Community Pharmacy Workforce Willingness, Readiness, and Infrastructural Capacity to Deliver Vaccination Services: A Cross-Sectional Study in Nigeria

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In some Nigerian states, community pharmacists were trained in vaccination, but there are concerns about their capacity to enroll as vaccination service providers. This study evaluated the community pharmacy workforce's willingness, readiness, and infrastructural capacity to deliver vaccination services in Nigeria. Methods We conducted a descriptive cross-sectional study using a self-administered structured questionnaire among community pharmacists in Nigeria through online platforms. Descriptive statistics was performed on the collected data using SPSS statistical software, version 21. Results Of the 414 community pharmacists sampled, 395(response rate = 95.4%) were retrieved and included in the final analysis. Although most community pharmacists did not currently practice vaccine administration in their pharmacies (n = 295, 74.9%), most were willing to start administering vaccines (n = 359, 91.3%), participate in routine and supplemental immunization services(n = 373, 95.4%), receive training related to vaccination (n = 374, 95.2%), and encourage patients to get vaccinated in their pharmacies (n = 367, 93.6%). Tetanus vaccine was the most common ( n = 158, 40%) among the vaccines administered by the respondents. Infrastructure was inadequate in many critical areas; vaccine-specific refrigerators(n = 222, 57.1%), temperature monitoring equipment (n = 263, 67.8%), safety boxes (n = 216, 55.7%), medical waste bins (n = 178, 45.8%), portable vaccine refrigerators in case of power failures(n = 218, 56.1%), anaphylaxis response kit (n = 340, 87.4%), and anaphylaxis management guidance (n = 346, 88.9%). Barriers to the pharmacists’ willingness to deliver vaccination services were inadequate funds to procure appropriate storage equipment (n = 269, 70.0%), inadequate training (n = 265, 69.1%), conflicts with other professionals (n = 246, 64.4%), concerns about patient safety (n = 185, 47.7%) and handling vaccines and disposal of sharps (n = 182, 47.4%). Conclusions Community pharmacists are willing to embrace the advanced role of vaccine administration. The government and other healthcare stakeholders should address the infrastructural gaps and other barriers highlighted in the study to help improve vaccine access and availability. Vaccination Community Pharmacists Willingness Infrastructure Nigeria INTRODUCTION Nigeria is grappling with another vaccine-preventable disease outbreak. In June 2024, the World Health Organisation (WHO) reported 1094 new cases of cholera outbreak posing a threat to Nigeria's healthcare system 1 . Globally, vaccine development has undeniably improved health outcomes (Rodrigues & Plotkin, 2020). The World Health Organisation estimates that vaccines prevent 3.5 million to 5 million deaths annually 2 . Despite this, immunization coverage in Nigeria remains poor 3 , 4 , with only 23% of children fully immunized and more than 2300 childhood deaths occurring daily from vaccine-preventable diseases 3 . To mitigate the danger of infectious diseases and enhance vaccination acceptance, numerous countries have broadened the responsibilities of community pharmacists to include administering vaccines 5 . In addition, the International Pharmaceutical Federation (FIP) published a comprehensive worldwide report on the influence of pharmacists on immunization services. The report revealed that out of the 45 countries examined, 13 countries were authorized to administer vaccines in community settings. These countries include Argentina, Australia, Canada, Costa Rica, Denmark, Ireland, New Zealand, Philippines, Portugal, South Africa, Switzerland, the U.K., and the USA. 6 In recent years, there has been growing recognition of community pharmacists' role in improving vaccination coverage. 7 – 9 As one of the most accessible and frequently consulted healthcare providers, community pharmacists are well-positioned to ensure increased vaccination uptake in communities. 9 The U.S. statistics by the Center for Disease Control (CDC) show that adults who received influenza vaccines in 2016 increased in 2017 from 23–28%. 10 However, community pharmacists' involvement in vaccine administration in Nigeria remains suboptimal. 9 , 11 The question remains: are pharmacists willing and ready to embrace its new role in vaccine uptake? Some of the barriers to Nigerian pharmacists' involvement in vaccination delivery services include inadequate policies 12 , insufficient training 11 , and supply chain problems. 13 Nevertheless, most importantly, pharmacists can only practice vaccination/immunization in a suitably equipped community pharmacy with the necessary vaccination-specific infrastructure. 14 In response, several studies have assessed the preparedness of community pharmacies for vaccination services in other countries, 5 , 15 but similar research has not been conducted in Nigeria. This study therefore sought to fill this literature gap by assessing community pharmacists' readiness and preparedness for vaccination delivery services in Nigeria. It assessed community pharmacists' current vaccination practices, willingness to act as pharmacist–vaccinators, and their pharmacies' suitability for vaccination/immunization services. It also identified barriers to community pharmacists' involvement in vaccination and recommended how best to promote the practice among pharmacists in Nigeria. METHODS Study Design This study employed an internet-based cross-sectional survey conducted anonymously among community pharmacists in Nigeria using a snowballing sampling procedure and a semi-structured questionnaire to survey a representative sample of Community Pharmacists(CPs) from the 36 states and Nigeria’s Federal Capital Territory (FCT). Study Population The study population comprises community pharmacists practising in Nigeria. As of December 31, 2022, the Register Pharmacists and Pharmaceutical Premises of the Pharmacy Council of Nigeria recorded 5,538 licensed community pharmacists in Nigeria. Sample Size A sample size calculation was conducted using Taro Yamane's method, as described in Adam's (2021) study. The calculation was based on the total number of registered community pharmacists in Nigeria as of December 2022, which was 5,538 (n = 5,538). The formula used was n = N / (1 + N(e)^2). N denotes the target population. The sample size (n) was calculated from this number as 373, with an expected 0.05 degree of error. An acceptable level of statistical analysis was achieved by using a margin of error of 5% and a confidence level of 95%. Exclusion criteria the study excluded pharmacists practicing in other areas outside the community pharmacy setting, retired CPs, Nigeran pharmacists who practice abroad, and those who were not actively practicing. Pharmacists who could not be contacted because their contact information had changed and those who declined to participate in the study were also not included. Instrument for data collection The questionnaire was designed based on a comprehensive review of literature on community pharmacy, vaccination delivery services, health workforce, and infrastructural capacity. The draft questionnaire was subjected to review by eight subject matter experts, after which it was pretested for clarity and reliability among 20 community pharmacists who did not participate in the data collection. Revisions were made before commencement of data collection. The reliability of the questionnaire was assessed using Cronbach's alpha. The study's introduction page provided a concise overview of the background, the survey's purpose, directions for completing the questionnaire, and a statement of informed consent. The questionnaire was divided into six domains. The first domain consisted of 8-item questions about demographics such as age, work experience, highest level of education, religion, type of pharmacy, position, pharmacy location, and gender. The second domain contained questions to assess community pharmacists' willingness to provide vaccination delivery services. Multiple-choice answers were provided for the queries, and CPs had to select their responses to ‘yes,’ ‘no,’ or ‘not sure' questions. The third domain contained questions to assess the type of vaccination services pharmacists are willing to provide, with seven questions requiring ‘yes,’ ‘no,’ or ‘not sure' answers. The fourth domain evaluated the technical capacity to deliver vaccination services, including training. In contrast, the fifth domain accessed the infrastructural capacity to provide vaccination services with ‘yes,’ ‘no,’ or ‘I don’t know’ questions. The sixth domain addresses the type of vaccines the community pharmacists were administering. In contrast, the seventh domain addressed the barriers affecting community pharmacists’ willingness to provide immunization services using a 5-point Likert scale, which indicates their degree of agreement or disagreement with statements regarding their barriers, with 1 = Strongly disagree, 2 = Disagree, 0 = Neutral, 3 = Agree, and 4 = Strongly agree. Data Collection A Google form was distributed to community pharmacists via WhatsApp to gather responses for an anonymous online questionnaire. The questionnaire was shared on all CPs' WhatsApp chatrooms in the 36 states plus the FCT of Nigeria through their respective ACPN chairmen and State Officers of the Pharmacy Council of Nigeria. We also broadcasted WhatsApp messages through the phones of all team members, with requests for the recipients to forward the survey link to all CPs in their contact list. Periodic reminders continued as long as the data collection period lasted. Ethical considerations We adhered to the scientific requirements and research protocols outlined in the Declaration of Helsinki for recruiting human participants for this study. Ethical Approval was received from the Research Ethical Review Committee of the College of Medicine, University of Lagos, with the reference number CMUL/HREC/05/24/1457. Before each survey, informed consent was sought from every participant, and this consent was documented with a Yes/No question. Statistical Analysis Data from the survey were inputted into a specially designed Excel database and then processed by the primary author to remove any errors or inconsistencies. After this, the data was transferred to SPSS version 21. Descriptive statistics were employed to present the respondents' demographic characteristics and responses to the survey questions. Continuous variables were reported as means and standard deviations (± S.D.) for variables that followed a normal distribution. The