.2013.08.02.art016
Ogbuabor DC, Chime AC. Prevalence and predictors of vaccine hesitancy among expectant mothers in Enugu metropolis, South-east Nigeria. Journal of Public Health Policy. 2021;42(2):222-235. doi:10.1057/s41271-020-00273-8
Adekeye OA, Ahmadu F, Adekeye BT, Chenube OO. Knowledge, Attitude and Barriers towards children Immunization among women in selected rural primary health centres. IFE PsychologIA. 2015;23(1):89-97.
Sanni TA, Olasehinde OK, Adeniyi MA, Ipinnimo TM. Uptake of immunization and associated factors among 0-11 months infants in a rural community of Ekiti State. Nigerian Journal of Medicine/the Nigerian Journal of Medicine. 2019;28(4):440. doi:10.4103/1115-2613.278636
Nwokocha EE, Obioma C. social and cultural factors influencing immunization of children in rural abia state, nigeria. International Journal of Child, Youth & Family Studies. 2016;7(3-4):404. doi:10.18357/ijcyfs73-4201616128
Taylor S, Khan M, Muhammad A, et al. Understanding vaccine hesitancy in polio eradication in northern Nigeria. Vaccine. 2017;35(47):6438-6443. doi:10.1016/j.vaccine.2017.09.075
Osadebe LU, MacNeil A, Elmousaad H, et al. Assessing inactivated polio vaccine introduction and utilization in Kano State, Nigeria, April–November 2015. the Journal of Infectious Diseases (Online University of Chicago Press)/the Journal of Infectious Diseases. 2017;216(suppl_1):S137-S145. doi:10.1093/infdis/jix044
Sato R, Takasaki Y. Vaccine Hesitancy and Refusal: Behavioral Evidence from Rural Northern Nigeria. Vaccines. 2021;9(9):1023. doi:10.3390/vaccines9091023
Gunnala R, Ogbuanu IU, Adegoke OJ, et al. Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015. PloS One. 2016;11(12):e0167835. doi:10.1371/journal.pone.0167835
Obasohan, Anosike, Etsunyakpa. Determinants of full immunization coverage and reasons for its failure for children in Bida Emirate Area, Niger state, Nigeria - White Rose Research Online. Merit Research Journal of Medicine and Medical Sciences. https://eprints.whiterose.ac.uk/154887/
Oluwalomola OV, Daniel EO, Abiodun PO, et al. Factors influencing utilization of child immunization services in a tertiary health institution in Sokoto North-West Nigeria. International Journal of Immunology. 2020;8(2):25. doi:10.11648/j.iji.20200802.13
Sato R. Differential determinants and reasons for the non- and partial vaccination of children among Nigerian caregivers. Vaccine. 2020;38(1):63-69. doi:10.1016/j.vaccine.2019.09.097
Oleribe O, Kumar V, Awosika-Olumo A, Taylor-Robinson SD. Individual and socioeconomic factors associated with childhood immunization coverage in Nigeria. the Pan African Medical Journal. 2017;26. doi:10.11604/pamj.2017.26.220.11453
Owoaje E, Rahimi AO, Kalbarczyk A, Akinyemi O, Peters MA, Alonge OO. Conflict, community, and collaboration: shared implementation barriers and strategies in two polio endemic countries. BMC Public Health. 2020;20(S4). doi:10.1186/s12889-020-09235-x
Sato R. Zero-Dose, Under-Immunized, and Dropout Children in Nigeria: The Trend and Its Contributing Factors over Time. Vaccines. 2023;11(1):181. doi:10.3390/vaccines11010181
Adeyanju GC, Sprengholz P, Betsch C. Understanding drivers of vaccine hesitancy among pregnant women in Nigeria: A longitudinal study. Npj Vaccines. 2022;7(1). doi:10.1038/s41541-022-00489-7
Olorunsaiye CZ, Degge H. Variations in the uptake of routine immunization in Nigeria: Examining determinants of inequitable access. Global Health Communication. 2016;2(1):19-29. doi:10.1080/23762004.2016.1206780
Freeland C, Kanu F, Mohammed Y, et al. Barriers and facilitators to hepatitis B birth dose vaccination: Perspectives from healthcare providers and pregnant women accessing antenatal care in Nigeria. PLOS Global Public Health. 2023;3(6):e0001332. doi:10.1371/journal.pgph.0001332
Ignis IO, Tomini S. Vaccination Coverage: Vaccine-Related Determinants & Anthropometric Measures in Children Resident in a Rural Community in Nigeria. Current Drug Safety. 2022;17(3):199-210. doi:10.2174/1574886316666211029153212
