Provider and community perceptions of integrated COVID-19 and routine childhood immunisation programmes in Nigeria: a qualitative exploratory study.
COVID-19 pandemic
Childhood immunisation
Essential health services
Health systems
Integrated vaccine delivery
Nigeria
Preventive care
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
21 Oct 2024
21 Oct 2024
Historique:
received:
13
02
2024
accepted:
20
09
2024
medline:
22
10
2024
pubmed:
22
10
2024
entrez:
21
10
2024
Statut:
epublish
Résumé
In Nigeria, COVID-19 vaccines were delivered through outreach activities, as well as integrated within routine immunisation. However, evaluations of integrated approaches for novel vaccines are scarce. We aimed to understand the perceived benefits and challenges of integrating the COVID-19 vaccine within routine immunisation in Nigeria, and identify ways to strengthen this approach. We conducted 30 semi-structured interviews with community members and healthcare workers in primary healthcare facilities (PHCs) in Jigawa (n = 16) and Oyo (n = 14) states, Nigeria from 08 August to 13 September 2022. Participants were selected purposively from PHCs. We obtained information on participants' perception about routine immunisation, and perceived benefits and challenges associated with integrated COVID-19 vaccine delivery. Healthcare worker and community interviews were analysed separately following a thematic analysis approach. We identified four themes that describe the community and healthcare workers' responses, perceived impact, and the health system adaptions to the challenges associated with the integrated vaccine delivery approach. Community members expressed concern that children might be given COVID-19 vaccines instead of routine immunisations, while others appreciated the integrated approach due to their trust in the efficacy of COVID-19 vaccines, government, and healthcare providers. Healthcare providers perceived the integrated approach as improving vaccination coverage and awareness but noted additional problems of increased workload, vaccine scarcity, and prolonged clinic visits. Insufficient resources were subsisting barriers to effective integration in both states, but the provider's gender was also a challenge in Jigawa state. Additionally, the use of incentives to generate demand had ambiguous effects in Jigawa state. Taking an integrated approach to deliver COVID-19 vaccines was acceptable by healthcare providers but community members expressed concerns. Given existing vaccination programmes have persistent challenges, it is pertinent to address these barriers to enhance effectiveness of an integrated approach.
Sections du résumé
BACKGROUND
BACKGROUND
In Nigeria, COVID-19 vaccines were delivered through outreach activities, as well as integrated within routine immunisation. However, evaluations of integrated approaches for novel vaccines are scarce. We aimed to understand the perceived benefits and challenges of integrating the COVID-19 vaccine within routine immunisation in Nigeria, and identify ways to strengthen this approach.
METHODS
METHODS
We conducted 30 semi-structured interviews with community members and healthcare workers in primary healthcare facilities (PHCs) in Jigawa (n = 16) and Oyo (n = 14) states, Nigeria from 08 August to 13 September 2022. Participants were selected purposively from PHCs. We obtained information on participants' perception about routine immunisation, and perceived benefits and challenges associated with integrated COVID-19 vaccine delivery. Healthcare worker and community interviews were analysed separately following a thematic analysis approach.
RESULTS
RESULTS
We identified four themes that describe the community and healthcare workers' responses, perceived impact, and the health system adaptions to the challenges associated with the integrated vaccine delivery approach. Community members expressed concern that children might be given COVID-19 vaccines instead of routine immunisations, while others appreciated the integrated approach due to their trust in the efficacy of COVID-19 vaccines, government, and healthcare providers. Healthcare providers perceived the integrated approach as improving vaccination coverage and awareness but noted additional problems of increased workload, vaccine scarcity, and prolonged clinic visits. Insufficient resources were subsisting barriers to effective integration in both states, but the provider's gender was also a challenge in Jigawa state. Additionally, the use of incentives to generate demand had ambiguous effects in Jigawa state.
CONCLUSION
CONCLUSIONS
Taking an integrated approach to deliver COVID-19 vaccines was acceptable by healthcare providers but community members expressed concerns. Given existing vaccination programmes have persistent challenges, it is pertinent to address these barriers to enhance effectiveness of an integrated approach.
Identifiants
pubmed: 39434115
doi: 10.1186/s12913-024-11623-7
pii: 10.1186/s12913-024-11623-7
doi:
Substances chimiques
COVID-19 Vaccines
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1262Subventions
Organisme : Swedish Research Council
ID : 2020-04737
Organisme : Swedish Research Council
ID : 2020-04737
Informations de copyright
© 2024. The Author(s).
Références
Shang W, Wang Y, Yuan J, Guo Z, Liu J, Liu M. Global excess mortality during COVID-19 pandemic: a systematic review and Meta-analysis. Vaccines. 2022;10(10). https://doi.org/10.3390/vaccines10101702 .
