President of the Paediatric Association of Nigeria (PAN), Professor Ekanem Ekure, in this interview with SADE OGUNTOLA, says that children’s health is everybody’s business and that everybody needs to play their role if Nigerian children are to survive.
THE Paediatric Association of Nigeria is carrying out advocacy on HPV vaccination in Nigeria. What was its aim?
In Nigeria, cervical cancer is the second most common cancer death among women aged 15 to 44 years of age, with HPV as the most common cause. The HPV vaccine, a powerful tool in our arsenal, therefore holds the promise of protecting millions of young lives, especially those of adolescent girls, from this devastating disease. Until recently, HPV vaccination was only available in private health facilities, thereby making it inaccessible for most of the population. The Federal Ministry of Health (FMOH), Nigeria, introduced the HPV vaccine in the fourth quarter of the year 2023 as a part of the National Immunisation Schedule, making it accessible for all. The advocacy aims to create an enabling environment for the introduction and scale-up of the HPV vaccine in Nigeria.
To begin the project, we trained immunization champions comprised of paediatricians, media personnel/health educators, and nurses on HPV vaccination uptake strategies in a project in collaboration with the International Paediatric Association. This was to ensure that these immunization champions could give the right information to patients and the public. Previous studies on vaccine hesitancy have shown that there is a need for healthcare providers to be trained because people believe in them and want to hear from them. Also, the media needs to have the correct information on HPV vaccination. Social media has become so powerful now, and a lot of rumours, myths, misinformation, and disinformation on vaccination are widely spread there. By sharing the right information on social media, we felt we would be able to debunk false information widely. So, our immunization champions are adequately empowered to do all of that.
So, can you share some of your success stories?
In terms of the summary of the coverage of the first rollout and the second rollout, there was a clear difference. Whereas for the first rollout, we had a state that had scored 36%, sadly, that is Lagos State. But by the second rollout, the least state had 78 percent coverage. So, we were very happy to be part of that success story that took the average coverage for Nigeria to 96% with 7.3million adolescent girls vaccinated in the second rollout. That for us, was a significant achievement.
We had different stories from different parts of Nigeria. One, for example, is a secondary school in Katsina state that hadn’t been reached. Our immunization champions went there for sensitization. After that event, the vaccinators were mobilised to vaccinate the girls who were now well-informed and ready to take the vaccine. And about 195 girls were successfully immunised. Our immunization champions have been drafted into the immunization technical working group of some states in Nigeria as valuable contributors or trainers. And then, of course, through social media, we have been able to reach millions of people across the nation. The Association sponsored videos produced by our immunization champions and social media influencers – Noisy Doctor and Akproko Doctor to circulate and give correct information about HPV.
At our virtual experience-sharing event, you could see places where just the right information changed the narrative. In Oyo State, there was a similar situation where the whole school felt that the vaccination should not be given. But through the intervention of one of our immunization champions, it was accepted, and immunization took place. So, we will continue to work on ensuring improved vaccination coverage because the lives and future of children are very important to us.
Vaccination is central to preventing many diseases in children. Can you do a reappraisal of vaccination coverage in Nigeria?
Now, the most recent data on vaccination in Nigeria reveals that only one in five children aged 12 to 23 months in Nigeria is fully vaccinated according to the national schedule of immunization. That is just 20%. And just 11% of those aged 24 to 35 months were fully immunized. Overall, 39% of children aged 12 to 23 months are fully vaccinated with basic antigens meaning fully vaccinated at 9 months of age. Thirty-one percent of children aged 12–23 months have received no vaccinations. We are talking about 2.1 million children here. This is the highest number in the world. Appalling!
Although the percentage of children aged 12 to 23 months who have received all the basic antigens has increased over time from 13% in 2003 to 39% in 2023 to 2024, it is still not good enough because there is a strong correlation between immunization coverage and child mortality. The recent 2023/2024 NDHS data shows that during the 5 years immediately preceding the survey, the neonatal mortality rate was 41 deaths per 1000 live births, meaning that one out of every 25 neonates in this country dies within the first month of life.
And sadly, the neonatal mortality rate has increased from 39 deaths per 1000 live births documented five years ago. If we look at infant mortality, that is those dying within the first year, i
t is 63 per 1000 live births, which means one out of every 16 infants will die in the first year of life. Although it dropped from 67 per 1000 live births to 63 per 1000 live births, it was a minimal drop. And then when we look at the under-5 mortality rate as a whole, we are having 110 deaths per 1,000 live births, meaning that one out of every nine children will die before their 5th birthday in Nigeria. The rate was 132/1000 live births five years ago.
With this rate of decrease in childhood mortality that we are seeing, it is not surprising that Nigeria is not on track to achieve Sustainable Development Goals in 2030, which is just six years away. Most of these deaths are caused by vaccine-preventable deaths. For us to have vaccination coverage that will prevent outbreaks, reduce deaths, and achieve elimination goals, we need to have about 95 percent coverage. We still have a long way to go.
What do you think should be done differently to improve vaccination coverage?
In the first instance, Nigeria should learn to make the issues of children first on the list; it should be given the priority that it deserves. When we talk about vaccines, there are different issues related to vaccines. One is vaccine financing. The 2025 health budget is 5.18% of the total budget, an increase of less than 1% (0.71%) compared to the 2024 budget but far below the recommended 15% at the Abuja declaration. Funds must be made available for vaccines and released on time. When we had the immunization champions virtual experience sharing, we heard of places where vaccines were not available though people were ready to be vaccinated. So, in vaccine financing, there shouldn’t be delays; the involved logistics need to be a priority. Next is addressing current vaccination challenges such as improving accessibility, enhancing public awareness and education, strengthening health infrastructure and systems, improving data collection and monitoring, building public trust, instituting a reminder system and defaulter tracking and targeting high-risk communities such as urban slums, hard-to-reach areas and conflict settings.
