By Bashir Hassan Abubakar
The Maternal, Newborn and Child Health indices in Bauchi State has continued to be of great concern to the State Government, World bodies like WHO, UNICEF, CDC, UNFPA and other technical partners like USAID, UKAID and local Civil Society Organisations (CSOs) in the State.
For long, medical experts and other key stakeholders like CSOs, CBOs, FBOs working in the health sectors all agreed that low immunization coverage is one of the major factors that is responsible for the death or permanent disability among children not only in Bauchi State but across Nigeria as a whole.
We were all witnesses to the resistance that greeted polio, COVID 19 and other routine immunization vaccines in some communities, despite consistent awareness that is still being carried out by different stakeholders.
As Bauchi State is grappling with the disturbing issues on low immunization coverage among children, another more worrisome challenge now is that of Zero Dose. Zero Dose means infants or children that have never been immunized against child killer diseases since birth. The mere thought of this in this 21st century is unheard of, but sadly, thses are some of the current situations, among other challenges, that are giving stakeholders in MNCH sleepless nights.
According to the 2021 Multiple Indicator Cluster Survey (MICS 2021), the percentage of immunization coverage in Bauchi State is lower than the entire Northeast region and National averages. The survey indicates that immunization coverage in Children aged 12-25 months is 16.5 percent, while that of Children aged 24-35 months stands at merely 7.9 percent.
Also, early childhood death rates are higher in Bauchi State compared to the rates for the Northeast region and National rates of children dying.
As contained in the MICS 2021, under-five mortality per 1000 live birth is 153 in Bauchi State, which is above the national average of 102 and the entire north east that stands at 114. Child mortality rate in Bauchi stand at 70 per 1000 live birth and infant mortality rate is 89 per 1000 live births. Post neonatal and neonatal mortality rates in Bauchi State are 43 and 45 per 1000 live births. (MICS 2021).
It goes without saying that most of these deaths in children were as a result of child killer diseases like Diphtheria, Measles, Whooping Cough, Influenza etc. These child killer diseases can be prevented through the uptake of routine children immunization and other self care therapy like the six months exclusive breastfeeding of infants.
What the above statistics means is that, despite all the efforts by the State Government, Donor/Implementing partners and other key sector stakeholders, some caregivers are not complying with routine immunization.
Over the years, there has been consistent awareness campaigns on routine immunization through the mass media and other channels, reaching out to care givers to allow their children be vaccinated against these child killer diseases, yet some of these caregivers especially the male tend to abhor routine immunization and other vaccinations for their children.
When Daily Chronicle sought to know why some of the caregivers have this lackluster attitude towards vaccines, their answers varied. While some complain of perceived myth associated with the vaccines, like the Western agenda of population control, others expressed their concerns on the frequency of administering the vaccines. Also, some see the elites among them rejecting the vaccines as role models, thereby copying them. But the greater percentage of both the male and caregivers interviewed revealed their ignorance on the benefits of immunization vaccines.
Salihu Ibrahim, a peasant farmer from Belisu community in Misau LGA is a father of six, whose children have not had their complete doses of immunization due to the lackluster attitude and poor knowledge of the importance of immunization.
It was heartwarming to observed, after informing him about the importance of the vaccines and how it can protect his children against certain diseases, how his perception of vaccine immunization change.
“In all honesty, prior to my conversation with you, i don’t really care whether my children have had their full doses of immunization or not. Though i have never rejected the vaccines for my children, but i don’t go out of my way to ensure that they are upto date in the uptake. In fact, at the peak of the farming, most of the children follow me to the farm to assist in one way or the other. I don’t even have second thought on the prospect of them missing out on immunization”, Salihu admitted.
Daily Chronicle’s conversation with Salihu buttresses the need for continuous engagement with caregivers before, during and after implementation of immunization campaigns. Even Salihu himself stressed the need for such engagements saying, “except for now that you have taken your time to explain to me the importance of such vaccinations, I would not have gotten the message clearly. Going forward, not only will i ensure total compliance to immunization, but i would equally passed the message to other male caregivers in my community”.
But while the case of Ibrahim Salihu can be said to be smooth sailing in convincing him about the importance of immunization, that of another male caregiver in Mai Ari community of Alkaleri LGA, simply identified as Mallam Abubakar, was somewhat aggressive, venting his anger on a system that he described as “insensitive to the persistent poverty , hunger and high cost of living within the citizens”.
Abubakar’s transferred aggression on immunization campaigns and his likes can be understood and the need to thread carefully in advocating for his buy in on immunization required tact and diplomacy. But one thing that came out of the conversation with Abubakar was that poverty also played a significant role in affecting the uptake of immunization in communities.
Zero Dose Threat
As if the low coverage on immunization in Bauchi State is not enough, another hydraheaded threat to children health is the growing number of Zero Dose children being discovered in over half of the 20 LGAs across the State. Simply put, zero dose child is that newborn child that has not had any vaccination within the first few months of life. These zero dose vaccines provide crucial protection against serious diseases, setting the foundation for lifelong health and growth of the child.
