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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 2  |  Issue : 4  |  Page : 175-178

Assessment of oral polio vaccine coverage in the Nigeria demographic and health surveys 1990, 1999, 2003, and 2008


1 Department of Community Medicine; Nigeria Field Epidemiology and Laboratory Training Program, Ahmadu Bello University, Zaria, Nigeria
2 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
3 Nigeria Field Epidemiology and Laboratory Training Program, Ahmadu Bello University, Zaria, Nigeria
4 Department of Human Physiology, Ahmadu Bello University, Zaria, Nigeria
5 Department of Human Physiology, Kaduna State University, Kaduna, Nigeria

Date of Submission15-May-2015
Date of Acceptance30-Nov-2015
Date of Web Publication22-Dec-2015

Correspondence Address:
Aisha Ahmed Abubakar
Department of Community Medicine, Faculty of Medicine, Ahmadu Bello University, Zaria
Nigeria
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DOI: 10.4103/2384-5147.172446

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  Abstract 

Introduction: By 1988, when the Global Polio Eradication Initiative began, there was an estimated 350,000 cases of poliomyelitis were occurring annually worldwide. By 2015, due to global vaccination efforts, indigenous transmission of wild poliovirus had been eliminated from all countries, except Afghanistan and Pakistan. A cornerstone of the polio eradication strategy is achieved by ensuring high levels of routine immunization coverage with 3 doses of oral polio vaccine (OPV) in children <1 year. Routine OPV coverage was assessed including some of the factors affecting coverage including region, place of residence, and mother's level of education. Methods: Secondary dataset analysis of the Nigeria Demographic and Health Survey carried out in Nigeria in 1990, 1999, 2003, and 2008 with available datasets was conducted. Results: Lowest coverage rates of 9%, 11%, 11% for 1999, 2003, and 2008, respectively, were recorded for the Northwest of Nigeria. OPV 0 coverage was twice that in urban areas compared to rural areas in 1999 and 2003 (42% vs. 19.91% in 1999 and 35.35% vs. 18.35% in 2003). OPV 0 coverage in children of mothers with no education was 12% in 1999, 2003, and 2008 compared to children of mothers with a tertiary education that were 56% in 1999, 50% in 2003, and 81% in 2008. Conclusion: OPV coverage was generally lower in the Northern region and in rural areas. Children of mothers with lower levels of education were less likely to receive OPV. Campaigns to improve routine immunization coverage should be targeted to the Northern regions, rural areas, and mothers with low educational levels.

Keywords: Demographic survey, oral polio vaccine, vaccine coverage


How to cite this article:
Abubakar AA, Gobir AA, Ibrahim MS, Nguku PM, Akor-Dewu MB, Chiroma FL. Assessment of oral polio vaccine coverage in the Nigeria demographic and health surveys 1990, 1999, 2003, and 2008. Sub-Saharan Afr J Med 2015;2:175-8

How to cite this URL:
Abubakar AA, Gobir AA, Ibrahim MS, Nguku PM, Akor-Dewu MB, Chiroma FL. Assessment of oral polio vaccine coverage in the Nigeria demographic and health surveys 1990, 1999, 2003, and 2008. Sub-Saharan Afr J Med [serial online] 2015 [cited 2019 Nov 14];2:175-8. Available from: http://www.ssajm.org/text.asp?2015/2/4/175/172446


  Introduction Top


In 1988, when the Global Polio Eradication Initiative started, there was an estimated 350,000 cases of poliomyelitis were occurring annually worldwide. By 2005, due to global vaccination efforts, indigenous transmission of wild poliovirus had been eliminated from all except four countries - Afghanistan, India, Nigeria, and Pakistan. [1] In 2015, Nigeria and India were removed from this list. The reduction in global polio cases was due to the concerted efforts of the Global Poliomyelitis Eradication Program launched by the World Health Organization (WHO) and other partners.

In addition to routine polio immunization included in the Expanded Program on Immunization (EPI) of the WHO, two major activities were planned.