categorical variables were displayed as frequencies and percentages. The statistical analyses were conducted using SPSS statistical software for Windows version 21 (SPSS Inc., Chicago, USA). RESULTS Response rate Of the 414 community pharmacists that were sampled, 395 responses were retrieved. In total, 395 community pharmacists were included in the final analysis, which resulted in a response rate of 95.4%. This represents 7.1% of all employed community pharmacists (n = 5538) in Nigeria and meets the calculated sample size expectation (373). Social demographic characteristics The majority of the participants were above 40 years old (n = 236, 60.8%), male (n = 230, 58.4%), and pharmacist directors (n = 241, 61.3%) with a Bachelor of Pharmacy (B. Pharm) educational qualification (n = 225, 57.1%) and more than ten years work experience (n = 235, 59.8%). The majority of the respondents practice in urban locations (n = 178, 45.4%), Table 1 . Table 1 Demographic characteristics of participants Variable Category Frequency (Percent) Age Less than 30 years 32 (8.1) 30–40 years 125 (31.1) above 40 years 236 (60.8) Gender Male 230 (58.4) Female 164 (41.6) Work experience Less than 5 years 53 (13.5) 5–10 years 105 (26.7) Above 10 years 235 (59.8) Highest educational qualification B.Pharm 225 (57.1) PharmD 28 (7.1) Masters 99 (25.1) FPCPharm 35 (8.9) PhD 7 (1.8) Position Pharmacist Director 241 (61.3) Superintendent Pharmacist 134 (34.1) Full-time Pharmacist employee 18 (4.6) Type of Pharmacy Chain(At least 5 branches) 33 (8.5) Independent(less than 5 branches) 354 (91.5) Pharmacy location Urban 178 (45.4) Semi-Urban 110 (28.1) Capital City 86 (21.9) Rural 18 (4.6) State of Practice The highest participation rates were recorded for Lagos (n = 111, 28.1%). Rivers, Delta, and Edo States had the second-highest participation rate (n = 31, 7.8%). States with the lowest participation rate were Bayelsa, Jigawa, and Zamfara (n = 1, 0.3%). Table 2 . Table 2 State of Practice Frequency Percent Valid 2 .5 Abia 2 .5 Abuja 19 4.8 Adamawa 4 1.0 Akwaibom 2 .5 Anambra 8 2.0 Bauchi 6 1.5 Bayelsa 1 .3 Benue 11 2.8 Cross river 3 .8 Delta 31 7.8 Ebonyi 7 1.8 Edo 31 7.8 Ekiti 3 .8 Enugu 12 3.0 Gombe 5 1.3 Imo 3 .8 Jigawa 1 .3 Kaduna 10 2.5 Kano 4 1.0 Katsina 4 1.0 Kogi 4 1.0 Kwara 6 1.5 Lagos 111 28.1 Nassarawa 8 2.0 Niger 5 1.3 Ogun 13 3.3 Ondo 7 1.8 Osun 12 3.0 Oyo 21 5.3 Plateau 3 .8 Rivers 31 7.8 Taraba 2 .5 Yobe 2 .5 Zamfara 1 .3 Total 395 100.0 Willingness to Vaccinate Although most community pharmacists did not currently practice vaccine administration in their pharmacies (n = 295, 74.9%), the majority were willing to start administering vaccines (n = 359, 91.3%), receive training related to vaccination (n = 374, 95.2%), and encourage patients to get vaccinated in their pharmacies (n = 367, 93.6%). Most of the community pharmacists also indicated willingness to participate in routine and supplemental immunization services (n = 373, 95.4%), Table 3 . Table 3 The willingness of community pharmacists for vaccination delivery services Yes No Not sure Do you currently practice vaccine administration in your pharmacy? 96 (24.4) 295(74.9) 3 (0.8) Do you wish to start/continue administering vaccines? 359(91.3) 16 (4.1) 18 (4.6) Will you encourage patients to get vaccinated in your community pharmacy? 367(93.6) 10 (2.6) 15 (3.8) Will you wish to get first aid training for vaccination? 366(93.1) 12 (3.1) 15 (3.8) Will you wish to get training related to vaccination? 374(95.2) 11 (2.8) 8 (2.0) Will you wish to get Cardiopulmonary Resuscitation (CPR) training? 375(95.9) 7 (1.8) 9 (2.3) Will you wish to get an anaphylactic shock kit? 370(94.4) 7 (1.8) 15 (3.8) Will you ask for an administrative fee if the vaccines are free (already paid for, by the government or NGO)? 204(52.2) 123(31.5) 64(16.4) Will you wish to have a private place for vaccination within your pharmacy? 357(91.1) 18 (4.6) 17 (4.3) Will you wish to have an appointment system for vaccination services? 356(91.0) 22 (5.7) 13 (3.3) As a community pharmacy owner, would you be willing to pay for appropriate vaccine handling and storage facilities from the professional association if made available at a discounted price and/or installment payment? 305(78.2) 26 (6.7) 59(15.1) Participate in routine and supplemental immunization services 373(95.4) 8 (2.0) 10 (2.6) Distribution of vaccines for pharmaceutical companies 232(60.4) 93 (24.2) 59(15.4) Referring clients to other immunization centres outside your pharmacy 254 (66) 80 (20.8) 51(13.2) Engaging in campaign on immunization 359(91.6) 9 (2.3) 24 (6.1) Administering vaccines to clients 364(92.9) 14 (3.6) 14 (3.6) Educating Clients on immunization 385(98.0) 4 (1.0) 4 (1.0) Retailing of vaccines to end users 331(85.1) 33 (8.5) 25 (6.4) Training on vaccination and vaccine management Most community pharmacists (n = 222, 56.6%) received no training on vaccination delivery services. Among those who received training (n = 170, 43.4%), the training duration was mostly less than three days (n = 94, 52.8%). Among the various types of training required for vaccination delivery, most community pharmacists had received first aid training (n = 219, 56.6%), and most had not received vaccine adverse event handling and documentation training (n = 226, 57.7%). Professional associations (n = 144, 39.6%) took the lead among the organizations that coordinated training for community pharmacists, Table 4 . Table 4 Questions on Vaccination Training Variable Yes (%) No (%) Have you received any training on vaccination delivery services? 170 (43.4) 222 (56.6) If yes, how many days was the training? 5 days 28 (15.7) Training received First aid 219 (56.6) 168 (43.4) Cardiopulmonary Resuscitation (CPR) 175 (44.5) 218 (55.5) Vaccine storage and handling 196 (49.9) 197 (50.1) Vaccine administration 173 (44.0) 220 (56.0) Vaccine adverse event handling and documentation 166 (42.3) 226 (57.7) Which organization coordinated your training? Professional associations 144 (39.6) NGOs 65 (17.9) Webinars 34 (9.3) National Primary Health Care Development Agency (NPHCDA) 43 (11.8) Educational institutions 78 (21.4) Infrastructural Capacity to deliver vaccination services While more than half of the community pharmacists indicated having a vaccination room in their pharmacy (n = 196, 50.5%), medical waste bin (n = 206, 53.0%), and materials for hand sanitation and surface cleaning (n = 306, 78.7%), most did not have other infrastructures like refrigerators specific for vaccines (n = 222, 57.1%), temperature monitoring equipment (n = 263, 67.8%), portable refrigerators in case of power failure (n = 218, 56.1%), anaphylaxis response kits (n = 340, 87.4%), anaphylaxis management posters/guidance (n = 346, 88.9%), safety boxes (n = 216, 55.7%), and records for vaccinated patients (n = 280, 72.4%), Table 5 . Table 5 Infrastructural Capacity to deliver vaccination services Yes No I don't know Vaccination specific place/room 196 (50.5) 162 (41.8) 30 (7.7) Refrigerator specific for vaccines 155 (39.8) 222 (57.1) 12 (3.1) Temperature monitoring equipment 116 (29.9) 263 (67.8) 9 (2.3) Portable refrigerator in case of power failure 167 (42.9) 218 (56.1) 4 (1.0) Anaphylaxis response kit 46 (11.8) 340 (87.4) 3 (0.8) Anaphylaxis management poster/guidance 38 (9.8) 346 (88.9) 5 (1.3) Safety box 165 (42.5) 216 (55.7) 7 (1.8) Medical waste bin 206 (53.0) 178 (45.8) 5 (1.3) Materials for hand sanitisation and surface cleaning 306 (78.7) 80 (20.6) 3 (0.8) Vaccinated patients record 101 (26.1) 280 (72.4) 6 (1.6) Type of vaccines being administered by community pharmacists The tetanus toxoid vaccine was the most commonly administered in community pharmacies (n = 158), and the rabies vaccine was the second most commonly administered vaccine (n = 72). Bacille-Calmette Guerin (BCG) was the least common vaccine administered by community pharmacists (n = 3), Table 6 . Table 6 If you are already administering vaccines in your pharmacy, what type of vaccines are you administering? Select all that apply Type of Vaccines Number of persons administering the vaccines Flu 9 Hepatitis A 15 Hepatitis B 61 Chickenpox 10 Meningitis 10 Pneumonia 6 Tetanus 158 Rotavirus 14 Rabies 72 Measles, Mumps, and Rubella (MMR) 14 Human Papilloma Virus (HPV) 20 Oral Polio Virus 8 Bacille-Calmette Guerin (BCG) 3 Others 21 - Antisnake(1), Covid(13), Typhoid(6), Malaria(1) Barriers affecting community pharmacists' willingness to provide immunization services The most highlighted barriers to the pharmacists’ willingness to deliver vaccination services were inadequate funds to procure appropriate storage equipment (n = 269, 70.0%), inadequate training (n = 265, 69.1%), conflicts with other professionals (n = 246, 64.4%), concerns about patient safety (n = 185, 47.7%) and handling vaccines and disposal of sharps (n = 182, 47.4%), Table 7 . Table 7 Barriers affecting community pharmacists' willingness to provide immunization services SA A N D SD Mean Pharmacists are busy and they have no time to provide immunization services 17 (4.4) 30 (7.8) 118 (30.6) 113 (29.4) 107 (27.8) 3.68 The pharmacies are not designed to accommodate such services 18 (4.7) 53 (13.8) 110 (28.6) 107 (27.9) 96 (25.0) 3.55 Inadequate funds to set up a designated space and/or procure and appropriate storage facility by the community pharmacist 117 (30.4) 152 (39.5) 55 (14.3) 41 (10.6) 20 (5.2) 2.21 Patient safety is a concern and serious advents beyond the capacity of the pharmacy may occur 48 (12.4) 137 (35.3) 90 (23.2) 79 (20.4) 34 (8.8) 2.78 Lack of adequate training 97 (25.3) 168 (43.8) 60 (15.6) 34 (8.9) 25 (6.5) 2.28 Pharmacists are less trusted by patients to provide such service 19 (5.0) 37 (9.7) 123 (32.5) 80 (21.0) 122 (32.0) 3.65 Conflicts with other professionals who are currently empowered by the Law to vaccinate 82 (21.5) 164 (42.9) 69 (18.1) 38 (9.9) 29 (7.6) 2.39 Concerns about handling vaccines, storage, and disposal of sharps 59 (15.4) 123 (32.0) 88 (22.9) 58 (15.1) 56 (14.6) 2.82 Pharmacists are not comfortable using needles 15 (4.0) 44 (11.6) 123 (32.5) 91 (24.1) 105 (27.8) 3.60 Discussion Community pharmacists are a significant first-line contact for many healthcare consumers and intermediaries between physicians and patients, making them indispensable in modern healthcare delivery. Despite this daunting task, pharmacists are still an underutilized resource in achieving universal health coverage and implementing many healthcare policies. There have been calls for pharmacists in Nigeria to take up their emerging roles in vaccine management and administration. At the same time, there is no legislation mandating pharmacists to engage in vaccination, no law also prevents them from doing so. 16 The COVID-19 pandemic was an eye-opener about the shortage of healthcare practitioners, and CPs have the workforce to help make healthcare services readily available. To augment their career, pharmacists have initiated a process of self-reinvention by seeking ways to expand their responsibilities in community pharmacy. 