By Dr. Obinna Ebirim, Senior Advocacy officer, Niyel
Passing stool or pooing often can kill – literally. This is the case for thousands of children under the age of 5 who die from diarrhea every year. Attending to nature’s call daily is healthy, however problems arise when it becomes too watery and happens too frequently. Excessive loss of fluids and other essential minerals harm the body’s ability to function well.
According to a UNICEF report 1,300 children yet to celebrate their fifth birthday, die from diarrhea every day, accounting for approximately 9% of all infant mortality cases. In Sub-Saharan Africa, these figures are worse. In West Africa, specifically Nigeria, diarrhea is the second topmost cause of child death largely due to poor hygienic and sanitary practices. Standing at 18.8%, this child killer is twice as prevalent in Nigeria as compared with global figures.
The alarming and incredibly sad aspect of diarrhea related child deaths is that a readily available preventive solution exists and for almost two decades. The rotavirus, one of the deadliest diarrhea causing-agents, is responsible for over 40% of diarrhea cases in Nigerian children and accounts for 14% of total global rotavirus related deaths.
Fortunately, a rotavirus vaccine exist that protects against diarrheal diseases.
If this preventive solution has been around for so long, why is diarrhea still a menace? A few reasons include the fact that the rotavirus vaccine was not included in some country’s national routine immunization program such as Nigeria – not until August 2022. Although the vaccine has been available in private hospitals at a fee, many parents in high-risk communities are unable to afford it, miss doses, or stay away altogether due to a mistrust and fear of vaccines. This is the case in some other countries.
In 2017, the WHO urged all countries, particularly those with high diarrhea mortality rates in children, such as Nigeria, to introduce rotavirus vaccines into their immunization programs. Thankfully in August 2022, Nigeria’s federal government, through the National Primary Healthcare Development Agency (NPHCDA) introduced the rotavirus vaccine into the national routine immunization schedule. According to a mapping by the ROTA Council, Nigeria is among 79% of African countries (including Senegal, Mali, Burkina Faso, Kenya and Ethiopia) and 115 countries worldwide who have introduced the rotavirus vaccines into their national routine immunization schedule. This was a lifesaving saving event capable of averting about 50,000 deaths of Nigerian children yearly, according to a report by the WHO African office. Also, researchers have reportedabout 59% reduction in hospitalization due to rotavirus and 36% reduction in diarrheal hospitalization and deaths in children under 5 years among over 100 countries that have introduced the rotavirus vaccine.
The rotavirus vaccine introduction into the routine immunization schedule in Nigeria means that the vaccine is available at no cost in public health facilities for infants aged 6, 10 and 14 weeks. At some private hospitals across the country, it was discovered that parents pay about 20,000 naira (or 47 US dollars) for just one of the three required doses of the vaccine. Children whose parents could not afford to pay, likely paid with their lives in a country where over 40% of the population (about 82 million people) are poor (live on less than 12,000 naira monthly or 28 US dollars).
Unfortunately, access to these vaccines at no cost in public health facilities in Nigeria does not mean everyone who requires vaccination will take up this life-saving offer. A recently released survey by UNICEF titled, 2021 Nigeria Multiple Indicator Cluster Survey (MICS) & National Immunization Coverage Survey (NICS) shows that 18% of children in Nigeria have not received any vaccine while 46% missed out on some doses. Some identified reasons why children were not fully vaccinated were lack of knowledge or information (51%) and mistrust or fears (26%).
There is evidence that repeated infections of diarrhea can affect later development in children which can lead to lifelong implications for health and wellbeing. These include stunted growth, decrease in cognitive development and increased risk of mortality from other infectious diseases such as malaria, measles, and pneumonia. Even later in life, adults who suffered frequently with severe diarrhea as children may potentially be at higher risk for developing chronic disease including cardiovascular disease, diabetes, obesity, and hypertension. There are other economic, and educational consequences. Missed days from school due to diarrheal hospitalization can affect the child’s intellectual growth, while missed days from work while talking care of the sick child can affect the family’s earning power added to the cost of treatment.
The inclusion of the rotavirus vaccine into the routine immunization schedule is a ray of hope for many Nigerian children, especially the poor.
Improved efforts must be made to educate the public and build their confidence to increase uptake of this lifesaving vaccines and others. At Niyel, we are engaging high-reach and credible African voices to work with us in increasing trust and confidence in vaccines and routine immunization. We are building momentum by driving further education to reach more people in Africa through podcasts, radio shows, trivia games, pitching battles and support for media activations of Civil Society Organizations (CSOs). We’re simultaneously working with healthcare workers, local community, religious and cultural leaders, as well as with humorists, that have a key role to play in initiating conversations to build trust and improve uptake of vaccination services for young children in their respective communities.
The rotavirus vaccine introduction in Nigeria should reduce the consequences of diarrheal diseases including thousands of children, yet to celebrate their 5th birthday, who die daily from diarrhea. However, we need to implement a comprehensive strategy that ensures access to these vaccines so many lives are saved.