Mass polio vaccination campaigns and surveillance of all cases of acute flaccid paralysis. [2] A cornerstone of the polio eradication strategy is the need to ensure high levels of routine immunization coverage with 3 doses of oral polio vaccine (OPV) in children <1 year at national, regional, and district levels. [3],[4] Good routine OPV coverage reduces the incidence of polio and makes eradication feasible. The WHO through EPI has established a global target of at least 90% immunization coverage by 2000 for six diseases diphtheria, tetanus, whooping cough, tuberculosis, measles, and poliomyelitis. Global routine vaccination coverage of infants with 3 doses of trivalent OPV (tOPV) by age 12 months was estimated at 83% in 2008, coverage varied by WHO region: African 72%, Southeast Asia 73%, Eastern Mediterranean 84%, European 96%, and Western Pacific 97%. [1],[5] Estimated national 3 dose tOPV coverage for 2008 was 85% in Afghanistan, 81% in Pakistan, 67% in India, and 61% in Nigeria. However, less than 40% coverage was reported from the Indian states of Bihar and Uttar Pradesh, parts of Afghanistan and Pakistan, and the Northern Nigerian states. [1] Some studies in Nigeria found routine immunization coverage in 2008 to be 80% nationally. Other vaccination coverage surveys conducted in 2007 and 2008 found coverage with 3 doses of tOPV to be <40% nationally and <30% in the Northern states. [6] WHO and UNICEF OPV 3 coverage estimates for the years 1990, 1999, 2003, and 2008 were 55%, 19%, 46%, and 61%, respectively. [7]


  Methods Top


Secondary dataset analysis of the Nigeria Demographic and Health Survey (DHS) so far carried out in Nigeria in 1990, 1999, 2003, and 2008 was conducted. DHSs are nationally representative household surveys that provide data for monitoring and impact evaluation indicators in population, health, and nutrition. The DHSs are typically conducted every 5 years to allow for comparison over time. [8] Data were analyzed using SPSS 17.0 (SPSS Inc, Chicago USA); proportions on routine OPV coverage were assessed with some of the factors affecting coverage which include region, place of residence, and mother's educational level. All the regions in Nigeria were covered.


  Results Top


Generally, OPV coverage was lower than 80% in all regions except OPV 1 coverage in the Southwest in 2003 that was 86%. OPV coverage was consistently lower in the Northern regions compared with the Southern regions for all years. OPV 0 coverage in the Northwest was lowest with coverage rates for 1999, 2003, and 2008 being 9%, 11%, and 11% compared to the Southwest with the highest coverage at 46%, 60%, and 50% in 1999, 2003, and 2008, respectively. For OPV 3 coverage, the Northwest still had the lowest coverage at 18% in 1990, 12% in 1999, 25% in 2003, and 26% in 2008, whereas the Southwest had the highest coverage at 54% in 1990, 38% in 1999, 39% in 2003, and 45% in 2008 [Table 1].
Table 1: Percentage oral polio vaccine 0 and oral polio vaccine 3 coverage by region, Nigeria


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OPV coverage was also consistently higher in the urban areas than in the rural areas sometimes coverage in the urban areas was twice that in the rural areas. OPV 0 coverage in the urban areas was 42% in 1999, 35% in 2003, and 52% in 2008 compared to the rural areas where coverage rates were 20% in 1999, 18% in 2003, and 25% in 2008. These differences were statistically significant for all years (P < 0.00). OPV 3 coverage was also higher in the urban areas than in rural areas; in the urban areas, the coverage was 53% in 1990, 38% in 1999, 37% in 2003, and 45% in 2008 compared to coverage in the rural areas which was 23% in 1990, 19% in 1999, 31% in 2003, and 33% in 2008 [Table 2].
Table 2: Percentage oral polio vaccine 0 and oral polio vaccine 3 coverage by place of residence, Nigeria


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OPV coverage was consistently higher in children whose mothers had higher levels of education. OPV 0 coverage in children of mothers with no education was 12% in 1999, 2003, and 2008 compared to children of mothers with tertiary education where coverage was 56% in 1999, 50% in 2003, and 81% in 2008. OPV 3 coverage in children of mothers with no education was 21% in 1990, 11% in 1999, 24% in 2003, and 26% in 2008 compared to children of mothers with tertiary education where OPV 3 coverage was 72% in 1990, 58% in 1999, 52% in 2003, and 60% in 2008 [Table 3].
Table 3: Percentage oral polio vaccine 0 and oral polio vaccine 3 coverage by mother's level of education, Nigeria