12 Therefore, this study sought to explore the willingness of community pharmacists in Nigeria to engage in vaccination programmes and highlight the challenges community pharmacists face in setting up appropriate vaccine storage facilities and administration in their pharmacies. The findings of this study indicate that community pharmacists in Nigeria demonstrate a high level of willingness to administer and dispense vaccines, as seen by 91.3% (n = 359) of respondents expressing their support for this practice. However, the effective deployment of a pharmacist-provided vaccination service is contingent upon proper training, logistics availability, and patient acceptance, which are highly significant considerations. The cost-effectiveness of vaccination services offered by pharmacists varies depending on the healthcare systems and reimbursement mechanisms in place. 17 Several studies have suggested that pharmacist participation in vaccination programmes can be economically advantageous, particularly in cases where pharmacists can charge for their services. Moreover, data indicates that immunizations delivered via community pharmacies are more economically efficient than those administered in medical settings. 18 , 19 This forestalls the urgent need for the government to put systems and structures in place to empower community pharmacists to provide vaccination services. The results also show that most community pharmacists do not practice vaccine services. This can be attributed to the fact that although many pharmacists were willing to proceed, they felt inadequately prepared due to insufficient education and infrastructural capacity to incorporate vaccination into their practice. They believed that formal certification should be a requirement to do so. Still, they all demonstrated zeal in engaging in these training and certifications that will equip them with the requisite knowledge to practice these services. This study is among the first to assess Nigerian community pharmacists' willingness and readiness to provide vaccination services. The result is similar to studies in Lebanon 20 and Saudi Arabia 21 , where pharmacists strongly desire vaccination. In both studies, it was observed that there is a deficiency in the knowledge gap in handling possible adverse effects from vaccines; this occurrence is evident in our study, where pharmacists show higher training in vaccine handling than in vaccine adverse event handling and documentation. Therefore, it is equally crucial to have a proficient healthcare system with competent routine immunization service providers who can administer and oversee these vaccines and have them themselves to achieve the necessary level of immunization coverage. It has been posited that "conducting training in little clusters or batches over a while is more likely to be impactful as compared to a situation where a large number of service providers are trained at the same time." 22 An important factor contributing to high immunization rates in many developing nations is the presence of enough well-trained healthcare workers capable of efficiently administering vaccines to children within healthcare facilities and during outreach programs. 23 In our study, most pharmacists were trained by their professional society and this shows a dire desire by professional leaders to improve accessibility. It was observed that CPs frequently encounter common infrastructure obstacles while establishing vaccine services, precisely the absence of appropriate vaccine storage equipment, temperature monitoring equipment, anaphylaxis management posters/guidance, and safety boxes. The enduring nature of certain obstacles might impact the behavioral aspects of individuals when it comes to accepting pharmacist-administered vaccinations, as it fosters a sense of distrust and portrays pharmacists as lacking competence. Studies have shown the effect of infrastructural defects on vaccine uptake, efficacy, and safety. 24 , 25 Hence, there is a need for interventional support for pharmacists who indicate interest in establishing vaccine services. Although pharmacist-provided vaccination programmes have achieved universal popularity and have had a favorable impact, numerous barriers remain. Our study highlighted inadequate funds to set up a designated space or procure an appropriate storage facility by the community pharmacist as the significant barrier encountered by CPs followed by a lack of training and conflicts with other professionals currently empowered by the Law to vaccinate. Most barriers CPs face are systemic, which often does not lie within the means of pharmacists alone to solve. A study conducted in Canada among traditional vaccinators revealed only moderate support for pharmacists delivering vaccines. The survey reported that 32% of nurses and 46% of physicians disapproved of this practice. 26 Similarly, fewer than 50% of the questioned nurses and physicians would recommend their patients to a pharmacist for vaccine administration; the reasons for this hesitation and lack of support were mainly concerns regarding the adequacy and effectiveness of pharmacists' training in handling adverse effects that may arise from vaccination administration 26 ; this lack of support should be reproved knowing that CPs who administer vaccines do not seek to engage in a conflict over payment or infringe upon other healthcare practitioners' professional responsibilities, but instead, pharmacist as healthcare professionals have been equipped with the proper knowledge and can engage in vaccination to improve Universal Health Coverage as common with other nations where evidence exist of improved coverage of immunization by the pharmacist. Instead, the crucial aspect is to engage in collaborative efforts as members of an integrated healthcare team to facilitate patients' seamless access to this critical healthcare service. To overcome the multiple hurdles and barriers to pharmacist-led vaccines, a collaborative effort from all members of the healthcare team and policymakers is necessary. Efforts like the collaborative practice agreement in the United States, where the pharmacist's role has been advanced, should be emulated. 27 Limitations This study is not without limitation, firstly it was designed as a cross-sectional study "The primary limitation of the cross-sectional study design is that because the exposure and outcome are simultaneously assessed, there is generally no evidence of a temporal relationship between exposure and outcome." 28 . Hence, establishing a genuine cause-and-effect link is unattainable without longitudinal data. It is recommended that further studies such as longitudinal studies be conducted to provide more evidence for this result. Conclusion Despite the inadequacies in infrastructural capacity, community pharmacists have positioned themselves as advocates, educators, facilitators, and qualified providers of vaccinations. The importance of pharmacists as vaccinators in improving community vaccination rates through increased accessibility should be recognized. Pharmacists have the potential to expand their role in delivering public health services by safely and effectively administering injectable medications and managing adverse drug reactions with the proper training and legislation. This study emphasizes that when CPs are empowered, they are willing to advance in vaccine administration and handling. Targeted interventions are needed to enhance their capacity to deliver effective vaccination services. Declarations Ethics approval and consent to participate Ethical Approval was received from the Research Ethical Review Committee of the College of Medicine, University of Lagos, with the reference number CMUL/HREC/05/24/1457. Before each survey, informed consent was sought from every participant, and this consent was documented with a Yes/No question. Consent for publication Not Applicable Data Availability The datasets used and analysed during the current study are available from the corresponding author on reasonable request Conflict of Interest The authors have no competing interests to declare that are relevant to the content of this article. Funding The authors received no funding to carry out this study. Authors’ contributions All authors made substantial contributions to the study. AAO and UGO conceptualized the study. AAO, UGO, COO, and OMA conducted the literature review and designed the study and the survey tool. AAO, UGO, and OMA coordinated the review and pretesting of the survey tool. AAO, UGO, COO, and OMA collected the data. AAO, UGO, and COO analysed the collected data. AAO, UGO, COO, and OMA interpreted the data. UGO and AAO developed the first draft of the manuscript. All the authors reviewed and edited the manuscript and approved the final manuscript before submission. Acknowledgments The authors are grateful to the State chairmen of the Association of Community Pharmacists of Nigeria and State Officers of the Pharmacy Council of Nigeria who supported the administration of questionnaires in their state social media platforms. Authors’ information AAO is a community pharmacist with vast experience and passion in pharmacy practice based research. He is the immediate past National chairman of the Association of Community Pharmacists of Nigeria. UGO is an Associate Professor of Global Health and Health Systems Research at the Department of Global Health and Bioethics, Euclid University, Bangui, Central African Republic, with a public health pharmacy and regulation background. COO is a pharmacist and manager of the Research and Development Unit of the Association of Community Pharmacists of Nigeria, he has master degree and he is deeply interested in community pharmacy based research. OMA is a distinguished community pharmacist, with interest in operational and practice research. She continuously explores innovative ways to improve patient care, optimize therapeutic outcomes and contribute to the advancement of Pharmacy practice. References WHO. (2024) Multi-country outbreak of cholera. file:///C:/Users/HP/Downloads/20240717_multi-country_outbreak-of-cholera_sitrep_16.pdf World Health Organization. (2024). Vaccines and immunization. Who.int; WHO. https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1 UNICEF. (2021). UNICEF Nigeria and Facebook test effectiveness of immunization messages in Nigeria. Www.unicef.org. https://www.unicef.org/nigeria/press-releases/unicef-nigeria-and-facebook-test-effectiveness-immunization-messages-nigeria WHO. (2023). WHO partners government for big-catch-up campaign to close immunization coverage gaps. WHO | Regional Office for Africa. https://www.afro.who.int/countries/nigeria/news/who-partners-government-big-catch-campaign-close-immunization-coverage-gaps Balkhi B, Aljadhey H, Mahmoud MA, Alrasheed M, Pont LG, Mekonnen AB, Alhawassi TM. Readiness and willingness to provide immunization services: a survey of community pharmacists in Riyadh, Saudi Arabia. Safety in Health. 