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Benefits of Immunization in Nigeria, A Preventive not Curative Strategy

PUBLIC HEALTH INFORMATION:

  • Immunization is Free and It is your basic right as a Nigerian.
  • We can save millions of Nigerians from vaccine-preventable diseases through immunization, .
  • Millions of Nigerians are dying from Vaccine preventable diseases.
  • immunization is made to prevent diseases and not to cure sicknesses.
  • Immunization/Vaccination is not a means/strategy to reduce population.
  • Immunization/Vaccination doesnt cause impotence/sterility or any other disease.
  • Nigeria has the lowest immunization rate in Africa
  • Nigeria is the only country in Africa with polio with a high transmission in the north.
  • Ignorance, religion, culture and misinformation contribute to immunization failure in Nigeria
  • Nigeria has to develop Vaccines locally, to combat various diseases.

 

CASE FILE:

A 2 year old male was brought to the children Out-patient of a Nigerian University Teaching Hospital by the mother. The mother complains of weakness in his left leg. He is afebrile and does not have any signs of respiratory distress. His left leg appears flaccid. No deep tendon reflex or Babinski sign could be elicited although sensation looks intact.

The tone, reflexes, movement and sensation of the other limbs are normal.

Examination of his cardiovascular, respiratory and abdominal systems are all normal.

 

Upon further investigation, his mother reveals that he had a fever of 38.3 C and cough that resolved one week before they came to the clinic. His mother also gave history of a normal birth history and appropriate well baby check ups.

His mother on further investigations, revealed that he has not been up to date with his immunization schedule. He only received his first dose of BCG, HiB, DPT, and pneumococcal vaccine.

She revealed the she stopped the immunization due to the fever he developed after the shots and the information she got during the period that immunizations are not safe.

 

FBC and Serum IgG/IgA/IgM are normal and CSF demonstrates elevated protein with normal glucose. Stool culture reveals presence of the Poliovirus type 3.

 

Diagnosis: Poliomyelitis caused by the polio virus, a vaccine-preventable disease.

 

DISCUSSION:

Polio (known as poliomyelitis) is a highly contagious and infectious illness that exclusively affects humans. The polio virus is transmitted through the fecal-oral route (through mouth), though oral-to-oral transmission is possible.

After the virus is contacted, it invades tissues of the oropharynx (mouth and gullet). The virus reproduces in the gastrointestinal system. Spread of the virus to other systems of the body like  the blood, lymph, etc  leads to destruction, which causes the paralysis that is seen in persons who have polio.

Despite the decrease in the incidence of polio in the world (following the introduction of polio vaccines), Nigeria, especially Northern Nigeria is still battling the menace of the disease.

In our later publication, we would discuss polio, but today, we want to center our discussion on immunization, which has drastically reduced the occurrence of Polio, the world over.

 

IMMUNIZATION

Vaccine-preventable diseases remain the most common cause of childhood mortality with an estimated three million deaths each year.

Immunization is a medical practice which employs the use of vaccines, which are weakened or dead antigens(could be virus, or protozoa) to improve our immune system. This enable the body to fight better and prevent diseases, which otherwise would have caused death of the child. Complete immunization protects the average Nigerian child from contracting a number of vaccine-preventable diseases such as polio, tetanus, hepatitis, influenza, Pneumonia and recently cervical cancer. Hence, immunization is a means of prevention and not a means of treatment, and should be taken at the right time.

Immunization in Nigeria

Immunization is as important as feeding in the life of a growing child, and it is sad that Nigeria, according to statistics, has the lowest immunization rate in Africa. In the same analysis, Urban centres (with over 60%) recorded more vaccinations than rural centres( with 25%). The South eastern Nigeria has over 80% Vaccination for children with the North East has less than 20%. There is 12% immunization stats for children with mothers with no Education compared to 82% stats for children born to educated mothers(with minimum of SSCE). This can be attributable to several factors, which include;

  • Ignorance/Lack of Education
  • Religion
  • Misinformation
  • Culture
  • among others

 

This publication is aimed at enlightening the average Nigerian Populace, who can read and understand, on the basic immunization required of every Nigerian child, the disease it protect against, where it is given, how it is given, what it contains and finally, where you can get them. It is our hope that every Nigerian who comes across this publication can be able to educate the parents around them, especially in the Villages on the importance and benefits of immunization. Over time, we would embark on a rural outreach to educate new, inexperienced and uneducated mothers on the benefits of immunization.

 

See this video for some challenges and Myths spread by less educated persons about Immunization.

Finally, we would shed some lights on the challenges facing vaccination practices in Nigeria and dispel the rumors which people harbor about the immunization process.