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  Discussion Top


Generally, OPV coverage was lower than 80% in all the regions with the exception of 86% coverage in the Southwest in 2003. High coverage rates of 80% or more are required for routine immunization to be effective in breaking transmission of poliomyelitis. Other studies have reported generally low routine immunization coverage in 2008 OPV 3 coverage was reported to be 50%. [5],[6],[9],[10] OPV coverage was consistently lower in the Northern regions than in the Southern regions for all years. This is similar to what has been reported by other studies. [11] In mid-2003, the disparity was further compounded by the high rejection of vaccination in Northern Nigeria due to fears of vaccine safety. [2] OPV coverage was also consistently higher in children in urban areas than in rural areas; this was similar to findings from studies across Africa and South-Asia. [12] However, a study by Odusanya et al. in a rural area in Nigeria found routine immunization coverage to be 81% this was much higher than found in this study and may be due to a public-private partnership that supplied vaccines for routine immunization to the rural area thus, improving access to routine immunization. [12]

OPV coverage was higher in children of mothers with higher levels of education compared with those with no education. This finding was similar to findings by other studies [12],[13],[14] where children of literate mothers had a higher likelihood of being immunized compared to children of illiterate mothers. Mothers who are educated are likely to have better health seeking behavior and utilize health services more than mothers with no education.


  Conclusion Top


Routine OPV immunization coverage is generally poor. The Northern regions, rural areas, and children of mothers with low educational levels had lower OPV routine immunization coverage. Campaigns to improve routine immunization coverage should be targeted to the Northern regions, rural areas, and mothers with low educational levels.

Limitations

The study was based on secondary dataset analysis other factors affecting immunization coverage such as availability and access to routine immunization services could not be determined.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Polio Eradication Department, WHO. Progress toward interruption of wild poliovirus transmission worldwide, 2009. MMWR Morb Mortal Wkly Rep 2010;59:545-50.  Back to cited text no. 1
    
2.
Rey M, Girard MP. The global eradication of poliomyelitis: Progress and problems. Comp Immunol Microbiol Infect Dis 2008;31:317-25.  Back to cited text no. 2
    
3.
Polio Eradication Initiative. Routine Immunization. Available from: http://www.polioeradication.org/content/fixed/routine.shtml. [Last accessed on 2011 May 27].  Back to cited text no. 3
    
4.
Ehrenfeld E, Modlin J, Chumakov K. Future of polio vaccines. Expert Review of Vaccines 2009;8:899-905  Back to cited text no. 4
    
5.
Arevshatian L, Clements C, Lwanga S, Misore A, Ndumbe P, Seward J, et al. An evaluation of infant immunization in Africa: Is a transformation in progress? Bull World Health Organ 2007;85:449-57.  Back to cited text no. 5
    
6.
World Health Organization. Progress towards eradicating poliomyelitis in Nigeria, January 2008-July 2009. Wkly Epidemiol Rec 2009;43:445-2. Available from: http://www.who.int/wer. [Last accessed on 2012 May 20].  Back to cited text no. 6
    
7.
World Health Organization. Nigeria Country Profile. Available from: http://www.apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm. [Last accessed on 2010 May 27].  Back to cited text no. 7
    
8.
Measuredhs. DHS Survey Overview. Available from: http://www.measuredhs.com/aboutsurveys/dhs/statr.cfm. [Last accessed on 2011 May 27].  Back to cited text no. 8
    
9.
Schimmer B, Ihekweazu C. Polio eradication and measles immunization in Nigeria. Lancet 2006;6:63-4.  Back to cited text no. 9
[PUBMED]    
10.
Berhane Y, Clements CJ, Ndiaye JM, Taylor P. Has routine immunization in Africa become endangered? Lancet 2009;9:655-6.  Back to cited text no. 10
[PUBMED]    
11.
Cheng MH. Nigeria struggles to contain poliomyelitis. Lancet 2008;372:1287-90.  Back to cited text no. 11
[PUBMED]    
12.
Odusanya OO, Alufohai EF, Meurice FP, Ahonkhai VI. Determinants of vaccination coverage in rural Nigeria. BMC Public Health 2008;8:381.  Back to cited text no. 12
    
13.
Bonu S, Rani M, Razum O. Global public health mandates in a diverse world: The polio eradication initiative and the expanded programme on immunization in sub-Saharan Africa and South Asia. Health Policy 2004;70:327-45.  Back to cited text no. 13
    
14.
Renne E. Perspectives on polio and immunization in Northern Nigeria. Soc Sci Med 2006;63:1857-69.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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