2018 Dec;4:1-7. Rosado H, Bates I. An overview of current pharmacy impact on immunization. A global report. FIP. 2016. https://fip.org/files/fip/publications/ FIP_report_on_Immunisation.pdf. DeMaagd G, Pugh A. Pharmacists' Expanding role in immunization practices. 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A., Ajibade, A., Yussuf, A. O., ... & Adetunji, O. (2024). Stakeholders' perspectives on the involvement of community pharmacists in vaccine delivery services and implications for policy reform in Nigeria. Discover Public Health, 21(1), 26. Olutuase VO, Iwu-Jaja CJ, Akuoko CP, Adewuyi EO, Khanal V. Medicines and vaccines supply chains challenges in Nigeria: a scoping review. BMC Public Health. 2022 Dec;22:1-5. Alnahar SA, Gkountouras G, Darwish RM, Bates I. Community pharmacists workforce readiness to deliver vaccination services: A cross‐sectional study from Jordan. Pharmacology Research & Perspectives. 2022 Apr;10(2):e00943. Ang WC, Fadzil MS, Ishak FN, Adenan NN, Nik Mohamed MH. Readiness and willingness of Malaysian community pharmacists in providing vaccination services. Journal of pharmaceutical policy and practice. 2022 Dec 31;15(1):81. Agbo BB, Esienumoh E, Inah SA, Eko JE, Nwachukwu EJ. Community pharmacists, participation in immunization services in Cross River State, Nigeria. Int J Public Heal Pharm Pharmacol. 2019 Aug;4:11-25. Ayenew W, Anagaw YK, Limenh LW, Simegn W, Bizuneh GK, Bitew T, Minwagaw T, Fitigu AE, Dessie MG, Asmamaw G. Readiness of and barriers for community pharmacy professionals in providing and implementing vaccination services. BMC Health Services Research. 2024 Jul 30;24(1):867. Grabenstein JD, Hartzema AG, Guess HA, Johnston WP, Rittenhouse BE. Community pharmacists as immunization advocates: cost-effectiveness of a cue to influenza vaccination. Medical care. 1992 Jun 1:503-13. Burson RC, Buttenheim AM, Armstrong A, Feemster KA. Community pharmacies as sites of adult vaccination: a systematic review. Human vaccines & immunotherapeutics. 2016 Dec 1;12(12):3146-59. Youssef D, Abou-Abbas L, Farhat S, Hassan H. Pharmacists as immunizers in Lebanon: a national survey of community pharmacists' willingness and readiness to administer adult immunization. Human resources for health. 2021 Dec;19:1-1. Lindner N, Riesenhuber M, Müller-Uri T, Weidmann AE. The role of community pharmacists in immunisation: a national cross-sectional study. International journal of clinical pharmacy. 2022 Apr;44(2):409-17. Arogundade L, Akinwumi T, Molemodile S, Nwaononiwu E, Ezika J, Yau I, Wonodi C. Lessons from a training needs assessment to strengthen the capacity of routine immunization service providers in Nigeria. BMC Health Services Research. 2019 Dec;19:1-2. LaFond A, Kanagat N, Steinglass R, Fields R, Sequeira J, Mookherji S. Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies. Health policy and planning. 2015 Apr 1;30(3):298-308. Abad N, Uba BV, Patel P, Barau DN, Ugochukwu O, Aliyu N, Ayanleke HB, Franka R, Waziri NE, Bolu O. A rapid qualitative assessment of barriers associated with demand and uptake of health facility-based childhood immunizations and recommendations to improve immunization service delivery in Sokoto State, Northwest Nigeria, 2017. The Pan African Medical Journal. 2021;40(Suppl 1). Mahachi K, Kessels J, Boateng K, Baptiste AE, Mitula P, Ekeman E, Lochlainn LN, Rosewell A, Sodha SV, Abela-Ridder B, Gabrielli AF. Zero-or missed-dose children in Nigeria: contributing factors and interventions to overcome immunization service delivery challenges. Vaccine. 2022 Sep 2;40(37):5433-44. MacDougall D, Halperin BA, Isenor J, MacKinnon-Cameron D, Li L, McNeil SA, Langley JM, Halperin SA. Routine immunization of adults by pharmacists: Attitudes and beliefs of the Canadian public and health care providers. Human vaccines & immunotherapeutics. 2016 Mar 3;12(3):623-31. Cernasev A, Aruru M, Clark S, Patel K, DiPietro Mager N, Subramaniam V, Truong HA. Empowering public health pharmacy practice—moving from collaborative practice agreements to provider status in the US. Pharmacy. 2021 Mar 9;9(1):57. Carlson MD, Morrison RS. Study design, precision, and validity in observational studies. Journal of palliative medicine. 2009 Jan 1;12(1):77-82. Additional Declarations No competing interests reported. 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In June 2024, the World Health Organisation (WHO) reported 1094 new cases of cholera outbreak posing a threat to Nigeria's healthcare system\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Globally, vaccine development has undeniably improved health outcomes (Rodrigues \u0026amp; Plotkin, 2020). The World Health Organisation estimates that vaccines prevent 3.5\u0026nbsp;million to 5\u0026nbsp;million deaths annually\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Despite this, immunization coverage in Nigeria remains poor\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, with only 23% of children fully immunized and more than 2300 childhood deaths occurring daily from vaccine-preventable diseases\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. To mitigate the danger of infectious diseases and enhance vaccination acceptance, numerous countries have broadened the responsibilities of community pharmacists to include administering vaccines\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. In addition, the International Pharmaceutical Federation (FIP) published a comprehensive worldwide report on the influence of pharmacists on immunization services. The report revealed that out of the 45 countries examined, 13 countries were authorized to administer vaccines in community settings. These countries include Argentina, Australia, Canada, Costa Rica, Denmark, Ireland, New Zealand, Philippines, Portugal, South Africa, Switzerland, the U.K., and the USA.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn recent years, there has been growing recognition of community pharmacists' role in improving vaccination coverage.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e As one of the most accessible and frequently consulted healthcare providers, community pharmacists are well-positioned to ensure increased vaccination uptake in communities.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The U.S. statistics by the Center for Disease Control (CDC) show that adults who received influenza vaccines in 2016 increased in 2017 from 23\u0026ndash;28%.\u003csup\u003e10\u003c/sup\u003e However, community pharmacists' involvement in vaccine administration in Nigeria remains suboptimal.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The question remains: are pharmacists willing and ready to embrace its new role in vaccine uptake?\u003c/p\u003e \u003cp\u003eSome of the barriers to Nigerian pharmacists' involvement in vaccination delivery services include inadequate policies\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, insufficient training\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, and supply chain problems.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Nevertheless, most importantly, pharmacists can only practice vaccination/immunization in a suitably equipped community pharmacy with the necessary vaccination-specific infrastructure.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In response, several studies have assessed the preparedness of community pharmacies for vaccination services in other countries,\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e but similar research has not been conducted in Nigeria. This study therefore sought to fill this literature gap by assessing community pharmacists' readiness and preparedness for vaccination delivery services in Nigeria. It assessed community pharmacists' current vaccination practices, willingness to act as pharmacist\u0026ndash;vaccinators, and their pharmacies' suitability for vaccination/immunization services. It also identified barriers to community pharmacists' involvement in vaccination and recommended how best to promote the practice among pharmacists in Nigeria.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study employed an internet-based cross-sectional survey conducted anonymously among community pharmacists in Nigeria using a snowballing sampling procedure and a semi-structured questionnaire to survey a representative sample of Community Pharmacists(CPs) from the 36 states and Nigeria\u0026rsquo;s Federal Capital Territory (FCT).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Population\u003c/strong\u003e \u003cp\u003eThe study population comprises community pharmacists practising in Nigeria. As of December 31, 2022, the Register Pharmacists and Pharmaceutical Premises of the Pharmacy Council of Nigeria recorded 5,538 licensed community pharmacists in Nigeria.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSample Size\u003c/strong\u003e \u003cp\u003eA sample size calculation was conducted using Taro Yamane's method, as described in Adam's (2021) study. The calculation was based on the total number of registered community pharmacists in Nigeria as of December 2022, which was 5,538 (n\u0026thinsp;=\u0026thinsp;5,538).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe formula used was n\u0026thinsp;=\u0026thinsp;N / (1\u0026thinsp;+\u0026thinsp;N(e)^2).\u003c/p\u003e \u003cp\u003eN denotes the target population.\u003c/p\u003e \u003cp\u003eThe sample size (n) was calculated from this number as 373, with an expected 0.05 degree of error. An acceptable level of statistical analysis was achieved by using a margin of error of 5% and a confidence level of 95%.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion criteria\u003c/strong\u003e \u003cp\u003ethe study excluded pharmacists practicing in other areas outside the community pharmacy setting, retired CPs, Nigeran pharmacists who practice abroad, and those who were not actively practicing. Pharmacists who could not be contacted because their contact information had changed and those who declined to participate in the study were also not included.