By Rakiya A. Muhammad
Umm Nasir, 31, gently lifts her six-month-old child into the arms of her neighbour. The infant’s small hand brushes against hers in farewell. The trusted neighbour will carry the child on a familiar path through the dusty streets to the Primary Healthcare Centre in Gagi, Sokoto State, Northwest Nigeria.
Here, the baby will receive routine immunisations, a crucial step to shield against diseases that could threaten their life now and as they grow older. Medical experts say vaccines protect people from various illnesses throughout life, from birth to old age.
Umm cannot take her infant because of the refusal of her husband, influenced by vaccine hesitancy—recognised by the World Health Organisation (WHO) as a major public health threat. He voices concerns about myth that vaccines may cause harm or contain dangerous substances, echoing common local fears.
In conservative societies like Umm’s, women typically need their husband’s permission before going out. Findings show that although many fathers champion vaccination, others hesitate, swayed by rumours and cultural beliefs. As a result, some Gagi women, such as Umm, often rely on friends or neighbours to help get their children vaccinated.
Tipping the Scales Between Life and Loss
“Vaccination can mean the difference between life and death,” remarks Dr Bilyaminu Yari Sifawa, the Director of Sokoto State’s Department of Disease Control and Immunisation.
“Vaccination can mean the difference between life and death,” remarks Dr Bilyaminu Yari Sifawa, the Director of Sokoto State’s Department of Disease Control and Immunisation.
“It is the first line of defence against various diseases: measles, diphtheria, tetanus, whooping cough (pertussis), tuberculosis, hepatitis, flu, polio, yellow fever, dengue, cervical cancer.”
He adds that it can protect against pneumonia, which, according to the WHO, caused 14% of all deaths in children under 5 and killed 740,180 in 2019.
“It prevents diarrhoea, which kills over 484,000 children under age five globally each year,” adds the Director Disease Control.
“It not only saves an estimated 4.4 million lives annually, but it also improves the health and wealth of individuals and communities. It helps children not only survive but also thrive.”
He characterises vaccination as humanity’s paramount public health accomplishment. He highlights its exceptional efficacy and cost-effectiveness.
However, Sifawa observes that some parents downplay the seriousness of preventable illnesses and abstain from vaccines due to misconceptions about harmful toxins.
He notes that some parents believe good diets and lifestyle make their children less likely to contract preventable illnesses.
“Vaccines are as important to your overall health as diet and exercise; vaccines will help keep you healthy,” the Director explains.
“Vaccinations not only protect your child from deadly diseases, such as polio, tetanus, and diphtheria, but they also keep other children safe by eliminating or greatly decreasing dangerous diseases that used to spread from child to child.”
Making Forward-Thinking Health Decisions
Umm acknowledges the significance of immunisation and is always ready to ensure that her child adheres to the prescribed schedule.
“I made sure that my newborn received the essential vaccinations upon delivery and at six weeks, ten weeks, fourteen weeks, and six months,” she states. “I’ll ensure he completes the remaining ones as scheduled.”
The women of Gagi demonstrate significant knowledge about vaccinations. They welcome vaccinators during house-to-house campaigns and ensure their children attend scheduled immunisations at the health facility.
Despite pressures, these women balance tradition with proactive health decisions for their families, showing agency and adaptability.
These women have shown commendable initiative in Nigeria, where data shows the country has the second-highest number of children who have never received any vaccination—2.2 million unvaccinated children.
According to the State of the World’s Children report, 67 million children missed routine immunisation between 2019 and 2022; of these, 48 million received no regular doses at all (zero-dose children). UNICEF reports that zero-dose children represent nearly 50% of all deaths from diseases preventable by vaccines.
Analysts note this staggering number not only signifies a current gap in global health coverage but also sets the stage for potential future outbreaks. One unvaccinated child could lead to the resurgence of diseases previously under control, causing a cascading effect.
However, Dr Maryam Darwesh Said, Chief of the UNICEF Field Office Sokoro, reveals that they are now focusing on reaching these children who are zero-dose. They are targeting the top 100 zero-dose local government areas in 18 states of Nigeria.
She names Sokoto, Kebbi, and Zamfara as the states with the highest burden of unimmunised children. As of December 2022, 186,452 children across these three states have not received a single dose of any vaccine in the Routine Immunisation Schedule.
