Factors affecting childhood immunization across communities in Sokoto State, Nigeria, and recommendations to improve vaccine uptake
Background: Immunization continues to be one of the most effective and affordable public health interventions across the globe. Immunization initiatives have saved approximately 154 million lives over the past 50 years, the equivalent to 6 lives every minute of year-round with more than 101 million of those lives being infants (WHO, 2024). However, despite the effectiveness of this life-saving intervention, deaths from vaccine-preventable diseases (VPDs) remain very high in Africa with an estimated half a million children dying from VPDs every year, representing approximately 58% of global VPD-related deaths. Globally, more than 22.7 million children estimated to be zero-dose children, of which an estimated 3.1 million (~14%) reside in Nigeria (WHO, 2024) with most in the northern part of the country, particularly the northwestern states of Sokoto state (Gavi, 2023).
Methods: Data were collected through document review, informal interviews, key informant interviews (KIIs), and focus group discussions (FGDs) and MAXQDA was used to analyze the data. A comprehensive search of childhood immunization documents from the National Primary Health Care Development Agency site as well as sites from Centers for Disease Control and Prevention sites, World Health Organization, and UNICEF. Informal interviews were conducted with national level health care experts, KIIs with state, local government area (LGA), and community level health care workers, and community leaders, and FGDs with care givers in 8 communities across 4 LGAs. Participants were purposively selected to capture their perspectives on the challenges faced in increasing the demand for childhood immunization services in the state and recommendations for improving uptake.
Results: Thematic analysis identified factors such as incentives, community engagement, care givers knowledge and awareness about the value of immunization, and engagement of fathers as some of the biggest factors influencing childhood immunization in Sokoto state. Factors like insecurity had limited impact on childhood immunization. Themes such as addressing felt needs, continuous education, and trusted expertise were identified across the different data sources.
Conclusion: Findings underscore the need for state-specific interventions that improve childhood immunization across Sokoto state. Tailored approaches that consider the socio-economic and cultural context of the state will be critical in increasing the demand for and uptake of childhood immunization across communities in the state.