Care seeking for under-five children and vaccine perceptions during the first two waves of the COVID-19 pandemic in Lagos State, Nigeria: a qualitative exploratory study

Abstract

ObjectiveTo explore healthcare seeking practices for children and the context-specific direct and indirect effects of public health interventions during the first two waves of COVID-19 in Lagos State, Nigeria. We also explored decision-making around vaccine acceptance at the start of COVID-19 vaccine roll-out in Nigeria.Design, setting and participantsA qualitative explorative study involving 19 semistructured interviews with healthcare providers from public and private primary health facilities and 32 interviews with caregivers of under-five children in Lagos from December 2020 to March 2021. Participants were purposively selected from healthcare facilities to include community health workers, nurses and doctors, and interviews were conducted in quiet locations at facilities. A data-driven reflexive thematic analysis according to Braun and Clark was conducted.FindingsTwo themes were developed: appropriating COVID-19 in belief systems, and ambiguity about COVID-19 preventive measures. The interpretation of COVID-19 ranged from fearful to considering it as a ‘scam’ or ‘falsification from the government’. Underlying distrust in government fuelled COVID-19 misperceptions. Care seeking for children under five was affected, as facilities were seen as contagious places for COVID-19. Caregivers resorted to alternative care and self-management of childhood illnesses. COVID-19 vaccine hesitancy was a major concern among healthcare providers compared with community members at the time of vaccine roll-out in Lagos, Nigeria. Indirect impacts of COVID-19 lockdown included diminished household income, worsening food insecurity, mental health challenges for caregivers and reduced clinic visits for immunisation.ConclusionThe first wave of the COVID-19 pandemic in Lagos was associated with reductions in care seeking for children, clinic attendance for childhood immunisations and household income. Strengthening health and social support systems with context-specific interventions and correcting misinformation is crucial to building adaptive capacity for response to future pandemics.Trial registration numberACTRN12621001071819.

Epidemiological profile, trend, seasonality, and factors associated with Yellow fever disease and barriers to vaccination: a retrospective observational study of multi-season national surveillance data in Nigeria, 2017 - 2021

“…We have shown that cases were about twice as likely to be unvaccinated for YF during the pandemic period. Ayobami et al (2023) had reported that the COVID-19 pandemic was associated with reduction in care seeking for children and clinic attendance for childhood immunization [33]. Similarly, Ribeiro da Silva et al (2022) reported a reduction in the number of YF vaccine doses administered in Brazil during the pandemic period compared to the pre-pandemic era [34].…”

“…Thus, the decrease in case reporting observed during the pandemic period may be a pointer to the disruptive effect of the COVID-19 pandemic on YF surveillance activities in Nigeria [32]. The pandemic resulted in the conversion of several public hospitals to COVID-19 treatment centers in Nigeria and elicited patients’ apathy towards hospital attendance [33]. We have shown that cases were about twice as likely to be unvaccinated for YF during the pandemic period.…”

“We Live Our Life Normal”: A Qualitative Analysis of Nigerian Women’s Health-Seeking Behavior during the COVID-19 Pandemic

“…The resulting barriers were highlighted and further compounded by the COVID-19 pandemic, which resulted in disruptions in healthcare systems, economic downturns, increased household stress and burdens, and amplified disparities within and between nations [ 9 , 16 , 17 ]. Current studies indicate that Nigerian women had difficulty accessing health services with a significant reduction in essential routine health services, including maternal and child health services [ 14 , 18 , 19 ]. These declines in healthcare utilization during the COVID-19 pandemic amplified the COVID-19 pandemic’s harmful effects on health outcomes [ 19 , 20 ].…”