Nigeria's Decentralized Immunization Monitoring (DIM) Round 3 assessment confirms progress in strengthening routine immunization performance across the eight Learning Hub local government areas (LGAs) in Bauchi, Borno, Kano, and Sokoto States. Targeted micro-planning and data-use interventions have led to measurable gains in coverage and equity, with improvements observed for key antigens like DTP1–3, IPV1/2, PCV1–3, and MCV1. However, persistent challenges remain:
- Birth-dose gaps (HepB0 and OPV0) reflect weak postnatal service linkage, especially among non-facility births.
- Dropout rates across multi-dose series (DTP, PCV) highlight critical needs for consistent session delivery and defaulter tracking.
- Persistent inequities show urban LGAs outperforming rural and security-challenged areas. Multivariable analysis identified rural residence, low maternal education, lack of antenatal care, home deliveries, and lower wealth as key determinants of zero-dose and under-immunized status. This calls for integrated service delivery models.
Behavioral and social drivers (BeSD) data confirms caregiver confidence, trust in health workers, and perceived service quality are major determinants of vaccination decisions. Conversely, low intention to vaccinate and the need for spousal permission constrained uptake, reinforcing the importance of tailored social and behavior change interventions.
The report outlines that operationally, the LQAS-based DIM approach proves effective in providing timely, actionable data. The reduction in failed lots between rounds confirms that local decision-making improves resource targeting. DIM also adds value by incidentally detecting suspected cases, strengthening integrated disease surveillance. Round 3 results affirm that decentralized monitoring is an effective strategy for improving coverage, accountability, and equity. Sustaining progress requires embedding DIM within state-level review mechanisms, addressing birth-dose and dropout gaps, and intensifying behaviorally informed demand generation efforts, aligning with Nigeria's National Immunization Recovery Plan and IA2030 goals.
A summary briefer provides a concise overview of the study design, detailed antigen coverage trends, and key recommendations to guide programming.