Early Impact of SARS-CoV-2 Pandemic on Immunization Services in Nigeria
2.1. Study Design
2.2. Study Setting
2.3. Sampling and Sample Size
2.4. Data Collection Process
2.6. Data Analysis
3.1. Impacts of COVID-19 Pandemic on Accessibility to Immunization
3.1.1. Decrease in Healthcare Service Delivery
“The lockdown affected people and most caregivers were not able to visit the healthcare facilities, even here there are no vaccines and other drugs to administer, due to the COVID-19 pandemic”—HCW (Narayi PHC). “We are just trying to improvise now, at least to see how we can maintain the clients” HCW (Rayfield PHC). “People are scared of coming to the hospital because they read what is happening about the pandemic”—Caregiver (FGD: Yelwa, Iloko, Ijebu-Ijesha,Yekemi…communities).
3.1.2. General Fear of Overcrowding, Especially among Caregivers with Pre-Existing Conditions
“It is difficult for clients who are suffering from other illnesses to come and follow all the sanitary protocols—HCW (Naray, Oja Timi, Oriade PHCs…). “Some healthcare facilities were not giving PPE to protect HCWs against COVID-19. so, we were exposing ourselves to so many dangers in crowded situations” HCW (Godogodo, Barkin Ladi, Foron, Kaduna south, Jema’a PHCs…). “There are not even enough face masks in the hospital, we are just managing, and I will come and expose myself because of what?” HCW (Agban, Igbona, Samaru…PHCs).
3.1.3. Lockdown and Movement Restrictions to Curb Community Transmission of COVID-19
“We are restricted in offering immunization services. So, it is one of the major reasons for decline in services”—HCW (Baban Dodo, Badiko, Kawo, Oba-Ife, Bokkos, Jos North…PHCs). “…it affected immunization services because we had total lockdown and transportation was not easy. So HCWs were found it difficult to come to work”—HCW (Kakuri, Jarmi, Dengi, Shika, Alaye…PHCs). “The caregivers were not able to reach healthcare facilities due to the lockdown”—Caregivers (FGD: Okefia, Kuda, Kagoma… communities). “Our children did not take immunization because we feared going out”—Caregivers (FGD, Oba-Ile, Oke-Oniti… communities). “Since there was a ban, no movement of vehicle or motorcycle due to the lockdown, this affected the ability of many caregivers to go to the healthcare facilities”—HCW (FGD: Ijebu-Ijesha, Kajola, Barnawa…PHCs and communities).
3.1.4. Decrease in Social Interactions and Public Gatherings
“Unlike before where ceremonies are done with huge gatherings, now it is no longer the same”—Caregiver (FGD, Badiko community)
3.1.5. Cost of Transportation
“…It affected healthcare services because of transportation. Some patients wanted to come to the facility but because they are far away, it was difficult for them to come due to problems of transportation” - HCW (Pankshin, Chip, Buruku…PHCs). “The healthcare facility was opened but most parents were not able to come because of transportation issues, especially costs”—Caregivers (FGD: Op, Gyel, Rantya, Zarazong, Timbol, Madubi…communities).“I have a patient who told me that she could not afford the transport fare to take her child to the facility…the charges are unbearable”—HCW (Imo PHC). “There was no vehicle for them to transport the vaccine from cold store and distribute to facilities”—HCW (Sekona PHC).
3.1.6. Lack of Personal Protective Equipment (PPE) Stalls Vaccination Services Based on Perceived Risks
“We, the HCWs are not well equipped. There was no provision of PPE for us to protect ourselves”—HCW (Olusokan, Shendam, Rukuba, Eleyele… PHCs). “Caregivers are afraid of coming to the healthcare facilities. Before attending to the caregivers, we need to wear the required PPE, because they are scared” – HCW (Oriade, Tundun-wada PHCs). “Many caregivers came to the facilities without their face masks, so we tell them to return home to get them, but many never return” – HCW (Eleyele PHC); Caregivers (FGD: Okefia community).
3.1.7. High-Handedness of Law Enforcement Agents
“Amotekun, police, soldiers, they stopped us from going or coming to hospital”—Caregivers (FGD: Iloko, Lokoro, Narayi…communities). “They can’t come out because the police arrest the people who don’t stay at home”—HCW (Sekona PHC).
3.1.8. Low Uptake in Hard-to-Reach Locations (Suspension of House-to-House Outreach)
“The reason is that people don’t like to come to the hospital. We had to go and educate people about the importance of vaccination. So, due to the Lockdown, going from house to house is no longer feasible”—HCW (Chikun PHC). “We are appealing to the Government to provide ways of receiving the vaccines easily, in such a way that HCWs don’t even have to travel” – Caregivers (FGD: Oba-oke, Aloma, Sakadadi, Ungwan Dosa…communities).
3.2. Impact of COVID-19 Pandemic on Uptake of Immunization Services
3.2.1. Fear of Contracting COVID-19 and Fear of Forceful Vaccination against COVID-19
“We are afraid of contracting the disease from the HCWs. We will go to get immunization for our children after the lockdown is relax and COVID-19 is gone”—Caregivers (IROJO community). “People were not able to come down because of fear. Since it is a hospital, caregivers argue that other patients visiting might carry infection…they say ‘eh no dey show for face’. They don’t know much about the virus and that is one of the fears they have that prevents them coming to the facility“—HCW (Godogodo, Saminaka…PHCs). “Some were thinking that we have added COVID-19 vaccine into the immunization services, so they refused to come” – HCW (Ologunna PHC).
