BCG BIRTH DOSE VACCINATION IN NIGERIA: CHALLENGES AND SUCCESSES

Bacille Calmette Guerin(BCG) is the vaccine given to prevent Tuberculosis, a communicable
disease that has an incidence of about 322 per 100,000 in Nigeria with only about 15% of the
cases suspected to be reported. Nigeria is thus one of the 30 countries in the world with high
burden of Tuberculosis.

Birth Dose BCG vaccination is recommended to be given as soon after birth in Nigeria and
should be given in conjunction with HepB and OPV birth doses. The vaccine is given
intradermally and is quite safe. Adverse reactions to BCG vaccination is rare and there is no
true contraindication.

BCG vaccination coverage rates in Nigeria is estimated to be at about 32%, with no data on the
timely compliance rate with timeliness defined as ‘soon as possible after birth’. According to
WHO , BCG should best be given within 1 week after birth for adequate realization of its
preventive potential. We advocate that BCG vaccination should be administered preferably in
the immediate post -natal period and before the baby leaves the health facility i.e. in health
facility delivery.

A major challenge to BCG Birth Dose vaccination in Nigeria is vaccine management bearing in
mind that:

  • BCG dose must be used within 6 hours of vial opening.
  • Each vial contains 20 doses and to avoid wastage , vaccinators only open the vial when
    at least 10 women bring their children for vaccination to avoid wastage.
  • A caregiver presenting with a child at an Immunisation center without the critical number
    of 10 is likely not to receive BCG vaccination at presentation.

In Nigeria, however, not all births occur in the health facilities. It is estimated that 30% of births
are home delivery occurring in homes, prayer houses, churches etc attended by local midwives
and traditional birth attendants. This increases the chance of not only receiving birth dose BCG
but also hep B and OPV birth dose due to remoteness from the National program on
Immunization.

The above cohort and to a lesser extent -health facility deliveries faces in addition a challenge of
dearth of knowledge on the importance of birth dose vaccination. Thus a concerted effort should
be championed through policy adaptation to integrate Birth Dose vaccination education into the
formal and informal antenatal visits thus building up demand for Birth Dose vaccination.

Action should be focused on designating a Birth Dose vaccine personnel in the immediate
postnatal environment i.e in health facility delivery and guidelines on outreach administration of
Birth Dose vaccination during home birth clearly spelt out bearing in mind that skill birth
attendants working in our primary health centers could be effectively adapted to give birth dose
vaccines as has been successfully tried in other countries.

Dr.​ ​Ihedioha,​ ​Emmanuel​ ​Chukwunwike​ ​is a Public health physician and epidemiologist. He
writes from Nigeria.