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInstrument for data collection\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was designed based on a comprehensive review of literature on community pharmacy, vaccination delivery services, health workforce, and infrastructural capacity. The draft questionnaire was subjected to review by eight subject matter experts, after which it was pretested for clarity and reliability among 20 community pharmacists who did not participate in the data collection. Revisions were made before commencement of data collection. The reliability of the questionnaire was assessed using Cronbach's alpha.\u003c/p\u003e \u003cp\u003eThe study's introduction page provided a concise overview of the background, the survey's purpose, directions for completing the questionnaire, and a statement of informed consent.\u003c/p\u003e \u003cp\u003eThe questionnaire was divided into six domains. The first domain consisted of 8-item questions about demographics such as age, work experience, highest level of education, religion, type of pharmacy, position, pharmacy location, and gender. The second domain contained questions to assess community pharmacists' willingness to provide vaccination delivery services. Multiple-choice answers were provided for the queries, and CPs had to select their responses to \u0026lsquo;yes,\u0026rsquo; \u0026lsquo;no,\u0026rsquo; or \u0026lsquo;not sure' questions. The third domain contained questions to assess the type of vaccination services pharmacists are willing to provide, with seven questions requiring \u0026lsquo;yes,\u0026rsquo; \u0026lsquo;no,\u0026rsquo; or \u0026lsquo;not sure' answers. The fourth domain evaluated the technical capacity to deliver vaccination services, including training.\u003c/p\u003e \u003cp\u003eIn contrast, the fifth domain accessed the infrastructural capacity to provide vaccination services with \u0026lsquo;yes,\u0026rsquo; \u0026lsquo;no,\u0026rsquo; or \u0026lsquo;I don\u0026rsquo;t know\u0026rsquo; questions. The sixth domain addresses the type of vaccines the community pharmacists were administering. In contrast, the seventh domain addressed the barriers affecting community pharmacists\u0026rsquo; willingness to provide immunization services using a 5-point Likert scale, which indicates their degree of agreement or disagreement with statements regarding their barriers, with 1\u0026thinsp;=\u0026thinsp;Strongly disagree, 2\u0026thinsp;=\u0026thinsp;Disagree, 0\u0026thinsp;=\u0026thinsp;Neutral, 3\u0026thinsp;=\u0026thinsp;Agree, and 4\u0026thinsp;=\u0026thinsp;Strongly agree.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Collection\u003c/strong\u003e \u003cp\u003eA Google form was distributed to community pharmacists via WhatsApp to gather responses for an anonymous online questionnaire. The questionnaire was shared on all CPs' WhatsApp chatrooms in the 36 states plus the FCT of Nigeria through their respective ACPN chairmen and State Officers of the Pharmacy Council of Nigeria. We also broadcasted WhatsApp messages through the phones of all team members, with requests for the recipients to forward the survey link to all CPs in their contact list. Periodic reminders continued as long as the data collection period lasted.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical considerations\u003c/strong\u003e \u003cp\u003e We adhered to the scientific requirements and research protocols outlined in the Declaration of Helsinki for recruiting human participants for this study. Ethical Approval was received from the Research Ethical Review Committee of the College of Medicine, University of Lagos, with the reference number CMUL/HREC/05/24/1457. Before each survey, informed consent was sought from every participant, and this consent was documented with a Yes/No question.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e \u003cp\u003eData from the survey were inputted into a specially designed Excel database and then processed by the primary author to remove any errors or inconsistencies. After this, the data was transferred to SPSS version 21. Descriptive statistics were employed to present the respondents' demographic characteristics and responses to the survey questions. Continuous variables were reported as means and standard deviations (\u0026plusmn;\u0026thinsp;S.D.) for variables that followed a normal distribution. The categorical variables were displayed as frequencies and percentages. The statistical analyses were conducted using SPSS statistical software for Windows version 21 (SPSS Inc., Chicago, USA).\u003c/p\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eResponse rate\u003c/h2\u003e \u003cp\u003eOf the 414 community pharmacists that were sampled, 395 responses were retrieved. In total, 395 community pharmacists were included in the final analysis, which resulted in a response rate of 95.4%. This represents 7.1% of all employed community pharmacists (n\u0026thinsp;=\u0026thinsp;5538) in Nigeria and meets the calculated sample size expectation (373).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSocial demographic characteristics\u003c/h3\u003e\n\u003cp\u003eThe majority of the participants were above 40 years old (n\u0026thinsp;=\u0026thinsp;236, 60.8%), male (n\u0026thinsp;=\u0026thinsp;230, 58.4%), and pharmacist directors (n\u0026thinsp;=\u0026thinsp;241, 61.3%) with a Bachelor of Pharmacy (B. Pharm) educational qualification (n\u0026thinsp;=\u0026thinsp;225, 57.1%) and more than ten years work experience (n\u0026thinsp;=\u0026thinsp;235, 59.8%). The majority of the respondents practice in urban locations (n\u0026thinsp;=\u0026thinsp;178, 45.4%), Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (Percent)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125 (31.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eabove 40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e236 (60.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e230 (58.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e164 (41.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWork experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (13.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105 (26.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e235 (59.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHighest educational qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB.Pharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225 (57.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePharmD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99 (25.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFPCPharm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (8.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePharmacist Director\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e241 (61.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuperintendent Pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134 (34.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFull-time Pharmacist employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of Pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChain(At least 5 branches)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (8.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent(less than 5 branches)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e354 (91.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePharmacy location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178 (45.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemi-Urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110 (28.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapital City\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86 (21.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eState of Practice\u003c/h2\u003e \u003cp\u003eThe highest participation rates were recorded for Lagos (n\u0026thinsp;=\u0026thinsp;111, 28.1%). Rivers, Delta, and Edo States had the second-highest participation rate (n\u0026thinsp;=\u0026thinsp;31, 7.8%). States with the lowest participation rate were Bayelsa, Jigawa, and Zamfara (n\u0026thinsp;=\u0026thinsp;1, 0.3%). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eState of Practice\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"35\" rowspan=\"36\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbuja\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdamawa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAkwaibom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnambra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBauchi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBayelsa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBenue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCross river\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEbonyi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEdo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEkiti\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnugu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGombe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJigawa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKaduna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKano\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKatsina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKogi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKwara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLagos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNassarawa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOgun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOndo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsun\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOyo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlateau\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRivers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTaraba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYobe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZamfara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eWillingness to Vaccinate\u003c/h3\u003e\n\u003cp\u003eAlthough most community pharmacists did not currently practice vaccine administration in their pharmacies (n\u0026thinsp;=\u0026thinsp;295, 74.9%), the majority were willing to start administering vaccines (n\u0026thinsp;=\u0026thinsp;359, 91.3%), receive training related to vaccination (n\u0026thinsp;=\u0026thinsp;374, 95.2%), and encourage patients to get vaccinated in their pharmacies (n\u0026thinsp;=\u0026thinsp;367, 93.6%). Most of the community pharmacists also indicated willingness to participate in routine and supplemental immunization services (n\u0026thinsp;=\u0026thinsp;373, 95.4%), Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe willingness of community pharmacists for vaccination delivery services\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot sure\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you currently practice vaccine administration in your pharmacy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e295(74.