Some of the zero dose vaccines include BCG which protects against tuberculosis, Hepatitis B birth dose, OPV (Oral Poliovirus Vaccine), IPV (Inactivated Poliovirus Vaccine), DTP (Diphtheria, Tetanus, Pertussis), PCV (Pneumococcal Conjugate Vaccine) etc.
According to WHO, UNICEF and CDC zero-dose vaccines shield vulnerable infants from life-threatening diseases and prevent disease transmission in communities. Taking the vaccines also reduces infant mortality rates and lay the foundation for future vaccinations and overall improved health status of the child.
But with all the benefits inherent in the Zero Dose vaccines, some children in Bauchi State are being discovered not to have had any of such vaccines at birth.
Yes, it is true that the Bauchi State Government, through the State Primary Health Care Development Board (BSPHCDB) alone cannot mitigate the challenges around zero dose and low immunization coverage because it involves almost all segments of the society, it being a community focused activity. Perhaps it was this knowledge that spured world organisations like UNICEF, WHO, CDC, USAID etc rally round to support Bauchi State in reversing the disturbing trend in child health.
Integrated Immunization Campaign
One of the new measures to be adopted by the Bauchi State Government in the forthcoming Measles immunization campaign is the use of multiple vaccines in a campaign. Stakeholders believes that the integrated measles campaign would reduce vaccination fatigue resulting from many rounds. It would also reduce cost of campaigns and further makes it possible to reach all eligible children with needed vaccines at once. It is also envisaged that the time saved from conducting multiple campaigns can be channelled to other clients in the health facilities. It is also much easier to target as the recipients of some of the vaccines are the same.
Role of Media
Journalists, being one of the critical stakeholders in influencing behaviour change and societal reorientation have a key role to play before, during and after immunization campaigns.
This much was reiterated over the years by the BSPHCDB and other technical partners at several engagements preparatory to the commencement of most immunization campaigns. The Measles integrated campaign scheduled to hold in mid October is not different, refresher trainings and reorientations were conducted for the media practitioners.
In one of such engagements organized by UNICEF Bauchi Field office in collaboration with BSPHCDB, social and behaviour change specialist of UNICEF BFO, Eki George said that the general public relay on Journalists for accurate information and that there is the need for them to verify all information about the integrated campaign from credible sources like the federal and States primary healthcare agencies before going to press.
The SBC specialist further implored the Journalists to take lead in dispelling rumours, myths, negative perceptions and misinformation regarding the immunization campaigns.
While urging the media practitioners to work hard in hand with respective State Governments and partners to ensure that people have correct information about the forthcoming integrated measles campaign, Mr. Eki George said, “Work to promote vaccine benefits at both State and Local Government levels and also become a source of credible information about the integrated measles campaign for the people”.
To further demonstrate how serious Government and partners take the issue around Zero Dose, Routine Immunization and Mitigation of disease outbreaks, another implementing partner, a USAID funded social behaviour change intervention , Breakthrough Action – Nigeria (BA- N) Project, in partnership with the BSPHCDB put together a re-orientation training aimed at galvanising media action with a view to mitigating challenges associated with Zero Dose in Bauchi State.
During that training, BA -N Project Bauchi Field office Social and Behaviour Change (SBC) officer, Nura Bashir Faggo said that the training activity would explore avenues to develop key topics and story angles to give visibility to challenges related to zero dose and address rumours, myths and misconceptions on the outbreak of Diphtheria in some communities of Bauchi State.
Nura Faggo said that the training was designed to deepen the capacity of the media to develop and produce Social Behaviour Change programs/reportage on how to prevent disease outbreaks through the uptake of routine immunization and other health behaviour promotions.
Daily Chronicle also observed, during the BA-N re-orientation capacity building training, the role played by the service providers in dampening the enthusiasm and confidence of caregivers in the uptake of immunization at health facilities. Some of the caregivers interviewed disclosed the hostile attitude exhibited by the service providers during immunization periods. This is also compounded by the service provider’s poor knowledge of the Adverse Events Following Immunization (AEFI) that manifest in eligible children atfer being administered with the vaccines.
AEFI refers to any medical occurrence that follows immunization like the feverish conditions the chid might experience after the pentavalent vaccine immunization. If the service providers could educate caregivers on some these AEFI conditions and what to do, it would allay the fears of caregivers when such occurs.
These were succinctly captured in a recommendation, while highlighting BA -N’s findings on zero dose, in some selected communities of Bauchi State, by the advocacy and capacity strengthening officer of the Project Hadiza Jibril Ahmed. Some of the shared recommendations of the findings include:
- increased awareness about individual vaccines and address fears through continuous community and mediaengagements.
- The need for Government to implement routine and periodic outreach activities, especially in underserved communities.
- Engage community and religious leaders to advocate for routine immunization
As Bauchi State gets set to roll out the integrated measles campaign across all the 20 LGAs, it has become imperative to remind them on the need to leverage on the existing structures provided by the wide range of community resource persons in order to reverse the poor indices on immunization, zero dose and other MNCH challenges associated with the State. End
Some pictures were used for illustrative purposes only