3.2.2. Knowledge Gap
“I don’t really know much about COVID-19 but what I heard is that it is like someone who feels malaria symptoms in their body, like weakness, cold, too much coughing and he can’t control himself…”—Caregivers (FGD: Ologunna community)
“It is a virus that does not belong here but where it was first reported in Wuhan (China)” – HCW (Eleyele PHC; FGD: Iloko community).
3.2.3. Misinformation and Disinformation about COVID-19 Pandemic and COVID-19 Vaccines
“Most of our patients thought that when they come to the healthcare facility, we might create another scene by saying we would move them to the isolation center, so most of the caregivers who were supposed to bring their children for immunization were scared” – HCW (Oja-timi PHC). “Some of us think that if we go to the facility, our children might be vaccinated with COVID-19 vaccine”—Caregivers (FGD: Imo, Isale-oyo, Adejuwan, Jos south…communities).
3.2.4. Socio-Economic Impact of the Pandemic
“They don’t have money…some have no money for transportation” – HCW (Ologunna PHC). “It really affected them because some people could not find a motorcycle to transport them to the clinic, and even if they found one, they can’t afford it, because it is double the price before the pandemic and lockdown started”—HCW (Olodan PHC; FGD: Giwa, Kakuri, Gora, Gidan Galadima…communities). “All the COVID-19 sanitary protocols put in place made me stay home because it would have cost me a lot of money”—Caregivers (FGD: Ologunna community). “People didn’t want to go because they were short of food stuff……. we that don’t have money to buy food, how can we go for vaccination?”—Caregivers (FGD: Olodan community).
3.2.5. Lack of Solar Energy to Power Vaccine Storage Facilities
“Electricity contributed to low uptake, because during the lockdown, some healthcare facilities didn’t have the electric power needed for vaccines storage. I think this is the things that really affected immunization services”—HCW (Ologunna, Iwaraja, Buruku…PHCs). “We don’t have anywhere to store vaccine during power cut, such as solar powered refrigerators, so caregivers didn’t bring their children for immunization”—HCW (Ologunna PHC). “Some facilities in rural areas where there are no solar refrigerators to store the vaccines were unable to provide immunization services”—HCW (Iso ege, Isale oyo PHCs).
3.2.6. Long Queues Due to Strict COVID-19 Sanitary Protocols
“We were not allowed to sit together as we used to before the pandemic started, and we were spending longer than before”—Caregivers (FGD: Imo community). “All of the HCWs were saying if you don’t use face masks, you can’t enter, even when we don’t have any, we had to go away to get a mask before they would see us” – Caregivers (FGD: Okefia, Ijebu Ijesha…communities).
3.3. Impact of COVID-19 on Confidence in Immunization Services
3.3.1. Lack of Confidence in COVID-19 Information and Poor Attitude among HCWs
“Not all HCW trusted the information provided that said once you practice the precautionary measures like social distancing, use of PPE and practicing personal hygiene like handwashing, you would be unlikely to be infected and when the COVID-19 vaccine also comes, you can take the vaccine and the chances of being infected are slim…if you are infected, the chances of severity are slim” – HCW (Oja timi, Ologunna PHCs). “They did not pay our allowances, so we are not motivated”—HCW (Kawo, Badarawa, Alomi…PHCs).
3.3.2. Risk Perception of COVID-19 Pandemic and Susceptibility to Infection at Healthcare Facilities
“People were even scared of going to the hospital because of reading what was happening and fear that hospitals were super spreader centers”—Caregiver (FGD: Yelwa, Sabon Tasha, Kaura, Olodon, Sekona…communities)
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
|AMP||Agence de Médecine Préventive|
|DTP3||Third dose of diphtheria-tetanus-pertussis containing vaccine,|
|EPI||Expanded Program on Immunization|
|FGD||Focus group discussion|
|GAVI||Global Alliance for Vaccines and Immunization|
|MoH||Ministry of Health|
|PHC||Primary health center|
|PPE||Personal protective equipment|
|Q&A||Question and answer|
|RI||Routine childhood immunization|
|UNICEF||United Nations International Children’s Emergency Fund|
|WHO||World Health Organization|
|WUENIC||WHO/UNICEF Estimates of National Immunization Coverage|
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Essoh, T.-A.; Adeyanju, G.C.; Adamu, A.A.; Ahawo, A.K.; Aka, D.; Tall, H.; Aplogan, A.; Wiysonge, C.S. Early Impact of SARS-CoV-2 Pandemic on Immunization Services in Nigeria. Vaccines 2022, 10, 1107. https://doi.org/10.3390/vaccines10071107
Essoh T-A, Adeyanju GC, Adamu AA, Ahawo AK, Aka D, Tall H, Aplogan A, Wiysonge CS. Early Impact of SARS-CoV-2 Pandemic on Immunization Services in Nigeria. Vaccines. 2022; 10(7):1107. https://doi.org/10.3390/vaccines10071107Chicago/Turabian Style
Essoh, Tene-Alima, Gbadebo Collins Adeyanju, Abdu A. Adamu, Alain Komi Ahawo, Desquith Aka, Haoua Tall, Aristide Aplogan, and Charles S. Wiysonge. 2022. "Early Impact of SARS-CoV-2 Pandemic on Immunization Services in Nigeria" Vaccines 10, no. 7: 1107. https://doi.org/10.3390/vaccines10071107