 

NATIONAL PROGRAMME OF IMMUNIZATION (NPI) VACCINATION IN NIGERIA AND THE VACCINES

The Expanded Programme on Immunization (EPI), was introduced in Nigeria in 1978. The NPI was designed by the Government of Nigeria to provide free immunization for Nigerian children less than 2 years against the 6 killer vaccine-preventable diseases which are polio, measles, diphtheria, whooping cough, tuberculosis, and yellow fever in the country. This free immunization can be obtained at any primary health centre in the country. The vaccines given are as follows;

  • The BCG (Bacille Calmitte Guerin) Vaccine: This vaccine when taken would help protect your child against Tuberculosis and Non-tuberculosis mycobacteria diseases. 0.05ml of the BCG vaccine is given anytime between birth-2 weeks at the left upper arm of your child to protect your child against tuberculosis (which is a terrible disease that we would discuss some other time).
  • BCG Vaccination
  • The Polio Vaccine: This vaccine protects your child against poliomyelitis, which plauged the world for centuries and is still causing epidemics in Northern Nigeria. There are 2 types of the vaccine. The Oral polio Vaccine (OPV) and the Injectable Polio Vaccine (IPV). According to the Nigerian immunization schedule, the polio vaccine is given at birth, at 6 weeks, at 10 weeks, at 14 weeks, and at 18 months. The IPV can still be given at 2-5 years. 0.5ml of this vaccine is given at the left thigh of the child to protect the child against polio.
  • Oral polio Vaccination
  • Diphtheria, Pertusis, tetanus (DPT) Vaccine: This is a vaccine which protect against the cardiotoxic and neurotoxic effects of Diphteheria, Pertusis and tetanus toxins. 0.5ml of this vaccine is given at 6 weeks, 14 weeks, 6 months and 18 months at the left thigh.
  • Hepatitis B Vaccine: This protects the child from Hepatitis B, which causes Hepatitis, a disease of the liver that causes the liver to be enlarged and inflammed. there are 5 types of hepatitis (A-E). 0.5ml of the vaccine is given, also in the left thigh, at birth, 6 weeks, 14 weeks and 6 months.
  • Hepatitis Vaccination
  • Haemophilus Influenza B (Hib) Vaccine: This protects the child against Haemophilus Influenza which causes a number of respiratory diseases. it is given in the left thigh at 6 weeks, 14 weeks and 6 months. It is not given before 6 weeks to prevent development of immune tolerance, leading to failure of antibody response after immunization.
  • Pneumococcal Conjugate Vaccine (PCV): This protects against streptococcus Pneumonia, which causes Pneumonia in children. Pneumonia is a very serious disease of the respiratory children and a major cause of death in African Children. The PCV vaccine is given in the right thigh at 6 weeks, 10 weeks, 14 weeks and 9 months.
  • Measles Vaccine: This vaccine protects the child against measles. Measles is the leading killer among Vaccine preventable diseases. The vaccine is given at 9 month of age in the right shoulder region.
  • Varicella Vaccine: This vaccine protects the child from Varicella virus, which causes chicken-pox. It is given at 12-15 months in the right shoulder region.
  • Yellow Fever Vaccine: This protects the child against the Yellow fever virus which causes Yellow Fever. The yellow fever vaccine is given at 9 months of age in, in the right shoulder.
  • Typhoid Vaccine: This protect the child from typhoid fever. It is given to a child between 2-5 years in the mouth or in the right shoulder.
  • Meningitis Vaccine: This protects the child from Bacterial Meningitis caused by Neiseria Spp. A disease which can cause convulsions or epilepsy in a child. Another possible cause of convulsion in children in Nigeria is Malaria but no vaccine is available yet for malaria. The meningitis vaccine is given to a child of 2-5 years in the Right thigh.
  • Vitamin A: This is the last but not the least member of the National programme for immunization in  Nigeria. It in itself is not a vaccine but is given to infants and sometimes, mothers to protect against Vit A deficiency diseases. It is given every 6 months, from the 6 months of life to 5 years.

NOTE: All Vaccines listed above in the National programme For immunization, are free for all citizens of Nigeria and are a basic right of every Nigerian Child. Hence, Poverty is not an excuse for not immunizing your child.

Although malaria is not among the list of vaccine-preventable diseases, researches are currently on to develop a malaria vaccine that will prevent and reduce malaria in children.

 

Other important vaccine as also available, though not listed in the National programme For immunization, and these are called the Voluntary/Special vaccines. They are not free but paid. They Include;

  • The Rotavirus Vaccine: which protects against Rotavirus which causes diarrhoea. Many children die from severe diarrhoea. This vaccine like others is also available at the primary health centres, but are not free.
  • The measles, Mumps, Rubella, Varicella (MMR-V) vaccine: This is also another paid vaccine.
  • The Human Papiloma Virus (HPV) Vaccine: This vaccine protects your child against the Human Papiloma Virus which causes Cervical Cancer. The vaccine is not free and cost around N9,000 at the time of publication. About 3 doses are required in a 9 month period.

 

According to the Nigerian Federal Ministry of Health definition, a child is considered fully vaccinated if he or she has received a BCG vaccination against tuberculosis; three doses of DPT to prevent diphtheria, pertussis (whooping cough), and tetanus; at least three doses of polio vaccine; and one dose of measles vaccine. All these vaccinations should be received during the first year of life, over the course of five visits, including the doses delivered at birth. According to this schedule, children aged 12–23 months would have completed their immunizations and be fully immunised.