Of the total identified children, 122,015 are in Sokoto alone. In Sokoto, the highest numbers of zero-dose children are found in 13 local government areas: Bodinga, Dange Shuni, Gada, Goronyo, Gwadabawa, Kware, Rabah, Sabon Birni, Shagari, Sokoto South, Tambuwal, Wamako, and Wurno.
Stakeholders are escalating efforts to address zero-dose cases by improving service delivery, coverage, supply chain, and logistics through routine immunisation interventions and state outreach.
However, all hands must remain on deck to ensure no child goes without immunisation.
Leading the Way to Lasting Change
Despite being in Sokoto South, one of the thirteen Local Government Areas (LGAs), Gagi stands out for its strong immunisation efforts, attributed to the traditional leader’s exemplary coordination.
Alhaji Sani Umar Jabbi, the District Head of Gagi, proudly asserts, “It’s difficult to identify any house with zero doses.”
Jabbi’s leadership centres on visibility, accountability, and incentives. He supports the health facility with supervision and monitoring, and rallies males who hold significant authority in making decisions for their families and communities. These men can let or restrict their women from accessing opportunities and services outside the home.
A trip to Gagi PHC reveals several mothers with their children waiting to receive their shots. One of them, Hadiza Ali, believes in immunisation and facility visits following her direct observation of their efficacy in preventing childhood diseases and preserving lives.
Many other mothers polled showed an adequate understanding of immunisation and related health issues.
From where did these rural women acquire such extensive knowledge?
“We enlighten them,” asserts Malama Hawwau Sarki, Gagi women’s leader.
Malama Hawwau also discloses that, as leaders, they contribute items such as soap, matches, and detergents to women who attend enlightenment programs. This encourages the women to come.
“Gagi is a community where women willingly bring their children for vaccination. Every Wednesday at this facility, you will observe several children’s immunisations,” she confidently states.
“Previously, children receiving immunisation got N500. Now they have raised it to N1000. The availability of funds supports access to immunisation services and benefits their well-being.”
Maryam Usman, who hails from another local government area, Denge Shuni, utilises the Gagi health centre because of its efficient healthcare delivery system.
Many others travel from across the state, a trend the district head attributes to the centre’s high-quality services.
“PHC Gagi is no longer just for Gagi. Five to six local governments use these services. Daily outpatients at Gagi go beyond the operational capacity of every PHC in Sokoto,” he explains.
“Day in and day out, clients come from Kware, Rabah, Wurno, Dange Shuni, and other parts of Sokoto. They patronise it because of the quality services delivered. Further, we are providing 24-hour service.”
The district head, who assumed the throne on January 29, 2005, reflects on the community’s transformation. “I met the hospital as a home for donkeys, goats, and horses,” describing how it was abandoned, with stray animals taking it over.
“I rallied the community behind our cause. Generous individuals began purchasing necessities like doors, windows, desks, and chairs for our staff. We also pushed the local government to send us highly qualified community health workers.”
He adds: “We restored the lost prestige of the drug revolving fund. We began acquiring clients and providing support. Eventually, we expanded to routine immunisation. Initially, we purchased paracetamol to ease pain after vaccination, responding to complaints.”
“From a small number of individuals, one, two, fifty, sixty, and today, to a significantly larger group of people, it’s enormous. Watching the vaccination queue will give you a sense of how many women show up. We won back the trust of the masses by consistently delivering excellent service.”
The traditional leader shines by setting the standard, embracing new practices first, and inspiring others to follow.
“As a leader, it is important to lead by example. If you want children to be immunised, your child should be the first to receive the immunisation. If it is family planning, your wife has to be number one,” he says.
“When the coronavirus vaccination came to Sokoto, I was the first person here to receive the first, second, and booster doses. When they immunised me the first time, it was with a group of 150 people; when they immunised me again, it was with a group of 215 people. When leaders model the behaviour they preach, followers follow.”
A highly enlightened traditional leader, whose authoritative demeanour commands community respect, has successfully influenced the behaviour of several men in their roles as household and community leaders.
He coordinates the participation of males, females, girls, and boys in the community, ensuring inclusivity.
“We engage communities in ensuring that we hold the government responsible for delivering high-quality healthcare services, including immunisation, family planning, facility delivery, antenatal care (ANC), nutrition, Oral Rehydration Therapy (ORT), water, sanitation, and hygiene (WASH), among others, “he avers.
“Today, there is a lot of demand for the services, and we are holding the government to its supply promises. We are challenging the government to guarantee sustainable supply chain management to facilitate the advancement of Sokoto state.”
