A Mixed-Methods Exposé of Systemic Barriers and Enablers for Vitamin A and Deworming in Nigeria's Maternal Newborn and Child Health Week Programme

Background Vitamin A Deficiency (VAD) remains a severe public health issue in Nigeria, contributing to preventable childhood morbidity and mortality. The bi-annual Maternal, Newborn, and Child Health Week (MNCHW) is the primary platform for delivering high-dose Vitamin A Supplementation (VAS) and deworming to children aged 6–59 months. However, national coverage estimates are suspected to be inaccurate and mask significant subnational inequities. This study was designed to validate the reported coverage of the November-December 2024 MNCHW and investigate the systemic barriers and enablers influencing the delivery and uptake of VAS and deworming in Nigeria. Methods A cross-sectional mixed-methods post-event coverage survey (PECS) was conducted across six purposively selected states (Bayelsa, Enugu, Gombe, Katsina, Lagos, Niger). A two-stage cluster sampling design was employed, surveying 6,468 caregivers of eligible children using computer-assisted personal interviewing. Quantitative data were analysed for coverage, and bivariate analyses identified factors associated with uptake. Knowledge of vitamin A and Deworming was assessed using a 20-point scale and categorised as good (≥15), fair (8–14), and poor (< 8). Qualitative key informant interviews (n = 15) with national and state-level stakeholders were thematically analysed using the WHO Health Systems Building Blocks framework. Results Coverage for VAS was 71.1%, meeting the national 65% target, with wide state-level disparities (49.2% in Katsina to 84.0% in Enugu). Deworming coverage was lower at 52.7%. A significant dissonance was found between these verified coverages and administrative reports (87%) in assessed states, which calls for strengthening of routine data systems. Caregiver knowledge score was poor (67%), lack of awareness (36.5%) and health worker absenteeism (31.2%) were primary reasons for non-uptake. Qualitative findings identified critical systemic barriers, including delayed funding release, frequent stockouts of deworming tablets, weak health system, sociocultural resistance, and insecurity in hard-to-reach areas. Enablers included strong partner support, house-to-house delivery strategies, and community engagement. Conclusion While the MNCHW platform has achieved good coverage, significant gaps persist due to systemic and equity-related barriers. Reliance on donor-driven campaigns is unsustainable. To achieve universal coverage, Nigeria must address funding delays, commodity security, administrative data gaps, and knowledge gaps through improved planning, integrated service delivery, and strengthened community mobilization.