IMPROVING IMMUNIZATION ACTIVITIES IN SUWA WARD, LAMURDE LOCAL

GOVERNMENT AREA, ADAMAWA STATE

INTRODUCTION

Immunization is a crucial public health intervention that significantly reduces morbidity and
mortality from infectious diseases. In Suwa Ward, Lamurde Local Government Area (LGA),
Adamawa State, improving immunization activities is essential to ensure better health outcomes
for the population. This paper explores strategies to enhance immunization activities in Suwa
Ward, focusing on increasing coverage, addressing barriers, and leveraging community
engagement.

The development and use of vaccines has been one of the greatest achievements in public health over
the past two centuries.1 Childhood immunisations are the most cost-effective medical intervention to
prevent death and disease.2 Not solely a good in itself, childhood immunisation represents the gateway
provisioning of comprehensive health care to all children (1). Over two million deaths are delayed through
immunization each year worldwide . Despite this, vaccine preventable diseases remain the most
common cause of childhood mortality with an estimated three million deaths each year. Uptake of
vaccination services is dependent not only on provision of these services but also on other factors
including knowledge and attitude of mothers ,density of health workers , accessibility to vaccination
clinics and availability of safe needles and syringes (2). The World Health Organization (WHO), United
Nations Children’s’ Fund (UNICEF), and National Programme on Immunization (NPI) guidelines stipulate
that a child should receive four doses of Oral Polio Vaccine (OPV), three doses of Hepatitis B Vaccine,
three doses of Diphtheria, Pertussis and Tetanus (DPT) vaccine and one dose each of Bacille Calmette –
Guerin (BCG), measles and yellow fever vaccines . Routine immunization with these vaccines is a cost
effective way of reducing childhood morbidity and mortality in developing countries. The prevention of
these diseases in one child also has a positive ripple effect on the population as the immunized child will
not transmit the disease to another child (herd immunity.

developed countries, risk factors for low vaccination of children at low socioeconomic level were
explored and effective strategies were implemented. The success of EPI dose not only depends on
effective vaccination series, but also high immunization coverage. Estimate of immunization coverage
that based on vaccination status of children in specific age or with specific demographic characteristic
is archieved. For example, first dose of MCV (MCV1) is used to monitor progress toward the
Millennium Development Goals and third dose of DPT coverage is used as an indicator of health
system performance in other countries. Pin pointing the non-vaccination determinants is important for
achieving the EPI target (4). Vaccines are temperature-sensitive biological products. Exposure to heat
shortens a vaccine’s shelf life, while freezing vaccines that should not be frozen causes irreversible loss
of potency. Therefore, maintaining vaccines inside the cold chain (ICC) is an essential part of a
successful immunization program. However, in many developing countries, a cold-chain infrastructure
is not available, especially in remote and rural areas. Some people live in remote areas, far away from
the county health center, and there is no cold-chain infrastructure. As a strategy to extend vaccination
coverage, some local health units have suggested winter delivery of vaccines, relying on ambient
temperatures outside the cold chain (OCC) (5).

Study done in Nigeria shows that, mothers older than 29 years tended to vaccinate more, and being
from a tribe other than Hausa Fulani was positively associated with complete immunization . The
perception that distance of home to the nearest health facility was far was associated with decreased
uptake of immunizations ( multivariate adjusted OR 0.70, 95% CI 0.57-0.86), as was being -of Islamic
faith (multivariate adjusted OR 0.63, 95% CI 0.49-0.82), living in the rural area(multivariate adjusted
OR 0.77, 95% CI 0.63-0.95), and being in a polygamous union (OR 0.77, 95% CI 0.61-0.97) which were
all inversely associated with complete immunization (6).

1.1. Background and Problem Statement :

Nigeria is the World’s 7th largest and African largest country in terms of population. It is situated in
Sub- Saharan Africa with an estimated total population of 164,036,151 per 2006 National census, with
an area of 937, 587 sq. km. The main religion is Islam which is predominant in the North followed by
Christianity in the South of this country. There are 36 States and one Federal Capital Territory in Nigeria
(7)
.