Doshi RH, Nsasiirwe S, Dahlke M, et al. COVID-19 Vaccination Coverage — World Health Organization African Region, 2021–2023. MMWR Morb Mortal Wkly Rep. 2024;73(14):307–11. https://doi.org/10.15585/MMWR.MM7314A3 .
doi: 10.15585/MMWR.MM7314A3
pubmed: 38602879
pmcid: 11008790
Africa CDC. COVID-19 Vaccination – Africa CDC. Accessed 10 Jul 2024. https://africacdc.org/covid-19-vaccination/
NPHCDA. Nigeria 11.7% short of COVID-19 vaccination target. Published 2023. Accessed 10 Jul 2024. https://punchng.com/nigeria-11-7-short-of-covid-19-vaccination-target/#google_vignette
WHO. Nigerians in situation of vulnerability to benefit from COVID-19 vaccination scale-up and integration through Canadian grant | WHO | Regional Office for Africa. Published 2023. Accessed 10 Jul 2024. https://www.afro.who.int/countries/nigeria/news/nigerians-situation-vulnerability-benefit-covid-19-vaccination-scale-and-integration-through
Ogunniyi TJ, Rufai BO, Uketeh SN, Turzin JK, Oyinloye EA, Effiong FB. Two years of COVID-19 vaccination in Nigeria: a review of the current situation of the pandemic: a literature review. Ann Med Surg. 2023;85(11):5528–32. https://doi.org/10.1097/ms9.0000000000001310 .
doi: 10.1097/ms9.0000000000001310
NCDC. COVID-19 Situation Report: Situation Report 95. Niger Cent Dis Control. 2021;95(June):1–4. https://ncdc.gov.ng/themes/common/files/sitreps/fe61a5d7bba46e835a7f6d09bd5343c8.pdf
WHO, United Nations. COVID-19 pandemic fuels largest continued backslide in vaccinations in three decades. Published 2022. Accessed 10 Jul 2024. https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades
GAVI. From equality to global poverty: how Covid-19 is affecting societies and economies. Published 2020. Accessed 10 Jul 2024. https://www.gavi.org/vaccineswork/equality-global-poverty-how-covid-19-affecting-societies-and-economies
WHO. States adopt integrated vaccination strategy to reach unimmunized children. | WHO | Regional Office for Africa. Published 2022. Accessed 10 Jul 2024. https://www.afro.who.int/countries/nigeria/news/states-adopt-integrated-vaccination-strategy-reach-unimmunized-children
Kozlowska O, Lumb A, Tan GD, Rea R. Barriers and facilitators to integrating primary and specialist healthcare in the United Kingdom: a narrative literature review. Futur Healthc J. 2018;5(1):64–80. https://doi.org/10.7861/futurehosp.5-1-64 .
doi: 10.7861/futurehosp.5-1-64
Offor C, Ade-Banjo O, Nwankwo C, et al. Evidence for Whole Family Approach in accelerating uptake of COVID-19 and routine immunizations among integrated primary health services in Nigeria. Front Heal Serv. 2023;3(May):1–9. https://doi.org/10.3389/frhs.2023.1157377 .
doi: 10.3389/frhs.2023.1157377
Shet A, Carr K, Danovaro-Holliday MC, et al. Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories. Lancet Glob Heal. 2022;10(2):e186–94. https://doi.org/10.1016/S2214-109X(21)00512-X .
doi: 10.1016/S2214-109X(21)00512-X
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). https://doi.org/10.1186/s12889-020-09169-4 .
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Heal. 2019;11(4):589–97. https://doi.org/10.1080/2159676X.2019.1628806 .
doi: 10.1080/2159676X.2019.1628806
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Heal Care. 2007;19(6):349–57. https://doi.org/10.1093/INTQHC/MZM042 .
doi: 10.1093/INTQHC/MZM042
NPC, Oyo. (State, Nigeria) - Population Statistics, Charts, Map and Location. Published 2022. Accessed 10 Jul 2024. https://citypopulation.de/en/nigeria/admin/NGA031__oyo/
GDL. Mean International Wealth Index (IWI) score of region - Area Database - Table - Global Data Lab. Published 2023. Accessed 10 Jul 2024. https://globaldatalab.org/areadata/table/iwi/NGA/?levels=1+4
United Nations Children’s Fund (UNICEF), (NBS) NB of S. About | National Bureau of Statistics. Published 2022. Accessed 10 Jul 2024. https://nigerianstat.gov.ng/news/77
NPC, Jigawa. (State, Nigeria) - Population Statistics, Charts, Map and Location. Published 2022. Accessed 10 Jul 2024. https://www.citypopulation.de/en/nigeria/admin/NGA018__jigawa/
Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med. 2022;292:114523. https://doi.org/10.1016/J.SOCSCIMED.2021.114523 .