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you wish to start/continue administering vaccines?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e359(91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill you encourage patients to get vaccinated in your community pharmacy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e367(93.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill you wish to get first aid training for vaccination?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e366(93.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill you wish to get training related to vaccination?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e374(95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill you wish to get Cardiopulmonary Resuscitation (CPR) training?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e375(95.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill you wish to get an anaphylactic shock kit?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e370(94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill you ask for an administrative fee if the vaccines are free (already paid for, by the government or NGO)?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e204(52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123(31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64(16.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill you wish to have a private place for vaccination within your pharmacy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e357(91.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWill you wish to have an appointment system for vaccination services?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e356(91.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (3.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAs a community pharmacy owner, would you be willing to pay for appropriate vaccine handling and storage facilities from the professional association if made available at a discounted price and/or installment payment?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e305(78.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59(15.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipate in routine and supplemental immunization services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e373(95.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistribution of vaccines for pharmaceutical companies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e232(60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59(15.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferring clients to other immunization centres outside your pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e254 (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51(13.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngaging in campaign on immunization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e359(91.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (6.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministering vaccines to clients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e364(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducating Clients on immunization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e385(98.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetailing of vaccines to end users\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e331(85.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (6.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eTraining on vaccination and vaccine management\u003c/h3\u003e\n\u003cp\u003eMost community pharmacists (n\u0026thinsp;=\u0026thinsp;222, 56.6%) received no training on vaccination delivery services. Among those who received training (n\u0026thinsp;=\u0026thinsp;170, 43.4%), the training duration was mostly less than three days (n\u0026thinsp;=\u0026thinsp;94, 52.8%). Among the various types of training required for vaccination delivery, most community pharmacists had received first aid training (n\u0026thinsp;=\u0026thinsp;219, 56.6%), and most had not received vaccine adverse event handling and documentation training (n\u0026thinsp;=\u0026thinsp;226, 57.7%). Professional associations (n\u0026thinsp;=\u0026thinsp;144, 39.6%) took the lead among the organizations that coordinated training for community pharmacists, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuestions on Vaccination Training\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you received any training on vaccination delivery services?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170 (43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e222 (56.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf yes, how many days was the training?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraining received\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst aid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e219 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e168 (43.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiopulmonary Resuscitation (CPR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175 (44.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e218 (55.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccine storage and handling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e196 (49.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197 (50.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccine administration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e173 (44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e220 (56.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccine adverse event handling and documentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e166 (42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e226 (57.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhich organization coordinated your training?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional associations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNGOs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWebinars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Primary Health Care Development Agency (NPHCDA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eInfrastructural Capacity to deliver vaccination services\u003c/h2\u003e \u003cp\u003eWhile more than half of the community pharmacists indicated having a vaccination room in their pharmacy (n\u0026thinsp;=\u0026thinsp;196, 50.5%), medical waste bin (n\u0026thinsp;=\u0026thinsp;206, 53.0%), and materials for hand sanitation and surface cleaning (n\u0026thinsp;=\u0026thinsp;306, 78.7%), most did not have other infrastructures like refrigerators specific for vaccines (n\u0026thinsp;=\u0026thinsp;222, 57.1%), temperature monitoring equipment (n\u0026thinsp;=\u0026thinsp;263, 67.8%), portable refrigerators in case of power failure (n\u0026thinsp;=\u0026thinsp;218, 56.1%), anaphylaxis response kits (n\u0026thinsp;=\u0026thinsp;340, 87.4%), anaphylaxis management posters/guidance (n\u0026thinsp;=\u0026thinsp;346, 88.9%), safety boxes (n\u0026thinsp;=\u0026thinsp;216, 55.7%), and records for vaccinated patients (n\u0026thinsp;=\u0026thinsp;280, 72.4%), Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfrastructural Capacity to deliver vaccination services\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eI don't know\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccination specific place/room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e196 (50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefrigerator specific for vaccines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155 (39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTemperature monitoring equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263 (67.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePortable refrigerator in case of power failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e167 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnaphylaxis response kit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e340 (87.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnaphylaxis management poster/guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e346 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSafety box\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e216 (55.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical waste bin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e206 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178 (45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaterials for hand sanitisation and surface cleaning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e306 (78.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccinated patients record\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101 (26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e280 (72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eType of vaccines being administered by community pharmacists\u003c/h2\u003e \u003cp\u003eThe tetanus toxoid vaccine was the most commonly administered in community pharmacies (n\u0026thinsp;=\u0026thinsp;158), and the rabies vaccine was the second most commonly administered vaccine (n\u0026thinsp;=\u0026thinsp;72). Bacille-Calmette Guerin (BCG) was the least common vaccine administered by community pharmacists (n\u0026thinsp;=\u0026thinsp;3), Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIf you are already administering vaccines in your pharmacy, what type of vaccines are you administering? Select all that apply\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of Vaccines\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of persons administering the vaccines\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChickenpox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeningitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTetanus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRotavirus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRabies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasles, Mumps, and Rubella (MMR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHuman Papilloma Virus (HPV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral Polio Virus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBacille-Calmette Guerin (BCG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 - Antisnake(1), Covid(13), Typhoid(6), Malaria(1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBarriers