The emergency approach to revamp routine immunization in Nigeria from 2017 to 2019: a mixed method retrospective study

Routine immunization performance in Nigeria has remained at 50% and below DPT3 coverage going by National Demographic Health Survey of 2018. This led to the declaration of the state of emergency in routine immunization in the country by the National Primary Healthcare Development Agency (NPHCDA) in June 2017. The purpose of this study was to describe the effect of the emergency approach on routine immunization program in Nigeria for the period 2017–2019. This was a mixed method retrospective study that analyzed immunization administered to infants on the National Nutrition and Health Survey (NNHS) for year 2014, 2015, 2018 and 2019, Lot Quality Assurance Sampling, routine administrative data and routine immunization reports via short message service from 2017 to 2019. Also reviewed was supportive supervisory data on open data kits from 2017 to 2019. Our study showed a national average of DPT 3 containing antigen coverage from NNHS conducted in Nigeria for 2015, 2018, and 2019 as 48.8%, 57.2%, and 70.3%, respectively. The 31% increase in DPT3 containing antigen in 2019 across 36 states and FCT was statistically significant (t = -6.464, p < 0.0001). The increase in DPT3 containing antigens from the year 2015 to 2019 for National Emergency Routine Immunization Coordination Center (NERICC) high-priority states was 58% (t = -7.476, p < 0.0001) compared to 11% in NERICC non-priority (t = 3.921, p < 0.001). The emergency approach or interventions by NERICC contributed significantly to the improvement in routine immunization performance in 36 states and FCT but more remarkable in the 18 NERICC high-priority states.