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Monday, May 13, 2013

Taking immunization seriously in Nigeria



Remmy Nweke in this report examines the merits of taking immunization in Nigeria very seriously by all strata of the society, including the grassroots community-based organisations to cover the hard-to-reach areas.
Preamble

A child receiving immunization
A spot at Maryland junction in Lagos is where Aisha Usman, a 28-year-old specially challenged lady graduate of microbiology, always stations herself with the help of a brother, Adamu. Aisha’s predicament was traced to the inability of her parents to heed to the calls for Nigerians to take immunization seriously.

Both Aisha and Adamu managed to transport themselves from northern Nigeria to Lagos in the west to beg for alms, an occupation they have engaged for over a year and in fact, it afforded them the luxury of now using a wheelchair to move Aisha around.

After a chat with them on if their parents had immunized Aisha particularly, her situation should not have been the same today. Like every other girl of her age, Aisha should have gained employment which has eluded her due to her disability.

In all honesty, Aisha confessed that she will get immunized, if she has powers to tune the hands of time and even become an advocate for immunization, especially for children whose parents take decision for them at tender age.

Aisha’s predicament represents several Nigerian children who may have missed out on basic vaccines, due to religious believes or absolute misinformation on the importance of immunization. As at press time, the World Health Organisation (WHO) says that Immunization currently averts an estimated 2 to 3 million deaths every year. But an estimated 22 million infants worldwide are still missing out on basic vaccines.



Immunization time table:

A nurse doing what she knows best ... courtesy Leadership
NaijaAgroNet gathered that based on WHO’s outline, at birth, antigens vaccines must be given, particularly the BCG, OPV0, HepB0, and six weeks for OPV1, Pentavalent 1, PCV 1; 10 weeks later is for OPV2, Pentavalent 2, PCV 2, then followed by OPV3, Pentavalent 3, PCV 3, which must be taken at 14 weeks, and 9 months for measles and Yellow Fever to be well monitored, even as Pentavalent vaccine comes in two forms Liquid and Liquid + Lyophilized. Liquid + Lyophilized will be used in Nigeria.



Immunization, a protection process:


An official of the National Primary Health Care Development Agency (NPHCDA), Dr. I.E Ukpong informed NaijaAgroNet, while addressing participants at the Association Of General Private Nursing Practitioners (AGPNP) annual scientific conference at Lagos Airport Hotel, recently, that immunization is a process whereby an individual is made immune or protected from a particular infectious or disease agent, which could be passive or active. Stressing that passive immunity is of relatively short duration induced by administration of antibody-containing preparation like antiserum or by transfer of maternal antibodies.


The medical practitioner noted that active immunity is usually of a longer duration and could be acquired through introduction of antigenic material into an individual body leading to development of specific protective antibodies or cellular immunity.

Thus, Ukpong said immunization is a cost-effective intervention which prevents suffering, disability and death, with its benefits universal in nature, comprising improvements in health, life expectancy and positive social and economic impact at the global, national and community levels.

Dwelling on Immunization in Nigeria: Challenges and Way Forward, Dr. Ukpong listed some global achievements through immunization to include eradication of smallpox, reduction in global incidence of polio by over 99 per cent, reduction in illness, disability and death from diphtheria, tetanus, pertusis and measles.



Nigeria and Under-five infant mortality:

In Nigeria, Dr. Ukpong noted that from 2000 and 2008 the national coverage for all antigens was between 10 per cent and 50 per cent. Consequently, the Under-Five (U5) mortality rate and the Infant mortality rate (IMR) for year 2003 were 201 per 1,000 and 100 per 1,000 respectively. While in 2008, U5MR number was at 157 per 1000 and IMR counted for 75 per 1000.

Experts have defined the IMR as the number of deaths of children less than one year of age per 1,000 live births, just as Under-five mortality rate (U5MR) is the probability of dying between birth and before their fifth birthdays.

Further, Dr. Ukpong outlined some challenges facing the Primary Health Care (PHC) in Nigeria, namely weak health and PHC system in most parts of the country, poor funding of the PHC system, low political will and commitment, poor cold chain system, shortage of vaccines and high turnover of health workers at the local administrations.

Additionally, the medical expert pointed out that weak and passive surveillance systems, false contra-indications – Fear of side-effects in patience, missed opportunities, whereas the under-served and hard-to-reach communities were part of the reasons immunization has not been successful as anticipated.

However, Dr. Ukpong proffered some solutions to include that inter-sectoral collaboration in PHC with involvement of the private health sector, should increase, while sustaining advocacy to political leadership for support.



Community mobilization imperative:

Community mobilization and sensitization through workshops, social clubs, markets, schools and health facilities, he said, should be sustained, even as increased funding for the PHC system, cold chain system strengthened, provision of transport logistics, solar refrigerators, whilst improvement of health care services through daily vaccinations of eligible women and children as at when due, plus disease surveillance would ensure that data obtained thereof would be used to improve service delivery.

Advocacy, Ukpong suggested should be taken to political, traditional and religious leaders for ownership and endorsement.