 

POSSIBLE ADVERSE EFFECTS OF VACCINES

It would be wrong for you to be informed about the various available vaccines and their benefits, without a little mention of the possible adverse effects of the vaccines. Vaccines are created for therapeutic purposes, and like other drugs have their own adverse effects. Though this rarely happens, they include;

  • Fever
  • site irritation
  • severe allergic reaction
  • site ulceration
  • Vaccine associated Paralytic poliomyelitis (for polio vaccine)
  • Seizure/Convulsions
  • diarrhoea
  • vomiting

When you notice these reactions, See your health physician immediately.

 

Problems/Challenges with Immunization/Vaccination In Nigeria

Nigeria, as we mentioned earlier has the lowest rate for immunization in Africa. This is worse in the Northern Part of the Country, especially in the Muslim occupied areas. This has contributed greatly to the severity of death of children under the age of 5 in the country. Another important cause of death of children under 5 in Nigeria is malnutrition. 

The poor rate of immunization in Nigeria can be attributed to various factors including;

  • Ignorance: It is very sad, but worthy of note that, in Nigeria, many people have this belief that vaccines can cause sterilization (impotence) and other diseases. Their minds need to be disabused because they are not alone in this belief.
  • Religion: It is funny to know that in some parts of the Northern Nigeria, Vaccination is considered a sin against their belief. Not only in Northern Nigeria, but even among southern Nigerian members of the Seven day Adventist Church. Little wonder immunization is low among the northern states and the muslim population of the south. According to the 2003 National Immunization Schedule the percentage of fully immunized infants in the targeted states was less than 1% in Jigawa, 1.5% in Yobe, 1.6% in Zamfara and 8.3% in Katsina. As a result, thousands of children are victims of vaccine-preventable diseases.
  • Culture: A survey carried out by the Association for the Advancement of Family Planning, an Abuja-Based organization reveals that over 90 per cent of women in northern Nigeria practice home delivery for their children. These women are the greater population of Nigerian women, and they did not have attend antenatal care visits, neither do they visit the hospital. Little wonder why the worst cases of healthcare failure occur persistently in the North-Western and North-Eastern part of Nigeria.
  • Misinformation: It is more disturbing to know that in the Northern part of Nigeria, which has the lowest vaccination rate in the world, majority of the women and men have this belief that Immunization is a strategy created  by the westerners to reduce their population. A lot of persons reject immunization because of these stories they hear, and this has made it difficult for vaccines to reach part of the country jigawa, Yobe or Kano states. Some also have this information that immunization cures all diseases, including epilepsy, malaria. In some places in Katsina state, it was understood that only polio immunization is required and once a child has gotten the polio ‘drops’, he/she is immunized against all illnesses, including with no vaccine available. Hence, when it fails to cure the disease, they start loosing confidence in the immunization scheme.
  • Inadequate Funding and Corruption: Nigeria, Pakistan, Afghanistan and india are the Only 4 countries in the world yet to eradicate Polio. Similarly, Nigeria was recently announced as the poverty capital of the world, followed by India, with Pakistan and Afghanistan following behind. These countries have various funding challenges, but above all, corruption challenges which allows health officials to sell vaccines, meant to be distributed free to those in need, at exorbitant prices. These has prevented the educated members of the public from getting free vaccines. Nigeria as a nation needs to increase efforts aimed at making vaccines widely available across the country, especially in the villages and motivate health workers to penetrate these villages where majority of these deaths occur.

 

Due to these challenges highlighted above, various diseases which have been completely eradicated in other countries of the world such as whooping cough, polio, pneumonia, tuberculosis, chicken pox and measles, are sadly wasting away lives in Nigeria.

 

Possible Solutions To Nigerian immunization Challenges

  • Education: The primary means of tackling the problems of immunization in Nigeria is Public Health Education. It is a responsibility for You and i.The religious, Village and Political heads of the various regions need to be involved in spreading this messages, to every mother in the Rural and Urban places.
  • Government Efforts: The government at all levels has to improve efforts to facilities required for the purchase, storage and distribution of these vaccines. We need to have a functional cold chain system. The oral polio vaccine must be kept at 2–8 degree Celsius for it to be effective while some other vaccines need to be kept at -20 degrees and Nigeria struggles with these requirements.
  • Finally, Nigeria has the develop the Local Capacity to produce these vaccines.

 

 

Credits:

  • Institute of Child Health, University of Nigeria Teaching Hospital (UNTH)
  • Dr. Okechukwu Nnani. ICH, UNTH
  • Mrs. Okafor, ICH, UNTH
  • Punch Nigeria
  • Infoguide Nigeria
  • WHO
  • UNICEF
  • National library of Medicine (NLM)
  • TRTWORLD
  • EuropeAID
  • PWTV
  • IVAC
  • WAVA
October 30, 2018

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