Why no child should die from vaccine preventable diseases

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World Immunisation Week – celebrated every year in the last week of April – aims to promote the use of vaccines to protect people of all ages particularly children. The recent Multiple Indicator Cluster Survey (MICS) conducted by the Federal Government in 2016/17 shows that only one in four children in the country receive all the recommended vaccines. In this report, APPOLONIA ADEYEMI reviews factors hindering routine immunisation in the country and proffers solution on the way forward

Nwanyibunwa Chukwudinma was eight months old when her parents sent a message that she was severely ill but lamented that the family lacked money to pay for her treatment in the hospital. Some relations who got the disturbing information promptly responded by urgently transferring the needed money to them. Although Nwanyibunwa was ultimately admitted into a nearby traditional healing home in Mbano, Imo State, the health outcome of the child became woeful; she lost both her hearing and speech functions. The child had suffered severe fever which culminated in measles within days.

Sadly, all efforts to persuade the child’s mother to take the baby to an orthodox health facility fell on deaf ears. According to the mother of Nwanyibunwa, she had earlier been advised to seek spiritual help as the challenges facing the baby were spiritual.

Today, Nwanyibunwa, 21 is an adolescent, but lives with mental disability; the measles that she suffered during her childhood has damaged her speech and hearing organs, leaving her hearing and speech impaired. From the time she marked her first birthday up till the present time, Nwanyibunwa has been dependent on others for her daily living because of the disability she faced, conditions that are preventable. However, medical experts said that she is fortunate to have survived; some children who experience the same challenge often lose their lives. Major childhood killer diseases like measles, chicken pox, polio, etc. have grave consequences when they affect children, yet they could be prevented via vaccines.

These are the highlights of ‘A Three-Day Media Dialogue On Routine Immunisation, Post Polio Certification And COVID-19 Vaccination’organised by the Child Rights Information Bureau (CRIB) of the Federal Ministry of Information and Culture in collaboration with UNICEF, held in Yola, Adamawa State from April 13 to 15.

The case of Nwanyibunwa is a common narrative in the Nigerian environment. Many children became crippled from polio in the country before the World Health Organisation (WHO) certified Nigeria polio-free. To date the impact of polio is still seen when those affected that are presently adults are seen going about their daily living, but they shouldn’t have been victims of polio. According to Mrs Elizabeth Onitolo, UNICEF Specialist, Communication For Development (C4D), the major cause of disability and death among children are vaccine preventable diseases.

“Immunisation is the best way to secure the future of children. It is safe, effective, free and available at all government health centres.” Key vaccines Among very important vaccines that the WHO has advocated for the protection of children include BCG which protects against meningitis and tuberculosis (TB) in children; oral polio vaccine (OPVo), that protects against infection with any one of the three related poliovirus types (referred to as types P1, P2, and P3); and in the case of OPV1, four doses are given, each of two drops. OPV is given at birth, six weeks, 10 weeks and 14 weeks of age.

The interval between all doses must be at least four weeks. The birth dose is known as OPV0; the subsequent doses are referred to as OPV1 (at six weeks), OPV2 (at 10 weeks), and OPV3 (at 14 weeks). Similarly, there is also Pentavac, which are vaccines used to protect against infectious diseases. This vaccine helps to protect children against diphtheria, tetanus, pertussis (whooping cough), poliomyelitis (polio) and serious diseases caused by Haemophilus influenzae type b (often just called Hib infections). In addition, the pneumococcal conjugate vaccine (PCV13) and the pneumococcal polysaccharide vaccine (PPSV23) protect against pneumococcal infections.

The bacteria that cause these infections spread through person-to-person contact. They can lead to serious infections like pneumonia, blood infections, and bacterial meningitis. Furthermore, measles can be prevented with a vaccine, which protects against three diseases: measles, mumps, and rubella.

The United States (U.S.) Centre for Disease Control (CDC) recommends that children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at four through six years of age. On its part, the Yellow Fever Vaccine is recommended for children aged nine months or older.

