A 10-year review of morbidity from childhood preventable diseases in Nigeria: how successful is the expanded programme on immunization (EPI)? An update.

Morbidity and mortality in children of developing countries are primarily due to preventable infectious diseases such as measles, poliomyelitis, tuberculosis, whooping cough, diphtheria, and tetanus. By 1990 WHO hopes to have every child in the world immunized against these six diseases, that was why the Expanded Programme on Immunization (EPI) was launched. In Nigeria, a nationwide execution of EPI began in 1979. In view of the huge population of Nigeria, an evaluation of the efficiency of the EPI programme at reducing morbidity and mortality from the six target diseases has national and global importance. One such analysis of disease trends showed that apart from tuberculosis and acute poliomyelitis there was no clear reduction in morbidity from the EPI target diseases between 1979 and 1983. The programme was revised and relaunched nationwide in 1984. This paper attempts to update documented programme achievements by including information on EPI diseases from 1974 to 1988. An analysis of available data shows that there has been clear reduction in morbidity from measles and whooping cough since 1986, and that the incidence of tuberculosis is on the increase from 1984, despite a national BCG coverage of over 80 per cent. It is suggested that future evaluations should include data on community-based surveys on poliomyelitis and neonatal tetanus, and use the technique of decision analysis to estimate EPI impact on mortality. A similar effort in this paper predicted a 42 per cent morbidity and 37 per cent mortality reductions from EPI target diseases in Nigeria by the end of 1989.