title: Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015.
abstract: BACKGROUND
  Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria.
  
  
  METHODS
  Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014-2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12-23 months was documented based on vaccination card or caretaker's recall. District-level coverage estimates were calculated using survey methods.
  
  
  RESULTS
  Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1-63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%-139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%).
  
  
  CONCLUSIONS
  Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria.
authors.affiliation: U.S. Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, Georgia, United States of America.
authors.forename: Rajni
authors.identifier: http://orcid.org/0000-0003-3996-1311
authors.initials: R
authors.lastname: Gunnala
authors.affiliation: U.S. Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, Georgia, United States of America.
authors.forename: Ikechukwu U
authors.initials: IU
authors.lastname: Ogbuanu
authors.affiliation: Nigeria National Stop Transmission of Polio, Abuja, Nigeria.
authors.forename: Oluwasegun J
authors.initials: OJ
authors.lastname: Adegoke
authors.affiliation: U.S. Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, Georgia, United States of America.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Scobie
authors.affiliation: Nigeria National Stop Transmission of Polio, Abuja, Nigeria.
authors.forename: Belinda V
authors.initials: BV
authors.lastname: Uba
authors.affiliation: U.S. Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, Georgia, United States of America.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.affiliation: U.S. Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, Georgia, United States of America.
authors.forename: Alicia
authors.initials: A
authors.lastname: Ruiz
authors.affiliation: U.S. Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, Georgia, United States of America.
authors.forename: Hashim
authors.initials: H
authors.lastname: Elmousaad
authors.affiliation: Nigeria National Stop Transmission of Polio, Abuja, Nigeria.
authors.forename: Chima J
authors.initials: CJ
authors.lastname: Ohuabunwo
authors.affiliation: National Primary Health Care Development Agency, Abuja, Nigeria.
authors.forename: Mahmud
authors.initials: M
authors.lastname: Mustafa
authors.affiliation: Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Nguku
authors.affiliation: Nigeria National Stop Transmission of Polio, Abuja, Nigeria.
authors.forename: Ndadilnasiya Endie
authors.initials: NE
authors.lastname: Waziri
authors.affiliation: U.S. Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, Georgia, United States of America.
authors.forename: John F
authors.initials: JF
authors.lastname: Vertefeuille
mesh_terms: D001500:BCG Vaccine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008458:Measles Vaccine / Q000008:administration & dosage; D009549:Nigeria; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D001500:BCG Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine; D011055:Poliovirus Vaccine, Oral