New Telegraph

MI CS: Why we immunise our children –Kebbi women


•Govt strives to close immunisation gap, says Commissioner for health

A few years ago, Kebbi, like many other states in Nigeria, lagged behind in the immunisation rate, but with the most recent Multiple Indicator Cluster Survey 6 (MICS 6), all that has changed. The report showed an impressive improvement in this regard with about 50 per cent increase in vaccine uptake in recent years. Isioma Madike reports that the bug of immunisation is gradually but steadily catching up also with rural areas in that state

A’isha was diagnosed by a doctor at a very tender age of seven with post-polio syndrome. Now she is fully grown and has had surgeries on both legs so that she can get around with the help of a cane. Aminah, a 28-year-old, is in a similar situation.

Today, she struggles to ride her tricycle with her hands as she navigates the harsh sun in a suburb of Jega in Jega Local Government Area of Kebbi State. She contracted polio when she was three years old. Usually, riding the tricycle is not so strenuous.

But, the harsh sun often makes her area difficult to navigate. Often, her tricycle’s handbrake is broken, making it even more difficult to manoeuvre. Yet, this mother of one, powers on, keeping pace with vaccination teams going house to house to administer the oral polio vaccine to children under the age of five in her neigbourhood. With a smile on her face, it was easy to suggest a sense of triumph.

If she comes across an open drain that her tricycle cannot cross, she gets off and walks on her hands, or she takes a long detour around it and finds the path again. However, to stem this ugly tide, and to help keep children safe, it is important to get them not only vaccinated but fully immunised to these killer diseases. This will not only protect them, but will also help prevent the spread of these diseases to their friends and loved ones. Immunisations can save a family time and money, experts say. In the past 50 years, vaccines have saved more than a billion people and made life better for everyone by preventing more illnesses and disabilities than one can count.

Before vaccines, illnesses like polio, smallpox, tetanus, and measles killed and disabled thousands every year. But, vaccination has proved to be one of the best tools to reduce fatal and debilitating communicable diseases and make a safer, healthier world. However, accessing healthcare at the primary facility in Gwandu, headquarters of Gwandu Local Government is the delight of most women within the locality of the facility. The major reason for this attraction happens to the availability of needed healthcare products and services that are always available at the centre.

Perhaps this is what warranted the joyous mood of the majority of women who visited the health facility daily to access immunisation services for their children. Very early, sometimes as early as 7a.m. the spacious hall which serves as patients’ waiting area at the health centre had become filled with every available seat, occupied by mostly mothers who brought their children to keep earlier booked immunisation appointments, geared towards tackling childhood diseases.

While some mothers breastfed their babies as young as three months old to pacify them while they waited for the clock to strike 8am, the official resumption of official engagements, others rocked theirs while playing with them as the time ticked by. At 8.15a.m, a female staff called out names of the babies, who were on appointment to be immunised. Our reporter, who interacted with some of the mothers to find out why the immunisation exercise was a priority for them, got a full load of sweet stories from these cheery, mostly young mothers, some of whom surprised this reporter with their impeccable English. Kerimo Bello is married with three children, the last being just one-year-old as at the time of our reporter’s visit.

She is 18 years old. She told Saturday Telegraph that it was both exciting and fulfilling to have brought her one-year-old daughter, Sofia, for polio vaccination haven seen the devastating effect of polio on other children. She said: “The vaccine she was just given was aimed at protecting her from contracting the infections and deadly diseases.

So, I don’t miss her immunisation appointments. Even her first and second children also accessed all the prescribed vaccines. “My children grew up properly; their statures are normal. And when other children have some of these infectious diseases, they never had any despite living and playing with them.“ She however advised other mothers to ensure that their children get vaccinated. While explaining that not even her business engagement would prevent her from bringing her children for immunisation, Bello said she was happy for keeping up with this particular responsibility.