Babalola. Inequalities within Nigeria’s education system: a focus on secondary schools in Lagos, Ondo State and Ogun state. Bulgarian Comparative Education Society. Published online 2018. http://files.eric.ed.gov/fulltext/ED586174.pdf
Fàbregues S, Escalante-Barrios EL, Molina-Azorin JF, Hong QN, Verd JM. Taking a critical stance towards mixed methods research: A cross-disciplinary qualitative secondary analysis of researchers’ views. PloS One. 2021;16(7):e0252014. doi:10.1371/journal.pone.0252014
Kaufman J, Tuckerman J, Bonner C, et al. Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews. BMJ Global Health. 2021;6(9):e006860. doi:10.1136/bmjgh-2021-006860
Kerrigan AR, Aitnouri I, Mar J, Altman W. What barriers exist in the minds of Vaccine-Hesitant parents, and how can we address them? Family Medicine. 2020;52(9):626-630. doi:10.22454/fammed.2020.432940
Conklin L, Hviid A, Orenstein WA, Pollard AJ, Wharton M, Zuber P. Vaccine safety issues at the turn of the 21st century. BMJ Global Health. 2021;6(Suppl 2):e004898. doi:10.1136/bmjgh-2020-004898
Anderson EL. Recommended solutions to the barriers to immunization in children and adults. Missouri Medicine. 2014;111(4):344-348. https://pubmed.ncbi.nlm.nih.gov/25211867/
Saidu Y, Vouking M, Njoh AA, et al. The effect of the ongoing civil strife on key immunisation outcomes in the North West and South West regions of Cameroon. Conflict and Health. 2021;15(1). doi:10.1186/s13031-021-00341-0
Grundy J, Biggs BA. The impact of conflict on immunisation coverage in 16 countries. International Journal of Health Policy and Management. 2018;8(4):211-221. doi:10.15171/ijhpm.2018.127
World Health Organization: WHO. Vaccines and immunization. Published October 29, 2019. Accessed May 20, 2024. https://www.who.int/health-topics/vaccines-and-immunization
Sato R. Effect of armed conflict on vaccination: evidence from the Boko haram insurgency in northeastern Nigeria. Conflict and Health. 2019;13(1). doi:10.1186/s13031-019-0235-8
Olayinka F, Sauer M, Menning L, et al. Building and sustaining public and political commitment to the value of vaccination: Recommendations for the Immunization Agenda 2030 (Strategic Priority Area 2). Vaccine. Published online December 1, 2022. doi:10.1016/j.vaccine.2022.11.038
Albers AN, Thaker J, Newcomer SR. Barriers to and facilitators of early childhood immunization in rural areas of the United States: A systematic review of the literature. Preventive Medicine Reports. 2022;27:101804. doi:10.1016/j.pmedr.2022.101804
UNICEF. Vaccination and Immunization Statistics - UNICEF DATA. UNICEF DATA. Published November 14, 2023. Accessed April 20, 2024. https://data.unicef.org/topic/child-health/immunization/
Mavundza EJ, Cooper S, Wiysonge CS. A Systematic Review of Factors That Influence Parents’ Views and Practices around Routine Childhood Vaccination in Africa: A Qualitative Evidence Synthesis. Vaccines. 2023;11(3):563. doi:10.3390/vaccines11030563
Wilson L, Rubens-Augustson T, Murphy M, et al. Barriers to immunization among newcomers: A systematic review. Vaccine. 2018;36(8):1055-1062. doi:10.1016/j.vaccine.2018.01.025
Attwell K, Betsch C, Dubé E, et al. Increasing vaccine acceptance using evidence-based approaches and policies: Insights from research on behavioural and social determinants presented at the 7th Annual Vaccine Acceptance Meeting. International Journal of Infectious Diseases. 2021;105:188-193. doi:10.1016/j.ijid.2021.02.007
Blackford JK. Immunization controversy: Understanding and addressing public misconceptions and concerns. the Journal of School Nursing/Journal of School Nursing. 2001;17(1):32-37. doi:10.1177/105984050101700105
Adebowale A, Obembe T, Bamgboye E. Relationship between household wealth and childhood immunization in core-North Nigeria. African Health Sciences. 2019;19(1):1582. doi:10.4314/ahs.v19i1.33
Oku A, Oyo-Ita A, Glenton C, et al. Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study. BMC Public Health. 2017;17(1). doi:10.1186/s12889-017-4020-6