Knowledge and Perceptions of Nurse Practitioners on Adverse Events Following Immunization and Barriers to Reporting in the Central Region, Eritrea: A Cross-Sectional Study

Background: Though vaccines are generally considered extremely safe and effective, they have been associated with some serious adverse events following immunization (AEFIs). AEFIs might be related to either the vaccine, immunization error, anxiety related to immunization, and/or coincidental events. If they are not reported and investigated in timely fashion, they can create rumors and confidence gaps. In the last few years, reporting AEFIs in the Central Region of Eritrea, compared to other regions, has been found to be very low, with the root cause for this variation unknown, making intervention strategies challenging. This study was conducted to assess nurse practitioners' knowledge and perceptions on AEFI surveillance and barriers to reporting in the region. Methods: An analytical cross-sectional study was conducted among all nurse practitioners who were directly or indirectly involved in immunization services working in all health facilities of the region. Data were collected between October 2019 and February 2020 using an interview-based questionnaire. Percentages and medians (IQR) were used as descriptive statistics, and Mann-Whitney and Kruskal-Wallis tests were used as inferential tools. Results: A total of 130 respondents with a median age of 40 (IQR 23) years were included in the study. The overall median (IQR) knowledge score of the respondents on AEFI surveillance was 87.50 (19) out of 100. Furthermore, median (IQR) comprehensive perception score was 70 (20) out of 100 (range 40-95). Shortage of motivation and not knowing how to report were identified as the main barriers to reporting AEFIs. Conclusion: Knowledge and perceptions of nurse practitioners in the Central Region on AEFI surveillance were generally encouraging. They should however need to be further trained on the basics of AEFI surveillance to bridge the identified barriers to reporting. Keywords: adverse event following immunization, nurse practitioners, knowledge, perception, barriers, Eritrea