“I am also a business woman but I closed my shop to come and vaccinate my daughter just like I did for her older siblings. We should not, because of money, forsake these all-important inoculations. I strongly believe that our children’s wellbeing should come first among other considerations. Health they say is wealth and I key in to that. “So, parents, especially mothers should create time to get their children vaccinated so as to pave the way for their proper growth. It’s the right of every child to get the proper and full vaccination.

“We should forget that when they fall sick, all the money we pretend to be making would go into their healing and sometimes we lose them to these preventable diseases,” she said. Many other women who spoke to this reporter had one sweet tale and another to tell also. The interesting part of these stories is that they were mostly from women from the rural areas in at least four of the local government areas visited.

The women, who praised the authorities for sensitising them about the importance of immunisation, said they were only taking advantage of this to immunise their children, particularly because it is free. This, unlike Kebbi counterparts, has made the state record a very impressive leap of 50 per cent in childhood immunisation, rising from 11 per cent in 2017 to the current figure of 55 per cent.

This is a feat Sokoto State, also in the north, is struggling to record. With seven per cent in the 2017 MICS report to 11 per cent in the last survey, Sokoto, on the other hand, stands highest in number of unimmunised children in the country, despite advocacy efforts involving the Sultan of Sokoto and other community leaders to encourage more families to embrace routine immunisation. According to UNICEF Chief of Measurement for Result, Claes Johanson, some of the reasons responsible for low vaccine uptake in Nigeria generally include lack of knowledge or information, poor health service delivery, mistrust, fear, socio-cultural barriers, myths and misconceptions.

Johanson did not fail to draw out the clear fact that Kebbi was doing something different that was positively turning around the lives of more children in the state, by giving them a better shot at living a healthy life free from preventable childhood diseases which were capable of destroying or crippling the future. According to him, “one of the ways to change the trend is to invest more in the human resource and in healthcare in the country. States should look at the survey results and consider what they need to change. If there is commitment and the right investment is made, the country will have a success story to tell.”

Satisfied with this modest achievement, the Kebbi State Commissioner for Health, Jafaru Muhammad, told our reporter that several measures were adopted before the state could achieve this feat. Such measures, he said, are a domestic response mobilisation through a month ly basket fund, partnership with the European Union (EU)on interventions implemented by UNICEF, and strengthening of health care delivery services in all the local government areas. Others, according to Muhammad include the implementation of Primary Health Care (PHC) under one roof, introduction of supporting supervision at all health service delivery points, and recruitment of qualified health workers were adopted. He said: “As of 2018, our health indices were very bad and the state government decided to declare a state of emergency on health. A basket fund was committed monthly to accelerate services, scale up services across the state and so the PHC under one roof was approved to achieve that.

“Through the partnership we had also with the EU implemented by UNICEF, we were able to strengthen healthcare services within our LGAs so that we will be able to carry out intensive supervision and frequent coordination to ensure all services at the PHC level were carried out properly. “We had to scale up services in the area of local information dissemination, and deployed supporting supervision to all health service points.

“All these were what helped us record an increase from 11 per cent to 55 per cent, because all stakeholders in Kebbi State healthcare delivery were brought to book and the basket fund coming in every month helped us change the narrative.” He further revealed that the government has a target of bridging the numbers of children yet to be immunised in the state. Besides, he said the 309 workers employed as a result of the three year ongoing intervention from GAVI, the vaccine alliance, UNICEF and WHO, a budget line has been created in the 2023 budget to enable Kebbi State recruit more health workers sustainably, with a view to sustaining the tempo in its immunisation indices.

But to scale up routine immunisation in states with poor indices, the Director, PHC Systems and Development, National Primary Health Care Development Agency (NPHCDA), Ngozi Nwosu, has urged states to invest in human and capital development. She noted that this would only enable mothers to access a healthcare facility that has the needed infrastructure.

“Explaining this has become necessary given that many families were already used to also house to house immunisation,” she said. She added: “If states are able to have a routine system where mothers know the facilities to access immunisation for their children and also have a place where they can access treatments for other diseases like malaria, tuberculosis (TB), hypertension, diabetes, and cancers, we will be able to improve on immunisation coverage because that is where people are able to go for these services. “Also, if there are no infrastructures, if the infrastructure is poor, if the human resources, that is the health workers are not there, if the equipment is not there, or if it’s there but no light or no water, and the right things are not there, people will not go.”

