Ene Ngbede rides in the arms of her father all through. The registration at Comprehensive Health Centre in Kaita, Katsina, doesn’t take long.
But she cringes when it was time to get her shot. The two-year-old buries her face in her father’s biceps as the syringe comes toward her arm. Her father, Sunday Ngbede, adjusts her for comfort on his lap, helps hold out her arm.
The vaccinator swabs the spot on the girl’s arm with methylated spirit. Then the syringe finds its mark and pushes, emptying a single dose of measles vaccine into Ene.
Her cry is only momentary; she quiets as soon her father rises with her. Now he’s sure his daughter, the last of four children yet, is protected from one more deadly killer of children her age.
Millions of children her age, born after the last vaccination campaign against measles in 2013, have never been vaccinated against measles.
Those who have never taken routine immunisation are even at more risk of contracting the disease.
That’s the prompt for a vaccination campaign against the disease across the country – to vaccinate a record 33 million children aged nine months to five years between November and next February.
Reports and cases
Katsina hopes to have vaccinated 1.8 million children like Ene by the time the campaign winds up. A first phase is for 22 local government areas of Katsina; a further 12 council areas make up the second phase.
At the health centre, vaccinators target at least 154 children every day. Similar target is at health centres across Katsina in hopes of stemming possible outbreaks.
The campaign nationwide has had to overcome possible failure after rumours of “forced vaccination” took root in the South East, forcing parents to keep back their children and refuse vaccines.
But the sheer numbers in terms of measles meant the campaign went ahead.
In 39 weeks of reporting entering this year, more than 18,000 cases of measles have been reported; in 105 cases, the children died of the disease, according to the Nigeria Centre for Disease Control which tracks priority diseases
By contrast, some 14,000 cases of measles were recorded in 2010.
The National Primary Health Care Development Agency, which coordinates routine immunisation and is pushing the ongoing measles vaccination campaign, says outbreaks of the disease topped 183 in 2016, up from 166 in 2015.
This year alone, more than 16,343 cases of measles have been recorded, meaning nearly every one of Nigeria’s council areas has had a case.
Political will
It has taken much political will to get the campaign off the ground. Top government officials appeared at the official start of the campaign in Batagarawa to whip up support for measles vaccination.
Women and health workers rallied in the streets, carrying banners calling on parents to take their children to health centres to be vaccinated. Young men and boys wrapped themselves in the banners and marched through streets.
At birthdays and naming ceremonies and in mosques, prayers take regular breaks for announcement about the ongoing vaccination, according to Umma Mahatu, head of Kaita’s local government administration.
Vaccinators are meant to work at fixed posts. But expedience calls for exceptions: they move out into communities when parents don’t show up at health centres; they stage a mobile post at schools and centres for Islamic education.
Vaccinators work in teams of six in each centre. One supervises, one injects the children, two people document, one more person controls the crowds and a last person is the town crier speaking through a bullhorn.
Abdul Dankatu is the announcer attached to his six-man team. His voice is firm and carries far over a bullhorn once he begins his broadcast.
“When I enter a town, I greet everyone and then tell them health workers are starting vaccination for children. The venue is the health centre. Women, gather your children and take them where it is happening,” he says.
The announcement brought out Aisha Danjuma, with her two children. She has no problems with the vaccine, she says as the vaccinator jabs the needle into the arm of her younger son.
The boy cries and she passes him to one of the two women documenting her children’s vaccination. She grabs her older son and clasps him into position, baring his left bicep. A jab and the boy winces.
By routine, the supervisor on the vaccination team “educates” mothers on what to expect after a measles vaccination. After effects range from fever to a rash up to hours or days after vaccination.
Danjuma has to wait at least 15 minutes to be sure her children aren’t immediately reacting to the vaccine before she leaves the centre.
The 15-minute wait is “just to observe,” says Ibrahim Galadima, who supervises the team that injected Danjuma’s two sons.
“But when they see something else after going home, they come back here. That’s what we tell them, but none has.”
Each vaccination team doesn’t have just syringe and vaccine doses. They also carry a special kit to deal with after effects of immunisation.
The kit contains adrenalin, hydrocortisone, intravenous fluids, paracetamol, all of which are critical to managing children reacting to the vaccine.
The setup for the vaccination is to send serious cases to a referral unit where doctors can take charge.
Each vaccination team’s supervisor must take part in a review meeting at the end of the day’s work. The report goes to a ward level with a district head present, where ward reports are collated for a council-level meeting. To show political will, heads of local government administration like Mahatu are required to attend the review meeting – and help sort through the day’s challenges and prepare for the next day of vaccination.