Every State has certain numbers of Local Government Areas (LGAs) and every LGA has certain numbers
of wards. In Northern Nigeria, people live in settlements which are the lowest administrative units
headed by community settlement heads. Several settlements constitute a ward, which is headed by
District heads. Jigawa, with a total land area of over 22, 000 square kilometres, is one of the thirty-six
states that constitute the Federal Republic of Nigeria. It is one of the seven States in the present north-
western political Zone of Nigeria (Kano, Katsina, Kaduna, Zamfara, Sokoto and Kebbi). The state
borders Kano and Katsina States to the west, Bauchi State to the east and Yobe State to the northeast.
 To the north, Jigawa shares an international border with the Republic of Niger. Both the international
and state borders are porous due to economic and other social movements .Jigawa is mostly
populated by Hausa/Fulani. Other tribes are Kanuri and Badawa. Islam is the predominant religion and
the population is mostly rural with subsistence farming as the main activity
2. Current Status of Immunization in Suwa Ward

To develop effective strategies, it is important to understand the current status of immunization

activities in Suwa Ward. This includes:

- Coverage rates of various vaccines (e.g., BCG, DPT, Polio, Measles)

- Availability and accessibility of immunization services

- Community awareness and attitudes towards immunization

- Challenges faced by healthcare providers

3. Barriers to Effective Immunization

Several factors may impede immunization efforts in Suwa Ward:

Logistical Challenges: Limited transportation and storage facilities for vaccines.

Healthcare Infrastructure: Inadequate number of healthcare facilities and trained personnel.

Cultural and Social Barriers: Misconceptions about vaccines, religious beliefs, and lack of trust
in healthcare services.

Economic Factors: Poverty and lack of financial resources to access healthcare services.

Political and Policy Issues: Inconsistent government policies and lack of funding for
immunization programs.

4. Strategies to Improve Immunization Activities

4.1 Strengthening Healthcare Infrastructure

Increase Healthcare Facilities: Establish more immunization centers within Suwa Ward to reduce
travel distances for residents.
Improve Vaccine Storage and Transportation: Ensure proper cold chain management to maintain
vaccine efficacy.

Training and Capacity Building: Regularly train healthcare workers on immunization practices,
cold chain management, and community engagement.

4.2 Community Engagement and Education

Awareness Campaigns: Conduct community-based campaigns to educate residents about the

importance and safety of vaccines.

Involvement of Community Leaders: Engage religious and traditional leaders to endorse

immunization and address cultural misconceptions.

School Programs: Implement immunization education programs in schools to inform students

and their families.

4.3 Addressing Logistical and Financial Barriers

Mobile Clinics: Deploy mobile immunization units to reach remote areas and populations with
limited access to healthcare facilities.

Financial Support Programs: Provide financial incentives or subsidies for families to encourage
immunization.

4.4 Policy and Governance

Strengthening Policies: Advocate for robust immunization policies at the local and state levels to
ensure consistent funding and support.

Monitoring and Evaluation: Establish a monitoring and evaluation system to track immunization
coverage and identify areas needing improvement.

Partnerships: Collaborate with non-governmental organizations (NGOs), international agencies,

and private sector partners to support immunization efforts.

5. Case Studies and Best Practices

Successful Immunization Campaigns: Review case studies of successful immunization programs

in similar contexts to identify best practices.
Lessons Learned: Analyze challenges and solutions from previous immunization efforts in
Adamawa State and other regions.

Technical support was provided pre, post and during implementation of Feb, March 2011 IPDs and
mop up activities in Brinig kudu , Duste, Gumel and Babura LGAs; the main activities conducted were
to Participate in task force meeting and daily evening review meeting out ward and locality level ,
Supportive supervision in ward level training , Participate in chronically missed children
investigation( area with more than 10% missed children) in Feb - March 20012 , we also participate in
Reviewing , updating and validating the IPDs micro planning and HROP (high risk operational plan),
Facilitate in Capacity building for LGA - WHO facilitators training in state level in March 2012 . We
conducted tally sheet analysis and Participated in planning and supervision of cross border activities
and synchronization activities, these were with border states (Katsin Boutshi ). Concerning social
mobilisation, several activities were conducted including religious men and conducting sensitization
meeting with districts head and teacher of women and children Quaranic schools.