Overall, children’s health is everybody’s business. It’s not just the government and health workers but parents/caregivers, traditional and religious leaders, health partners, professional Associations such as the Paediatric Association of Nigeria and other stakeholders that are all involved. Everybody needs to play their role. And most importantly, there should be collaboration. Many times, in this country, different groups work in silos, and it does not help with progress. So, integration, collaboration, and then prioritising the most important interventions and focusing on those relevant interventions will ensure that children survive. Immunization is definitely one of such. So, we will continue with advocacy to change this narrative for the children. Nobody can turn a blind eye if we want our children to survive.
Are there child-rearing practices in Nigeria that you feel should be talked about, particularly now?
Cultural practices play a significant role in child-rearing. As the generations come, so the child-rearing practices change. But now we have newer ones coming up. There are lots of them, unfortunately, that can hinder and affect a child’s development. Every child, whether having a developmental disorder or not, should have adequate stimulation in early childhood to enhance optimum development. Adverse experiences in childhood such as violence in the family can affect child development. Many people do not realize how important play is in early development, be it at home or school. Lack of play or inadequate stimulation through play at home and/or at school can be detrimental to optimal socio-emotional development in early childhood. The child loses out on the benefits of play which include social skills, language development, problem-solving, emotional maturity, emotional intelligence, organization, self-confidence, and human interaction.
Now we also have to contend with excessive screen exposure because the iPad or phone serves as a babysitter. When you want the child to be quiet, you quickly use the iPad. And so little children are exposed to the screen for hours with poor parental regulation on what they are watching. It’s affecting many children. It limits their social interaction, their language development, and even sleep. And some of the children end up getting addicted to screens. The day you take back the screen, they throw tantrums. Some children have presented with severe mental health manifestations due to unhealthy content watched on electronic devices.
Another disturbing practice in the country is the early age of school entry whereby children are enrolled in school as early as 1-2 years of life and are made to spend long hours (7/8 am to 3/4 pm, sometimes even longer) in school without significant playtime. Play is a critical aspect of child development. But some school environments don’t even have space for play. Unlike many years ago, when you go to schools, you can see playgrounds, things for play, and so on.
The long school hours limit their early development and prevent adequate sleep as some do not even get to take naps. Daytime naps, adequate play and sufficient sleep are very important for brain development in early childhood. Sleep-deprived children may be hyperactive and difficult to manage in school.
Of course, we know of the older practices like corporal punishment in disciplining the child. If you discipline the child such that it causes injury to a child, whether it’s physical or emotional, that is now abuse. PAN commends the Lagos State government for the prompt intervention in the recent physical abuse of a 3-year-old child in a school in Ikorodu. We hope the law takes its course and serves as a deterrent to other such abusers.
There is also the practice of lack of emotional communication. In our culture, a boy is told to be strong and that boys shouldn’t cry. Parents don’t openly communicate with children about their feelings leading to emotional suppression and a lack of coping mechanisms. Sometimes, the expectations from these children are too high. There is so much academic pressure on some of them, which doesn’t allow them to become the children they should be. And then, of course, children are neglected due to economic pressure. It can cause delays in cognitive and social development. These practices need to change if we want to see our children. achieve their full mental health development.
PAN is hosting its annual conference soon. Can you tell us about the conference?
The theme of the 56th Annual Scientific Conference and Annual General Meeting (AGM) of the Paediatric Association of Nigeria is “Intersectoral Collaboration in Advancing Child Health and Development,” and the subthemes are overcoming the harmful mix of insecurity and poverty on child health, leveraging technology to promote child health and effect of climate change on child health. This year the conference is tagged PANConf Gombe 2025 and will take place in Gombe State from Wednesday 22nd to Friday 24th January 2025. Part of the preconference workshop starting Monday 20th January 2025 will be the training of healthcare workers at the LGA level on resuscitating newborns and resuscitation equipment will be shared with all the trainees.
The conference will enable us to achieve many objectives of the Association such as advancing the practice and study of paediatrics and child health through dissemination of knowledge and research findings, advocating for the well-being of children, networking and collaborations among members and with government at all levels as well as Associations, multilateral development agencies, companies and organizations in the advancement of child care and development.
Nigeria has started malaria vaccination in some states. How do you see that helping us to reduce under-five deaths?
It is an important development. About 68 million cases of malaria occur in Nigeria annually, and most of the people affected are children. Malaria is still one of the top causes of under-5 deaths and accounts for 25% of all under-five admissions in Nigeria. While acknowledging the availability of other malaria interventions to prevent, diagnose, and treat malaria, the malaria vaccine adds an important dimension to this effort. First, you can see it targets the most vulnerable children between the ages of 5 and 11 months. Second, it improves access to at least one malaria intervention within the concept of universal coverage that no child should be left behind. Third, it provides a more broad-based approach to preventing the disease or limiting its severity, thereby reducing deaths in the face of such challenges as insecticide resistance. Our fourth consideration is that with malaria accounting for about 25% of under-five admissions, a reduction in malaria will be a major improvement in our under-5 mortality rate. PAN acknowledges funding constraints, hence, the limited introduction to Bayelsa and Kebbi states. We call on the government, the Gavi, and other international health partners to ensure accelerated scale-up to other states this year. We must however reiterate that the malaria vaccine is an added intervention, and we will reach our goal of elimination faster by not stepping back on existing interventions which consist of the use of insecticide-treated mosquito nets, environmental management, testing all suspected cases and effective treatment of both uncomplicated and severe malaria. We also call on the government to continue strengthening the health system through human capacity developments, improved referrals, and expanded health insurance coverage and harmonized electronic medical record system.
