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

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 vaccin...

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Bibliographic Details
Published in:	BMJ open 2023-03, Vol.13 (3), p.e069294-e069294
Main Authors:	Bakare, Ayobami Adebayo, Olojede, Omotayo E, King, Carina, Graham, Hamish, Uchendu, Obioma, Colbourn, Tim, Falade, Adegoke G, Alvesson, Helle Molsted, Burgess, Rochelle Ann, Iuliano, Agnese, McCollum, Eric, Ahmed, Tahlil, Ahmar, Samy, Cassar, Christine, Valentine, Paula, Isah, Adamu, Osebi, Adams, Abdullahi, Magama, Haruna, Ibrahim, Olowookere, Temitayo Folorunso, MacCalla, Matt, Falade, Adegoke Gbadegesin, Salako, Julius, Shittu, Funmilayo, Bakare, Damola, Olojede, Omotayo
Format:	Article
Language:	eng
Subjects:	Ambulatory Care Facilities care-seeking Caregivers Child Children & youth Communicable Disease Control Community Health Workers Coronaviruses COVID-19 - epidemiology COVID-19 - prevention & control COVID-19 pandemic COVID-19 Vaccines Decision making Economic activity Epidemics Health facilities Humans Immunization Interviews lockdown Malaria Medicin och hälsovetenskap Mortality Nigeria - epidemiology Pandemics Pandemics - prevention & control Pneumonia Public Health Qualitative research Restrictions Tropical diseases under-five children vaccine hesistancy Vaccines
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Summary:	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.
ISSN:	2044-6055 2044-6055