2.2. AFP surveillance and IDSR:

On-job training for AFP focal persons in hospital and health facilities in Garki ,Babura and Gumel ,
sensitization meeting was conducted in three main hospitals, on focus in clinicians ,focal persons for
surveillance and local community traditional healers. we also Participated as facilitators training 36
clinicians and surveillance focal persons on IDSR/ AFP surveillance disseminating the principles of case
definition, documentation and reporting process in surveillance system .we Reviewed and updated
the surveillance plan and net work in terms of number of site and frequency of visits. AFP and measles
active search surveillance and supportive supervisions were provided for priority focal site in Gumel
Babura (100%) and Garki (only general hospital ) . 4 AFP cases were verified with community active
search in Bring Kudu Babura LGA.

2.3. Routine immunization activities:

We participated in state level meeting to review state Feb, 2012 emergency planning additionally we
Conducted sensitization meeting with EPI officer to enhance the RI activities in ward level in Gumel
and Babura LGAs. Great work applied in the field of Supportive supervision provided to fixed and
outreach. Flow up was done for some of the HFs. We regularly attended monthly meetings sessioned
in Gumel, Babura and Garki LGAs (18 health facilities).all action points were documented to
disseminate our feedbacks and correction measure. the importance of involving community leader in
immunisation activities considered in our activities and represented in attending several community
leader meeting with health authority. Special attention was paid to Cold chain management and
monitoring.

3. BEST PRACTICES

Our field work noted several best practices and innovations such as, Community leaders were well
involved in IPDs and RI activities and the results were cleared in attending daily review meeting. it is
very interesting to mention that the quality of training improved because of involving IM and senior
supervisors ,team supervisors and immunisation teams in same session field practical training .renew
and updated microwaving and mapping system at word level strengthen the micro planning and filling
the previous existing gabs .enormous work obtained for rational healers for the reason that all of them
were well sensitized about the AFP system and have visited from EPI staff.

4. FIELD WORK FINDINGS

Missed children and missed settlements reported in Feb and March IPDs in some ward due to
inadequate number teams assigned and poor close supervision. Among the immunisation team
surveyed indicated that, Poor team performance due to poor team selection and poor training practice
especially in word level. As well as Supervision gabs seen in particular at LGA level regarding
surveillance focal persons. improper measles and AFP active search visit were noted in surveillance site
and this is characterized by unavailability of fixed date for visiting in the surveillance planning net
work and National surveillance guide lines are not available in most of focal surveillance site in
Babura,Garkiand Gumel.we observed significant documentation gap within surveillance site. Regard
routine immunisation ,vaccinators were not regularly using tally sheet records during the sessions in
the way that could cause missing data .logistically, cold chain need to be assessed to enhance vaccine
potency , that for the reason there is no cold chain check-up and pack up conducted during six month
before the survey.

5. RECOMMENDATIONS

The following recommendations were suggested to sustain and achieve the goals of Polio Eradication
in LGAs of assignment and Jigawa State in general. State team should continue advocate for political
engagement to support and successes polio eradication activities. Technical support should be to
obtain and intensified monitoring and supervision at field level during the IPDs through all level of
supervisors to play as solution for improving team performance and reach the missed children .close
 supportive supervision to the surveillance site by the State, WHO officers and the LGA Facilitator
should be intensified. Improving data management and documentation at the surveillance Cold chain
system and vaccine management should be improved to keep the vaccines in optimal environment.

Conclusion

Improving immunization activities in Suwa Ward requires a multi-faceted approach that

addresses logistical, infrastructural, cultural, and financial barriers. By strengthening healthcare
infrastructure, engaging the community, addressing logistical challenges, and advocating for
strong policies, immunization coverage can be significantly improved, leading to better health
outcomes for the population. Collaboration among government entities, healthcare providers,
community leaders, and external partners is essential for the success of these initiatives.
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