The EPI in Borno State, Nigeria: impact on routine disease notifications and hospital admissions
Abstract: This report attempts to determine the effectiveness of the EPI (Expanded Programme on Immunization) in Borno State, Nigeria. Specifically, it reviews vaccine utilization and coverage, and the impact of the programme on target disease morbidity and mortality over the period 1983-91. Trends in routine notifications for the main diseases: diphtheria, pertussis, tetanus, tuberculosis, measles and pneumonia were included for analysis and a before and after comparison in terms of the intensifications of EPI by age-specific strata was performed. Borno State is one of the 21 states of Nigeria, with a population of almost 3 million, of whom around 75% live in the rural areas. The results of the study show an apparent reduction in morbidity from disease, particularly following intense vaccinations between 1988-91. This reduction occurred despite the prevailing adverse socioeconomic conditions and the absence of a specific control strategy for pneumonia. On the whole therefore, EPI was seen to have a positive impact in Borno State, as shown by a decline in hospital admissions. Based on the results of the study it is concluded nevertheless that there is a need to develop new strategies to improve immunization services in Nigeria. These include encouraging vaccine compliance and addressing the mechanisms that facilitate disease transmission such as poor maternal hygiene and education. There is a need to intensify other intervention measures alongside EPI activities.ADDITIONAL ABSTRACT:Borno State had a population of almost 3 million in 1963, when the last accurate census in Nigeria was taken. About 75% of these people live in rural areas. In the present study on the Expanded Programme on Immunization (EPI), disease was diagnosed clinically-by paediatricians in hospital, and by nurses and trained community workers in the remote health facilities. Routine vaccination has been complemented by a series of mass campaigns; reported vaccination coverage increased steadily from 10% in 1985 to 86% in 1991. However, the rates for measles were lower than those with BCG; and vaccinations with oral polio and diphtheria-pertussis-tetanus (DPT) vaccines were substantially less than 3 times those rates, indicating that many children received fewer than the required 3 doses. Nevertheless, there has been a sustained decline in reported cases of EPI diseases from the entire State, except for tuberculosis. Moreover, whereas the total admissions to hospital for the periods 1983-87 and 1988-91 were similar, there was a 40% decline in admissions for EPI diseases between these periods. Whilst welcoming this evidence of a positive impact of EPI, the authors note an absence of laboratory confirmation of the diagnoses, and the need for improvement of the immunization services. N.W. Preston