affecting community pharmacists' willingness to provide immunization services\u003c/h2\u003e \u003cp\u003eThe most highlighted barriers to the pharmacists\u0026rsquo; willingness to deliver vaccination services were inadequate funds to procure appropriate storage equipment (n\u0026thinsp;=\u0026thinsp;269, 70.0%), inadequate training (n\u0026thinsp;=\u0026thinsp;265, 69.1%), conflicts with other professionals (n\u0026thinsp;=\u0026thinsp;246, 64.4%), concerns about patient safety (n\u0026thinsp;=\u0026thinsp;185, 47.7%) and handling vaccines and disposal of sharps (n\u0026thinsp;=\u0026thinsp;182, 47.4%), Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBarriers affecting community pharmacists' willingness to provide immunization services\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacists are busy and they have no time to provide immunization services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e118 (30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e113 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e107 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe pharmacies are not designed to accommodate such services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e107 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e96 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate funds to set up a designated space and/or procure and appropriate storage facility by the community pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e41 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient safety is a concern and serious advents beyond the capacity of the pharmacy may occur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e137 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e79 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of adequate training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e168 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacists are less trusted by patients to provide such service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e123 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80 (21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e122 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConflicts with other professionals who are currently empowered by the Law to vaccinate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e164 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e29 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcerns about handling vaccines, storage, and disposal of sharps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e58 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e56 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacists are not comfortable using needles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e123 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e91 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e105 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCommunity pharmacists are a significant first-line contact for many healthcare consumers and intermediaries between physicians and patients, making them indispensable in modern healthcare delivery. Despite this daunting task, pharmacists are still an underutilized resource in achieving universal health coverage and implementing many healthcare policies. There have been calls for pharmacists in Nigeria to take up their emerging roles in vaccine management and administration. At the same time, there is no legislation mandating pharmacists to engage in vaccination, no law also prevents them from doing so.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The COVID-19 pandemic was an eye-opener about the shortage of healthcare practitioners, and CPs have the workforce to help make healthcare services readily available. To augment their career, pharmacists have initiated a process of self-reinvention by seeking ways to expand their responsibilities in community pharmacy.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Therefore, this study sought to explore the willingness of community pharmacists in Nigeria to engage in vaccination programmes and highlight the challenges community pharmacists face in setting up appropriate vaccine storage facilities and administration in their pharmacies.\u003c/p\u003e \u003cp\u003eThe findings of this study indicate that community pharmacists in Nigeria demonstrate a high level of willingness to administer and dispense vaccines, as seen by 91.3% (n\u0026thinsp;=\u0026thinsp;359) of respondents expressing their support for this practice. However, the effective deployment of a pharmacist-provided vaccination service is contingent upon proper training, logistics availability, and patient acceptance, which are highly significant considerations. The cost-effectiveness of vaccination services offered by pharmacists varies depending on the healthcare systems and reimbursement mechanisms in place.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Several studies have suggested that pharmacist participation in vaccination programmes can be economically advantageous, particularly in cases where pharmacists can charge for their services. Moreover, data indicates that immunizations delivered via community pharmacies are more economically efficient than those administered in medical settings.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e This forestalls the urgent need for the government to put systems and structures in place to empower community pharmacists to provide vaccination services.\u003c/p\u003e \u003cp\u003eThe results also show that most community pharmacists do not practice vaccine services. This can be attributed to the fact that although many pharmacists were willing to proceed, they felt inadequately prepared due to insufficient education and infrastructural capacity to incorporate vaccination into their practice. They believed that formal certification should be a requirement to do so. Still, they all demonstrated zeal in engaging in these training and certifications that will equip them with the requisite knowledge to practice these services. This study is among the first to assess Nigerian community pharmacists' willingness and readiness to provide vaccination services. The result is similar to studies in Lebanon\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e and Saudi Arabia\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, where pharmacists strongly desire vaccination. In both studies, it was observed that there is a deficiency in the knowledge gap in handling possible adverse effects from vaccines; this occurrence is evident in our study, where pharmacists show higher training in vaccine handling than in vaccine adverse event handling and documentation. Therefore, it is equally crucial to have a proficient healthcare system with competent routine immunization service providers who can administer and oversee these vaccines and have them themselves to achieve the necessary level of immunization coverage. It has been posited that \"conducting training in little clusters or batches over a while is more likely to be impactful as compared to a situation where a large number of service providers are trained at the same time.\" \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e An important factor contributing to high immunization rates in many developing nations is the presence of enough well-trained healthcare workers capable of efficiently administering vaccines to children within healthcare facilities and during outreach programs.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e In our study, most pharmacists were trained by their professional society and this shows a dire desire by professional leaders to improve accessibility.\u003c/p\u003e \u003cp\u003eIt was observed that CPs frequently encounter common infrastructure obstacles while establishing vaccine services, precisely the absence of appropriate vaccine storage equipment, temperature monitoring equipment, anaphylaxis management posters/guidance, and safety boxes. The enduring nature of certain obstacles might impact the behavioral aspects of individuals when it comes to accepting pharmacist-administered vaccinations, as it fosters a sense of distrust and portrays pharmacists as lacking competence. Studies have shown the effect of infrastructural defects on vaccine uptake, efficacy, and safety.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Hence, there is a need for interventional support for pharmacists who indicate interest in establishing vaccine services.\u003c/p\u003e \u003cp\u003eAlthough pharmacist-provided vaccination programmes have achieved universal popularity and have had a favorable impact, numerous barriers remain. Our study highlighted inadequate funds to set up a designated space or procure an appropriate storage facility by the community pharmacist as the significant barrier encountered by CPs followed by a lack of training and conflicts with other professionals currently empowered by the Law to vaccinate. Most barriers CPs face are systemic, which often does not lie within the means of pharmacists alone to solve. A study conducted in Canada among traditional vaccinators revealed only moderate support for pharmacists delivering vaccines. The survey reported that 32% of nurses and 46% of physicians disapproved of this practice.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Similarly, fewer than 50% of the questioned nurses and physicians would recommend their patients to a pharmacist for vaccine administration; the reasons for this hesitation and lack of support were mainly concerns regarding the adequacy and effectiveness of pharmacists' training in handling adverse effects that may arise from vaccination administration\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e; this lack of support should be reproved knowing that CPs who administer vaccines do not seek to engage in a conflict over payment or infringe upon other healthcare practitioners' professional responsibilities, but instead, pharmacist as healthcare professionals have been equipped with the proper knowledge and can engage in vaccination to improve Universal Health Coverage as common with other nations where evidence exist of improved coverage of immunization by the pharmacist. Instead, the crucial aspect is to engage in collaborative efforts as members of an integrated healthcare team to facilitate patients' seamless access to this critical healthcare service. To overcome the multiple hurdles and barriers to pharmacist-led vaccines, a collaborative effort from all members of the healthcare team and policymakers is necessary. Efforts like the collaborative practice agreement in the United States, where the pharmacist's role has been advanced, should be emulated.