The Federal Government through the National Primary Health Care Development Agency (NPHCDA) supports and provides leadership for the development of primary health care (PHC) system in Nigeria. The Agency has seven goals as follows: control preventable diseases; improve access to basic health services; improve quality of care; strengthen institutions; develop high performing health workforce; strengthen partnerships; and strengthen community engagement. It achieves these goals by supporting States and LGAs in developing sustainable system of PHC services that are accessible, affordable and of good quality through the participation of individuals, families and communities in partnership with government and non-governmental organizations (NGOs).
In the recent past, some major accomplishments have been recorded in the increasing coverage for routine immunization (RI), Midwives Service Scheme (MSS), Measles Control, and the Polio Eradication Initiative (PEI). The improvement in the RI coverage has immensely contributed to the reduction in the morbidity and mortality from vaccine-preventable diseases (VPDs). For instance; the sustained OPV3 coverage >80 per cent is most probably responsible for the significant reduction in the WPV transmission in the country; sustained improvement in the measles RI coverage >80% in most States is also responsible for the reduced morbidity and mortality from measles cases nationwide. Some of the key factors responsible for improved RI performance in the country are sustained vaccine availability; the overhauling of the immunization system in general, coordinated planning in collaboration with our development partners and other key stakeholders, and the new vaccine introduction in the country. The NPHCDA has ensured that this is on-going on a sustainable basis.
Major causes of U5 deaths in Nigeria
New Vaccines Introduction (NVI)
Infectious diseases are still responsible for nearly 30% of all deaths worldwide; more than 15 million people die every year, mostly in low-income and middle-income countries3. The Global Immunization Vision and Strategy (GIVS) 2006-2015, for fighting VPDs has 3 priority objectives: (1) immunize more people against more diseases (2) introduce a range of newly available vaccines and technologies, and (3) provide a number of critical health interventions through immunization.
The Millennium Development Goals (MDGs) prescribes attainment by 2015, of an under 5-mortality rate of not more than 75/1000 live births (MDG4). The 2008 National Demographic & Health Survey (NDHS) estimated Nigeria’s under 5-mortality rate to be 157, declining at a rate of 1.2 per cent annually. This rate of progress was deemed insufficient to keep the country on track to achieve MDG4. Nigeria must therefore commit to and implement high impact interventions aimed at reducing the child deaths.
Pentavalent Vaccine Introduction
The Pentavalent vaccine is a combination vaccine that protects infants against the following five diseases: diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type b (Hib) pneumonia and meningitis. Prior to 2012, the RI schedule consisted of the traditional vaccines: BCG, OPV, DPT, Measles and Yellow Fever Vaccines. Commencing in May 2012, Nigeria introduced the Pentavalent Vaccine into its National Immunisation Schedule in a phased manner over a three-year period; in order to reduce substantially child mortality from pneumonia and meningitis and thus save up to 30,000 lives annually following full introduction. Currently, it is available in all PHC facilities nationwide.
However, pneumonia is a disease that can be caused by a number of other infectious agents that include bacteria, viruses and fungi; the most common in children being Streptococcus pneumoniae (pneumococcus). The Haemophilus influenzae type b (Hib) – is the second most common cause of bacterial pneumonia. Other causes are the Respiratory Syncytial Virus (RSV) and in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia.
Pneumococcal Conjugate Vaccine-10 (PCV-10) Introduction
Most recently, we have also introduced the PCV-10 to protect infants against the diseases caused by the pneumococcal bacteria (Streptococcus pneumoniae) such as pneumonia, meningitis and bacteraemia. The national launch event was conducted on the 22nd December, last year at Lokoja, Kogi State. The 12 States of the federation that commenced this phased introduction were selected on zonal basis, immunization coverage and their capacities to receive and store the new vaccine, viz: Adamawa, Yobe, Kaduna, Katsina, Kogi, Plateau, Ondo, Osun, Edo, Rivers, Anambra and Ebonyi. This introduction of the PCV-10 is continuing in a phased manner that by 2017, it will be available to infants in all the States and the FCT.
Supplemental Immunisation Vaccines
Other supplemental vaccines such as Measles, Yellow Fever and the newer MenAfriVac vaccine that protects against the commonest cause of cerebro-spinal meningitis (CSM) serotype A are also given as needed. In the period 2011-2014, the MenAfriVac vaccine was administered through the 23 meningitis belt States in Nigeria to an extended age-group of one to 29 years old in our effort to eliminate CSM serotype A as a major public health issue.
The NDHS 2003, 2008 and 2013 have indicated a gradual, sustained improvement in child survival indices. The introduction of these new vaccines will further reduce childhood mortality rates in Nigeria.