doi: 10.1016/J.SOCSCIMED.2021.114523
pubmed: 34785096
Graham HR, Maher J, Bakare AA, et al. Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: analysis of a stepped-wedge trial in Nigeria. PLoS ONE. 2021;16(7 July):1–17. https://doi.org/10.1371/journal.pone.0254229 .
doi: 10.1371/journal.pone.0254229
King C, Burgess RA, Bakare AA, et al. Integrated sustainable childhood pneumonia and infectious disease reduction in Nigeria (INSPIRING) through whole system strengthening in Jigawa, Nigeria: study protocol for a cluster randomised controlled trial. Trials. 2022;23(1):1–13. https://doi.org/10.1186/s13063-021-05859-5 .
doi: 10.1186/s13063-021-05859-5
Conlon C, McDonnell T, Barrett M, et al. The impact of the COVID-19 pandemic on child health and well-being: are children slipping through the net ? A qualitative study of frontline emergency care staff. BMC Health Serv Res. 2021;9(1):1–29. https://doi.org/10.1186/s12913-021-06284-9 . https://bmchealthservres.biomedcentral.com/articles/ .
doi: 10.1186/s12913-021-06284-9
Kanma-Okafor O, Odusolu Y, Abayomi A, et al. A qualitative analysis of the COVID-19 vaccination rollout in Lagos, Nigeria: client and provider perspectives on the plan, the process and the progress. PLOS Glob Public Heal. 2022;2(11):1–19. https://doi.org/10.1371/journal.pgph.0000486 .
doi: 10.1371/journal.pgph.0000486
Ojewale LY, Mukumbang FC. COVID-19 vaccine hesitancy among nigerians living with non-communicable diseases: a qualitative study. BMJ Open. 2023;13(2). https://doi.org/10.1136/bmjopen-2022-065901 .
Dash S, Parray AA, De Freitas L, et al. Combating the COVID-19 infodemic: a three-level approach for low and middle-income countries. BMJ Glob Heal. 2021;6(1):1–5. https://doi.org/10.1136/bmjgh-2020-004671 .
doi: 10.1136/bmjgh-2020-004671
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. Pan Afr Med J. 2021;40(Suppl 1):10. https://doi.org/10.11604/PAMJ.SUPP.2021.40.1.23793 .
doi: 10.11604/PAMJ.SUPP.2021.40.1.23793
pubmed: 36157555
pmcid: 9475061
Babalola S. Maternal reasons for non-immunisation and partial immunisation in northern Nigeria. J Paediatr Child Health. 2011;47(5):276–81. https://doi.org/10.1111/j.1440-1754.2010.01956.x .
doi: 10.1111/j.1440-1754.2010.01956.x
pubmed: 21244560
Abdullahi S. Factors affecting completion of childhood immunization in North West Nigeria. Walden Univ Diss Dr Stud Collect. 2019;80(3-B(E)). https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=7095&context=dissertations
Bennett NG, Bloom DE, Ferranna M. Factors underlying COVID-19 vaccine and booster hesitancy and refusal, and incentivizing vaccine adoption. PLoS ONE. 2022;17(9 September):1–11. https://doi.org/10.1371/journal.pone.0274529 .
doi: 10.1371/journal.pone.0274529
Khazanov GK, Stewart R, Pieri MF, et al. The effectiveness of financial incentives for COVID-19 vaccination: a systematic review. Prev Med (Baltim). 2023;172(January). https://doi.org/10.1016/j.ypmed.2023.107538 .
Schwalbe N, Hanbali L, Nunes MC, Lehtimaki S. Use of financial incentives to increase adult vaccination coverage: a narrative review of lessons learned from COVID-19 and other adult vaccination efforts. Vaccine X. 2022;12:100225. https://doi.org/10.1016/j.jvacx.2022.100225 .
doi: 10.1016/j.jvacx.2022.100225
pubmed: 36217357
pmcid: 9535879
WHO, UNICEF. Considerations for integrating COVID-19 vaccination into immunization. Published 2023. Accessed 11 Jul 2024. https://www.who.int/publications/i/item/9789240064454
Aigbogun EO, Ibrahim R, Yusufari Y, et al. Impact of the COVID-19 pandemic on Routine Immunization Programs in Northern Nigeria. Sustain. 2023;15(17). https://doi.org/10.3390/su151712966 .