Yellow fever is a viral infection that occurs in Africa and South America. Most people begin to develop immunity within ten days of vaccination and 99 per cent are protected within one month and this impact appears to be lifelong. Irrespective of the availability of vaccines many of which can be accessed free from public health facilities, some Nigerian children have continued to fall victim to preventable diseases, sometimes leading to their untimely death. The recent Multiple Indicator Cluster Survey (MICS) conducted by the Federal Government in 2016/17 shows that only one in four children in the country receive all the recommended vaccines. In spite of their advantages, lifesaving vaccines have been rejected out rightly by some, based on their cultural and religious beliefs.

Similarly, misinformation and unsubstantiated materials about vaccinations have been disseminated, often leading to the rejection of immunisations. Another problem with vaccination exercise is when children miss taking complete doses of specific vaccinations. Based on ignorance and cultural beliefs some parents and guardians do not ensure their children complete the doses of vaccination as prescribed by medical personnel.

Onitolo said it is very important to complete routine immunisation as prescribed. Speaking on the need to sustain polio vaccine despite the WHO polio certification of Nigeria in the past three years, Onitolo said Nigeria can only sustain the current success if children continue to get vaccinated. “Virus can re-enter the community if there is an under-immunised child. She stressed that 180+ countries in the world, although most eradicated polio decades ago, still continue Polio vaccination for children to sustain Polio free status.

On the importance of completing vaccination doses, a foremost Virologist, Prof. Oyewale Toomori and chairman, Expert Review Committee on COVID-19, said, “When either children or adults fail to complete their vaccination doses, they will be partially protected with low level of immunity; the complement dose/doses increase immunity. Experts have also affirmed that sustaining immunisation would ensure that many children would be protected from diseases. The recent Multiple Indicator Cluster Survey (MICS) conducted by the Federal Government in 2016/17 shows that only one in four children in the country receive all the recommended vaccines.

Speaking at the media dialogue in Yola, the National Supervisor for Adamawa, COVID-19 Vaccination at the National Primary Health Care Development Agency (NPHCDA), Abba Mohammed Bawa said most of the reason why Nigeria has low routine immunisation coverage is the lack of awareness and lack of community involvement.

“For instance, when a caregiver takes a child to the hospital, she may not be aware that she needs to bring the child four or five times to the hospital to complete the immunisation schedule. They feel when the child is vaccinated during the immunisation campaign, they feel that the child is fully immunised.” However, he noted that there is a wide gap of knowledge, not involving the community people to enable them to own the immunisation programme because health personnel cannot sustain these gains.

“We have to involve people in the community to drive the ownership they wanted.” To ensure that children do not miss immunisation, Bawa advised parents to take eligible children to receive immunisation as at when due. For instance, if it has to be five times for a child to be fully immunised, parents should present the child five times to get vaccinated.

He said, “They should ask their relatives for eligible children for vaccination five times and as much as possible retain the child’s health vaccination card. It is important and evident that the child has been fully immunised. “Children should be immunised against diseases such as, polio, measles, yellow fever, meningitis, pneumonia and TB with the BCG vaccine we give at birth.” Speaking also on the integrity of vaccine distribution, Bawa said, when Nigeria declared routine immunisation (RI) emergency back in 2017.

“We developed an accountability framework where anybody in the RI activities in the country will be held accountable for their work, even to the facility level where we give the vaccines to the recorders and persons that are going to immunise people. “For every dose given to the recorder, he will be held accountable. We have people who go to the facilities in the local government arrears (LGAs) to conduct an audit; they will compare the vaccine and the doses we give to people that have been vaccinated. “We also check records to see the people that are immunised. Also, we do conduct surveys.

We go to the community, take a sample and check the immunisation records to see that the person that has been immunised to ensure that it is reflected in the record. To some extent, we have accountability in place.” According to Bawa sustaining RI for every eligible child in the country could pave the way for children such as Nwanyibunwa and million others to avert her disability from measles and other childhood preventable diseases.

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