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study is not without limitation, firstly it was designed as a cross-sectional study \"The primary limitation of the cross-sectional study design is that because the exposure and outcome are simultaneously assessed, there is generally no evidence of a temporal relationship between exposure and outcome.\" \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Hence, establishing a genuine cause-and-effect link is unattainable without longitudinal data. It is recommended that further studies such as longitudinal studies be conducted to provide more evidence for this result.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite the inadequacies in infrastructural capacity, community pharmacists have positioned themselves as advocates, educators, facilitators, and qualified providers of vaccinations. The importance of pharmacists as vaccinators in improving community vaccination rates through increased accessibility should be recognized. Pharmacists have the potential to expand their role in delivering public health services by safely and effectively administering injectable medications and managing adverse drug reactions with the proper training and legislation. This study emphasizes that when CPs are empowered, they are willing to advance in vaccine administration and handling. Targeted interventions are needed to enhance their capacity to deliver effective vaccination services.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical Approval was received from the Research Ethical Review Committee of the College of Medicine, University of Lagos, with the reference number CMUL/HREC/05/24/1457. Before each survey, informed consent was sought from every participant, and this consent was documented with a Yes/No question.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no funding to carry out this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made substantial contributions to the study. AAO and UGO conceptualized the study. AAO, UGO, COO, and OMA conducted the literature review and designed the study and the survey tool. AAO, UGO, and OMA \u0026nbsp;coordinated the review and pretesting of the survey tool. AAO, UGO, COO, and OMA \u0026nbsp; collected the data. AAO, UGO, and COO analysed the collected data. AAO, UGO, COO, and OMA interpreted the data. UGO and AAO developed the first draft of the manuscript. All the authors reviewed and edited the manuscript and approved the final manuscript before submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the State chairmen of the Association of Community Pharmacists of Nigeria and State Officers of the Pharmacy Council of Nigeria who supported the administration of questionnaires in their state social media platforms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAAO is a community pharmacist with vast experience and passion in pharmacy practice based research. He is the immediate past National chairman of the Association of Community Pharmacists of Nigeria.\u003c/p\u003e\n\u003cp\u003eUGO is an Associate Professor of Global Health and Health Systems Research at the Department of Global Health and Bioethics, Euclid University, Bangui, Central African Republic, with a public health pharmacy and regulation background.\u003c/p\u003e\n\u003cp\u003eCOO is a pharmacist and manager of the Research and Development Unit of the Association of Community Pharmacists of Nigeria, he has master degree and he is deeply interested in community pharmacy based research.\u003c/p\u003e\n\u003cp\u003eOMA is a distinguished community pharmacist, with interest in operational and practice research. She continuously explores innovative ways to improve patient care, optimize therapeutic outcomes and contribute to the advancement of Pharmacy practice.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. 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A rapid qualitative assessment of barriers associated with demand and uptake of health facility-based childhood immunizations and recommendations to improve immunization service delivery in Sokoto State, Northwest Nigeria, 2017. The Pan African Medical Journal. 2021;40(Suppl 1).\u003c/li\u003e\n\u003cli\u003eMahachi K, Kessels J, Boateng K, Baptiste AE, Mitula P, Ekeman E, Lochlainn LN, Rosewell A, Sodha SV, Abela-Ridder B, Gabrielli AF. Zero-or missed-dose children in Nigeria: contributing factors and interventions to overcome immunization service delivery challenges. Vaccine. 2022 Sep 2;40(37):5433-44.\u003c/li\u003e\n\u003cli\u003eMacDougall D, Halperin BA, Isenor J, MacKinnon-Cameron D, Li L, McNeil SA, Langley JM, Halperin SA. Routine immunization of adults by pharmacists: Attitudes and beliefs of the Canadian public and health care providers. Human vaccines \u0026amp; immunotherapeutics. 2016 Mar 3;12(3):623-31.\u003c/li\u003e\n\u003cli\u003eCernasev A, Aruru M, Clark S, Patel K, DiPietro Mager N, Subramaniam V, Truong HA. Empowering public health pharmacy practice\u0026mdash;moving from collaborative practice agreements to provider status in the US. Pharmacy. 2021 Mar 9;9(1):57.\u003c/li\u003e\n\u003cli\u003eCarlson MD, Morrison RS. Study design, precision, and validity in observational studies. Journal of palliative medicine. 2009 Jan 1;12(1):77-82.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Vaccination, Community Pharmacists, Willingness, Infrastructure, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-5178906/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5178906/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThere is a growing need for community pharmacists to contribute to universal health coverage through vaccination services due to their being one of the most accessible healthcare professionals and low vaccination coverage. In some Nigerian states, community pharmacists were trained in vaccination, but there are concerns about their capacity to enroll as vaccination service providers. This study evaluated the community pharmacy workforce's willingness, readiness, and infrastructural capacity to deliver vaccination services in Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a descriptive cross-sectional study using a self-administered structured questionnaire among community pharmacists in Nigeria through online platforms. Descriptive statistics was performed on the collected data using SPSS statistical software, version 21.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 414 community pharmacists sampled, 395(response rate\u0026thinsp;=\u0026thinsp;95.4%) were retrieved and included in the final analysis. Although most community pharmacists did not currently practice vaccine administration in their pharmacies (n\u0026thinsp;=\u0026thinsp;295, 74.9%), most were willing to start administering vaccines (n\u0026thinsp;=\u0026thinsp;359, 91.3%), participate in routine and supplemental immunization services(n\u0026thinsp;=\u0026thinsp;373, 95.4%), receive training related to vaccination (n\u0026thinsp;=\u0026thinsp;374, 95.2%), and encourage patients to get vaccinated in their pharmacies (n\u0026thinsp;=\u0026thinsp;367, 93.6%). Tetanus vaccine was the most common ( n\u0026thinsp;=\u0026thinsp;158, 40%) among the vaccines administered by the respondents. Infrastructure was inadequate in many critical areas; vaccine-specific refrigerators(n\u0026thinsp;=\u0026thinsp;222, 57.1%), temperature monitoring equipment (n\u0026thinsp;=\u0026thinsp;263, 67.8%), safety boxes (n\u0026thinsp;=\u0026thinsp;216, 55.7%), medical waste bins (n\u0026thinsp;=\u0026thinsp;178, 45.8%), portable vaccine refrigerators in case of power failures(n\u0026thinsp;=\u0026thinsp;218, 56.1%), anaphylaxis response kit (n\u0026thinsp;=\u0026thinsp;340, 87.4%), and anaphylaxis management guidance (n\u0026thinsp;=\u0026thinsp;346, 88.9%). Barriers to the pharmacists\u0026rsquo; willingness to deliver vaccination services were inadequate funds to procure appropriate storage equipment (n\u0026thinsp;=\u0026thinsp;269, 70.0%), inadequate training (n\u0026thinsp;=\u0026thinsp;265, 69.1%), conflicts with other professionals (n\u0026thinsp;=\u0026thinsp;246, 64.4%), concerns about patient safety (n\u0026thinsp;=\u0026thinsp;185, 47.7%) and handling vaccines and disposal of sharps (n\u0026thinsp;=\u0026thinsp;182, 47.4%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCommunity pharmacists are willing to embrace the advanced role of vaccine administration. The government and other healthcare stakeholders should address the infrastructural gaps and other barriers highlighted in the study to help improve vaccine access and availability.\u003c/p\u003e","manuscriptTitle":"Community Pharmacy Workforce Willingness, Readiness, and Infrastructural Capacity to Deliver Vaccination Services: A Cross-Sectional Study in Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-12 05:01:25","doi":"10.21203/rs.3.rs-5178906/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-26T01:34:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-09T18:48:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238392557537212763345188773279811695236","date":"2024-11-06T14:01:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-04T07:13:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3691609993365088559118921759877478974","date":"2024-10-30T12:49:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"321540494355449864468879696372136165079","date":"2024-10-30T07:09:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171346406695508871276856004212632394727","date":"2024-10-28T20:53:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260453500433720898357546975917596952091","date":"2024-10-23T12:51:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-21T12:35:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-10-01T06:20:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-01T06:02:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-01T06:01:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-09-30T07:54:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"893e4da8-5359-4476-bca1-1d7f906d64ce","owner":[],"postedDate":"December 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-07T15:59:19+00:00","versionOfRecord":{"articleIdentity":"rs-5178906","link":"https://doi.org/10.1186/s12913-025-12655-3","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-04-02 15:57:06","publishedOnDateReadable":"April 2nd, 2025"},"versionCreatedAt":"2024-12-12 05:01:25","video":"","vorDoi":"10.1186/s12913-025-12655-3","vorDoiUrl":"https://doi.org/10.1186/s12913-025-12655-3","workflowStages":[]},"version":"v1","identity":"rs-5178906","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5178906","identity":"rs-5178906","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}