Political will:

This option may have motivated the likes of Bill Gates Foundation to institute a grant initiative for the Nigeria Governors Forum (NGF), for any state that scales through its threshold on immunization to win some grants among others.

Tagged Governors’ Immunization Leadership Challenge, the initiative challenges governors under the aegis of NGF to deliver an improve polio and routine immunization for the populace and any governor whose state passes a pre-defined threshold to improve routine immunization coverage and end polio will be awarded a $500,000 grant from the Bill & Melinda Gates Foundation to support their top health priorities.

Gov. Mimiko and wife, attending to a baby recently
According to Bill Gates, leaders are critical to making Nigeria polio free and their renewed commitments will make an important difference. Stressing, “As Nigeria’s partner, the Gates Foundation is committed to doing what we can support their efforts to end this terrible, but preventable, disease.”



Gates challenges Nigerian governors:

Also, NaijaAgroNet gathered that the award would support winning governors’ priority initiatives in public health, such as malaria and tuberculosis, improving immunization, HIV prevention and treatment, or safe drinking water and hygiene promotion. 

The grant, would also enable those governors who achieved the goals to receive special recognition from Mr. Gates for their contribution to the elimination of polio. Winning governors will be highlighted in foundation communications, such as Mr. Gates’ annual letter or the foundation’s annual report, social media materials and Mr. Gates’ public engagements globally.

“As governors push hard over the next year … to end polio, I want to ensure their efforts are acknowledged and that the governors are simultaneously supported to tackle other key health problems they face in their states,” said Mr. Gates.

For the Governor of Rivers State and Chairman of the Nigeria Governors’ Forum, Chibuike Rotimi Amaechi, they want to stop polio and improve routine immunization to protect Nigeria’s children against preventable diseases.

His Imo State colleague, Mr. Rochas Okorocha, declared that the issue of polio is embrassing to Nigeria and needs urgent steps to curb.



Eradicating polio by 2016:

Visible effect of polio in Nigeria
Chief Executive Officer, NPHCDA, Dr. Ado Muhammad recently maintained that the agency would set priorities in the areas of polio eradication and strengthen routine immunization, activate save- one-million-lives initiative, integrate and ensure a programming of HIV/AIDS intervention, as well as health accountability measures and efficient communication approach to name a few, promising that 2016 is targeted year for eradication of most of these ailments.

Dr. Muhammad said his agency recently achieved successful innovations such as capacity building and deployment of over 7,500 health care workers to 1,500 health facilities through the National Midwifery Scheme and Maternal and Child Health project of the Subsidy Re-investment Programme (SURE-P) in that order.



Conclusion:

The United Nations Children Education Fund (UNICEF) recent reports that the unprotected children under one year of age who did not receive Diphtheria-tetanus-pertussis (DTP3) immunization vaccine worldwide, amounts to 22.4 million in 2011 compared to 21.1 million in 2010. Whereas over 70 per cent of these children live in 10 countries, namely Afghanistan, Chad, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa; calls for an urgent action by African Union (AU) whose members made up five out of the 10 countries mostly affected.

Equally important in ensuring that Nigerian society, mostly the children enjoy an improved public health, especially routine immunization, media participation and consistency in enlightenment cannot be over emphasized. Hence, it was most demeaning when some elements who claim to be media practitioners at a radio station up northern Nigeria, was using a public medium to pass negative information concerning the efficacy of immunization and future of country like Nigeria.

Thank God, the National Broadcasting Commission (NBC) promptly banned the programme and ensured that it is off-air, at least, as deterrent to future occurrence and goes far in reiterating government’s determination to attain a polio-free state.

Although WHO cautioned that annually, about 400,000 Haemophilus influenzae type b (Hib) associated diseases occur in under five years bracket in Nigeria. Noteworthy, is that Hib vaccines protect against Haemophilus influenzae type b, but do not prevent diseases caused by other types of Haemophilus influenzae, such as bronchitis, otitis, and sinusitis. They do not prevent meningitis and pneumonia caused by other agents.

The National Primary Health Care Development Agency (NPHCDA), therefore, must ensure that immunization are administered according to WHO schedule which states that at birth antigens vaccines must be given, particularly on what to take and when, are well monitored in Nigeria.

Parents, especially fathers’ inclusion will make the subject a family affair, so that in a case where a mother forgets, the father can remind her.

Taking enlightenment to village squares, market places, schools, age-group associations and village heads, while not leaving out the collaboration of grassroots community-based organizations to reach the under-served and hard-to-reach communities should be involved as Public-Private Partnership (PPP).

Other states in Nigeria, should as a matter of urgency, emulate the kind gesture of the Ondo State governor, Olusegun Mimiko, who provided pregnant women with free 100,000 mobile phones, to assist them in reaching out to health personnel and act as calendar reminder for immunization, in addition to offering tips on family health in general, despite studies which canvassed against its use by pregnant women.

It is imperative to state that though Information and Communication Technology (ICT) tools like mobile devices should be used with caution, its advantages for a better health care cannot be ruled out entirely, because a healthy nation is a wealthy nation.

Remmy Nweke/NaijaAgroNet
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