Nwosu who noted that eight states; Jigawa, Bayelsa, Zamfara, Kebbi, had disclosed that rejection has been one of the challenges confronting immunisation uptake in their states. “Sometimes it is not that the government is not doing anything; sometimes this is what we call rejection.

Some mothers just tell you they are not interested. Sometimes it is linked to religious or cultural belief. We have deployed human resources to find out the exact problems, sensitise them on the importance of immunisation in helping their children live healthy lives. “We have also scaled up engagement with the traditional and religious leaders, health workers, the Civil Society Organisations (CSOs) and the media to make sure we close the gap in noncompliance to ensure that the health services that the Nigerian government has spent so much on make the desired impact.

“We want to make sure that the Nigerian primary healthcare system is strengthened, is revitalised and that we are able to provide health services to at least 70 per cent of our population because when we do that, then the general hospitals that we also call secondary facilities are able to concentrate on more difficult diseases. “The tertiary hospitals that we also call the specialist hospitals or the teaching hospitals are now able to concentrate on research, concentrate on those very difficult diseases and not having to treat malaria, not having to treat diarrhea and measles; these are very basic things,” Nwosu said.

However, Mrs. Coker Rufus, Nurse in charge at the Sir Yahaya Memorial Hospital, Birnin Kebbi, told our reporter that vaccines operate on a well-established scientific principle. When one’s immune system encounters disease-causing bacteria or viruses, she said, it responds by producing antibodies that fight off the disease.

The body in turn fights off many minor bacterial or viral invasions, and one often isn’t even aware of it. She said: “Unfortunately, some diseases are potent enough to spread throughout the body before the immune system can increase antibody production to fight it off. For these diseases, vaccines act as training for the body by kick-starting antibody production. They are made of dead or weakened versions of the disease that trigger the immune system.

“To protect against death and disability, vaccinations should begin early in an infant’s life and continue regularly throughout childhood and adolescence. I’d like to advise consultation with a pediatrician for a specific schedule or to review immunisation schedule. “But general guidelines indicate that children should begin vaccination during their first year against Hepatitis B, Tetanus, Diphtheria, Whooping Cough (Pertussis), Polio, Measles, Mumps, Rubella, and a number of other illnesses.” Immunisation, according to experts, is an essential, cost-effective strategy to reduce childhood morbidity and mortality, which saves lives.

However, unvaccinated children remain vulnerable to vaccine-preventable diseases and are often disadvantaged due to poverty, conflict, and lack of access to basic health services. However, in most parts of Kebbi, like in other states, seven out of 10 children are said not to have received full vaccinations with some having received as low as just one vaccine, according to available data.

The data also showed that 19 per cent of children aged between 12 and 23 months are not vaccinated at all in most parts of the country. Children who have never been vaccinated are at the greatest risk of contracting diseases such as measles, whooping cough, tuberculosis and tetanus, which may be fatal or lead to long-term debilitating effects on survivors. However, experts have said that providing evidence based information on immunisations will go a long way to remove doubts about vaccines as well as make them more widely acceptable.

Apart from polio, other vaccine-preventable diseases like tuberculosis, measles and pneumonia continue to rank among the top killers of children under age five in Nigeria and other developing countries. Each year, nearly 31 million children under five suffer from these diseases and many of them end up dying from the diseases. Pneumonia alone, according to reports, claims the lives of more than 800,000 children every year.

These are deaths that could be prevented with adequate vaccine coverage. According to the Federal Ministry of Health, a child is considered fully vaccinated if he or she has received a Bacillus Calmette-Guérin (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. Nigeria, reports say, contributes about 30 per cent of the global number of unimmunised children under five. Government efforts to strengthen routine immunisation coverage and reduce under-five mortality, according to such reports, have had limited success over the last decade.

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