Developing Educational Interventions and Reporting Mechanisms to Enhance Aefi Surveillance and Management in Underserved Settings

Adverse Events Following Immunization (AEFI) surveillance is critical for maintaining vaccine safety and public trust. However, in underserved settings like Billiri Local Government Area (LGA) in Gombe State, Nigeria, surveillance systems are often sub-optimal. This study investigates the knowledge, attitudes, and practices (KAP) of Primary Health Care (PHC) providers regarding AEFI to identify gaps and develop targeted educational interventions and reporting mechanisms. Despite the recognized importance of AEFI surveillance, significant underreporting persists in Billiri LGA. PHC providers face systemic barriers, including knowledge gaps, negative attitudes, poor reporting practices, weak infrastructure, and fear of blame. The lack of tailored educational interventions and efficient reporting tools further compromises data quality and vaccine safety monitoring, ultimately eroding public confidence in immunization programs. This study aims to develop evidence-based recommendations for enhancing AEFI surveillance. The objectives are to: (1) assess PHC providers' knowledge, attitudes, and practices regarding AEFI reporting; (2) identify barriers to effective AEFI management; and (3) ascertain feasible educational interventions and digital reporting tools. A descriptive cross-sectional study was conducted among 391 PHC providers selected from a population of 415 across 84 health facilities in Billiri LGA. A multistage sampling technique was used. Data were collected using a validated, structured questionnaire (KAPBEIAEFI) and analyzed using descriptive statistics (frequencies and percentages). While 86% of providers demonstrated good knowledge of AEFI definitions and 91% affirmed the need for timely reporting, a significant knowledge-practice gap existed. Only 57% reported cases consistently, and 60% rarely counselled caregivers on AEFI. Positive attitudes were recorded (88% rejected the notion that reporting is futile), but barriers were pervasive: 67% lacked designated AEFI officers, 76% reported poor supervisory support, 70% feared breaching patient confidentiality, and 60% lacked AEFI kits. Over 90% of respondents strongly supported solutions, including regular training (83%), digital reporting tools (88%), toll-free hotlines, and systematic feedback mechanisms. There is a critical disconnect between positive attitudes/knowledge and actual AEFI reporting practices in Billiri LGA. This is driven by structural, logistical, and psychological barriers. Addressing these requires a multi-pronged strategy. It is recommended to: (1) appoint and train dedicated AEFI focal persons; (2) implement continuous capacity-building workshops; (3) introduce confidential, user-friendly digital reporting platforms (mobile apps, SMS); (4) establish structured feedback and peer-review forums; and (5) ensure consistent supply of AEFI kits and reporting forms. These interventions are essential for strengthening surveillance, improving vaccine safety, and sustaining community trust.